Heading Description
Details of the woman’s assessment scales.
The following FHIR profiles are used to form the Assessment scales list structure:
- CareConnect-List-1
- CareConnect-Observation-1
- CareConnect-Encounter-1
- CareConnect-Practitioner-1
- CareConnect-PractitionerRole-1
- CareConnect-Location-1
The following profiles are referenced from the Assessment scales list structure:
Assessment Scales Structure
Maternity Data Standard Mapping to FHIR profiles
Mapping Overview
Data Standard Element | FHIR Profile Mapping | FHIR Element |
Date/Time Recorded | List | entry.date |
ODS/ORD Site Code | Location | identifier |
Performing Professional | Practitioner | name |
SDS Job Role Name | PractitionerRole | code |
Coded Assessment Tool Type | Observation | code value component.code component.value |
Comment | Observation | comment |
Mapping for Assessment Scales List
> | Level 1 | List Resource | > | Level 2 | CareConnect-List-1 | > | Level 3 | None |
View Used FHIR Elements | View All FHIR Elements |
Name | Card. | Conformance | Type | Description, Constraints and mapping for Implementation |
---|---|---|---|---|
List | | Information summarized from a list of other resources Constraint (dom-2): If the resource is contained in another resource, it SHALL NOT contain nested Resources Constraint (dom-1): If the resource is contained in another resource, it SHALL NOT contain any narrative Constraint (dom-4): If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated Constraint (dom-3): If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource Constraint (lst-2): The deleted flag can only be used if the mode of the list is “changes” Constraint (lst-1): A list can only have an emptyReason if it is empty |
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- id | 0..1 | Optional | Id | Logical id of this artifact |
- meta | 0..1 | Mandatory | Meta | Metadata about the resource The value attribute of the profile element MUST contain the value 'https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-List-1' |
- identifier | 0..* | Required | Identifier | Business identifier An identifier for this Assessment scales list |
- - system | 1..1 | Required | Uri | The namespace for the identifier value The system from which the identifier came from |
- - value | 1..1 | Mandatory | String | The value that is unique Business identifier An identifier for this Assessment scales list |
- - - display | 0..1 | Required | String | Text alternative for the resource The organization that allocated the identifier |
- status | 1..1 | Mandatory | Code | current : retired : entered-in-error Binding (required): The current state of the list ListStatus The status of the list MUST contain the value 'current' |
- mode | 1..1 | Mandatory | Code | working : snapshot : changes Binding (required): The processing mode that applies to this list ListMode The mode of the list MUST contain the value 'snapshot' |
- title | 0..1 | Mandatory | String | Descriptive name for the list This MUST contain the value 'Assessment scales' Mapping to Maternity data item = 'PSRB Heading Assessment scales' |
- code | 0..1 | Mandatory | CodeableConcept | What the purpose of this list is Binding (preferred): What the purpose of a list is CareConnect-ListCode-1 The PRSB heading for this list. Note: for Maternity the value stated below is used which is not from the preferred value set |
- - coding | 0..* | Mandatory | Coding | Code defined by a terminology system The SNOMED CT concept for the PRSB heading type |
- - - system | 0..1 | Mandatory | Uri | Identity of the terminology system This MUST contain the value 'http://snomed.info/sct' |
- - - code | 0..1 | Mandatory | Code | Symbol in syntax defined by the system This MUST contain the value '887141000000103' |
- - - display | 0..1 | Mandatory | String | Representation defined by the system This MUST contain the value 'Assessment scales' Mapping to Maternity data item = 'PSRB Heading Assessment scales' |
- subject | 0..1 | Mandatory | Reference | If all resources have the same subject Constraint (ref-1): SHALL have a contained resource if a local reference is provided This is a reference to the Patient who is the subject of the list. |
Mandatory | CareConnect-Patient-1 | This is the subject of the Assessment scales List. This MUST use the CareConnect patient profile. See patient resource reference for information on how to populate the resource. |
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- - reference | 0..1 | Mandatory | String | Literal reference, Relative, internal or absolute URL A reference to the patient resource included in the Patient demographics list within the FHIR Bundle. Note the Patient demographics list is mandatory in the FHIR bundle |
- date | 0..1 | Mandatory | dateTime | When the list was prepared This MUST contain a system date to indicate when the list was created or updated Mapping to Maternity data item = 'Date/Time Recorded' |
- note | 0..* | Optional | Annotation | Comments about the list |
Required | String | Who authored the comment on the list. | ||
- - time | 0..1 | Required | dateTime | When the annotation was made |
- - text | 1..1 | Required | String | The annotation - text content |
- entry | 0..* | Mandatory | BackboneElement | Entries in the list The entries MUST be as per the diagram for this PRSB headings list with the Observation resource being the focal resource. Multiple resources MAY be present |
- - date | 0..1 | Required | dateTime | When item added to list The SHOULD contain a system time of when the item was added to the list. |
