Guidance

Capturing Certainty of Evidence Using Structured Ratings

To transparently represent the certainty of evidence for specific outcomes, guideline developers must capture evidence assessments using structured data. This includes ratings from established systems such as GRADE, AGREE II, ROBIS, AMSTAR 2, or Oxford 2011.

These assessments are expressed using the CertaintyOfEvidenceRating profile, based on the FHIR ArtifactAssessment resource. Each instance represents the evaluation of one piece of evidence (e.g., an OutcomeEvidence resource) using a specific rating system.

The profile requires explicitly stating:

• Which rating system was used (e.g., GRADE, AGREE II),
• The overall level of evidence certainty,
• Additional domain-specific ratings (e.g., risk of bias, inconsistency) where relevant.

Example: General Structure

The general structure of an evidence assessment using this profile looks as follows:

Instance: EvidenceCertaintyExample
InstanceOf: certainty-of-evidence-rating
* artifactReference = Reference(OutcomeEvidence/mortality-effect)
* workflowStatus = #applied

* content[ratingSystem]
  * type = $cs-ebm-ig#rating-system
  * classifier = cs-evidence-rating-system#GRADE

* content[levelOfEvidence]
  * type = $cs-certainty-type#Overall
  * classifier = cs-rating-certainty-of-evidence#moderate

This example specifies that the GRADE system was used to rate the evidence for a specific outcome, and that the overall certainty of the evidence is “moderate”.

Extending for GRADE Domain-Level Ratings

When using GRADE, additional domain-specific components can be added to detail why the overall certainty was rated as it was:

* content[riskOfBias]
  * type = $cs-certainty-type#RiskOfBias

* content[inconsistency]
  * type = $cs-certainty-type#Inconsistency

* content[indirectness]
  * type = $cs-certainty-type#Indirectness

* content[imprecision]
  * type = $cs-certainty-type#Imprecision

* content[publicationBias]
  * type = $cs-certainty-type#PublicationBias

These allow precise attribution of strengths and weaknesses in the body of evidence.

Example: AGREE II Assessment of a Guideline

If the evidence being rated is a guideline, a different profile derived from CertaintyOfEvidenceRating can be used, for example for AGREE II:

Instance: AGREEAssessmentExample
InstanceOf: certainty-of-evidence-rating-agreeii
* artifactReference = Reference(Guideline/021-001)
* workflowStatus = #applied

* content[ratingSystem]
  * type = $cs-ebm-ig#rating-system
  * classifier = cs-evidence-rating-system#AGREEII

* content[levelOfEvidence]
  * type = $cs-certainty-type#Overall
  * classifier = cs-rating-certainty-of-evidence#high

Linking to Recommendations

To link the evidence assessment to a recommendation, the recommendation justification uses:

RecommendationJustification[ArtifactAssessment]
* artifactReference = Reference(GuidelineRecommendation/rec-001)

* content[evidence][+]
  * relatedArtifact
    * type = #derived-from
    * resource = Reference(CertaintyOfEvidenceRating/Example)

This structured approach ensures that both automated systems and human users can transparently trace how certainty of evidence influenced the recommendations.

