eHealth Infrastructure
2022.1 - release

eHealth Infrastructure - Local Development build (v2022.1). See the Directory of published versions

Resource Profile: ehealth-clinicalimpression

Defining URL:http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression
Version:2022.1
Name:ehealth-clinicalimpression
Status:Active as of 1/18/22, 9:57 AM
Publisher:Systematic | Trifork
Source Resource:XML / JSON / Turtle

The official URL for this profile is: 

http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression

Introduction

A record of a clinical assessment performed to determine what problem(s) may affect the patient and before planning the treatments or management strategies that are best to manage a patient’s condition. Assessments are often 1:1 with a clinical consultation / encounter, but this varies greatly depending on the clinical workflow. This resource is called “ClinicalImpression” rather than “ClinicalAssessment” to avoid confusion with the recording of assessment tools such as Apgar score.

Scope and Usage

In scope of the eHealth Infrastructure, the ClinicalImpression resource is used for:

  • representing the result of automated processing such as triaging and decision support performed on submitted measurement(s)
  • representing a placeholder for subsequent Practitioner assessment. This ClinicalImpression instance is generated when no instance is otherwise created as per automated processing described above.
  • representing an assessment of a Practitioner such as approval and/or approval for publication in national document sharing
  • representing an approval for using an InterpretedView (ehealth-view) for QuestionnaireResponses

The element code specifies which of the above uses is the case.

The ClinicalImpression can refer to another ClinicalImpression through the element previous. It can also refer to measurement resources such as Observation, QuestionnaireResponse and Media through a number of investigation.item.

Use for Decision Support Result / Triaging Result

With the extension ehealth-clinicalimpression-decisionContext, the ClinicalImpression is able to capture decision support invocations such as the automated triaging. This entails:

  • decision rule identification in the form of a versioned reference to the Library containing the decision rule details including input and output parameter definitions
  • actual parameter values used at invocation, in the form of versioned references to resource(s), for instance input Observation

Use for Practitioner’s Assessment

The ClinicalImpression instance for the Practitioner assessment can refer to a ClinicalImpression instance of the other types through the element previous.

The element ehealth-clinicalimpression-decision contains the Practitioner’s assessment of the measurement/triaging result/decision support result, that is whether the measurement/result is approved and/or approved for publishing in national document sharing.

In case the Practitioner has comments or notes, these can be captured as one or more occurrences of the element note.text.

Use for approving InterpretedView

The element code must be set to approved-view

The element ehealth-clinicalimpression-decision must be set to citizen-view-approved

The element investigation.ehealth-clinicalimpression-viewInvestigationItem must contain references to the ehealth-views that are approved.

The element investigation.item must contain references to the QuestionnaireResponses that may use the views.

This indicates to the patient solution that the patient referenced in the subject element is allowed to use the InterpretedViews for the specified QuestionnaireResponses.

Required if CarePlan is known

  1. The ClinicalImpression.ehealth-clinicalimpression-careplan must be set when the ClinicalImpression references a resource that somewhere in the reference chain references a CarePlan.

    • For example, when a Practitioner assessment ClinicalImpression refers another ClinicalImpression through the element previous then it must also have the ehealth-clinicalimpression-careplan element set, referring the same CarePlan as the previous ClinicalImpression.

  2. A ClinicalImpression is not allowed to concern resources from different CarePlans, for example Observations from different CarePlans.

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from ClinicalImpression

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalImpression 0..*ClinicalImpressionA clinical assessment performed when planning treatments and management strategies for a patient
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ehealth-clinicalimpression-careplan 0..1Reference(ehealth-careplan) {r}The Careplan
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-careplan
... ehealth-clinicalimpression-decisionContext 0..*Reference(Parameters) {rc}Library and relevant resources used for evaluation
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-decisionContext
... workflow-episodeOfCare 1..1Reference(EpisodeOfCare)Associated Encounter episode of care
URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
... code 1..1CodeableConceptKind of assessment performed
Binding: Clinical Impression Codes (required)
... subject 1..1Reference(ehealth-patient) {r}Patient or group assessed
... assessor 0..1Reference(ehealth-practitioner) {r}The clinician performing the assessment
... previous 0..1Reference(ehealth-clinicalimpression) {r}Reference to last assessment
... problem 0..*Reference(ehealth-condition | AllergyIntolerance) {r}Relevant impressions of patient state
... investigation
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ehealth-clinicalimpression-viewInvestigationItem 0..*Reference(ehealth-view) {r}View item
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-viewInvestigationItem
.... item 0..*Reference(ehealth-media | ehealth-observation | ehealth-questionnaireresponse | FamilyMemberHistory | DiagnosticReport | RiskAssessment | ImagingStudy) {r}Record of a specific investigation
... finding
.... itemCodeableConcept 0..1CodeableConceptWhat was found
Binding: ClinicalImpression Finding Codes (required)
.... itemReference 0..1Reference(Observation | ehealth-condition)What was found
... prognosisReference 0..*Reference(RiskAssessment) {r}RiskAssessment expressing likely outcome
... note
.... authorReference 0..1Reference(ehealth-practitioner | ehealth-patient | ehealth-relatedperson)Individual responsible for the annotation
.... authorString 0..1stringIndividual responsible for the annotation

