{
  "resourceType": "StructureDefinition",
  "id": "7a24e162-338f-4443-ba01-3ec07498c669",
  "meta": {
    "versionId": "2",
    "lastUpdated": "2023-10-04T15:03:48.1759182+00:00"
  },
  "url": "https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-PainScore-2022Q1",
  "name": "NICE-PainScore",
  "title": "NICE-PainScore",
  "status": "active",
  "date": "2023-10-26T09:56:07.4563357+00:00",
  "publisher": "NICE",
  "contact": [
    {
      "name": "NICE",
      "telecom": [
        {
          "system": "email",
          "value": "vragen@stichting-nice.nl"
        }
      ]
    }
  ],
  "description": "This profile is for submitting data to the NICE related to pain scores. The pain score is a general measurement for pain experience of an ICU patient at rest. It is not a description of specific, localized pain.",
  "purpose": "This profile is used to submit pain score related information to the Dutch National Intensive Care Evaluation (NICE). It was derived from the Nictiz Health and Care Information Model (HCIM; Dutch: Zorginformatiebouwsteen or ZIB) PainScore, 2017 release version 3.1",
  "copyright": "CC0",
  "fhirVersion": "3.0.2",
  "mapping": [
    {
      "identity": "NICE-AI",
      "uri": "https://www.stichting-nice.nl/dd/#791",
      "name": "NICE2Improve (Actionable Indicators)"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "Observation",
  "baseDefinition": "http://fhir.nl/fhir/StructureDefinition/nl-core-observation",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Observation",
        "path": "Observation",
        "short": "PainScore",
        "definition": "The pain score is a general measurement for pain experience, not a description of specific, localized pain.\r\n\r\nThe following are used as an easily reproducible measurement for pain experience:\r\n\r\n    NRS (Numeric Rating Scale) in which the patient gives the pain a number on a scale of 1 (no pain) to 10 (unbearable pain).\r\n    VAS (Visual Analogue Score), in which the patient points to a bar with a line to indicate the pain they feel. The back of the bar has a scale from 0 (no pain) to 10 (unbearable pain) on it.\r\n    BPS (Behavioural Pain Scale) in which the care provider scores pain based on three indicators: facial expression, upper limb movement and compliance with ventilation. Each indicator is scored a 1, 2, 3 or 4. High scores indicate more pain.\r\n    CPOT (Critical-Care Pain Observation Tool) in which the care provider scores pain based on four indicators: facial expression, body movements muscle tension and compliance with the ventilator if intubated, or vocalization if extubated. Each indicator is scored a 0, 1 or 2. High scores indicate more pain.\r\n    CIA (Critically Ill Assessment scale) in which five items are scored (alertness, facial tension, muscle tone, body movements and respiratory response) with a total score between 5 and 20",
        "alias": [
          "Pijnscore"
        ],
        "constraint": [
          {
            "key": "maxValue-for-method",
            "severity": "error",
            "human": "maxValue of 10 if method is VAS10 or NRS, 100 if VAS100, 12 if BPS, 8 if CPTOT, or 20 if CIA",
            "expression": "((method.coding.code = 'VAS10' or method.coding.code = 'NRS') and valueQuantity.value <= 10) or (method.coding.code='VAS100' and valueQuantity.value <= 100) or (method.coding.code = 'BPS' and valueQuantity.value <= 12) or (method.coding.code='CPTOT' and valueQuantity.value <= 8) or (method.coding.code='CIA' and valueQuantity.value <= 20)"
          },
          {
            "key": "minValue-for-method",
            "severity": "error",
            "human": "minValue of 1 if method is NRS, 0 if VAS or CPTOT, 4 if BPS and 5 if CIA",
            "expression": "((method.coding.code = 'VAS10' or method.coding.code = 'VAS100' or method.coding.code = 'CPTOT') and valueQuantity.value >= 0) or (method.coding.code='NRS' and valueQuantity.value >= 1) or (method.coding.code='BPS' and valueQuantity.value >= 4)  or (method.coding.code='CIA' and valueQuantity.value >= 5)"
          }
        ],
        "mapping": [
          {
            "identity": "NICE-AI",
            "map": "https://www.stichting-nice.nl/dd/#752",
            "comment": "Pain score"
          },
          {
            "identity": "hcim-painscore-v3.1-2017EN",
            "map": "NL-CM:12.9.1",
            "comment": "Pain score"
          }
        ]
      },
      {
        "id": "Observation.identifier",
        "path": "Observation.identifier",
        "max": "1",
        "mustSupport": true,
        "mapping": [
          {
            "identity": "NICE-AI",
            "map": "https://www.stichting-nice.nl/dd/#750",
            "comment": "Pijnmeting volgnummer"
          }
        ]
      },
      {
        "id": "Observation.status",
        "path": "Observation.status",
        "constraint": [
          {
            "key": "completed",
            "severity": "error",
            "human": "NICE observations SHALL be completed",
            "expression": "$this = 'final' or $this =  'amended' or $this = 'corrected'"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.code",
        "path": "Observation.code",
        "mustSupport": true
      },
      {
        "id": "Observation.code.coding",
        "path": "Observation.code.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "system"
            },
            {
              "type": "value",
              "path": "code"
            }
          ],
          "rules": "open"
        },
        "max": "1"
      },
      {
        "id": "Observation.code.coding:PainScoreCode",
        "path": "Observation.code.coding",
        "sliceName": "PainScoreCode",
        "max": "1"
      },
      {
        "id": "Observation.code.coding:PainScoreCode.system",
        "path": "Observation.code.coding.system",
        "fixedUri": "http://snomed.info/sct"
      },
      {
        "id": "Observation.code.coding:PainScoreCode.code",