This profile of a FHIR ArtifactAssessment is derived from the certainty-of-evidence FHIR resource.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ArtifactAssessment		0..*	CertaintyOfEvidence	Adds metadata-supported comments, classifiers or ratings related to a Resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
contained		0..*	Resource	Contained, inline Resources
Slices for extension				Content/Rules for all slices
extension:url		0..1	uri	Canonical identifier for this artifact, represented as a URI (globally unique) URL: http://hl7.org/fhir/StructureDefinition/artifact-url
extension:description		0..1	markdown	Natural language description of the artifact URL: http://hl7.org/fhir/StructureDefinition/artifact-description
extension:author		0..*	ContactDetail	Who authored the artifact URL: http://hl7.org/fhir/StructureDefinition/artifact-author
extension:useContext		0..*	UsageContext	The context that the content is intended to support URL: http://hl7.org/fhir/StructureDefinition/artifact-useContext
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
Slices for artifact[x]	Σ	1..1		The artifact that is rated Slice: Unordered, Open by type:$this
artifactReference			Reference(Resource)
artifactCanonical			canonical(Any)
artifactUri			uri
artifact[x]:artifactReference	Σ	0..1	Reference(Outcome Evidence)	The artifact that is rated
Slices for content		0..*	BackboneElement	Comment, classifier, or rating content Slice: Unordered, Open by value:type
content:All Slices				Content/Rules for all slices
Slices for extension				Content/Rules for all slices
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
content:ratingSystem	S	0..1	BackboneElement	Comment, classifier, or rating content
Slices for extension				Content/Rules for all slices
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: https://fevir.net/resources/CodeSystem/179423
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rating-system
display		1..1	string	Representation defined by the system Fixed Value: Rating System
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
classifier		1..1	CodeableConcept	Rating, classifier, or assessment Binding: Evidence Rating System Value Set (extensible)
content:overall	S	0..1	BackboneElement	Comment, classifier, or rating content
Slices for extension				Content/Rules for all slices
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/certainty-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Overall
display		1..1	string	Representation defined by the system Fixed Value: Overall certainty
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
content:levelOfEvidence		0..1	BackboneElement	Comment, classifier, or rating content
Slices for extension				Content/Rules for all slices
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/certainty-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Overall
display		1..1	string	Representation defined by the system Fixed Value: Overall certainty
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
workflowStatus	Σ	1..1	code	submitted | triaged | waiting-for-input | resolved-no-change | resolved-change-required | deferred | duplicate | applied | published | entered-in-error Binding: ArtifactAssessmentWorkflowStatus (required) Required Pattern: applied
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ArtifactAssessment.content:ratingSystem.type	example	Pattern Value: rating-system("Rating System") http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:ratingSystem.classifier	extensible	EvidenceRatingSystemVS(a valid code from Evidence Rating System Code System) http://fhir.awmf.org/awmf.ig/ValueSet/vs-evidence-rating-system From this IG
ArtifactAssessment.content:overall.type	extensible	Pattern Value: Overall("Overall certainty") http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:levelOfEvidence.type	example	Pattern Value: Overall("Overall certainty") http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.workflowStatus	required	Pattern Value: applied http://hl7.org/fhir/ValueSet/artifactassessment-workflow-status|6.0.0-ballot3 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	ArtifactAssessment	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ArtifactAssessment	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ArtifactAssessment	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ArtifactAssessment	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ArtifactAssessment	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from CertaintyOfEvidence

