DSTU2

This page is part of the FHIR Specification (v1.0.2: DSTU 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

4.11 Resource RiskAssessment - Content

Clinical Decision Support Work GroupMaturity Level: 0Compartments: Device, Patient, Practitioner

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

4.11.1 Scope and Usage

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.

4.11.2 Boundaries and Relationships

Risk assessments are a specialized type of observation. We use a specialized resource to provide a simpler mechanism to capture of a series of risks and to associate those risks with time-ranges, probabilities, etc. All risk assertions are captured at one time based on a single set of source inputs. Capture of a single risk MAY be done using the Observation class, particularly in circumstances where it's treated as a generic observation, but for consistency, all risk assessments and prognosis SHOULD be captured using RiskAssessment.

Risk assessments may be based on a variety of factors, including:

Because so many resources can potentially be used, no limit is placed on what resources can be sent in RiskAssessment.basis. However, some resources would be nonsensical for this use (e.g. MessageHeader).

AllergyIntolerance and RiskAssessment

AllergyIntolerance describes a specific type of risk - propensity to reaction to a substance while RiskAssessment describes general risks to a subject, not generally based on a reaction.

4.11.3 Background and Context

Risk Assessments can be determined manually by health-care providers based on their professional expertise, by using an algorithmic scoring system or through a combination. Risk assessments can also be computed by decision support systems. OperationDefinitions may be defined by servers to generate risk assessments based on particular combinations of source resources or other inputs.

This resource is referenced by goal

4.11.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. RiskAssessment DomainResourcePotential outcomes for a subject with likelihood
... subject Σ0..1Reference(Patient | Group)Who/what does assessment apply to?
... date Σ0..1dateTimeWhen was assessment made?
... condition Σ0..1Reference(Condition)Condition assessed
... encounter Σ0..1Reference(Encounter)Where was assessment performed?
... performer Σ0..1Reference(Practitioner | Device)Who did assessment?
... identifier Σ0..1IdentifierUnique identifier for the assessment
... method Σ0..1CodeableConceptEvaluation mechanism
... basis 0..*Reference(Any)Information used in assessment
... prediction 0..*BackboneElementOutcome predicted
.... outcome 1..1CodeableConceptPossible outcome for the subject
.... probability[x] I0..1Likelihood of specified outcome
Risk Probability (Example)
low and high must be percentages, if present
Must be <= 100
..... probabilityDecimaldecimal
..... probabilityRangeRange
..... probabilityCodeableConceptCodeableConcept
.... relativeRisk 0..1decimalRelative likelihood
.... when[x] 0..1Timeframe or age range
..... whenPeriodPeriod
..... whenRangeRange
.... rationale 0..1stringExplanation of prediction
... mitigation 0..1stringHow to reduce risk

doco Documentation for this format

UML Diagram

RiskAssessment (DomainResource)The patient or group the risk assessment applies tosubject : Reference [0..1] « Patient|Group »The date (and possibly time) the risk assessment was performeddate : dateTime [0..1]For assessments or prognosis specific to a particular condition, indicates the condition being assessedcondition : Reference [0..1] « Condition »The encounter where the assessment was performedencounter : Reference [0..1] « Encounter »The provider or software application that performed the assessmentperformer : Reference [0..1] « Practitioner|Device »Business identifier assigned to the risk assessmentidentifier : Identifier [0..1]The algorithm, process or mechanism used to evaluate the riskmethod : CodeableConcept [0..1]Indicates the source data considered as part of the assessment (FamilyHistory, Observations, Procedures, Conditions, etc.)basis : Reference [0..*] « Any »A description of the steps that might be taken to reduce the identified risk(s)mitigation : string [0..1]PredictionOne of the potential outcomes for the patient (e.g. remission, death, a particular condition)outcome : CodeableConcept [1..1]How likely is the outcome (in the specified timeframe)probability[x] : Type [0..1] « decimal|Range|CodeableConcept; The likelihood of the occurrence of a specified outcome (Strength=Example)Risk Probability?? »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.)relativeRisk : decimal [0..1]Indicates the period of time or age range of the subject to which the specified probability applieswhen[x] : Type [0..1] « Period|Range »Additional information explaining the basis for the predictionrationale : string [0..1]Describes the expected outcome for the subjectprediction[0..*]

