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tags: USCDI v4
title: Health Status Assessments
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Assessments of a health-related matter of interest, importance, or worry to a patient, patient’s authorized representative, or patient’s healthcare provider that could identify a need, problem, or condition.

## :new: Health Status Assessments Data Elements

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Draft


Final


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DATA ELEMENT|APPLICABLE VOCABULARY STANDARD(S)|US Core V6 Proposal
---|---|---
**Physical Activity**<br/>Evaluation of a patient's current or usual exercise.<br/>Examples include but are not limited to Exercise Vital Sign.||Base it on US Core's [Screening and Assessments](http://hl7.org/fhir/us/core/screening-and-assessments.html) In other words, reused Simple Observations/US Core Condition Problems and Health Concerns, The US Core Observation Screening Assessment Profile,The SDC Base Questionnaire/US Core QuestionnaireResponse Profile with recommendation to use value sets from [Physical activity IG](http://hl7.org/fhir/us/physical-activity/2023May)
**Alcohol Use**<br/>Evaluation of a patient's consumption of alcohol.<br/>Examples include but are not limited to history of alcohol use, alcohol use disorder identification test and alcohol intake assessment.||Same as above with recommended domain specific value set from (TAPS or SDOH)
**Substance Use**<br/>Evaluation of a patient's reported use of drugs or other substances for non-medical purposes or in excess of a valid prescription.<br/>Examples include but are not limited to substance use disorder score, and substance use knowledge assessment.||Same as above with recommended domain specific value set from (TAPS or SDOH)

### Known issues

1. Bindings for each are unique and in some cases may be considered a vital sign
3. Some EHRs may record as a Condition
4. additional category codes?
- "Physical Activity"
- "Substance Use"
5. Data Element Description do not address the central questions:
- whether this patient is sufficiently active to maintain good health
- whether this patient abuses substances too much to maintain good health?

### Next steps

Review US Realm profiles for applicable bindings (Gravity, et al)

#### Physical activity IG: link http://hl7.org/fhir/us/physical-activity/2023May/

Base Measures (http://hl7.org/fhir/us/physical-activity/2023May/measures.html#base-measures)

Exercise Vital Sign: primary measure of patient physical activity level

- how many days per week did you engage in moderate to vigorous exercise
- On those days that you engage in moderate to vigorous exercise, how many minutes, on average, do you exercise?

Supporting Measures (http://hl7.org/fhir/us/physical-activity/2023May/measures.html#supporting-measures)

- Step count / Day
- Peak heart rate / Activity
- Peak heart rate / Day
- Calories / Activity
- Calories / Day
- Average resting heart rate
- Activity duration
- Minutes of moderate physical activity / Activity
- Minutes of intense physical activity / Activity
- Activity performed (walk/run/bike/swim/…)
- Hours device is worn

##### :arrow_right: [Physical Activity Examples Based on US Core Screenings and Assessements](https://healthedata1.github.io/USCDI4-Sandbox/artifacts.html#physical-activity)

#### Substance Use

From the submitter: [TAPS](https://nida.nih.gov/taps2/#/) : [The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool](https://www.apaservices.org/practice/reimbursement/health-registry/tobacco-alcohol-prescription-substance.pdf)

#### Review of Other profiles for applicable bindings.

[HCIM DrugUse](https://simplifier.net/packages/nictiz.fhir.nl.stu3.zib2017/2.2.14/files/2048392)

##### :arrow_right: [Substance Use Examples Based on US Core Screenings and Assessements](https://healthedata1.github.io/USCDI4-Sandbox/artifacts.html#substance-use)

#### Alcohol Use

From the Submitter:

LOINC|LCN
---|---
5640-8| Ethanol [Mass/volume] in Blood
69721-9| Do you ever drink alcohol - including beer or wine [Reported.PHQ]
74013-4| Alcoholic drinks per day
11286-2| Alcohol binge episodes per month - Reported
74043-1| Alcohol use disorder
64718-0| During this pregnancy, did you receive help with an alcohol or drug problem [PhenX]
72109-2| Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]

#### Review of Other profiles for applicable bindings.

Type 1 - "drinking status"

[AU Core Alcohol Status](https://build.fhir.org/ig/hl7au/au-fhir-core/StructureDefinition-au-core-alcoholstatus.html) (same as to MedMij AlcoholGebruikStatusCodelijst)

Type 2 - Drinks/day

[CZ_ObservationAlcoholUsePS](http://fhir.org/guides/stats/structuredefinition-ncez.fhir.cz.patientsummary-cz-observationalcoholuseps.html) (drinks/day) (same as IPS, CA infoway)

##### :arrow_right: [Alcohol Use Examples Based on US Core Screenings and Assessements](https://healthedata1.github.io/USCDI4-Sandbox/artifacts.html#alcohol-use)

### Decisions

1. Use existin US Core Screenings and Assessements Guidance and Profile (see Table)
2. Provide implementer Guidance on appropriate terminology and Assessment Tools
- Physical Activity IG
- TAPS : The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool

### IG Updates

- [x] USCDI Mapping Table
- [X] Implementation Specific Guidance
- [X] New Example(s)
- [ ] Update Example(s)
- [ ] Update Assessements page
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