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ArtifactAssessment		0..*	CertaintyOfEvidence	Adds metadata-supported comments, classifiers or ratings related to a Resource
Slices for artifact[x]		1..1	Reference(Resource), canonical(), uri	The artifact that is rated Slice: Unordered, Open by type:$this
artifact[x]:artifactReference		0..1	Reference(Outcome Evidence)	The artifact that is rated
Slices for content				Content/Rules for all slices
content:ratingSystem		0..1	BackboneElement	Comment, classifier, or rating content
classifier		1..1	CodeableConcept	Rating, classifier, or assessment Binding: Evidence Rating System Value Set (extensible)
content:levelOfEvidence		0..1	BackboneElement	Comment, classifier, or rating content
Slices for extension				Content/Rules for all slices
extension:RelatesToWithQuotation		0..*	RelatesToWithQuotation	Related artifact with quoted portion
type		1..1	CodeableConcept	What type of content Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/certainty-type
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Overall
display		1..1	string	Representation defined by the system Fixed Value: Overall certainty
component
Slices for extension				Content/Rules for all slices
extension:RelatesToWithQuotation		0..*	RelatesToWithQuotation	Related artifact with quoted portion
workflowStatus		1..1	code	submitted | triaged | waiting-for-input | resolved-no-change | resolved-change-required | deferred | duplicate | applied | published | entered-in-error Required Pattern: applied
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ArtifactAssessment.content:ratingSystem.classifier	extensible	EvidenceRatingSystemVS(a valid code from Evidence Rating System Code System) http://fhir.awmf.org/awmf.ig/ValueSet/vs-evidence-rating-system From this IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ArtifactAssessment		0..*	CertaintyOfEvidence	Adds metadata-supported comments, classifiers or ratings related to a Resource
id	Σ	0..1	id	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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:url		0..1	uri	Canonical identifier for this artifact, represented as a URI (globally unique) URL: http://hl7.org/fhir/StructureDefinition/artifact-url
extension:description		0..1	markdown	Natural language description of the artifact URL: http://hl7.org/fhir/StructureDefinition/artifact-description
extension:author		0..*	ContactDetail	Who authored the artifact URL: http://hl7.org/fhir/StructureDefinition/artifact-author
extension:useContext		0..*	UsageContext	The context that the content is intended to support URL: http://hl7.org/fhir/StructureDefinition/artifact-useContext
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Additional identifier for the CertaintyOfEvidence
title	Σ	0..1	string	A label for use in displaying and selecting the artifact assessment
citeAs		0..1	markdown	How to cite the CertaintyOfEvidence
Slices for artifact[x]	Σ	1..1		The artifact that is rated Slice: Unordered, Open by type:$this
artifactReference			Reference(Resource)
artifactCanonical			canonical(Any)
artifactUri			uri
artifact[x]:artifactReference	Σ	0..1	Reference(Outcome Evidence)	The artifact that is rated
relatesTo		0..*	BackboneElement	Relationship to other Resources
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
type		1..1	code	documentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes Binding: ArtifactRelationshipType (required): The type of relationship to the related artifact.
target[x]		1..1		The artifact that is related to this ArtifactAssessment
targetUri			uri
targetAttachment			Attachment
targetCanonical			canonical(Resource)
targetReference			Reference(Resource)
targetMarkdown			markdown
date	Σ	0..1	dateTime	Date last changed
copyright		0..1	markdown	Use and/or publishing restrictions
approvalDate		0..1	date	When the CertaintyOfEvidence was approved by publisher
lastReviewDate	Σ	0..1	date	When the CertaintyOfEvidence was last reviewed
Slices for content		0..*	BackboneElement	Comment, classifier, or rating content Slice: Unordered, Open by value:type
content:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		0..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example)
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (example)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the CertaintyOfEvidence content
component		0..*	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		0..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example)
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (example)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the content
component		0..*	See content (ArtifactAssessment)	Comment, classifier, or rating content
content:ratingSystem	S	0..1	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		1..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: https://fevir.net/resources/CodeSystem/179423
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rating-system
display		1..1	string	Representation defined by the system Fixed Value: Rating System
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
classifier		1..1	CodeableConcept	Rating, classifier, or assessment Binding: Evidence Rating System Value Set (extensible)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the EvidenceAssessment content
component		0..*	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		0..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example)
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (example)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the content
component		0..*	See content (ArtifactAssessment)	Comment, classifier, or rating content
content:overall	S	0..1	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		1..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/certainty-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Overall
display		1..1	string	Representation defined by the system Fixed Value: Overall certainty
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (extensible)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the EvidenceAssessment content
component		0..*	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		0..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example)
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (example)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the content
component		0..*	See content (ArtifactAssessment)	Comment, classifier, or rating content
content:levelOfEvidence		0..1	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		1..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/certainty-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Overall
display		1..1	string	Representation defined by the system Fixed Value: Overall certainty
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (example)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the CertaintyOfEvidence content
component		0..*	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		0..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example)
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (example)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the content
component		0..*	See content (ArtifactAssessment)	Comment, classifier, or rating content
workflowStatus	Σ	1..1	code	submitted | triaged | waiting-for-input | resolved-no-change | resolved-change-required | deferred | duplicate | applied | published | entered-in-error Binding: ArtifactAssessmentWorkflowStatus (required) Required Pattern: applied
