Pan-Canadian Patient Summary (PS-CA) CI Build
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Condition (PS-CA)
Links
Profile
Derived from
http://hl7.org/fhir/StructureDefinition/Condition
Examples
Description
This profile represents the constraints applied to the Condition resource by the PS-CA project, which is informed by the constraints of the Condition IPS-UV profile and the Canadian Baseline Profile to allow for cross-border and cross-jurisdiction sharing of a record of a problem represented in the patient summary as an instance of the Condition resource constrained by this profile.
References to this resource
Resource Content
| ConditionPSCA (Condition) | C | Condition | |
| id | Σ | 0..1 | string |
| meta | Σ | 0..1 | Meta |
| implicitRules | Σ ?! | 0..1 | uri |
| language | 0..1 | codeBinding | |
| text | 0..1 | Narrative | |
| contained | 0..* | Resource | |
| extension | C | 0..* | Extension |
| modifierExtension | ?! C | 0..* | Extension |
| identifier | Σ | 0..* | Identifier |
| clinicalStatus | S Σ ?! C | 0..1 | CodeableConceptBinding |
| verificationStatus | Σ ?! C | 0..1 | CodeableConceptBinding |
| category | 0..* | CodeableConceptBinding | |
| severity | 0..1 | CodeableConceptBinding | |
| code | S Σ | 1..1 | CodeableConceptPSCABinding |
| bodySite | Σ | 0..* | CodeableConceptBinding |
| subject | S Σ | 1..1 | Reference(PatientPSCA) |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| reference | S Σ C | 1..1 | string |
| type | Σ | 0..1 | uriBinding |
| identifier | Σ | 0..1 | Identifier |
| display | Σ | 0..1 | string |
| encounter | Σ | 0..1 | Reference(Encounter) |
| onset[x] | S Σ | 0..1 | |
| onsetAge | Age | ||
| onsetPeriod | Period | ||
| onsetRange | Range | ||
| onsetString | string | ||
| onsetDateTime | S Σ | 0..1 | dateTime |
| abatement[x] | C | 0..1 | |
| abatementDateTime | dateTime | ||
| abatementAge | Age | ||
| abatementPeriod | Period | ||
| abatementRange | Range | ||
| abatementString | string | ||
| recordedDate | Σ | 0..1 | dateTime |
| recorder | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) |
| asserter | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) |
| stage | C | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| summary | C | 0..1 | CodeableConcept |
| assessment | C | 0..* | Reference(ClinicalImpression | DiagnosticReport | Observation) |
| type | 0..1 | CodeableConcept | |
| evidence | C | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| code | Σ C | 0..* | CodeableConcept |
| detail | Σ C | 0..* | Reference(Resource) |
| note | 0..* | Annotation |
| ConditionPSCA (Condition) | Condition | ||
| clinicalStatus | S | ||
| verificationStatus | |||
| category | Binding | ||
| severity | Binding | ||
| code | S | 1.. | CodeableConceptPSCABinding |
| bodySite | Binding | ||
| subject | S | Reference(PatientPSCA) | |
| reference | S | 1.. | |
| onset[x] | S | ||
| onsetDateTime | S | dateTime |
<description value="This profile represents the constraints applied to the Condition resource by the PS-CA project, which is informed by the constraints of the [Condition IPS-UV profile](http://hl7.org/fhir/uv/ips/StructureDefinition-Condition-uv-ips.html) and the [Canadian Baseline Profile](http://build.fhir.org/ig/HL7-Canada/ca-baseline/branches/master/StructureDefinition-profile-condition.html) to allow for cross-border and cross-jurisdiction sharing of a record of a problem represented in the patient summary as an instance of the Condition resource constrained by this profile." />
<copyright value="Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy)." />
<comment value="While the IPS-UV specification considers this a Must Support element, some systems will not have a field directly representing clinicalStatus, but have other means of differentiating between current and historical conditions. Implementers are expected to be able to differentiate between active and inactive conditions. However, the valueSet that is required in the base specification does not provide an 'unknown' concept to support legacy data without a clinicalStatus. This has resulted in additional burdens that some participating systems could not meet with their legacy data.\n\n The requirement from the base FHIR specification to provide a system and value from the bound value set means the PS-CA CodeableConcept data type profile does not need to be applied on this particular element.\n\nIn the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed." />
</element>
<comment value="IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.\n\nFHIR Base Note: This element is a modifier element with a required vocabulary binding in the base FHIR specification.\n\nIPS-UV Note: In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed." />
</element>
