{
  "resourceType": "StructureDefinition",
  "id": "RiskAssessment",
  "meta": {
    "lastUpdated": "2021-01-01T21:58:31.578+00:00"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-category",
      "valueString": "Clinical.Care Provision"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "trial-use"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 1
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category",
      "valueCode": "patient"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "cds"
    },
    {
      "url": "http://hl7.org/fhir/build/StructureDefinition/entered-in-error-status",
      "valueCode": ".status = entered-in-error"
    }
  ],
  "url": "http://hl7.org/fhir/StructureDefinition/RiskAssessment",
  "version": "4.6.0",
  "name": "RiskAssessment",
  "status": "draft",
  "date": "2021-01-01T21:58:31+00:00",
  "publisher": "Health Level Seven International (Clinical Decision Support)",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://hl7.org/fhir"
        }
      ]
    },
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/dss/index.cfm"
        }
      ]
    }
  ],
  "description": "An assessment of the likely outcome(s) for a patient or other subject as well as the likelihood of each outcome.",
  "fhirVersion": "4.6.0",
  "mapping": [
    {
      "identity": "workflow",
      "uri": "http://hl7.org/fhir/workflow",
      "name": "Workflow Pattern"
    },
    {
      "identity": "v2",
      "uri": "http://hl7.org/v2",
      "name": "HL7 v2 Mapping"
    },
    {
      "identity": "rim",
      "uri": "http://hl7.org/v3",
      "name": "RIM Mapping"
    },
    {
      "identity": "openehr",
      "uri": "http://openehr.org",
      "name": "Open EHR Archetype Mapping"
    },
    {
      "identity": "w5",
      "uri": "http://hl7.org/fhir/fivews",
      "name": "FiveWs Pattern Mapping"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "RiskAssessment",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource",
  "derivation": "specialization",
  "differential": {
    "element": [
      {
        "id": "RiskAssessment",
        "path": "RiskAssessment",
        "short": "Potential 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.",
        "alias": [
          "Prognosis"
        ],
        "min": 0,
        "max": "*",
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event"
          },
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "Observation[classCode=OBS, moodCode=EVN, code=\"Risk Assessment\"]"
          },
          {
            "identity": "openehr",
            "map": "OpenEHR-EHR-EVALUATION.risk.v1"
          },
          {
            "identity": "w5",
            "map": "clinical.general"
          }
        ]
      },
      {
        "id": "RiskAssessment.identifier",
        "path": "RiskAssessment.identifier",
        "short": "Unique identifier for the assessment",
        "definition": "Business identifier assigned to the risk assessment.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Identifier"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.identifier"
          },
          {
            "identity": "w5",
            "map": "FiveWs.identifier"
          },
          {
            "identity": "rim",
            "map": ".id"
          },
          {
            "identity": "openehr",
            "map": "Workflow Identifier"
          }
        ]
      },
      {
        "id": "RiskAssessment.basedOn",
        "path": "RiskAssessment.basedOn",
        "short": "Request fulfilled by this assessment",
        "definition": "A reference to the request that is fulfilled by this risk assessment.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Resource"
            ]
          }
        ],
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.basedOn"
          }
        ]
      },
      {
        "id": "RiskAssessment.parent",
        "path": "RiskAssessment.parent",
        "short": "Part of this occurrence",
        "definition": "A reference to a resource that this risk assessment is part of, such as a Procedure.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Resource"
            ]
          }
        ],
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.partOf"
          }
        ]
      },
      {
        "id": "RiskAssessment.status",
        "path": "RiskAssessment.status",
        "short": "registered | preliminary | final | amended +",
        "definition": "The status of the RiskAssessment, using the same statuses as an Observation.",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "code"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "RiskAssessmentStatus"
            }
          ],
          "strength": "required",
          "description": "The status of the risk assessment; e.g. preliminary, final, amended, etc.",
          "valueSet": "http://hl7.org/fhir/ValueSet/observation-status"
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.status"
          },
          {
            "identity": "w5",
            "map": "FiveWs.status"
          }
        ]
      },
      {
        "id": "RiskAssessment.method",
        "path": "RiskAssessment.method",
        "short": "Evaluation mechanism",
        "definition": "The algorithm, process or mechanism used to evaluate the risk.",
        "requirements": "The method can influence the results of the assessment.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "RiskAssessmentMethod"
            }
          ],
          "strength": "example",
          "description": "The mechanism or algorithm used to make the assessment; e.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc."