disposition	Σ	0..1	code	unresolved | not-persuasive | persuasive | persuasive-with-modification | not-persuasive-with-modification Binding: ArtifactAssessmentDisposition (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ArtifactAssessment.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot3 From the FHIR Standard
ArtifactAssessment.relatesTo.type	required	ArtifactRelationshipType http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3 From the FHIR Standard
ArtifactAssessment.content.type	example	EvidenceCertaintyType http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content.classifier	example	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.content.component.type	example	EvidenceCertaintyType http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content.component.classifier	example	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.content:ratingSystem.type	example	Pattern Value: rating-system("Rating System") http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:ratingSystem.classifier	extensible	EvidenceRatingSystemVS(a valid code from Evidence Rating System Code System) http://fhir.awmf.org/awmf.ig/ValueSet/vs-evidence-rating-system From this IG
ArtifactAssessment.content:ratingSystem.component.type	example	EvidenceCertaintyType http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:ratingSystem.component.classifier	example	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.content:overall.type	extensible	Pattern Value: Overall("Overall certainty") http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:overall.classifier	extensible	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.content:overall.component.type	example	EvidenceCertaintyType http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:overall.component.classifier	example	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.content:levelOfEvidence.type	example	Pattern Value: Overall("Overall certainty") http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:levelOfEvidence.classifier	example	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.content:levelOfEvidence.component.type	example	EvidenceCertaintyType http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:levelOfEvidence.component.classifier	example	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.workflowStatus	required	Pattern Value: applied http://hl7.org/fhir/ValueSet/artifactassessment-workflow-status|6.0.0-ballot3 From the FHIR Standard
ArtifactAssessment.disposition	required	ArtifactAssessmentDisposition http://hl7.org/fhir/ValueSet/artifactassessment-disposition|6.0.0-ballot3 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	ArtifactAssessment	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ArtifactAssessment	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ArtifactAssessment	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ArtifactAssessment	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ArtifactAssessment	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ArtifactAssessment		0..*	CertaintyOfEvidence	Adds metadata-supported comments, classifiers or ratings related to a Resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
contained		0..*	Resource	Contained, inline Resources
Slices for extension				Content/Rules for all slices
extension:url		0..1	uri	Canonical identifier for this artifact, represented as a URI (globally unique) URL: http://hl7.org/fhir/StructureDefinition/artifact-url
extension:description		0..1	markdown	Natural language description of the artifact URL: http://hl7.org/fhir/StructureDefinition/artifact-description
extension:author		0..*	ContactDetail	Who authored the artifact URL: http://hl7.org/fhir/StructureDefinition/artifact-author
extension:useContext		0..*	UsageContext	The context that the content is intended to support URL: http://hl7.org/fhir/StructureDefinition/artifact-useContext
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
Slices for artifact[x]	Σ	1..1		The artifact that is rated Slice: Unordered, Open by type:$this
artifactReference			Reference(Resource)
artifactCanonical			canonical(Any)
artifactUri			uri
artifact[x]:artifactReference	Σ	0..1	Reference(Outcome Evidence)	The artifact that is rated
Slices for content		0..*	BackboneElement	Comment, classifier, or rating content Slice: Unordered, Open by value:type
content:All Slices				Content/Rules for all slices
Slices for extension				Content/Rules for all slices
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
content:ratingSystem	S	0..1	BackboneElement	Comment, classifier, or rating content
Slices for extension				Content/Rules for all slices
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: https://fevir.net/resources/CodeSystem/179423
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rating-system
display		1..1	string	Representation defined by the system Fixed Value: Rating System
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
classifier		1..1	CodeableConcept	Rating, classifier, or assessment Binding: Evidence Rating System Value Set (extensible)
content:overall	S	0..1	BackboneElement	Comment, classifier, or rating content
Slices for extension				Content/Rules for all slices
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/certainty-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Overall
display		1..1	string	Representation defined by the system Fixed Value: Overall certainty
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
content:levelOfEvidence		0..1	BackboneElement	Comment, classifier, or rating content
Slices for extension				Content/Rules for all slices
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/certainty-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Overall
display		1..1	string	Representation defined by the system Fixed Value: Overall certainty
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
workflowStatus	Σ	1..1	code	submitted | triaged | waiting-for-input | resolved-no-change | resolved-change-required | deferred | duplicate | applied | published | entered-in-error Binding: ArtifactAssessmentWorkflowStatus (required) Required Pattern: applied
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ArtifactAssessment.content:ratingSystem.type	example	Pattern Value: rating-system("Rating System") http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:ratingSystem.classifier	extensible	EvidenceRatingSystemVS(a valid code from Evidence Rating System Code System) http://fhir.awmf.org/awmf.ig/ValueSet/vs-evidence-rating-system From this IG
ArtifactAssessment.content:overall.type	extensible	Pattern Value: Overall("Overall certainty") http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:levelOfEvidence.type	example	Pattern Value: Overall("Overall certainty") http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.workflowStatus	required	Pattern Value: applied http://hl7.org/fhir/ValueSet/artifactassessment-workflow-status|6.0.0-ballot3 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	ArtifactAssessment	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ArtifactAssessment	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ArtifactAssessment	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ArtifactAssessment	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ArtifactAssessment	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from CertaintyOfEvidence