        "path": "Observation.code.coding.code",
        "fixedCode": "225908003"
      },
      {
        "id": "Observation.code.coding:PainScoreCode.display",
        "path": "Observation.code.coding.display",
        "defaultValueString": "Pain score (observable entity)"
      },
      {
        "id": "Observation.subject",
        "path": "Observation.subject",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-Patient-2022Q1"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.context",
        "path": "Observation.context",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-Encounter-2022Q1"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.effective[x]:effectiveDateTime",
        "path": "Observation.effectiveDateTime",
        "sliceName": "effectiveDateTime",
        "alias": [
          "PijnscoreDatumTijd"
        ],
        "type": [
          {
            "code": "dateTime"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-painscore-v3.1-2017EN",
            "map": "NL-CM:12.9.3",
            "comment": "Pain measurement time"
          },
          {
            "identity": "NICE-AI",
            "map": "https://www.stichting-nice.nl/dd/#751",
            "comment": "Pain measurement time"
          }
        ]
      },
      {
        "id": "Observation.value[x]:valueQuantity",
        "path": "Observation.valueQuantity",
        "sliceName": "valueQuantity",
        "definition": "The score is a general measurement of pain experience, not a description of specific, localized pain.\r\n\r\nDepending on the measuring method used, it indicates the level of pain experienced by the patient on a scale of 0 to 10: 0 = no pain and 10 = the worst pain imaginable. No descriptions are used for the intermediate values, so that the value is displayed as a number and not as a code.\r\n\r\nSometimes a value range of 0-100, 4-12, 0-8 or 5-20 is used instead of 0-10.",
        "alias": [
          "PijnscoreWaarde"
        ],
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "example": [
          {
            "label": "Example of PainScore value",
            "valueQuantity": {
              "value": 7.0,
              "system": "http://unitsofmeasure.org",
              "code": "{score}"
            }
          }
        ],
        "mapping": [
          {
            "identity": "hcim-painscore-v3.1-2017EN",
            "map": "NL-CM:12.9.2",
            "comment": "PainScoreValue"
          }
        ]
      },
      {
        "id": "Observation.comment",
        "path": "Observation.comment",
        "definition": "Comment on the pain score measurement, including comments on for example the circumstances and/or disruptive factors that may influence the result.",
        "alias": [
          "Toelichting"
        ],
        "mapping": [
          {
            "identity": "hcim-painscore-v3.1-2017EN",
            "map": "NL-CM:12.9.5",
            "comment": "Comment"
          }
        ]
      },
      {
        "id": "Observation.bodySite.extension:Laterality",
        "path": "Observation.bodySite.extension",
        "sliceName": "Laterality",
        "definition": "Laterality adds information about body side to the anatomic location, e.g. left",
        "comment": "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.",
        "alias": [
          "Lateraliteit"
        ],
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/BodySite-Qualifier"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-painscore-v3.1-2017EN",
            "map": "NL-CM:12.9.7",
            "comment": "Laterality"
          }
        ]
      },
      {
        "id": "Observation.bodySite.extension:Laterality.valueCodeableConcept:valueCodeableConcept",
        "path": "Observation.bodySite.extension.valueCodeableConcept",
        "sliceName": "valueCodeableConcept",
        "binding": {
          "strength": "extensible",
          "description": "Laterality",
          "valueSetReference": {
            "reference": "https://simplifier.net/nictizstu3-zib2017/2.16.840.1.113883.2.4.3.11.60.40.2.12.9.3--20171231000000"
          }
        }
      },
      {
        "id": "Observation.method",
        "path": "Observation.method",
        "short": "How it was performed",
        "definition": "The pain score is a general measurement for pain experience, not a description of specific, localized pain.\r\n\r\nThe following are used as an easily reproducible measurement for pain experience:\r\n\r\n    NRS (Numeric Rating Scale) in which the patient gives the pain a number on a scale of 1 (no pain) to 10 (unbearable pain).\r\n    VAS (Visual Analogue Score), in which the patient points to a bar with a line to indicate the pain they feel. The back of the bar has a scale from 0 (no pain) to 10 (unbearable pain) on it.\r\n    BPS (Behavioural Pain Scale) in which the care provider scores pain based on three indicators: facial expression, upper limb movement and compliance with ventilation. Each indicator is scored a 1, 2, 3 or 4. High scores indicate more pain.\r\n    CPOT (Critical-Care Pain Observation Tool) in which the care provider scores pain based on four indicators: facial expression, body movements muscle tension and compliance with the ventilator if intubated, or vocalization if extubated. Each indicator is scored a 0, 1 or 2. High scores indicate more pain.\r\n    CIA (Critically Ill Assessment scale) in which five items are scored (alertness, facial tension, muscle tone, body movements and respiratory response) with a total score between 5 and 20",
        "min": 1,
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "description": "NICE-methods for pain measurement",
          "valueSetReference": {
            "reference": "https://fhir.stichting-nice.nl/fhir/ValueSet/NICE-PainMeasurementToolCodeList"
          }
        },
        "mapping": [
          {
            "identity": "NICE-AI",
            "map": "https://www.stichting-nice.nl/dd/#752",
            "comment": "Pain score"
          }
        ]
      }
    ]
  }
}