- - item | 1..1 | Required | Reference | Actual entry Constraint (ref-1): SHALL have a contained resource if a local reference is provided A reference to an Observation resource included in the list This MUST use the CareConnect Observation profile. See Observation resource for information on how to populate the resource. |
- - - reference | 0..1 | Mandatory | String | Literal reference, Relative, internal or absolute URL The reference to the included Observation resource. |
Mapping for Assessment Scales Observation
> | Level 1 | Observation Resource | > | Level 2 | CareConnect-Observation-1 | > | Level 3 | None |
View Used FHIR Elements | View All FHIR Elements |
Name | Card. | Conformance | Type | Description, Constraints and mapping for Implementation |
---|---|---|---|---|
Observation | | Measurements and simple assertions Constraint (dom-2): If the resource is contained in another resource, it SHALL NOT contain nested Resources Constraint (dom-1): If the resource is contained in another resource, it SHALL NOT contain any narrative Constraint (dom-4): If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated Constraint (dom-3): If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource Constraint (obs-7): If code is the same as a component code then the value element associated with the code SHALL NOT be present Constraint (obs-6): dataAbsentReason SHALL only be present if Observation.value[x] is not present |
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- id | 0..1 | Optional | Id | Logical id of this artifact |
- meta | 0..1 | Mandatory | Meta | Metadata about the resource The value attribute of the profile element MUST contain the value 'https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Observation-1' |
- identifier | 0..* | Required | Identifier | Business Identifier for observation An identifier for this Assessment scales observation |
- - - text | 0..1 | Required | String | Plain text representation of the concept |
- - system | 1..1 | Mandatory | Uri | The namespace for the identifier value |
- - value | 1..1 | Mandatory | String | The value that is unique |
- - assigner | 0..1 | Required | Reference | Organization that issued id (may be just text) Constraint (ref-1): SHALL have a contained resource if a local reference is provided |
- status | 1..1 | Mandatory | Code | registered : preliminary : final : amended + Binding (required): Codes providing the status of an observation. ObservationStatus MUST contain the value 'final'. |
- code | 1..1 | Mandatory | CodeableConcept | Type of observation (code / type) Binding (example): Codes identifying names of simple observations. LOINC Codes This example ValueSet is not used by Maternity record. The following SNOMED reference is used Assessment scale observables simple reference set Mapping to Maternity data item = 'Coded Assessment Tool Type' |
- - coding | 0..* | Required | Coding | Code defined by a terminology system Slicing: Discriminator: code, Ordering: false, Rules: Open |
- - coding (snomedCT) | 0..1 | Required | Coding | Code defined by a terminology system Binding (extensible): A code from the SNOMED Clinical Terminology UK coding system describing a type of observation CareConnect-ObservationType-1 This SNOMED ValueSet SHOULD be constrained to the ValueSet as indicated in the code element above. |
- - - system | 1..1 | Mandatory | Uri | Identity of the terminology system The element MUST contain the value 'http://snomed.info/sct' |
- - - code | 1..1 | Mandatory | Code | Symbol in syntax defined by the system A SNOMED concept from the ValueSet indicated. |
- - - display | 1..1 | Mandatory | String | Representation defined by the system The display associated with the SNOMED CT concept. This SHOULD be the preferred term |
- context | 0..1 | Required | Reference | Healthcare event during which this observation is made Constraint (ref-1): SHALL have a contained resource if a local reference is provided This MUST be a reference to Encounter resource |
Required | CareConnect-Encounter-1 | The Encounter where the assessment was carried out. This MUST use the Encounter resource. See Encounter resource for information on how to populate the resource. |
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- - reference | 0..1 | Required | String | Literal reference, Relative, internal or absolute URL A reference to the Encounter resource included in the Assessment scales list |
- effective[x] | 0..1 | Required | dateTime | Clinically relevant time/time-period for observation The date on which the assessment scale was recorded. |
- performer | 0..* | Required | Reference | Who is responsible for the observation Constraint (ref-1): SHALL have a contained resource if a local reference is provided The professional performing the assessment scale. |
Mandatory | CareConnect-Practitioner-1 | The professional performing the Assessment. This MUST use the Practitioner resource. See Practitioner resource for information on how to populate the resource. | ||
- - reference | 0..1 | Required | String | Literal reference, Relative, internal or absolute URL A reference to the Practitioner resource included in the Assessment scales list |
- value[x] | 0..1 | Required | Quantity | Actual result Constraint (qty-3): If a code for the unit is present, the system SHALL also be present The value of the assessment scales where one is required to recorded. |
Required | CodeableConcept | |||
Required | String | |||
Required | Boolean | |||
Required | Range | |||