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ArtifactAssessment		0..*	CertaintyOfEvidence	Adds metadata-supported comments, classifiers or ratings related to a Resource
Slices for artifact[x]		1..1	Reference(Resource), canonical(), uri	The artifact that is rated Slice: Unordered, Open by type:$this
artifact[x]:artifactReference		0..1	Reference(Outcome Evidence)	The artifact that is rated
Slices for content				Content/Rules for all slices
content:ratingSystem		0..1	BackboneElement	Comment, classifier, or rating content
classifier		1..1	CodeableConcept	Rating, classifier, or assessment Binding: Evidence Rating System Value Set (extensible)
content:levelOfEvidence		0..1	BackboneElement	Comment, classifier, or rating content
Slices for extension				Content/Rules for all slices
extension:RelatesToWithQuotation		0..*	RelatesToWithQuotation	Related artifact with quoted portion
type		1..1	CodeableConcept	What type of content Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/certainty-type
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Overall
display		1..1	string	Representation defined by the system Fixed Value: Overall certainty
component
Slices for extension				Content/Rules for all slices
extension:RelatesToWithQuotation		0..*	RelatesToWithQuotation	Related artifact with quoted portion
workflowStatus		1..1	code	submitted | triaged | waiting-for-input | resolved-no-change | resolved-change-required | deferred | duplicate | applied | published | entered-in-error Required Pattern: applied
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ArtifactAssessment.content:ratingSystem.classifier	extensible	EvidenceRatingSystemVS(a valid code from Evidence Rating System Code System) http://fhir.awmf.org/awmf.ig/ValueSet/vs-evidence-rating-system From this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ArtifactAssessment		0..*	CertaintyOfEvidence	Adds metadata-supported comments, classifiers or ratings related to a Resource
id	Σ	0..1	id	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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:url		0..1	uri	Canonical identifier for this artifact, represented as a URI (globally unique) URL: http://hl7.org/fhir/StructureDefinition/artifact-url
extension:description		0..1	markdown	Natural language description of the artifact URL: http://hl7.org/fhir/StructureDefinition/artifact-description
extension:author		0..*	ContactDetail	Who authored the artifact URL: http://hl7.org/fhir/StructureDefinition/artifact-author
extension:useContext		0..*	UsageContext	The context that the content is intended to support URL: http://hl7.org/fhir/StructureDefinition/artifact-useContext
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Additional identifier for the CertaintyOfEvidence
title	Σ	0..1	string	A label for use in displaying and selecting the artifact assessment
citeAs		0..1	markdown	How to cite the CertaintyOfEvidence
Slices for artifact[x]	Σ	1..1		The artifact that is rated Slice: Unordered, Open by type:$this
artifactReference			Reference(Resource)
artifactCanonical			canonical(Any)
artifactUri			uri
artifact[x]:artifactReference	Σ	0..1	Reference(Outcome Evidence)	The artifact that is rated
relatesTo		0..*	BackboneElement	Relationship to other Resources
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
type		1..1	code	documentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes Binding: ArtifactRelationshipType (required): The type of relationship to the related artifact.
target[x]		1..1		The artifact that is related to this ArtifactAssessment
targetUri			uri
targetAttachment			Attachment
targetCanonical			canonical(Resource)
targetReference			Reference(Resource)
targetMarkdown			markdown
date	Σ	0..1	dateTime	Date last changed
copyright		0..1	markdown	Use and/or publishing restrictions
approvalDate		0..1	date	When the CertaintyOfEvidence was approved by publisher
lastReviewDate	Σ	0..1	date	When the CertaintyOfEvidence was last reviewed
Slices for content		0..*	BackboneElement	Comment, classifier, or rating content Slice: Unordered, Open by value:type
content:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		0..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example)
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (example)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the CertaintyOfEvidence content
component		0..*	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		0..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example)
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (example)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the content
component		0..*	See content (ArtifactAssessment)	Comment, classifier, or rating content
content:ratingSystem	S	0..1	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		1..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: https://fevir.net/resources/CodeSystem/179423
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: rating-system
display		1..1	string	Representation defined by the system Fixed Value: Rating System
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
classifier		1..1	CodeableConcept	Rating, classifier, or assessment Binding: Evidence Rating System Value Set (extensible)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the EvidenceAssessment content
component		0..*	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		0..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example)
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (example)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the content
component		0..*	See content (ArtifactAssessment)	Comment, classifier, or rating content
content:overall	S	0..1	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		1..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/certainty-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Overall