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalImpression 0..*ClinicalImpressionA clinical assessment performed when planning treatments and management strategies for a patient
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ehealth-clinicalimpression-careplan 0..1Reference(ehealth-careplan) {r}The Careplan
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-careplan
... ehealth-clinicalimpression-decisionContext 0..*Reference(Parameters) {rc}Library and relevant resources used for evaluation
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-decisionContext
... ehealth-clinicalimpression-decision 0..*CodeableConceptapproved | approved-for-sharing
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-decision
Binding: ClinicalImpression Decision Codes (required)
... workflow-episodeOfCare 1..1Reference(EpisodeOfCare)Associated Encounter episode of care
URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness identifier
... status ?!Σ1..1codein-progress | completed | entered-in-error
Binding: ClinicalImpressionStatus (required): The workflow state of a clinical impression.

... statusReason 0..1CodeableConceptReason for current status
Binding: (unbound) (example): Codes identifying the reason for the current state of a clinical impression.

... code Σ1..1CodeableConceptKind of assessment performed
Binding: Clinical Impression Codes (required)
... description Σ0..1stringWhy/how the assessment was performed
... subject Σ1..1Reference(ehealth-patient) {r}Patient or group assessed
... encounter Σ0..1Reference(Encounter)Encounter created as part of
... effective[x] Σ0..1Time of assessment
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... date Σ0..1dateTimeWhen the assessment was documented
... assessor Σ0..1Reference(ehealth-practitioner) {r}The clinician performing the assessment
... previous 0..1Reference(ehealth-clinicalimpression) {r}Reference to last assessment
... problem Σ0..*Reference(ehealth-condition | AllergyIntolerance) {r}Relevant impressions of patient state
... investigation 0..*BackboneElementOne or more sets of investigations (signs, symptoms, etc.)
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ehealth-clinicalimpression-viewInvestigationItem 0..*Reference(ehealth-view) {r}View item
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-viewInvestigationItem
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code 1..1CodeableConceptA name/code for the set
Binding: InvestigationType (example): A name/code for a set of investigations.

.... item 0..*Reference(ehealth-media | ehealth-observation | ehealth-questionnaireresponse | FamilyMemberHistory | DiagnosticReport | RiskAssessment | ImagingStudy) {r}Record of a specific investigation
... protocol 0..*uriClinical Protocol followed
... summary 0..1stringSummary of the assessment
... finding 0..*BackboneElementPossible or likely findings and diagnoses
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemCodeableConcept 0..1CodeableConceptWhat was found
Binding: ClinicalImpression Finding Codes (required)
.... itemReference 0..1Reference(Observation | ehealth-condition)What was found
.... basis 0..1stringWhich investigations support finding
... prognosisCodeableConcept 0..*CodeableConceptEstimate of likely outcome
Binding: ClinicalImpressionPrognosis (example): Prognosis or outlook findings.


... prognosisReference 0..*Reference(RiskAssessment) {r}RiskAssessment expressing likely outcome
... supportingInfo 0..*Reference(Resource)Information supporting the clinical impression
... note 0..*AnnotationComments made about the ClinicalImpression
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for author[x] Σ0..1Individual responsible for the annotation
Slice: Unordered, Closed by type:$this
..... authorReferenceReference(Any)
..... authorStringstring
..... author[x]:authorReference Σ0..1Reference(ehealth-practitioner | ehealth-patient | ehealth-relatedperson)Individual responsible for the annotation
..... author[x]:authorString Σ0..1stringIndividual responsible for the annotation
.... time Σ0..1dateTimeWhen the annotation was made
.... text Σ1..1markdownThe annotation - text content (as markdown)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalImpression 0..*ClinicalImpressionA clinical assessment performed when planning treatments and management strategies for a patient

doco Documentation for this format

Differential View

This structure is derived from ClinicalImpression

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalImpression 0..*ClinicalImpressionA clinical assessment performed when planning treatments and management strategies for a patient
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ehealth-clinicalimpression-careplan 0..1Reference(ehealth-careplan) {r}The Careplan
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-careplan
... ehealth-clinicalimpression-decisionContext 0..*Reference(Parameters) {rc}Library and relevant resources used for evaluation
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-decisionContext
... workflow-episodeOfCare 1..1Reference(EpisodeOfCare)Associated Encounter episode of care
URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
... code 1..1CodeableConceptKind of assessment performed
Binding: Clinical Impression Codes (required)
... subject 1..1Reference(ehealth-patient) {r}Patient or group assessed
... assessor 0..1Reference(ehealth-practitioner) {r}The clinician performing the assessment
... previous 0..1Reference(ehealth-clinicalimpression) {r}Reference to last assessment
... problem 0..*Reference(ehealth-condition | AllergyIntolerance) {r}Relevant impressions of patient state
... investigation
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ehealth-clinicalimpression-viewInvestigationItem 0..*Reference(ehealth-view) {r}View item
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-viewInvestigationItem
.... item 0..*Reference(ehealth-media | ehealth-observation | ehealth-questionnaireresponse | FamilyMemberHistory | DiagnosticReport | RiskAssessment | ImagingStudy) {r}Record of a specific investigation
... finding
.... itemCodeableConcept 0..1CodeableConceptWhat was found
Binding: ClinicalImpression Finding Codes (required)
.... itemReference 0..1Reference(Observation | ehealth-condition)What was found
... prognosisReference 0..*Reference(RiskAssessment) {r}RiskAssessment expressing likely outcome
... note
.... authorReference 0..1Reference(ehealth-practitioner | ehealth-patient | ehealth-relatedperson)Individual responsible for the annotation
.... authorString 0..1stringIndividual responsible for the annotation