- comment | 0..1 | Required | String | Comments about result Supporting text may be given regarding the assessment scale as a whole or a subscale. code.text and component.code.text SHOULD be used when the scale cannot be coded using SNOMED, value.string and component.value.string should be used for the values where no suitable data type is available or applicable. Mapping to Maternity data item = 'Comment' |
- component | 0..* | Required | BackboneElement | Component results. Component Assessment scales |
- - code | 1..1 | Required | CodeableConcept | Type of component observation (code / type) Binding (example): Codes identifying names of simple observations. LOINC Codes This example ValueSet is not used by Maternity record. The following SNOMED reference is used Assessment scale observables simple reference set Mapping to Maternity data item = 'Coded Assessment Tool Type' |
- - coding | 0..* | Required | Coding | Code defined by a terminology system Slicing: Discriminator: code, Ordering: false, Rules: Open |
- - coding (snomedCT) | 0..1 | Required | Coding | Code defined by a terminology system Binding (extensible): A code from the SNOMED Clinical Terminology UK coding system describing a type of observation CareConnect-ObservationType-1 This SNOMED ValueSet SHOULD be constrained to the ValueSet as indicated in the code element above. |
- - - system | 1..1 | Required | Uri | Identity of the terminology system The element MUST contain the value 'http://snomed.info/sct' |
- - - code | 1..1 | Required | Code | Symbol in syntax defined by the system A SNOMED concept from the ValueSet indicated. |
- - - display | 1..1 | Required | String | Representation defined by the system The display associated with the SNOMED CT concept. This SHOULD be the preferred term |
- value[x] | 0..1 | Required | Quantity | Actual component result Constraint (qty-3): If a code for the unit is present, the system SHALL also be present The value of the assessment scales where one is required to be recorded. |
Required | CodeableConcept | |||
Required | String | |||
Required | Range |
Mapping for Assessment Scales Encounter
> | Level 1 | Encounter Resource | > | Level 2 | CareConnect-Encounter-1 | > | Level 3 | None |
View Used FHIR Elements | View All FHIR Elements |
Name | Card. | Conformance | Type | Description, Constraints and mapping for Implementation |
---|---|---|---|---|
Encounter | | An interaction during which services are provided to the patient Constraint (dom-2): If the resource is contained in another resource, it SHALL NOT contain nested Resources Constraint (dom-1): If the resource is contained in another resource, it SHALL NOT contain any narrative Constraint (dom-4): If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated Constraint (dom-3): If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource |
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- id | 0..1 | Optional | Id | Logical id of this artifact |
- meta | 0..1 | Mandatory | Meta | Metadata about the resource The value attribute of the profile element MUST contain the value 'https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Encounter-1' |
- identifier | 0..* | Required | Identifier | Identifier(s) by which this encounter is known An identifier for this Encounter |
- - system | 1..1 | Required | Uri | The namespace for the identifier value The system from which the identifier came from |
- - value | 1..1 | Required | String | The value that is unique An identifier for this Assessment scales encounter |
- status | 1..1 | Mandatory | Code | planned : arrived : triaged : in-progress : onleave : finished : cancelled + Binding (required): Current state of the encounter EncounterStatus The status of the Encounter MUST contain the value 'finished' |
- - - start | 0..1 | Required | dateTime | Starting time with inclusive boundary |
- - - end | 0..1 | Required | dateTime | End time with inclusive boundary, if not ongoing |
- location | 0..1 | Required | BackboneElement | List of locations where the patient has been |
- - location | 1..1 | Mandatory | Reference | Location the encounter takes place Constraint (ref-1): SHALL have a contained resource if a local reference is provided The site code of the unit to which the person was admitted |
Mandatory | CareConnect-Location-1 | The location This MUST use the CareConnect Location profile. See Location resource for information on how to populate the resource.” |
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- - - reference | 1..1 | Mandatory | String | Literal reference, Relative, internal or absolute URL A reference to the Location resource included in the Assessment scales list |
Patient Reference
The assessment scales details list has a mandated subject reference to the Patient resource. This means that any exchange of the assessment scales details heading data must also include the Patient demographics List.
Mapping for Assessment Scales Location
The assessment scales details has reference(s) to the Location resource. This means that any exchange of the assessment scales details heading data must also include the Location Details.
Mapping for Assessment Scales Practitioner
The assessment scales details has reference(s) to the Practitioner resource. This means that any exchange of the assessment scales details heading data must also include the Practitioner Details.
Mapping for Assessment Scales PractitionerRole
The assessment scales details has reference(s) to the Practitioner Role resource. This means that any exchange of the assessment scales details heading data must also include the Practitioner Role Details.