The ArtifactAssessment Resource represents one or more assessments of another record or resource. The resource captures metadata about the assessment, as well as the data for the results of the assessment which may include comments, classifications, ratings, questions, and responses.

Owning work group name:

Clinical Decision Support

Committee Approval Date:

Initial PSS: June 22, 2018

CDS Work Group approval:  September 23, 2021 - Q2 - CDS/CQI WGM Minutes

CDS Work Group voted to change name to ArtifactAssessment: 2021-10-06 Meeting Agenda

Contributing or Reviewing Work Groups:

Structured Documents

Clinical Quality Information

Patient Empowerment (9/23/21 vote)

Learning Health Systems (9/23/21 vote)

Patient Care

FHIR Resource Development Project Insight ID:


Scope of coverage:

The ArtifactAssessment Resource provides a structure to communicate judgments or qualitative data about a record (a resource or other set of data with a known identity or URL by which it can be accessed), including comments, corrections, classifications, and ratings. The ArtifactAssessment Resource is used when the content attribution and management rights differ from the record being commented upon, or the commenter desires to separate the comments from the target record. The scope is intended to cover assessments (added information) regarding clinical records about individual human subjects, assessments (added information) regarding healthcare provision for individual persons (such as care plans), and assessments (added information) regarding records related to community knowledge such as scientific evidence and group-oriented guidance.

RIM scope:

out of scope for the RIM

Resource appropriateness:

Across healthcare communities, there are an extensive number of comments and corrections regarding resources where the commenter is not able or permitted to modify the resource content, and there are many situations in which assessments with classifications and ratings of medical record content are made by parties who would not include the assessments in the medical record. Across the academic, scientific, quality measurement development, and clinical decision support communities there is an extensive need to report assessments and feedback about resources and records. These artifact assessments may take multiple forms (including text, classifications, ratings or measurements) and may or may not be created, queried and maintained independently from the artifact being rated or commented upon.

Expected implementations:

The COVID-19 Knowledge Accelerator and the Scientific Knowledge Accelerator Foundation will be using ArtifactAssessment Resources extensively and examples can be seen on the Fast Evidence Interoperability Resources (FEvIR) Platform at

MaxMD is planning to implement ArtifactAssessment Resources in conjunction with the medical record correction request workflow being defined by Patient Empowerment Work Group.

The openEHR Clinical Knowledge Manager could use the ArtifactAssessment Resource to support the review process.

Content sources:

For the approach to manage comments, classifications, and ratings, we reviewed our experiences across actual comments in note elements (Annotation datatypes) in multiple FHIR Resources, the classification elements in Citation Resource, and the certainty element (a type of rating) in the Evidence Resource.

For the portion of ArtifactAssessment that can support workflow tracking in processing the artifact comments, we reviewed the HL7 Jira interface to use similar terms for related concepts.

The proposed StructureDefinition is found at

Example Scenarios:

Example 1. a series of nested ratings to document the risk of bias assessment of an Evidence Resource –

Example 2. a classification (metadata tag) to be associated with an artifact where the classification is provided by someone other than the publisher of the classified artifact –

Example 3. a comment related to another artifact –

Example 4: a response to an artifact comment -

Example 5 is a request from a patient to correct content in a medical record.

Resource Relationships:

ArtifactAssessment may by referenced by ArtifactAssessment and by Task.

ArtifactAssessment may reference any resource of 'community knowledge' and will likely reference Evidence, EvidenceVariable, EvidenceReport, PlanDefinition, ActivityDefinition, Library, Measure, and Citation. ArtifactAssessment may reference any resource of a 'medical record' and will likely reference DocumentReference, Composition, CarePlan, and DiagnosticReport.

Resource Boundaries:

ArtifactAssessment is about the content of a Resource and not about the provenance of the Resource so should not be confused with Provenance.

ArtifactAssessment is not used for communications that are not about a Resource so should not be confused with Communication or Composition (or profiles of Composition) which may be used for the primary communication about the subject matter.

Observation Resource is used extensively for observations about people, groups, devices, locations, substances, and procedures – not about the record describing these entities. ArtifiactAssessment is used for observations where the subject is the artifact or record, not the entity described by the artifact.  Simple "assessments" about an Observation such as status, dataAbsentReason, interpretation and note would use the Observation Resource where this is already structured. ArtifactAssessment Resource may be used for complex assessments of an Observation such as justifications for reasons to correct the record.


Maturity level 1 targeted for January 2022

gForge Users:

brynrhodes (github user) Khalid-Shahin (github user)

When Resource Proposal Is Complete:

When you have completed your proposal, please send an email to

FMG Notes


  1. I don't know if this is covered, but the proposed resource should be able to have suggested changes in a structured form; i.e., associate a component.path with a corrected/recommended/suggested value. This would enable a patient to suggest a correction to heir phone number or address.

  2. Perhaps ArtifactComment.application.priorState and ArtifactComment.application.postState could be used to suggest the specific changes requested.   Perhaps "change-request" should be added to the informationType code list.

  3. CDS WG approved this resource proposal 19-0-0 in WGM Thursday Q2 session.

  4. Note that the Patient Empowerment WG has a project Patient Requests for Corrections, which will surely interact.