XML Template

<RiskAssessment xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <subject><!-- 0..1 Reference(Patient|Group) Who/what does assessment apply to? --></subject>
 <date value="[dateTime]"/><!-- 0..1 When was assessment made? -->
 <condition><!-- 0..1 Reference(Condition) Condition assessed --></condition>
 <encounter><!-- 0..1 Reference(Encounter) Where was assessment performed? --></encounter>
 <performer><!-- 0..1 Reference(Practitioner|Device) Who did assessment? --></performer>
 <identifier><!-- 0..1 Identifier Unique identifier for the assessment --></identifier>
 <method><!-- 0..1 CodeableConcept Evaluation mechanism --></method>
 <basis><!-- 0..* Reference(Any) Information used in assessment --></basis>
 <prediction>  <!-- 0..* Outcome predicted -->
  <outcome><!-- 1..1 CodeableConcept Possible outcome for the subject --></outcome>
  <probability[x]><!-- 0..1 decimal|Range|CodeableConcept Likelihood of specified outcome --></probability[x]>
  <relativeRisk value="[decimal]"/><!-- 0..1 Relative likelihood -->
  <when[x]><!-- 0..1 Period|Range Timeframe or age range --></when[x]>
  <rationale value="[string]"/><!-- 0..1 Explanation of prediction -->
 </prediction>
 <mitigation value="[string]"/><!-- 0..1 How to reduce risk -->
</RiskAssessment>

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. RiskAssessment DomainResourcePotential outcomes for a subject with likelihood
... subject Σ0..1Reference(Patient | Group)Who/what does assessment apply to?
... date Σ0..1dateTimeWhen was assessment made?
... condition Σ0..1Reference(Condition)Condition assessed
... encounter Σ0..1Reference(Encounter)Where was assessment performed?
... performer Σ0..1Reference(Practitioner | Device)Who did assessment?
... identifier Σ0..1IdentifierUnique identifier for the assessment
... method Σ0..1CodeableConceptEvaluation mechanism
... basis 0..*Reference(Any)Information used in assessment
... prediction 0..*BackboneElementOutcome predicted
.... outcome 1..1CodeableConceptPossible outcome for the subject
.... probability[x] I0..1Likelihood of specified outcome
Risk Probability (Example)
low and high must be percentages, if present
Must be <= 100
..... probabilityDecimaldecimal
..... probabilityRangeRange
..... probabilityCodeableConceptCodeableConcept
.... relativeRisk 0..1decimalRelative likelihood
.... when[x] 0..1Timeframe or age range
..... whenPeriodPeriod
..... whenRangeRange
.... rationale 0..1stringExplanation of prediction
... mitigation 0..1stringHow to reduce risk

doco Documentation for this format

UML Diagram

RiskAssessment (DomainResource)The patient or group the risk assessment applies tosubject : Reference [0..1] « Patient|Group »The date (and possibly time) the risk assessment was performeddate : dateTime [0..1]For assessments or prognosis specific to a particular condition, indicates the condition being assessedcondition : Reference [0..1] « Condition »The encounter where the assessment was performedencounter : Reference [0..1] « Encounter »The provider or software application that performed the assessmentperformer : Reference [0..1] « Practitioner|Device »Business identifier assigned to the risk assessmentidentifier : Identifier [0..1]The algorithm, process or mechanism used to evaluate the riskmethod : CodeableConcept [0..1]Indicates the source data considered as part of the assessment (FamilyHistory, Observations, Procedures, Conditions, etc.)basis : Reference [0..*] « Any »A description of the steps that might be taken to reduce the identified risk(s)mitigation : string [0..1]PredictionOne of the potential outcomes for the patient (e.g. remission, death, a particular condition)outcome : CodeableConcept [1..1]How likely is the outcome (in the specified timeframe)probability[x] : Type [0..1] « decimal|Range|CodeableConcept; The likelihood of the occurrence of a specified outcome (Strength=Example)Risk Probability?? »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.)relativeRisk : decimal [0..1]Indicates the period of time or age range of the subject to which the specified probability applieswhen[x] : Type [0..1] « Period|Range »Additional information explaining the basis for the predictionrationale : string [0..1]Describes the expected outcome for the subjectprediction[0..*]

