This profile sets minimum expectations for the Condition resource to represent data requested as part of the U.S. Public Health Case Based Surveillance messaging guides. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the resource when using this profile. This profile is built on top of the ECR US PH Condition profile and US Core Condition profile.

Example Usage Scenarios:

The following are example usage scenarios for the US CBS Condition of Interest profile:

• Capture a condition related to an Reportable Condition Trigger Code event to provide information tied directly to the condition in a surveillance report.

Relationship to ECR Public Health and US Core Conditions

The US CBS Condition profile is based on the ECR (Electronic Case Reporting) IG US PH Condition profile. The US PH Condition profile captures conditions of interest to public health. The US CBS Condition profile covers a narrower sub domain of public health, adding additional constraints and extensions to support Case Based Surveillance programs.

Relationship to CDC Message Mapping Guides

The Center for Disease Control’s (CDC) Message Mapping Guides (MMGs) provide guidance on the transmission of records from jurisdictions to case based surveillance programs. MMG documents are publicly available through the CDC’s website. In addition to generic information captured by the Gen V2 guide, there are program specific guides tied to specific conditions or groups of condition.

The US CBS Condition of Interest profile represents the core reported condition of interest (as defined by the Nationally Notifiable Disease Surveillance System & Other Conditions of Public Health Importance valueset) which is reported in the Gen V2 message mapping guide. It should be considered the resource which determines the recipient case surveillance program which oversees surveillance for the specified condition of interest.

Mandatory and Must Support Data Elements

The following data-elements must always be present (Mandatory definition]) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Profile Definition below provides the formal summary, definitions, and terminology requirements.

Each Condition must have:

1. a condition code from the NNDSS & Other Conditions of Public Health Importance valueset unless such a code does not exist
2. a cbs case class status extension indicating the current status as appropriate to that point in the reporting process
3. a category specified according to the US Core Condition Condition.category guidelines
4. a subject reference

Each Condition must support:

1. an asserted date extension (diagnosis date)
2. an illness duration
3. a clinical status
4. a verification status
5. affected body site(s)
6. an onset datetime
7. an abatement datetime
8. evidence capturing signs and symptoms related to the condition of interest

Additional US Case Based Surveillance Requirements

1. a Data Absent Reason extension set to a value of “masked” for each US Core Patient or US PH Patient mandatory item which cannot be included due to being patient identifying information

Profile specific implementation guidance:

• There should only be a single instance of a Condition of Interest profile in a case report, representative of the Condition Code (INV169 / OBR-31) element in the Gen V2 message mapping guide. If additional conditions resources are included in the case report, they should use the US Core Condition profile.
  • The US PH Condition profile should not be used for additional conditions due to a logical alignment with the purpose of the US CBS Condition of Interest in a public health reporting workflow.
• The US CBS Condition of Interest profile does not definitively indicate a diagnosis of the condition coded within the profile either at a clinical or public health level unless the case class status code is specified as confirmed present.
• The Condition.category code may be set to any appropriate value.
  • Death diagnosis should only be specified if the condition can be definitively tied to the cause of death according to public health or mortality reporting standards. This may be specified as a complimentary value to the [CBS Cause of Death] observation profile, but should not be considered a replacement.
• The HL7 Asserted Date extension should be considered equivalent to the concept of Diagnosis Date in message mapping guides, capturing the time that the condition was officially asserted/diagnosed by a clinician. Condition.onset[x] is used to capture onset of the condition, such as a patient reporting of the start of symptom occurence. Condition.recordedDate is typically a machine generated value and may not align with the assertion/diagnosis date, though likely will in modern systems.
• The illness duration extension may be used to obscure dates if desired, in alignment with Gen V2 data elements.
• Verification Status may be used to document status in sending systems (e.g. jurisdictions) or in regards to workflow considerations such as through the entered-in-error code, but should not be used to capture Case Class Status as per the context of public health case reporting to case based surveillance programs.

• Text Summary
• Differential Table
• Snapshot Table
• Snapshot Table (Must Support)
• All