display		1..1	string	Representation defined by the system Fixed Value: Overall certainty
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (extensible)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the EvidenceAssessment content
component		0..*	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		0..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example)
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (example)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the content
component		0..*	See content (ArtifactAssessment)	Comment, classifier, or rating content
content:levelOfEvidence		0..1	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		1..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/certainty-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Overall
display		1..1	string	Representation defined by the system Fixed Value: Overall certainty
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (example)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the CertaintyOfEvidence content
component		0..*	BackboneElement	Comment, classifier, or rating content
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:RelatesToWithQuotation		0..*	(Complex)	Related artifact with quoted portion URL: http://hl7.org/fhir/uv/ebm/StructureDefinition/relates-to-with-quotation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary		0..1	markdown	Brief summary of the content
type		0..1	CodeableConcept	What type of content Binding: EvidenceCertaintyType (example)
classifier		0..*	CodeableConcept	Rating, classifier, or assessment Binding: EvidenceCertaintyRating (example)
quantity		0..1	Quantity	Quantitative rating
author		0..*	Reference(Patient | Practitioner | PractitionerRole | Organization | Device)	Who authored the content
path		0..*	uri	What the comment is directed to
relatesTo		0..*	See relatesTo (ArtifactAssessment)	Relationship to other Resources
freeToShare		0..1	boolean	Acceptable to publicly share the content
component		0..*	See content (ArtifactAssessment)	Comment, classifier, or rating content
workflowStatus	Σ	1..1	code	submitted | triaged | waiting-for-input | resolved-no-change | resolved-change-required | deferred | duplicate | applied | published | entered-in-error Binding: ArtifactAssessmentWorkflowStatus (required) Required Pattern: applied
disposition	Σ	0..1	code	unresolved | not-persuasive | persuasive | persuasive-with-modification | not-persuasive-with-modification Binding: ArtifactAssessmentDisposition (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ArtifactAssessment.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot3 From the FHIR Standard
ArtifactAssessment.relatesTo.type	required	ArtifactRelationshipType http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3 From the FHIR Standard
ArtifactAssessment.content.type	example	EvidenceCertaintyType http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content.classifier	example	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.content.component.type	example	EvidenceCertaintyType http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content.component.classifier	example	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.content:ratingSystem.type	example	Pattern Value: rating-system("Rating System") http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:ratingSystem.classifier	extensible	EvidenceRatingSystemVS(a valid code from Evidence Rating System Code System) http://fhir.awmf.org/awmf.ig/ValueSet/vs-evidence-rating-system From this IG
ArtifactAssessment.content:ratingSystem.component.type	example	EvidenceCertaintyType http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:ratingSystem.component.classifier	example	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.content:overall.type	extensible	Pattern Value: Overall("Overall certainty") http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:overall.classifier	extensible	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.content:overall.component.type	example	EvidenceCertaintyType http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:overall.component.classifier	example	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.content:levelOfEvidence.type	example	Pattern Value: Overall("Overall certainty") http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:levelOfEvidence.classifier	example	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.content:levelOfEvidence.component.type	example	EvidenceCertaintyType http://hl7.org/fhir/ValueSet/certainty-type From the FHIR Standard
ArtifactAssessment.content:levelOfEvidence.component.classifier	example	EvidenceCertaintyRating http://hl7.org/fhir/ValueSet/certainty-rating From the FHIR Standard
ArtifactAssessment.workflowStatus	required	Pattern Value: applied http://hl7.org/fhir/ValueSet/artifactassessment-workflow-status|6.0.0-ballot3 From the FHIR Standard
ArtifactAssessment.disposition	required	ArtifactAssessmentDisposition http://hl7.org/fhir/ValueSet/artifactassessment-disposition|6.0.0-ballot3 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	ArtifactAssessment	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ArtifactAssessment	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ArtifactAssessment	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ArtifactAssessment	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ArtifactAssessment	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from CertaintyOfEvidence

Summary

Mandatory: 1 element(2 nested mandatory elements)

Structures

This structure refers to these other structures:

• Outcome Evidence (http://fhir.awmf.org/awmf.ig/StructureDefinition/outcome-evidence)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of ArtifactAssessment.artifact[x]