type: resourceresource: RiskAssessment

RiskAssessment

Scope and Usage

This resource is an event resource from a FHIR workflow perspective - see Workflow, specifically Event.

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.

Boundaries and Relationships

Risk assessments are a specialized type of observation. A specialized resource is used 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:

Basic demographic information from the Patient or Group resources
Various Observations including vital signs, lab information, assessments, genetic information, etc.
FamilyMemberHistory
Current, past and proposed therapies Immunization, Procedure, CarePlan, etc.

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.

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.

StructureDefinition

Elements (Simplified)

RiskAssessment [0..*]: - Potential outcomes for a subject with likelihood
RiskAssessment.identifier [0..*]: Identifier Unique identifier for the assessment
RiskAssessment.basedOn [0..1]: Reference(Resource) Request fulfilled by this assessment
RiskAssessment.parent [0..1]: Reference(Resource) Part of this occurrence
RiskAssessment.status [1..1]: code required:observation-status registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained
RiskAssessment.method [0..1]: CodeableConcept example:risk-assessment-method Evaluation mechanism
RiskAssessment.code [0..1]: CodeableConcept example:risk-assessment-method Type of assessment
RiskAssessment.subject [1..1]: [Reference(Patient](/Reference(Patient), Group)) Who/what does assessment apply to?
RiskAssessment.encounter [0..1]: Reference(Encounter) Where was assessment performed?
RiskAssessment.occurrence[x] [0..1]: dateTime, Period When was assessment made?
RiskAssessment.condition [0..1]: Reference(Condition) Condition assessed
RiskAssessment.performer [0..1]: [Reference(Patient](/Reference(Patient), Practitioner, PractitionerRole, RelatedPerson, Device)) Who did assessment?
RiskAssessment.reason [0..*]: CodeableReference Why was the assessment necessary?
RiskAssessment.basis [0..*]: Reference(Resource) Information used in assessment
RiskAssessment.prediction [0..*]: BackboneElement Outcome predicted
RiskAssessment.prediction.outcome [0..1]: CodeableConcept example:risk-assessment-outcome Possible outcome for the subject
RiskAssessment.prediction.probability[x] [0..1]: decimal, Quantity, Range Likelihood of specified outcome
RiskAssessment.prediction.qualitativeRisk [0..1]: CodeableConcept example:risk-probability Likelihood of specified outcome as a qualitative value
RiskAssessment.prediction.relativeRisk [0..1]: decimal Relative likelihood
RiskAssessment.prediction.when[x] [0..1]: Period, Range Timeframe or age range
RiskAssessment.prediction.rationale [0..1]: string Explanation of prediction
RiskAssessment.mitigation [0..1]: string How to reduce risk
RiskAssessment.note [0..*]: Annotation Comments on the risk assessment

Mappings

RiskAssessment Mappings — 47 mapping entries

Resource Packs

list-RiskAssessment-packs.xml

<?xml version="1.0" encoding="UTF-8"?>

<List xmlns="http://hl7.org/fhir">
  <id value="RiskAssessment-packs"/>
  <status value="current"/>
  <mode value="working"/>
</List>

Search Parameters

condition — reference — Condition assessed — RiskAssessment.condition
date — date — When was assessment made? — (RiskAssessment.occurrence.ofType(dateTime))
encounter — reference — Where was assessment performed? — RiskAssessment.encounter
identifier — token — Unique identifier for the assessment — RiskAssessment.identifier
method — token — Evaluation mechanism — RiskAssessment.method
patient — reference — Who/what does assessment apply to? — RiskAssessment.subject.where(resolve() is Patient)
performer — reference — Who did assessment? — RiskAssessment.performer
probability — number — Likelihood of specified outcome — RiskAssessment.prediction.probability.ofType(decimal)
probability-quantity — quantity — Likelihood of specified outcome (as a Quantity or Range) — RiskAssessment.prediction.probability.ofType(Quantity) | RiskAssessment.prediction.probability.ofType(Range)
risk — token — Likelihood of specified outcome as a qualitative value — RiskAssessment.prediction.qualitativeRisk
subject — reference — Who/what does assessment apply to? — RiskAssessment.subject

Full Search Parameters

Examples

breastcancer-risk — riskassessment-example-breastcancer — Breast cancer risk assessment
cardiac — riskassessment-example-cardiac — Cardiac risk assessment
genetic — riskassessment-example — Genetic risk assessment
population — riskassessment-example-population — Public health population risk assessment
prognosis — riskassessment-example-prognosis — Patient prognosis
riskassessment-example — riskassessment-example
riskassessment-example-breastcancer — riskassessment-example-breastcancer
riskassessment-example-cardiac — riskassessment-example-cardiac
riskassessment-example-population — riskassessment-example-population
riskassessment-example-prognosis — riskassessment-example-prognosis
riskassessment-examples-header — riskassessment-examples-header
riskexample — riskassessment-riskexample — Example risk assessment