This structure is derived from USPublicHealthCondition

Name	Flags	Card.	Type	Description & Constraints
Condition		0..*	USPublicHealthCondition	US Public Health Condition
extension		1..*	Extension	Extension
cbs-case-class-status	S	1..1	CodeableConcept	Case Based Surveillance Case Class Status URL: http://cbsig.chai.gatech.edu/StructureDefinition/cbs-case-class-status Binding: Case Classification Status (required): A code indicating the case class status.
cbs-illness-duration	S	0..1	Quantity	Case Based Surveillance Illness Duration URL: http://cbsig.chai.gatech.edu/StructureDefinition/cbs-illness-duration
code		1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: Nationally Notifiable Disease Surveillance System (NNDSS) & Other Conditions of Public Health Importance (required)
bodySite	S	0..*	CodeableConcept	Anatomical location, if relevant Binding: Body site (extensible)
subject		1..1	Reference(US Case Based Surveillance Patient Profile)	Who has the condition?
onsetDateTime	S	0..1	dateTime	Estimated or actual date, date-time, or age
abatementDateTime	S	0..1	dateTime	When in resolution/remission
evidence	S	0..*	BackboneElement	Signs and Symptoms of the Condition of Interest
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Condition	I	0..*	USPublicHealthCondition	US Public Health Condition
id	Σ	0..1	string	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
condition-assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
cbs-case-class-status	S	1..1	CodeableConcept	Case Based Surveillance Case Class Status URL: http://cbsig.chai.gatech.edu/StructureDefinition/cbs-case-class-status Binding: Case Classification Status (required): A code indicating the case class status.
cbs-illness-duration	S	0..1	Quantity	Case Based Surveillance Illness Duration URL: http://cbsig.chai.gatech.edu/StructureDefinition/cbs-illness-duration
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Ids for this condition
clinicalStatus	?!SΣI	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	?!SΣI	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
category	SI	1..*	CodeableConcept	problem-list-item | encounter-diagnosis | health-concern Binding: US Core Condition Category Codes (extensible)
severity		0..1	CodeableConcept	Subjective severity of condition Binding: Condition/DiagnosisSeverity (preferred): A subjective assessment of the severity of the condition as evaluated by the clinician.
code	SΣ	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: Nationally Notifiable Disease Surveillance System (NNDSS) & Other Conditions of Public Health Importance (required)
bodySite	SΣ	0..*	CodeableConcept	Anatomical location, if relevant Binding: Body site (extensible)
subject	SΣ	1..1	Reference(US Case Based Surveillance Patient Profile)	Who has the condition?
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
Slices for onset[x]	SΣ	0..1	dateTime	Estimated or actual date, date-time, or age Slice: Unordered, Closed by type:$this
onset[x]:onsetDateTime	SΣ	0..1	dateTime	Estimated or actual date, date-time, or age
Slices for abatement[x]	I	0..1	dateTime	When in resolution/remission Slice: Unordered, Closed by type:$this
abatement[x]:abatementDateTime	SI	0..1	dateTime	When in resolution/remission
recordedDate	Σ	0..1	dateTime	Date record was first recorded
recorder	Σ	0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Who recorded the condition
asserter	Σ	0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Person who asserts this condition
stage	I	0..*	BackboneElement	Stage/grade, usually assessed formally con-1: Stage SHALL have summary or assessment
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary	I	0..1	CodeableConcept	Simple summary (disease specific) Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).
assessment	I	0..*	Reference(ClinicalImpression | DiagnosticReport | Observation)	Formal record of assessment
type		0..1	CodeableConcept	Kind of staging Binding: ConditionStageType (example): Codes describing the kind of condition staging (e.g. clinical or pathological).
evidence	SI	0..*	BackboneElement	Signs and Symptoms of the Condition of Interest
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	ΣI	0..*	CodeableConcept	Manifestation/symptom Binding: ManifestationAndSymptomCodes (example): Codes that describe the manifestation or symptoms of a condition.
detail	ΣI	0..*	Reference(Resource)	Supporting information found elsewhere
note		0..*	Annotation	Additional information about the Condition
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Condition	I	0..*	USPublicHealthCondition	US Public Health Condition
condition-assertedDate		0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
cbs-case-class-status		1..1	CodeableConcept	Case Based Surveillance Case Class Status URL: http://cbsig.chai.gatech.edu/StructureDefinition/cbs-case-class-status Binding: Case Classification Status (required): A code indicating the case class status.
cbs-illness-duration		0..1	Quantity	Case Based Surveillance Illness Duration URL: http://cbsig.chai.gatech.edu/StructureDefinition/cbs-illness-duration
clinicalStatus	?!ΣI	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	?!ΣI	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
category	I	1..*	CodeableConcept	problem-list-item | encounter-diagnosis | health-concern Binding: US Core Condition Category Codes (extensible)
code	Σ	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: Nationally Notifiable Disease Surveillance System (NNDSS) & Other Conditions of Public Health Importance (required)
bodySite	Σ	0..*	CodeableConcept	Anatomical location, if relevant Binding: Body site (extensible)
subject	Σ	1..1	Reference(US Case Based Surveillance Patient Profile)	Who has the condition?
Slices for onset[x]	Σ	0..1	dateTime	Estimated or actual date, date-time, or age Slice: Unordered, Closed by type:$this
onset[x]:onsetDateTime	Σ	0..1	dateTime	Estimated or actual date, date-time, or age
abatement[x]:abatementDateTime	I	0..1	dateTime	When in resolution/remission
evidence	I	0..*	BackboneElement	Signs and Symptoms of the Condition of Interest
Documentation for this format