<definition value="A category assigned to the condition. In this profile, a health problem of the patient, therefore a 'problem-list-item'." />
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. \n\n Implementers should be aware that IPS encourages the use of 'problem-list-item'. This is identified through the additionalBinding extension as a component value set (which provides a subset of values from the base valueSet and context around their use). \n\n IPS also provides an additionalBinding to the LOINC value of 75326-9 for backwards compatibility. While not preferred for continued use this is also identified as a additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach)." />
</extension>
</extension>
<valueMarkdown value="Component of extensible valueSet put forth in IPS to encourage the use condition records with the category code of 'problem-list-item' for use in the Problems Section and History of Past Illness Section." />
</extension>
</extension>
</extension>
</extension>
<valueMarkdown value="Codes put forth in IPS to supply an additional binding to the LOINC "Problem" code - retained for backward compatibility. While not preferred for continued use this is also identified as an additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach)." />
</extension>
</extension>
</binding>
</element>
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received." />
</extension>
</extension>
<valueMarkdown value="Codes representing the severity of a problem using the preferred value set from base FHIR." />
</extension>
</extension>
</binding>
</element>
<definition value="Identification of the condition, problem or diagnosis or recording of "problem absent" or of "problems unknown"." />
<comment value="Many Canadian implementations use codes from either SNOMED CT and the SNOMED CT Canada Extension to describe this concept, while others may still be using localized code systems or text descriptions. The Condition - IPS ValueSet contains codes that are subsumed within the SNOMED CT CA ClinicalFindingCode ValueSet that is preferred for this element.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content." />
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" />
</type>
</extension>
</extension>
<valueMarkdown value="Any code from ICD-9 CM. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." />
</extension>
</extension>
</extension>
</extension>
<valueMarkdown value="Any Code from ICD-10 CA. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." />
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</binding>
</element>
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/anatomicaloracquiredbodystructurecode" />
</binding>
</element>
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" />
</type>
</element>
</element>
</discriminator>
</slicing>
<comment value="IPS-UV constrains the condition onset element to only DateTime and Period data types. Both IPS-UV and PS-CA prefer the use of onsetDateTime" />
</element>
</type>
</element>
</differential>
</StructureDefinition>
{
"description": "This profile represents the constraints applied to the Condition resource by the PS-CA project, which is informed by the constraints of the [Condition IPS-UV profile](http://hl7.org/fhir/uv/ips/StructureDefinition-Condition-uv-ips.html) and the [Canadian Baseline Profile](http://build.fhir.org/ig/HL7-Canada/ca-baseline/branches/master/StructureDefinition-profile-condition.html) to allow for cross-border and cross-jurisdiction sharing of a record of a problem represented in the patient summary as an instance of the Condition resource constrained by this profile.",
"copyright": "Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).",
{
"comment": "While the IPS-UV specification considers this a Must Support element, some systems will not have a field directly representing clinicalStatus, but have other means of differentiating between current and historical conditions. Implementers are expected to be able to differentiate between active and inactive conditions. However, the valueSet that is required in the base specification does not provide an 'unknown' concept to support legacy data without a clinicalStatus. This has resulted in additional burdens that some participating systems could not meet with their legacy data.\n\n The requirement from the base FHIR specification to provide a system and value from the bound value set means the PS-CA CodeableConcept data type profile does not need to be applied on this particular element.\n\nIn the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed.",
},
{
"comment": "IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.\n\nFHIR Base Note: This element is a modifier element with a required vocabulary binding in the base FHIR specification.\n\nIPS-UV Note: In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed."