Full Examples

Event.identifier → RiskAssessment.identifier
- shortUnmatched | reason=Unknown | pattern=Business identifier for risk assessment | resource=Unique identifier for the assessment
- definitionUnmatched | reason=Unknown | pattern=Business identifiers assigned to this risk assessment by the performer and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to server. | resource=Business identifier assigned to the risk assessment.
- commentsUnmatched | reason=Unknown | pattern=Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
- requirementsUnmatched | reason=Unknown | pattern=Allows identification of the risk assessment as it is known by various participating systems and in a way that remains consistent across servers.
Event.basedOn → RiskAssessment.basedOn
- missingTypes | reason=Unknown | pattern=Reference(Request)
- extraTypes | reason=Unknown
- summary | reason=Unknown | pattern=true
- shortUnmatched | reason=Unknown | pattern=Fulfills plan, proposal or order | resource=Request fulfilled by this assessment
- definitionUnmatched | reason=Unknown | pattern=A plan, proposal or order that is fulfilled in whole or in part by this risk assessment. | resource=A reference to the request that is fulfilled by this risk assessment.
- requirementsUnmatched | reason=Unknown | pattern=Allows tracing of authorization for the risk assessment and tracking whether proposals/recommendations were acted upon.
Event.partOf → RiskAssessment.parent
- missingTypes | reason=Unknown | pattern=Reference(Event)
- extraTypes | reason=Unknown
- summary | reason=Unknown | pattern=true
- shortUnmatched | reason=Unknown | pattern=Part of referenced event | resource=Part of this occurrence
- definitionUnmatched | reason=Unknown | pattern=A larger event of which this particular risk assessment is a component or step. | resource=A reference to a resource that this risk assessment is part of, such as a Procedure.
- commentsUnmatched | reason=Unknown | pattern=Not to be used to link an risk assessment to an Encounter - use 'context' for that.
Event.status → RiskAssessment.status
- shortUnmatched | reason=Unknown | pattern=preparation | in-progress | not-done | suspended | aborted | completed | entered-in-error | unknown | resource=registered | specimen-in-process | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | unknown | cannot-be-obtained
- definitionUnmatched | reason=Unknown | pattern=The current state of the risk assessment. | resource=The status of the RiskAssessment, using the same statuses as an Observation.
- commentsUnmatched | reason=Unknown | pattern=A nominal state-transition diagram can be found in the (Event pattern documentation

Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

Event.code → RiskAssessment.code
- shortUnmatched | reason=Unknown | pattern=What service was done | resource=Type of assessment
- definitionUnmatched | reason=Unknown | pattern=A code that identifies the specific service or action that was or is being performed. | resource=The type of the risk assessment performed.
Event.subject → RiskAssessment.subject
- shortUnmatched | reason=Unknown | pattern=Individual service was done for/to | resource=Who/what does assessment apply to?
- definitionUnmatched | reason=Unknown | pattern=The individual or set of individuals the action is being or was performed on. | resource=The patient or group the risk assessment applies to.
- requirementsUnmatched | reason=Unknown | pattern=Links the risk assessment to the Patient context. May also affect access control.
Event.encounter → RiskAssessment.encounter
- shortUnmatched | reason=Unknown | pattern=Encounter the risk assessment is part of | resource=Where was assessment performed?
- definitionUnmatched | reason=Unknown | pattern=The Encounter during which this risk assessment was created or to which the creation of this record is tightly associated. | resource=The encounter where the assessment was performed.
- commentsUnmatched | reason=Unknown | pattern=This will typically be the encounter the risk assessment was created during, but some risk assessments may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission lab tests).
- requirementsUnmatched | reason=Unknown | pattern=Links the risk assessment to the Encounter context. May also affect access control.
Event.occurrence[x] → RiskAssessment.occurrence[x]
- missingTypes | reason=Unknown | pattern=Timing
- shortUnmatched | reason=Unknown | pattern=When risk assessment occurred/is occurring | resource=When was assessment made?
- definitionUnmatched | reason=Unknown | pattern=The date, period or timing when the risk assessment did occur or is occurring. | resource=The date (and possibly time) the risk assessment was performed.
- commentsUnmatched | reason=Unknown | pattern=This indicates when the activity actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurence element of the Request this {{event}} is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds. .
Event.performer.actor → RiskAssessment.performer
- missingTypes | reason=Unknown | pattern=Reference(Organization, CareTeam)
- shortUnmatched | reason=Unknown | pattern=Who performed risk assessment | resource=Who did assessment?
- definitionUnmatched | reason=Unknown | pattern=Indicates who or what performed the risk assessment. | resource=The provider, patient, related person, or software application that performed the assessment.
Event.reason → RiskAssessment.reason
- summary | reason=Unknown | pattern=true
- shortUnmatched | reason=Unknown | pattern=Why was risk assessment performed? | resource=Why was the assessment necessary?
- definitionUnmatched | reason=Unknown | pattern=Describes why the risk assessment occurred in coded or textual form or Indicates another resource whose existence justifies this risk assessment. | resource=The reason the risk assessment was performed.
- commentsUnmatched | reason=Unknown | pattern=Textual reasons can be captured using reasonCode.text.
Event.note → RiskAssessment.note
- shortUnmatched | reason=Unknown | pattern=Comments made about the event | resource=Comments on the risk assessment
- definitionUnmatched | reason=Unknown | pattern=Comments made about the risk assessment by the performer, subject or other participants. | resource=Additional comments about the risk assessment.