This structure is derived from USPublicHealthCondition

Summary

Mandatory: 2 elements
Must-Support: 6 elements

Structures

This structure refers to these other structures:

• US Case Based Surveillance Patient Profile (http://cbsig.chai.gatech.edu/StructureDefinition/us-cbs-patient)

Extensions

This structure refers to these extensions:

• http://cbsig.chai.gatech.edu/StructureDefinition/cbs-case-class-status
• http://cbsig.chai.gatech.edu/StructureDefinition/cbs-illness-duration

Differential View

This structure is derived from USPublicHealthCondition

Name	Flags	Card.	Type	Description & Constraints
Condition		0..*	USPublicHealthCondition	US Public Health Condition
extension		1..*	Extension	Extension
cbs-case-class-status	S	1..1	CodeableConcept	Case Based Surveillance Case Class Status URL: http://cbsig.chai.gatech.edu/StructureDefinition/cbs-case-class-status Binding: Case Classification Status (required): A code indicating the case class status.
cbs-illness-duration	S	0..1	Quantity	Case Based Surveillance Illness Duration URL: http://cbsig.chai.gatech.edu/StructureDefinition/cbs-illness-duration
code		1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: Nationally Notifiable Disease Surveillance System (NNDSS) & Other Conditions of Public Health Importance (required)
bodySite	S	0..*	CodeableConcept	Anatomical location, if relevant Binding: Body site (extensible)
subject		1..1	Reference(US Case Based Surveillance Patient Profile)	Who has the condition?
onsetDateTime	S	0..1	dateTime	Estimated or actual date, date-time, or age
abatementDateTime	S	0..1	dateTime	When in resolution/remission
evidence	S	0..*	BackboneElement	Signs and Symptoms of the Condition of Interest
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Condition	I	0..*	USPublicHealthCondition	US Public Health Condition
id	Σ	0..1	string	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
condition-assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
cbs-case-class-status	S	1..1	CodeableConcept	Case Based Surveillance Case Class Status URL: http://cbsig.chai.gatech.edu/StructureDefinition/cbs-case-class-status Binding: Case Classification Status (required): A code indicating the case class status.
cbs-illness-duration	S	0..1	Quantity	Case Based Surveillance Illness Duration URL: http://cbsig.chai.gatech.edu/StructureDefinition/cbs-illness-duration
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Ids for this condition
clinicalStatus	?!SΣI	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	?!SΣI	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
category	SI	1..*	CodeableConcept	problem-list-item | encounter-diagnosis | health-concern Binding: US Core Condition Category Codes (extensible)
severity		0..1	CodeableConcept	Subjective severity of condition Binding: Condition/DiagnosisSeverity (preferred): A subjective assessment of the severity of the condition as evaluated by the clinician.
code	SΣ	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: Nationally Notifiable Disease Surveillance System (NNDSS) & Other Conditions of Public Health Importance (required)
bodySite	SΣ	0..*	CodeableConcept	Anatomical location, if relevant Binding: Body site (extensible)
subject	SΣ	1..1	Reference(US Case Based Surveillance Patient Profile)	Who has the condition?
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
Slices for onset[x]	SΣ	0..1	dateTime	Estimated or actual date, date-time, or age Slice: Unordered, Closed by type:$this
onset[x]:onsetDateTime	SΣ	0..1	dateTime	Estimated or actual date, date-time, or age
Slices for abatement[x]	I	0..1	dateTime	When in resolution/remission Slice: Unordered, Closed by type:$this
abatement[x]:abatementDateTime	SI	0..1	dateTime	When in resolution/remission
recordedDate	Σ	0..1	dateTime	Date record was first recorded
recorder	Σ	0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Who recorded the condition
asserter	Σ	0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Person who asserts this condition
stage	I	0..*	BackboneElement	Stage/grade, usually assessed formally con-1: Stage SHALL have summary or assessment
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary	I	0..1	CodeableConcept	Simple summary (disease specific) Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).
assessment	I	0..*	Reference(ClinicalImpression | DiagnosticReport | Observation)	Formal record of assessment
type		0..1	CodeableConcept	Kind of staging Binding: ConditionStageType (example): Codes describing the kind of condition staging (e.g. clinical or pathological).
evidence	SI	0..*	BackboneElement	Signs and Symptoms of the Condition of Interest
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	ΣI	0..*	CodeableConcept	Manifestation/symptom Binding: ManifestationAndSymptomCodes (example): Codes that describe the manifestation or symptoms of a condition.
detail	ΣI	0..*	Reference(Resource)	Supporting information found elsewhere
note		0..*	Annotation	Additional information about the Condition
Documentation for this format