RiskAssessment

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

Schema

Elements

Name	Required	Type	Description
identifier		Identifier[]	Unique identifier for the assessment Details Business identifier assigned to the risk assessment.
basedOn		Reference<Resource>	Request fulfilled by this assessment Details A reference to the request that is fulfilled by this risk assessment.
parent		Reference<Resource>	Part of this occurrence Details A reference to a resource that this risk assessment is part of, such as a Procedure.
status	✓	code	registered | preliminary | final | amended + Details The status of the RiskAssessment, using the same statuses as an Observation.
method		CodeableConcept	Evaluation mechanism Details The algorithm, process or mechanism used to evaluate the risk.
code		CodeableConcept	Type of assessment Details The type of the risk assessment performed.
subject	✓	Reference<Patient | Group>	Who/what does assessment apply to? Details The patient or group the risk assessment applies to.
encounter		Reference<Encounter>	Where was assessment performed? Details The encounter where the assessment was performed.
occurrence[x]		dateTime, Period	When was assessment made? Details The date (and possibly time) the risk assessment was performed.
condition		Reference<Condition>	Condition assessed Details For assessments or prognosis specific to a particular condition, indicates the condition being assessed.
performer		Reference< Practitioner | PractitionerRole | Device >	Who did assessment? Details The provider or software application that performed the assessment.
reasonCode		CodeableConcept[]	Why the assessment was necessary? Details The reason the risk assessment was performed.
reasonReference		Reference< Condition | Observation | DiagnosticReport | DocumentReference >[]	Why the assessment was necessary? Details Resources supporting the reason the risk assessment was performed.
basis		Reference<Resource>[]	Information used in assessment Details Indicates the source data considered as part of the assessment (for example, FamilyHistory, Observations, Procedures, Conditions, etc.).
prediction		RiskAssessmentPrediction[]	Outcome predicted Details Describes the expected outcome for the subject. Multiple repetitions can be used to identify the same type of outcome in different timeframes as well as different types of outcomes.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. 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 can 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.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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.
outcome		CodeableConcept	Possible outcome for the subject Details One of the potential outcomes for the patient (e.g. remission, death, a particular condition).
probability[x]		decimal, Range	Likelihood of specified outcome Details Indicates how likely the outcome is (in the specified timeframe). 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).
qualitativeRisk		CodeableConcept	Likelihood of specified outcome as a qualitative value Details Indicates how likely the outcome is (in the specified timeframe), expressed as a qualitative value (e.g. low, medium, or high).
relativeRisk		decimal	Relative likelihood Details 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.).
when[x]		Period, Range	Timeframe or age range Details Indicates the period of time or age range of the subject to which the specified probability applies. If not specified, the risk applies "over the subject's lifespan".
rationale		string	Explanation of prediction Details Additional information explaining the basis for the prediction.
mitigation		string	How to reduce risk Details A description of the steps that might be taken to reduce the identified risk(s).
note		Annotation[]	Comments on the risk assessment Details Additional comments about the risk assessment.

Search Parameters

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

Inherited Elements

Name	Required	Type	Description
id		string	Logical id of this artifact Details 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.
meta		Meta	Metadata about the resource Details The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRules		uri	A set of rules under which this content was created Details A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
language		code	Language of the resource content Details 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		Narrative	Text summary of the resource, for human interpretation Details A human-readable narrative that contains a summary of the resource and can 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 information is added later.
contained		Resource[]	Contained, inline Resources Details 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the resource. 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 can 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.
modifierExtension		Extension[]	Extensions that cannot be ignored Details 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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.

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.

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.

Referenced By

• ClinicalImpression
• Goal