        },
        "mapping": [
          {
            "identity": "w5",
            "map": "FiveWs.class"
          },
          {
            "identity": "rim",
            "map": ".methodCode"
          }
        ]
      },
      {
        "id": "RiskAssessment.code",
        "path": "RiskAssessment.code",
        "short": "Type of assessment",
        "definition": "The type of the risk assessment performed.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.code"
          },
          {
            "identity": "w5",
            "map": "FiveWs.what[x]"
          }
        ]
      },
      {
        "id": "RiskAssessment.subject",
        "path": "RiskAssessment.subject",
        "short": "Who/what does assessment apply to?",
        "definition": "The patient or group the risk assessment applies to.",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Patient",
              "http://hl7.org/fhir/StructureDefinition/Group"
            ]
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.subject"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject[x]"
          },
          {
            "identity": "rim",
            "map": ".participation[typeCode=SBJ].role"
          },
          {
            "identity": "openehr",
            "map": "Subject of Care"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject"
          }
        ]
      },
      {
        "id": "RiskAssessment.encounter",
        "path": "RiskAssessment.encounter",
        "short": "Where was assessment performed?",
        "definition": "The encounter where the assessment was performed.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Encounter"
            ]
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.encounter"
          },
          {
            "identity": "w5",
            "map": "FiveWs.context"
          },
          {
            "identity": "rim",
            "map": ".inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]"
          }
        ]
      },
      {
        "id": "RiskAssessment.occurrence[x]",
        "path": "RiskAssessment.occurrence[x]",
        "short": "When was assessment made?",
        "definition": "The date (and possibly time) the risk assessment was performed.",
        "requirements": "The assessment results lose validity the more time elapses from when they are first made.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "dateTime"
          },
          {
            "code": "Period"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.occurrence[x]"
          },
          {
            "identity": "w5",
            "map": "FiveWs.done[x]"
          },
          {
            "identity": "rim",
            "map": ".effectiveTime"
          }
        ]
      },
      {
        "id": "RiskAssessment.condition",
        "path": "RiskAssessment.condition",
        "short": "Condition assessed",
        "definition": "For assessments or prognosis specific to a particular condition, indicates the condition being assessed.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Condition"
            ]
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN]"
          }
        ]
      },
      {
        "id": "RiskAssessment.performer",
        "path": "RiskAssessment.performer",
        "short": "Who did assessment?",
        "definition": "The provider, patient, related person, or software application that performed the assessment.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Patient",
              "http://hl7.org/fhir/StructureDefinition/Practitioner",
              "http://hl7.org/fhir/StructureDefinition/PractitionerRole",
              "http://hl7.org/fhir/StructureDefinition/RelatedPerson",
              "http://hl7.org/fhir/StructureDefinition/Device"
            ]
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.performer.actor"
          },
          {
            "identity": "w5",
            "map": "FiveWs.actor"
          },
          {
            "identity": "rim",
            "map": ".participation[typeCode=PFM].role[classCode=ASSIGNED]"
          },
          {
            "identity": "openehr",
            "map": "Information Provider"
          }
        ]
      },
      {
        "id": "RiskAssessment.reason",
        "path": "RiskAssessment.reason",
        "short": "Why the assessment was necessary?",
        "definition": "The reason the risk assessment was performed.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "CodeableReference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Condition",
              "http://hl7.org/fhir/StructureDefinition/Observation",
              "http://hl7.org/fhir/StructureDefinition/DiagnosticReport",
              "http://hl7.org/fhir/StructureDefinition/DocumentReference"
            ]
          }
        ],
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.reason"
          },
          {
            "identity": "w5",
            "map": "FiveWs.why[x]"
          }
        ]
      },
      {
        "id": "RiskAssessment.basis",
        "path": "RiskAssessment.basis",
        "short": "Information used in assessment",
        "definition": "Indicates the source data considered as part of the assessment (for example, FamilyHistory, Observations, Procedures, Conditions, etc.).",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Resource"
            ]
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=DRIV].target"
          },
          {
            "identity": "openehr",
            "map": "Risk Factor; Link to Evidence"
          }
        ]
      },
      {
        "id": "RiskAssessment.prediction",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/svg",
            "valueCode": "320,0"
          }
        ],
        "path": "RiskAssessment.prediction",
        "short": "Outcome predicted",
        "definition": "Describes the expected outcome for the subject.",
        "comment": "Multiple repetitions can be used to identify the same type of outcome in different timeframes as well as different types of outcomes.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "constraint": [
          {
            "key": "ras-2",
            "severity": "error",
            "human": "Must be <= 100",
            "expression": "probability is decimal implies (probability as decimal) <= 100",
            "xpath": "not(f:probabilityDecimal) or f:probabilityDecimal/@value <= 100",
            "source": "http://hl7.org/fhir/StructureDefinition/RiskAssessment"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=VALUE].target[classCod=OBS, moodCode=RISK]"
          }
        ]
      },
      {
        "id": "RiskAssessment.prediction.outcome",
        "path": "RiskAssessment.prediction.outcome",
        "short": "Possible outcome for the subject",
        "definition": "One of the potential outcomes for the patient (e.g. remission, death,  a particular condition).",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "RiskAssessmentOutcome"
            }
          ],
          "strength": "example",
          "description": "The condition or other outcome; e.g. death, remission, amputation, infection, etc."