XML Template

<RiskAssessment xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <subject><!-- 0..1 Reference(Patient|Group) Who/what does assessment apply to? --></subject>
 <date value="[dateTime]"/><!-- 0..1 When was assessment made? -->
 <condition><!-- 0..1 Reference(Condition) Condition assessed --></condition>
 <encounter><!-- 0..1 Reference(Encounter) Where was assessment performed? --></encounter>
 <performer><!-- 0..1 Reference(Practitioner|Device) Who did assessment? --></performer>
 <identifier><!-- 0..1 Identifier Unique identifier for the assessment --></identifier>
 <method><!-- 0..1 CodeableConcept Evaluation mechanism --></method>
 <basis><!-- 0..* Reference(Any) Information used in assessment --></basis>
 <prediction>  <!-- 0..* Outcome predicted -->
  <outcome><!-- 1..1 CodeableConcept Possible outcome for the subject --></outcome>
  <probability[x]><!-- 0..1 decimal|Range|CodeableConcept Likelihood of specified outcome --></probability[x]>
  <relativeRisk value="[decimal]"/><!-- 0..1 Relative likelihood -->
  <when[x]><!-- 0..1 Period|Range Timeframe or age range --></when[x]>
  <rationale value="[string]"/><!-- 0..1 Explanation of prediction -->
 </prediction>
 <mitigation value="[string]"/><!-- 0..1 How to reduce risk -->
</RiskAssessment>

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

4.11.4.1 Terminology Bindings

PathDefinitionTypeReference
RiskAssessment.method The mechanism or algorithm used to make the assessment; e.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc.UnknownNo details provided yet
RiskAssessment.prediction.outcome The condition or other outcome; e.g. death, remission, amputation, infection, etc.UnknownNo details provided yet
RiskAssessment.prediction.probability[x] The likelihood of the occurrence of a specified outcomeExampleRisk Probability

4.11.4.2 Constraints

  • ras-1: On RiskAssessment.prediction.probability[x]: low and high must be percentages, if present (xpath on f:RiskAssessment/f:prediction/f:probability[x]: (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']))
  • ras-2: On RiskAssessment.prediction.probability[x]: Must be <= 100 (xpath on f:RiskAssessment/f:prediction/f:probability[x]: @value <= 100)

4.11.5 Open Issues

DSTU Note: There are several open issues around the risk assessment resource:

  • Is there an existing code system we can use as a recommended value set for risk probabilties?
  • Should risk assessments apply to devices, locations or any other resources (as part of the 80%)?
  • Is identification of risk assessment method part of the 80%?
  • Is relative risk in the 80%?

Feedback is sought here .

4.11.6 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
conditionreferenceCondition assessedRiskAssessment.condition
(Condition)
datedateWhen was assessment made?RiskAssessment.date
encounterreferenceWhere was assessment performed?RiskAssessment.encounter
(Encounter)
identifiertokenUnique identifier for the assessmentRiskAssessment.identifier
methodtokenEvaluation mechanismRiskAssessment.method
patientreferenceWho/what does assessment apply to?RiskAssessment.subject
(Patient)
performerreferenceWho did assessment?RiskAssessment.performer
(Device, Practitioner)
subjectreferenceWho/what does assessment apply to?RiskAssessment.subject
(Patient, Group)