Details
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Change Request
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Resolution: Persuasive with Modification
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Medium
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US Core (FHIR)
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6.0.0-ballot
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Cross-Group Projects
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STU
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US Core Simple Observation Profile
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Screening and Assessments
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Eric Haas / Yunwei Wang : 18-0-0
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Clarification
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Compatible, substantive
Description
The title “Simple Observation” either does not adequately describe the purpose of the profile or the scope of the profile is not adequately described.
The profile intro material states “The US Core Simple Observation Profile meets the requirements of the US Core Data for Interoperability (USCDI) Assessments. This profile promotes interoperability and adoption through common implementation by setting minimum expectations for the Observation resource to record, search, and retrieve observations representing a practitioner’s clinical observation or assertion about a patient’s health status. These observations may or may not be associated with a formal survey, screening, or assessment tool. For example, a social history status such as education or food insecurity or an assessment of the patient’s cognitive, functional, or disability status. This profile identifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource when using this profile. It provides the floor for standards development for specific use cases.”
- This seems to indicate that the use of the profile should be assessments.
- If this profile is only meant to be for assessments, please rename the profile something like “Simple Assessment Observation”. This will help reduce confusion on the use of the profile and implementers from capturing non-assessment observations with the wrong profile.
- If this profile is meant to capture any sort of “simple” observations that are not otherwise covered by other US Core Observation profiles, please describe the scope and use of the profile up front.
Additionally, change the description on the Screening and Assessments page (http://hl7.org/fhir/us/core/2023Jan/screening-and-assessments.html) section 3.6.1 where the US Core Simple Observation Profile is first mentioned to state something to the effect that simple assessments are captured using the Simple Observation profile. Not stating this could lead to an incorrect that the “Simple Observation” profile is synonymous with the assessment use case, though its scope is actually greater than that.
- The profile description states that the profile is about observations representing a “practitioner’s clinical observation”, however, the profile does allow the performer to be a patient. Related person, organization, or care Team (which may include non-practitioners). It seems the intent is that the profile should be able to be used to capture more than a practitioner’s observation and furthermore not just a clinical observation. For domains like SDOH, this may also mean other types of status of a patient than just their health status. Please reword to make this intent clear, perhaps something like “an observation or assertion (such as a practitioner’s clinical observation) about a patient’s status.
Attachments
Issue Links
- is duplicated by
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FHIR-40157 Remove "survey" concept from US Core Simple Observation Category ValueSet
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- Duplicate
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- is voted on by
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BALLOT-46518 Negative - Corey Spears : 2023-Jan-FHIR US CORE R5.1.0 STU
- Balloted
- relates to
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FHIR-39942 Correct the description of the Simple Observation Profile
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- Resolved - change required
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FHIR-39946 Update the “Screening and Assessment Activities” diagram with proper profile name
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- Resolved - change required
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FHIR-39947 Update “3.6.2 Screening and Assessments” title and content
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- Resolved - change required
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FHIR-39652 Clarify the difference between Simple Observation and Screening Assessment
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- Resolved - change required
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