        },
        "mapping": [
          {
            "identity": "rim",
            "map": ".value"
          },
          {
            "identity": "openehr",
            "map": "Risk"
          }
        ]
      },
      {
        "id": "RiskAssessment.prediction.probability[x]",
        "path": "RiskAssessment.prediction.probability[x]",
        "short": "Likelihood of specified outcome",
        "definition": "Indicates how likely the outcome is (in the specified timeframe).",
        "comment": "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).",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "decimal"
          },
          {
            "code": "Range"
          }
        ],
        "constraint": [
          {
            "key": "ras-1",
            "severity": "error",
            "human": "low and high must be percentages, if present",
            "expression": "(low.empty() or ((low.code = '%') and (low.system = %ucum))) and (high.empty() or ((high.code = '%') and (high.system = %ucum)))",
            "xpath": "(not(f:low) or f:low[f:code/@value='%' and f:system/@value='http://unitsofmeasure.org']) and (not(f:high) or f:high[f:code/@value='%' and f:system/@value='http://unitsofmeasure.org'])",
            "source": "http://hl7.org/fhir/StructureDefinition/RiskAssessment"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"probability\"].value"
          },
          {
            "identity": "openehr",
            "map": "Category"
          }
        ]
      },
      {
        "id": "RiskAssessment.prediction.qualitativeRisk",
        "path": "RiskAssessment.prediction.qualitativeRisk",
        "short": "Likelihood 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).",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "RiskAssessmentProbability"
            }
          ],
          "strength": "example",
          "description": "The likelihood of the occurrence of a specified outcome.",
          "valueSet": "http://hl7.org/fhir/ValueSet/risk-probability"
        }
      },
      {
        "id": "RiskAssessment.prediction.relativeRisk",
        "path": "RiskAssessment.prediction.relativeRisk",
        "short": "Relative 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.).",
        "requirements": "Absolute risk is less meaningful than relative risk.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "decimal"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"relative risk\"].value"
          }
        ]
      },
      {
        "id": "RiskAssessment.prediction.when[x]",
        "path": "RiskAssessment.prediction.when[x]",
        "short": "Timeframe or age range",
        "definition": "Indicates the period of time or age range of the subject to which the specified probability applies.",
        "comment": "If not specified, the risk applies \"over the subject's lifespan\".",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Period"
          },
          {
            "code": "Range"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": ".effectiveTime or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"age\"].value"
          }
        ]
      },
      {
        "id": "RiskAssessment.prediction.rationale",
        "path": "RiskAssessment.prediction.rationale",
        "short": "Explanation of prediction",
        "definition": "Additional information explaining the basis for the prediction.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": ".reasonCode.text"
          },
          {
            "identity": "openehr",
            "map": "Rationale"
          }
        ]
      },
      {
        "id": "RiskAssessment.mitigation",
        "path": "RiskAssessment.mitigation",
        "short": "How to reduce risk",
        "definition": "A description of the steps that might be taken to reduce the identified risk(s).",
        "requirements": "One of the main reasons for assessing risks is to identify whether interventional steps are needed to reduce risk.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "mapping": [
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=MTGT].target[classCode=ACT, moodCode=EVN].text"
          }
        ]
      },
      {
        "id": "RiskAssessment.note",
        "path": "RiskAssessment.note",
        "short": "Comments on the risk assessment",
        "definition": "Additional comments about the risk assessment.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Annotation"
          }
        ],
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.note"
          }
        ]
      }
    ]
  }
}