RiskAssessment

idΣ0..1id
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
textC0..1Narrative
containedC0..*Resource
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
identifierΣ C0..*Identifier
basedOnC0..1Reference(Resource)
parentC0..1Reference(Resource)
statusΣ1..1codeBinding
methodΣ0..1CodeableConcept
codeΣ0..1CodeableConcept
subjectΣ C1..1Reference(Group | Patient)
encounterΣ C0..1Reference(Encounter)
occurrenceDateTimedateTime
occurrencePeriodPeriod
conditionΣ C0..1Reference(Condition)
performerΣ C0..1Reference(Device | Patient | Practitioner | PractitionerRole | RelatedPerson)
reason0..*CodeableReference(Condition | DiagnosticReport | DocumentReference | Observation)
basisC0..*Reference(Resource)
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
outcome0..1CodeableConcept
probabilityDecimaldecimal
probabilityRangeRange
qualitativeRisk0..1CodeableConcept
relativeRisk0..1decimal
whenPeriodPeriod
whenRangeRange
rationale0..1string
mitigation0..1string
note0..*Annotation
{
"resourceType": "StructureDefinition",
"url": "https://fhir.synapxe.sg/StructureDefinition/profile-riskassessment",
"version": "1.2.0",
"name": "RiskAssessment",
"status": "active",
"description": "This resource captures predicted outcomes for a patient or population on the basis of source information. Examples include: A prognosis statement for a particular condition; Risk of health outcome (heart attack, particular type of cancer) on the basis of lifestyle factors and/or family history; List of potential health risks based on a patient's genetic analysis; A prediction of outbreak infection rates within a geography based on immunization rates. This resource can be used to represent the results of formal scoring/decision support tools that evaluate risk. It can also be used to capture a practitioner's subjective assessment of the patient's risk based on existing knowledge and previous experience.",
"fhirVersion": "5.0.0",
"kind": "resource",
"abstract": false,
"type": "RiskAssessment",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/RiskAssessment",
"derivation": "constraint"
}
RiskAssessment
ShortPotential outcomes for a subject with likelihood
Definition

An assessment of the likely outcome(s) for a patient or other subject as well as the likelihood of each outcome.

Cardinality0..*
AliasPrognosis
Constraints
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.empty()
  • dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
  • dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: n/a
  • rim: Entity. Role, or Act
  • rim: Entity, Role, or Act
  • workflow: Event
  • w5: clinical.general
  • v2: N/A
  • rim: Observation[classCode=OBS, moodCode=EVN, code="Risk Assessment"]
  • openehr: OpenEHR-EHR-EVALUATION.risk.v1
RiskAssessment.id
ShortLogical id of this artifact
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Cardinality0..1
Typeid
SummaryTrue
Comments

Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
RiskAssessment.meta
ShortMetadata about the resource
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Cardinality0..1
TypeMeta
SummaryTrue
Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
RiskAssessment.implicitRules
ShortA set of rules under which this content was created
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Cardinality0..1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
RiskAssessment.language
ShortLanguage of the resource content
Definition

The base language in which the resource is written.

Cardinality0..1
Typecode
Binding

IETF language tag for a human language

AllLanguages (required)

Additional bindings
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
RiskAssessment.text
ShortText summary of the resource, for human interpretation
Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Cardinality0..1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

ConditionsThe cardinality or value of this element may be affected by these constraints: dom-6
Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
RiskAssessment.contained
ShortContained, inline Resources
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

Cardinality0..*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

ConditionsThe cardinality or value of this element may be affected by these constraints: dom-2, dom-4, dom-3, dom-5
Mappings
  • rim: n/a
  • rim: Entity. Role, or Act
  • rim: N/A
RiskAssessment.extension
ShortAdditional content defined by implementations
Definition

May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Cardinality0..*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RiskAssessment.modifierExtension
ShortExtensions that cannot be ignored
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Cardinality0..*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RiskAssessment.identifier
ShortUnique identifier for the assessment
Definition

Business identifier assigned to the risk assessment.

Cardinality0..*
TypeIdentifier
SummaryTrue
Comments

The rules of the identifier.type determine if a check digit is part of the ID value or sent separately, such as through the checkDigit extension.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ident-1: Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason
    value.exists()
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • rim: .id
  • openehr: Workflow Identifier
RiskAssessment.basedOn
ShortRequest fulfilled by this assessment
Definition

A reference to the request that is fulfilled by this risk assessment.