},
{
"definition": "A category assigned to the condition. In this profile, a health problem of the patient, therefore a 'problem-list-item'.",
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. \n\n Implementers should be aware that IPS encourages the use of 'problem-list-item'. This is identified through the additionalBinding extension as a component value set (which provides a subset of values from the base valueSet and context around their use). \n\n IPS also provides an additionalBinding to the LOINC value of 75326-9 for backwards compatibility. While not preferred for continued use this is also identified as a additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach).",
{
{
},
{
},
{
"valueMarkdown": "Component of extensible valueSet put forth in IPS to encourage the use condition records with the category code of 'problem-list-item' for use in the Problems Section and History of Past Illness Section."
}
],
},
{
{
},
{
},
{
"valueMarkdown": "Codes put forth in IPS to supply an additional binding to the LOINC \"Problem\" code - retained for backward compatibility. While not preferred for continued use this is also identified as an additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach)."
}
],
}
],
}
},
{
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.",
{
{
},
{
},
{
"valueMarkdown": "Codes representing the severity of a problem using the preferred value set from base FHIR."
}
],
}
],
}
},
{
"comment": "Many Canadian implementations use codes from either SNOMED CT and the SNOMED CT Canada Extension to describe this concept, while others may still be using localized code systems or text descriptions. The Condition - IPS ValueSet contains codes that are subsumed within the SNOMED CT CA ClinicalFindingCode ValueSet that is preferred for this element.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content.",
"definition": "Identification of the condition, problem or diagnosis or recording of \"problem absent\" or of \"problems unknown\".",
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
]
}
],
{
{
},
{
},
{
"valueMarkdown": "Any code from ICD-9 CM. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
}
],
},
{
{
},
{
},
{
"valueMarkdown": "Any Code from ICD-10 CA. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
}
],
},
{
{
},
{
},
{
}
],
}
],
}
},
{
}
},
{
{
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps"
]
}
],
},
{
},
{
"comment": "IPS-UV constrains the condition onset element to only DateTime and Period data types. Both IPS-UV and PS-CA prefer the use of onsetDateTime",
},
},
{
],
}
]
}
}
Terminology bindings (Differential)
| Path | Conformance | ValueSet |
|---|---|---|
| Condition.category | extensible | http://hl7.org/fhir/ValueSet/condition-category |
| Condition.severity | preferred | https://fhir.infoway-inforoute.ca/ValueSet/severitycode |
| Condition.code | preferred | https://fhir.infoway-inforoute.ca/ValueSet/healthconditioncode |
| Condition.bodySite | preferred | https://fhir.infoway-inforoute.ca/ValueSet/anatomicaloracquiredbodystructurecode |
Terminology bindings (Snapshot)
Constraints
Key Differences between the IPS-UV and PS-CA
Must Support Differences:
The following elements are considered Must Support in the Condition (IPS) profile that are relaxed in this version of the PS-CA profile:
Condition.categoryCondition.severityNote: Systems that support these elements are encouraged to send them in patient summaries
Cardinality Differences:
There are no cardinality differences between this profile and IPS 2.0.0-ballot release.
Vocabulary Differences:
Condition.severity- additionalBindings added for:
- Condition severity Condition/DiagnosisSeverity
- additionalBindings added for:
Condition.code- additionalBindings added for:
- ICD-9 CM ICD9CMAllCode,
- ICD-10 CA ICD10CAAllCode,
- absent or unknown problems AbsentOrUnknownProblemsUvIps IPS absent/unknown ValueSets have been deprecated as of IPS 2.0.0-ballot and subsumed into their ProblemsUvIps. This change is pending analysis & alignment in a future update.
- additionalBindings added for:
Condition.bodySite- SNOMED CT Canadian Edition AnatomicalOrAcquiredBodyStructureCode indicated as preferred
Other differences between the IPS and PS-CA Include:
- Data type profiles (e.g., CodeableConcept) and reference targets (e.g., Patient) replaced with PS-CA equivalents when appropriate