This page is part of the FHIR Specification (v0.0.82: DSTU 1). 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 Content Examples Detailed Descriptions Mappings Profiles 4.12 Resource RiskAssessment - Content This resource maintained by the Clinical Decision Support Work Group An assessment of the likely outcome(s) for a patient or other subject as well as the likelihood of each outcome. 4.12.1 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 4.12.2 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: Basic demographic information from the Patient or Group resources Various Observations including vital signs, lab information, assessments, genetic information, etc. FamilyHistory 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 ). 4.12.3 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. 4.12.4 Resource Content Structure UML XML JSON All Structure Name Flags Card. Type Description & Constraints RiskAssessment DomainResource Potential outcomes for a subject with likelihood subject Σ 0..1 Patient | Group Who/what does assessment apply to? date Σ 0..1 dateTime When was assessment made? condition Σ 0..1 Condition Condition assessed performer Σ 0..1 Practitioner | Device Who did assessment? identifier Σ 0..1 Identifier Unique identifier for the assessment method Σ 0..1 CodeableConcept Evaluation mechanism basis 0..* Any Information used in assessment prediction 0..* Element Outcome predicted outcome 1..1 CodeableConcept Possible outcome for the subject probability[x] I Likelihood of specified outcome RiskAssessmentProbability ( Example ) low and high must be percentages, if present Must be <= 100 probabilityDecimal 0..1 decimal probabilityRange 0..1 Range probabilityCodeableConcept 0..1 CodeableConcept relativeRisk 0..1 decimal Relative likelihood when[x] Timeframe or age range whenPeriod 0..1 Period whenRange 0..1 Range rationale 0..1 string Explanation of prediction mitigation 0..1 string How to reduce risk UML Diagram RiskAssessment ( DomainResource ) The patient or group the risk assessment applies to subject : Reference ( Patient | Group ) 0..1 The date (and possibly time) the risk assessment was performed date : dateTime 0..1 For assessments or prognosis specific to a particular condition, indicates the condition being assessed condition : Reference ( Condition ) 0..1 The provider or software application that performed the assessment performer : Reference ( Practitioner | Device ) 0..1 Business identifier assigned to the risk assessment identifier : Identifier 0..1 The algorithm, processs or mechanism used to evaluate the risk method : CodeableConcept 0..1 Indicates the source data considered as part of the assessment (FamilyHistory, Observations, Procedures, Conditions, etc.) basis : Reference ( Any ) 0..* A description of the steps that might be taken to reduce the identified risk(s) mitigation : string 0..1 Prediction One 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] : decimal | Range | CodeableConcept 0..1 « ( The likelihood of the occurrence of a specified outcome RiskAssessmentProbability ) » 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 applies when[x] : Period | Range 0..1 Additional information explaining the basis for the prediction rationale : string 0..1 Describes the expected outcome for the subject prediction 0..* XML Template < <!-- from --> <!-- from --> <</subject> < <</condition> <</performer> <</identifier> <</method> <</basis> < <</outcome> <</probability[x]> < <</when[x]> < </prediction> < </RiskAssessment> JSON Template { "resourceType" : "", // from // from " " " " " " " " " ">, " }, " }, " " }, " }, " }], " } Structure Name Flags Card. Type Description & Constraints RiskAssessment DomainResource Potential outcomes for a subject with likelihood subject Σ 0..1 Patient | Group Who/what does assessment apply to? date Σ 0..1 dateTime When was assessment made? condition Σ 0..1 Condition Condition assessed performer Σ 0..1 Practitioner | Device Who did assessment? identifier Σ 0..1 Identifier Unique identifier for the assessment method Σ 0..1 CodeableConcept Evaluation mechanism basis 0..* Any Information used in assessment prediction 0..* Element Outcome predicted outcome 1..1 CodeableConcept Possible outcome for the subject probability[x] I Likelihood of specified outcome RiskAssessmentProbability ( Example ) low and high must be percentages, if present Must be <= 100 probabilityDecimal 0..1 decimal probabilityRange 0..1 Range probabilityCodeableConcept 0..1 CodeableConcept relativeRisk 0..1 decimal Relative likelihood when[x] Timeframe or age range whenPeriod 0..1 Period whenRange 0..1 Range rationale 0..1 string Explanation of prediction mitigation 0..1 string How to reduce risk UML Diagram RiskAssessment ( DomainResource ) The patient or group the risk assessment applies to subject : Reference ( Patient | Group ) 0..1 The date (and possibly time) the risk assessment was performed date : dateTime 0..1 For assessments or prognosis specific to a particular condition, indicates the condition being assessed condition : Reference ( Condition ) 0..1 The provider or software application that performed the assessment performer : Reference ( Practitioner | Device ) 0..1 Business identifier assigned to the risk assessment identifier : Identifier 0..1 The algorithm, processs or mechanism used to evaluate the risk method : CodeableConcept 0..1 Indicates the source data considered as part of the assessment (FamilyHistory, Observations, Procedures, Conditions, etc.) basis : Reference ( Any ) 0..* A description of the steps that might be taken to reduce the identified risk(s) mitigation : string 0..1 Prediction One 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] : decimal | Range | CodeableConcept 0..1 « ( The likelihood of the occurrence of a specified outcome RiskAssessmentProbability ) » 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 applies when[x] : Period | Range 0..1 Additional information explaining the basis for the prediction rationale : string 0..1 Describes the expected outcome for the subject prediction 0..* XML Template < <!-- from --> <!-- from --> <</subject> < <</condition> <</performer> <</identifier> <</method> <</basis> < <</outcome> <</probability[x]> < <</when[x]> < </prediction> < </RiskAssessment> JSON Template { "resourceType" : "", // from // from " " " " " " " " " ">, " }, " }, " " }, " }, " }], " }   Alternate definitions: Schema / Schematron , Resource Profile ( XML , JSON ), Questionnaire 4.12.4.1 Terminology Bindings Path Definition Type Reference RiskAssessment.method The mechanism or algorithm used to make the assessment. E.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc. Unknown No details provided yet RiskAssessment.prediction.outcome The condition or other outcome. E.g. death, remission, amputation, infection, etc. Unknown No details provided yet RiskAssessment.prediction.probability[x] The likelihood of the occurrence of a specified outcome Example http://hl7.org/fhir/vs/risk-probability 4.12.4.2 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 ) 4.12.5 Open Issues 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%? 4.12.6 Search Parameters Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services. Name Type Description Paths condition reference Condition assessed RiskAssessment.condition ( Condition ) date date When was assessment made? RiskAssessment.date 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 ( Patient ) performer reference Who did assessment? RiskAssessment.performer ( Device , Practitioner ) subject reference Who/what does assessment apply to? RiskAssessment.subject ( Patient , Group ) © HL7.org 2011+. 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