Cardinality0..1
TypeReference(Resource)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
  • ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided).
    reference.exists() or identifier.exists() or display.exists() or extension.exists()
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.basedOn
RiskAssessment.parent
ShortPart of this occurrence
Definition

A reference to a resource that this risk assessment is part of, such as a Procedure.

Cardinality0..1
TypeReference(Resource)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
  • ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided).
    reference.exists() or identifier.exists() or display.exists() or extension.exists()
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.partOf
RiskAssessment.status
Shortregistered | preliminary | final | amended +
Definition

The status of the RiskAssessment, using the same statuses as an Observation.

Cardinality1..1
Typecode
Binding

The status of the risk assessment; e.g. preliminary, final, amended, etc.

ObservationStatus (required)

SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.status
  • w5: FiveWs.status
RiskAssessment.method
ShortEvaluation mechanism
Definition

The algorithm, process or mechanism used to evaluate the risk.

Cardinality0..1
TypeCodeableConcept
Binding

The mechanism or algorithm used to make the assessment; e.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc.

(unbound) (example)

SummaryTrue
Requirements

The method can influence the results of the assessment.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.class
  • rim: .methodCode
RiskAssessment.code
ShortType of assessment
Definition

The type of the risk assessment performed.

Cardinality0..1
TypeCodeableConcept
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.code
  • w5: FiveWs.what[x]
RiskAssessment.subject
ShortWho/what does assessment apply to?
Definition

The patient or group the risk assessment applies to.

Cardinality1..1
TypeReference(Group | Patient)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
  • ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided).
    reference.exists() or identifier.exists() or display.exists() or extension.exists()
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.subject
  • w5: FiveWs.subject[x]
  • rim: .participation[typeCode=SBJ].role
  • openehr: Subject of Care
RiskAssessment.encounter
ShortWhere was assessment performed?
Definition

The encounter where the assessment was performed.

Cardinality0..1
TypeReference(Encounter)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
  • ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided).
    reference.exists() or identifier.exists() or display.exists() or extension.exists()
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.encounter
  • w5: FiveWs.context
  • rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
RiskAssessment.occurrence[x]
ShortWhen was assessment made?
Definition

The date (and possibly time) the risk assessment was performed.

Cardinality0..1
TypedateTime | Period
SummaryTrue
Requirements

The assessment results lose validity the more time elapses from when they are first made.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.occurrence[x]
  • w5: FiveWs.done[x]
  • rim: .effectiveTime
RiskAssessment.condition
ShortCondition assessed
Definition

For assessments or prognosis specific to a particular condition, indicates the condition being assessed.

Cardinality0..1
TypeReference(Condition)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
  • ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided).
    reference.exists() or identifier.exists() or display.exists() or extension.exists()
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .outboundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN]
RiskAssessment.performer
ShortWho did assessment?
Definition

The provider, patient, related person, or software application that performed the assessment.

Cardinality0..1
TypeReference(Device | Patient | Practitioner | PractitionerRole | RelatedPerson)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
  • ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided).
    reference.exists() or identifier.exists() or display.exists() or extension.exists()
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer.actor
  • w5: FiveWs.actor
  • rim: .participation[typeCode=PFM].role[classCode=ASSIGNED]
  • openehr: Information Provider
RiskAssessment.reason
ShortWhy the assessment was necessary?
Definition

The reason the risk assessment was performed.

Cardinality0..*
TypeCodeableReference(Condition | DiagnosticReport | DocumentReference | Observation)
Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.reason
  • w5: FiveWs.why[x]
RiskAssessment.basis
ShortInformation used in assessment
Definition

Indicates the source data considered as part of the assessment (for example, FamilyHistory, Observations, Procedures, Conditions, etc.).

Cardinality0..*
TypeReference(Resource)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
  • ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided).
    reference.exists() or identifier.exists() or display.exists() or extension.exists()
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .outboundRelationship[typeCode=DRIV].target
  • openehr: Risk Factor; Link to Evidence
RiskAssessment.prediction
ShortOutcome predicted
Definition

Describes the expected outcome for the subject.