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalImpression 0..*ClinicalImpressionA clinical assessment performed when planning treatments and management strategies for a patient
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ehealth-clinicalimpression-careplan 0..1Reference(ehealth-careplan) {r}The Careplan
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-careplan
... ehealth-clinicalimpression-decisionContext 0..*Reference(Parameters) {rc}Library and relevant resources used for evaluation
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-decisionContext
... ehealth-clinicalimpression-decision 0..*CodeableConceptapproved | approved-for-sharing
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-decision
Binding: ClinicalImpression Decision Codes (required)
... workflow-episodeOfCare 1..1Reference(EpisodeOfCare)Associated Encounter episode of care
URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness identifier
... status ?!Σ1..1codein-progress | completed | entered-in-error
Binding: ClinicalImpressionStatus (required): The workflow state of a clinical impression.

... statusReason 0..1CodeableConceptReason for current status
Binding: (unbound) (example): Codes identifying the reason for the current state of a clinical impression.

... code Σ1..1CodeableConceptKind of assessment performed
Binding: Clinical Impression Codes (required)
... description Σ0..1stringWhy/how the assessment was performed
... subject Σ1..1Reference(ehealth-patient) {r}Patient or group assessed
... encounter Σ0..1Reference(Encounter)Encounter created as part of
... effective[x] Σ0..1Time of assessment
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... date Σ0..1dateTimeWhen the assessment was documented
... assessor Σ0..1Reference(ehealth-practitioner) {r}The clinician performing the assessment
... previous 0..1Reference(ehealth-clinicalimpression) {r}Reference to last assessment
... problem Σ0..*Reference(ehealth-condition | AllergyIntolerance) {r}Relevant impressions of patient state
... investigation 0..*BackboneElementOne or more sets of investigations (signs, symptoms, etc.)
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... ehealth-clinicalimpression-viewInvestigationItem 0..*Reference(ehealth-view) {r}View item
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-clinicalimpression-viewInvestigationItem
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code 1..1CodeableConceptA name/code for the set
Binding: InvestigationType (example): A name/code for a set of investigations.

.... item 0..*Reference(ehealth-media | ehealth-observation | ehealth-questionnaireresponse | FamilyMemberHistory | DiagnosticReport | RiskAssessment | ImagingStudy) {r}Record of a specific investigation
... protocol 0..*uriClinical Protocol followed
... summary 0..1stringSummary of the assessment
... finding 0..*BackboneElementPossible or likely findings and diagnoses
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemCodeableConcept 0..1CodeableConceptWhat was found
Binding: ClinicalImpression Finding Codes (required)
.... itemReference 0..1Reference(Observation | ehealth-condition)What was found
.... basis 0..1stringWhich investigations support finding
... prognosisCodeableConcept 0..*CodeableConceptEstimate of likely outcome
Binding: ClinicalImpressionPrognosis (example): Prognosis or outlook findings.


... prognosisReference 0..*Reference(RiskAssessment) {r}RiskAssessment expressing likely outcome
... supportingInfo 0..*Reference(Resource)Information supporting the clinical impression
... note 0..*AnnotationComments made about the ClinicalImpression
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for author[x] Σ0..1Individual responsible for the annotation
Slice: Unordered, Closed by type:$this
..... authorReferenceReference(Any)
..... authorStringstring
..... author[x]:authorReference Σ0..1Reference(ehealth-practitioner | ehealth-patient | ehealth-relatedperson)Individual responsible for the annotation
..... author[x]:authorString Σ0..1stringIndividual responsible for the annotation
.... time Σ0..1dateTimeWhen the annotation was made
.... text Σ1..1markdownThe annotation - text content (as markdown)

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
ClinicalImpression.languagepreferredCommonLanguages
Max Binding: AllLanguages
ClinicalImpression.statusrequiredClinicalImpressionStatus
ClinicalImpression.statusReasonexample
ClinicalImpression.coderequiredClinicalImpressionCodes
ClinicalImpression.investigation.codeexampleInvestigationType
ClinicalImpression.finding.itemCodeableConceptrequiredClinicalImpressionFindingCodes
ClinicalImpression.prognosisCodeableConceptexampleClinicalImpressionPrognosis