Name Flags Card. Type Description & Constraints Condition I 0..* US Core Condition Profile us-core-1: A code in Condition.category SHOULD be from US Core Condition Category Codes value set. clinicalStatus S 0..1 code Binding: Condition Clinical Status Codes (required) verificationStatus S 1..1 code Binding: ConditionVerificationStatus (required) category SI 1..* CodeableConcept Binding: US Core Condition Category Codes (preferred) code S 1..1 CodeableConcept Binding: Problem Value Set (extensible) subject S 1..1 Reference(US Core Patient Profile) Documentation for this format
US Core Condition (a.k.a Problem) Profile
Health Level Seven International (Infrastructure and Messaging - Data Access Framework)
United States Minor Outlying Islands (the)
The US Core Condition Profile is based upon the core FHIR Condition Resource and created to meet the 2015 Edition Common Clinical Data Set 'Problems' and 'Health Concerns' requirements.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL NOT contain any narrative
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
contained.where(('#'+id in %resource.descendants().reference).not()).empty()
not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))
If condition is abated, then clinicalStatus must be either inactive, resolved, or remission
abatement.empty() or (abatement as boolean).not() or clinicalStatus='resolved' or clinicalStatus='remission' or clinicalStatus='inactive'
not(f:abatementBoolean/@value=true() or (not(exists(f:abatementBoolean)) and exists(*[starts-with(local-name(.), 'abatement')])) or f:clinicalStatus/@value=('resolved', 'remission', 'inactive'))
Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error
verificationStatus='entered-in-error' or clinicalStatus.exists()
f:verificationStatus/@value='entered-in-error' or exists(f:clinicalStatus)
A code in Condition.category SHOULD be from US Core Condition Category Codes value set.
where(category in 'http://hl7.org/fhir/us/core/ValueSet/us-core-condition-category').exists()
< 243796009 |Situation with explicit context|: 246090004 |Associated finding| = ((< 404684003 |Clinical finding| MINUS << 420134006 |Propensity to adverse reactions| MINUS << 473010000 |Hypersensitivity condition| MINUS << 79899007 |Drug interaction| MINUS << 69449002 |Drug action| MINUS << 441742003 |Evaluation finding| MINUS << 307824009 |Administrative status| MINUS << 385356007 |Tumor stage finding|) OR < 272379006 |Event|)
Observation[classCode=OBS, moodCode=EVN, code=ASSERTION, value<Diagnosis]
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.
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. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
The base language in which the resource is written.
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).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource, and may 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.
Contained resources do not have 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 in formation is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
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.
Additional Content defined by implementations
May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, 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.
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.
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. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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.
This records identifiers associated with this condition that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).
Need to allow connection to a wider workflow.
active | recurrence | inactive | remission | resolved
This element is labeled as a modifier because the status contains codes that mark the condition as not currently valid or of concern.
Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value
provisional | differential | confirmed | refuted | entered-in-error | unknown
The verification status to support the clinical status of the condition.
verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value
The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.
'problem' if from PRB-3. 'diagnosis' if from DG1 segment in PV1 message
A subjective assessment of the severity of the condition as evaluated by the clinician.
Coding of the severity with a terminology is preferred, where possible.
Can be pre/post-coordinated into value. Or ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="severity"].value
Identification of the condition, problem or diagnosis
Identification of the condition, problem or diagnosis.
0..1 to account for primarily narrative only resources.
Valueset to describe the actual problem experienced by the patient
code 246090004 |Associated finding| (< 404684003 |Clinical finding| MINUS << 420134006 |Propensity to adverse reactions| MINUS << 473010000 |Hypersensitivity condition| MINUS << 79899007 |Drug interaction| MINUS << 69449002 |Drug action| MINUS << 441742003 |Evaluation finding| MINUS << 307824009 |Administrative status| MINUS << 385356007 |Tumor stage finding|) OR < 413350009 |Finding with explicit context| OR < 272379006 |Event|
The anatomical location where this condition manifests itself.
Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [body-site-instance](extension-body-site-instance.html). May be a summary code, or a reference to a very precise definition of the location, or both.
Codes describing anatomical locations. May include laterality.
< 442083009 |Anatomical or acquired body structure|
Indicates the patient or group who the condition record is associated with.
Group is typically used for veterinary or public health use cases.
Encounter or episode when condition first asserted
Encounter during which the condition was first asserted.
This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
Estimated or actual date, date-time, or age
Estimated or actual date or date-time the condition began, in the opinion of the clinician.
Age is generally used when the patient reports an age at which the Condition began to occur.
.effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value
The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.
There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.
.effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at remission"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed
The date on which the existance of the Condition was first asserted or acknowledged.
The assertedDate represents the date when this particular Condition record was created in the EHR, not the date of the most recent update in terms of when severity, abatement, etc. were specified. The date of the last record modification can be retrieved from the resource metadata.
Individual who is making the condition statement.
Clinical stage or grade of a condition. May include formal severity assessments.
All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
exists(f:summary) or exists(f:assessment)
./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage/grade"]
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, 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.
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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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.
A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.
Codes describing condition stages (e.g. Cancer stages).
Reference to a formal record of the evidence on which the staging assessment is based.
Supporting Evidence / manifestations that are the basis on which this condition is suspected or confirmed.
The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.
.outboundRelationship[typeCode=SPRT].target[classCode=OBS, moodCode=EVN]
A manifestation or symptom that led to the recording of this condition.
Codes that describe the manifestation or symptoms of a condition.
Links to other relevant information, including pathology reports.
Additional information about the Condition
Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.
.inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value