Cardinality0..*
TypeBackboneElement
Comments

Multiple repetitions can be used to identify the same type of outcome in different timeframes as well as different types of outcomes.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ras-2: Probability as a deciml must be <= 100
    probability.empty() or ((probability is decimal) implies ((probability as decimal) <= 100))
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=VALUE].target[classCod=OBS, moodCode=RISK]
RiskAssessment.prediction.id
ShortUnique id for inter-element referencing
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality0..1
Typestring
ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1
Mappings
  • rim: n/a
RiskAssessment.prediction.extension
ShortAdditional content defined by implementations
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Cardinality0..*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RiskAssessment.prediction.modifierExtension
ShortExtensions that cannot be ignored even if unrecognized
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Cardinality0..*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RiskAssessment.prediction.outcome
ShortPossible outcome for the subject
Definition

One of the potential outcomes for the patient (e.g. remission, death, a particular condition).

Cardinality0..1
TypeCodeableConcept
Binding

The condition or other outcome; e.g. death, remission, amputation, infection, etc.

(unbound) (example)

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .value
  • openehr: Risk
RiskAssessment.prediction.probability[x]
ShortLikelihood of specified outcome
Definition

Indicates how likely the outcome is (in the specified timeframe).

Cardinality0..1
Typedecimal | Range
Comments

If range is used, it represents the lower and upper bounds of certainty; e.g. 40-60% Decimal values are expressed as percentages as well (max = 100).

ConditionsThe cardinality or value of this element may be affected by these constraints: ras-2
Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ras-1: low and high must be percentages, if present
    (low.empty() or ((low.code = '%') and (low.system = %ucum))) and (high.empty() or ((high.code = '%') and (high.system = %ucum)))
Mappings
  • rim: n/a
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="probability"].value
  • openehr: Category
RiskAssessment.prediction.qualitativeRisk
ShortLikelihood of specified outcome as a qualitative value
Definition

Indicates how likely the outcome is (in the specified timeframe), expressed as a qualitative value (e.g. low, medium, or high).

Cardinality0..1
TypeCodeableConcept
Binding

The likelihood of the occurrence of a specified outcome.

RiskProbability (example)

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
RiskAssessment.prediction.relativeRisk
ShortRelative likelihood
Definition

Indicates the risk for this particular subject (with their specific characteristics) divided by the risk of the population in general. (Numbers greater than 1 = higher risk than the population, numbers less than 1 = lower risk.).

Cardinality0..1
Typedecimal
Requirements

Absolute risk is less meaningful than relative risk.

Comments

Do not use an IEEE type floating point type, instead use something that works like a true decimal, with inbuilt precision (e.g. Java BigInteger)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="relative risk"].value
RiskAssessment.prediction.when[x]
ShortTimeframe or age range
Definition

Indicates the period of time or age range of the subject to which the specified probability applies.

Cardinality0..1
TypePeriod | Range
Comments

If not specified, the risk applies "over the subject's lifespan".

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .effectiveTime or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age"].value
RiskAssessment.prediction.rationale
ShortExplanation of prediction
Definition

Additional information explaining the basis for the prediction.

Cardinality0..1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .reasonCode.text
  • openehr: Rationale
RiskAssessment.mitigation
ShortHow to reduce risk
Definition

A description of the steps that might be taken to reduce the identified risk(s).

Cardinality0..1
Typestring
Requirements

One of the main reasons for assessing risks is to identify whether interventional steps are needed to reduce risk.

Comments

Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=MTGT].target[classCode=ACT, moodCode=EVN].text
RiskAssessment.note
ShortComments on the risk assessment
Definition

Additional comments about the risk assessment.

Cardinality0..*
TypeAnnotation
Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • workflow: Event.note

Terminology Bindings

PathBinding StrengthValue Set (Code System)Description
RiskAssessment.languagerequiredhttp://hl7.org/fhir/ValueSet/all-languages|5.0.0

IETF language tag for a human language

RiskAssessment.statusrequiredhttp://hl7.org/fhir/ValueSet/observation-status|5.0.0

The status of the risk assessment; e.g. preliminary, final, amended, etc.

RiskAssessment.methodexample

The mechanism or algorithm used to make the assessment; e.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc.

RiskAssessment.prediction.outcomeexample

The condition or other outcome; e.g. death, remission, amputation, infection, etc.

RiskAssessment.prediction.qualitativeRiskexamplehttp://hl7.org/fhir/ValueSet/risk-probability

The likelihood of the occurrence of a specified outcome.

Constraints