{
  "description": "This profile represents the constraints applied to the Observation resource by the PS-CA project to represent a more generic social history profile used to represent health related lifestyle factors or lifestyle observations in a patient summary. Currently, there is no equivalent IPS UV profile, however there are ISO CEN IPS 17269 requirements for a more generic social history section that were used to inform this profile.  This profile is considered a draft version, and is informed and created as per the requirements of the first jurisdiction (i.e. Alberta) to pilot its use in patient summary within jurisdictional context. The constraints have been compared against other Social History FHIR profiles in Canada and internationally (US Core, Cyprus Core, Malaysia Core)  and share many constraints in common with those profiles but represent the minimum requirements as they are known in Canada today. This profile is expected to be refined further as more jurisdictional requirements are defined and as more is known about use in the international patient summary space.",
  "_filename": "structuredefinition-profile-observation-socialhistory-ca-ps.json",
  "package_name": "ca.infoway.io.psca",
  "date": "2024-04-09T00:00:00-08:00",
  "derivation": "constraint",
  "publisher": null,
  "fhirVersion": "4.0.1",
  "name": "ObservationSocialHistoryPSCA",
  "abstract": false,
  "copyright": "Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).",
  "type": "Observation",
  "experimental": "false",
  "resourceType": "StructureDefinition",
  "title": "SHx Observation: Social History (PS-CA)",
  "package_version": "2.0.0-DFT-preBallot",
  "status": "draft",
  "id": "3328a2c7-17af-4a27-9023-543588e9b5a8",
  "kind": "resource",
  "url": "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-socialhistory-ca-ps",
  "version": null,
  "differential": {
    "element": [ {
      "id": "Observation",
      "path": "Observation",
      "constraint": [ {
        "key": "psca-obs-sh-1",
        "human": "This profile is being used for conformance requirements on generic social history (instances that aren't intended for tobacco or alcohol use profiles). If instance asserts conformance of instance to generic social history profile, observation.code SHALL NOT be 74013-4 or 72166-2 LOINC codes. This is done to prevent the instance matching multiple slices on composition.section",
        "severity": "error",
        "expression": "category.coding.where(system='http://terminology.hl7.org/CodeSystem/observation-category' and (code='social-history')).exists() implies code.coding.where(system='http://loinc.org' and (code='74013-4' or code='72166-2')).exists().not()"
      } ]
    }, {
      "id": "Observation.status",
      "path": "Observation.status",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
        "valueString": "default: final"
      } ],
      "mustSupport": true
    }, {
      "id": "Observation.category",
      "path": "Observation.category",
      "comment": "As this is an initial draft profile, it contains open slicing to maximize the ability to reuse for the full breadth of social history profiles that may contain further categorization (e.g., another optional category slice for SDOH)",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "$this",
          "type": "pattern"
        } ]
      },
      "mustSupport": true
    }, {
      "id": "Observation.category:social-history",
      "max": "1",
      "min": 1,
      "path": "Observation.category",
      "sliceName": "social-history",
      "mustSupport": true,
      "patternCodeableConcept": {
        "coding": [ {
          "code": "social-history",
          "system": "http://terminology.hl7.org/CodeSystem/observation-category"
        } ]
      }
    }, {
      "id": "Observation.code",
      "path": "Observation.code",
      "type": [ {
        "code": "CodeableConcept",
        "profile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" ]
      } ],
      "comment": "One challenge with a generic social history profile is that there is uneven terminology coverage for broad social history concepts (e.g., lifestyle risk factors, Social Determinants of Health factors) and specific social history concepts (e.g., tobacco use assessment) across both LOINC and SNOMED CT terminologies, as well as a lack of consistency in implementation across international implementation guides & vendors. In places where the International Patient Summary guide has defined terminology for a specific social history concept (e.g., tobacco use) via a specific profile, that terminology is governed by the specialized profile. However, in broader profiles where the terminology is not defined by external requirements and not well known, the terminology options will be expressed as examples rather than bindings or sliced value sets until further use is known regarding use & harmonization in the Canadian and International patient summary space. \r\n At minimum text is expected to be supplied for this element given that code is mandatory in FHIR and codings may not be supported by every implementation.",
      "example": [ {
        "label": "LifestyleRiskFactors",
        "valueCodeableConcept": {
          "text": "Risk Factor",
          "coding": [ {
            "code": "80943009",
            "system": "http://snomed.info/sct",
            "display": "Risk Factor"
          } ]
        }
      } ],
      "mustSupport": true
    }, {
      "id": "Observation.subject",
      "min": 1,
      "path": "Observation.subject",
      "type": [ {
        "code": "Reference",
        "targetProfile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" ]
      } ],
      "mustSupport": true
    }, {
      "id": "Observation.subject.reference",
      "min": 1,
      "path": "Observation.subject.reference",
      "mustSupport": true
    }, {
      "id": "Observation.effective[x]",
      "path": "Observation.effective[x]",
      "comment": "This element is not currently flagged as Must Support in PS-CA, as early implementers have indicated the element may not be supported by some piloting systems. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. \n\n While the ability to use structured data is desirable, the practice of documenting social history is still varied and some systems may not have the ability to differentiate individual history details.  For initial pilots, implementers should anticipate that some of this information will be populated as free text in the Observation.note element.\r\n The data types for this element are not constrained to provide maximum ability for reuse/refinement during draft stage. However, initial implementers using this profile to communicate lifestyle factors for Patient Summary are recommended to utilize effectivePeriod to identify a reference date range (noted in ISO CEN IPS 17269)"
    }, {
      "id": "Observation.value[x]",
      "path": "Observation.value[x]",
      "comment": "While the ability to use structured data is desirable, the practice of documenting social history is still varied and some systems may not have the ability to differentiate individual history details. Unlike FamilyMemberHistory, Observation has the expectation that value be populated in most cases (even if using a valueString). The supply of string values also has considerable support from consuming systems that are familiar with receiving free text in the valueString and therefore it is recommended for usage over note in this profile. For initial pilots, implementers should anticipate that some of this information may still be populated as free text in the Observation.note element. \n\n Base Resource Comment: An observation may have; 1)  a single value here, 2)  both a value and a set of related or component values,  or 3)  only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code.  A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value.  For additional guidance, see the [Notes section](observation.html#notes) below.",
      "mustSupport": true
    }, {
      "id": "Observation.note",
      "path": "Observation.note",
      "mustSupport": true
    }, {
      "id": "Observation.note.text",
      "path": "Observation.note.text",
      "mustSupport": true
    } ]
  },
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation"
}