HdBe-TreatmentDirective2
CBB | Description | Status |
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HdBe-TreatmentDirective2 | A treatment directive contains a joint decision between a health professional (for example a general practitioner) and a patient or his representative(s) about the desirability of performing a certain treatment, such as resuscitation, before this treatment becomes (acute) necessary. When the need arises and the treatment cannot be discussed with the patient or representative(s), that decision is an important indication for the treating health professional (for example an ER doctor). The term treatment limit is a synonym of the term treatment directive. PurposeA good overview of treatment instructions based on the wishes of the patient or their authorized representative on (un)desired treatments is important in a patient’s care. A concise, orderly list is of particular importance in acute care situations. Due to the large variety of symptoms, the situation concerns not only a CPR setting, but also cases in which the patient’s condition rapidly worsens as a result of existing symptoms. A healthcare professional consulting this information can discuss these existing treatment instructions with the patient, the patient’s family or the patient’s authorized representative and possibly include the instructions in their policy. Evidence BaseExplanation for TreatmentCodeList: In discussions on constraints in the therapeutic treatment of patients with a chronic neurological or respiratory condition, respiration is sometimes included as a separate restriction. The ‘Respiration’ item is to be seen separately from the decisions on CPR. | active |
TreatmentDirective2 | TreatmentDirective2 | ||
id | 0..1 | string | |
extension | I | 0..* | Extension |
TreatmentDecision | 1..1 | CodeableConceptBinding | |
Treatment | 1..1 | CodeableConceptBinding | |
SpecificationOther | 0..1 | string | |
MostRecentReviewDate | 1..1 | dateTime | |
DateExpired | 0..1 | dateTime | |
ReasonForEnding | 0..1 | string | |
AdvanceDirective | I | 0..* | Reference(HdBe-AdvanceDirective) |
AgreementParty | I | 2..* | BackboneElement |
id | 0..1 | string | |
extension | I | 0..* | Extension |
modifierExtension | Σ ?! I | 0..* | Extension |
Patient | I | 0..1 | Reference(HdBe-Patient) |
Representative | I | 0..1 | Reference(HdBe-ContactPerson) |
HealthProfessional | I | 0..1 | Reference(HdBe-HealthProfessional) |
Comment | 0..1 | string |
TreatmentDirective2 | 0..* | |
TreatmentDirective2.TreatmentDecision | CodeableConcept | 1..1 |
TreatmentDirective2.Treatment | CodeableConcept | 1..1 |
TreatmentDirective2.SpecificationOther | string | 0..1 |
TreatmentDirective2.MostRecentReviewDate | dateTime | 1..1 |
TreatmentDirective2.DateExpired | dateTime | 0..1 |
TreatmentDirective2.ReasonForEnding | string | 0..1 |
TreatmentDirective2.AdvanceDirective | Reference(HdBe-AdvanceDirective) | 0..* |
TreatmentDirective2.AgreementParty | BackboneElement | 2..* |
TreatmentDirective2.AgreementParty.Patient | Reference(HdBe-Patient) | 0..1 |
TreatmentDirective2.AgreementParty.Representative | Reference(HdBe-ContactPerson) | 0..1 |
TreatmentDirective2.AgreementParty.HealthProfessional | Reference(HdBe-HealthProfessional) | 0..1 |
TreatmentDirective2.Comment | string | 0..1 |
TreatmentDirective2 | |
Definition | Root concept of the TreatmentDirective2 information model. This concept contains all data elements of the TreatmentDirective2 information model. |
Cardinality | 0...* |
Invariants |
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Mappings |
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TreatmentDirective2.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Cardinality | 0...1 |
Type | string |
Mappings |
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TreatmentDirective2.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Cardinality | 0...* |
Type | Extension |
Alias | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Slicing | Unordered, Open, by url(Value) |
Invariants |
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Mappings |
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TreatmentDirective2.TreatmentDecision | |
Definition | The joint decision taken with regard to the desirability of performing the indicated treatment. If the agreement is 'Other', 'Specification Other' shall contain the instructions for whether or not to carry out the treatment. |
Cardinality | 1...1 |
Type | CodeableConcept |
Binding | TreatmentDecision codes |
Comments | Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. |
Invariants |
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Mappings |
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TreatmentDirective2.Treatment | |
Definition | The medical treatment to which the treatment instruction applies. |
Cardinality | 1...1 |
Type | CodeableConcept |
Binding | Treatment codes |
Comments | Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. |
Invariants |
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Mappings |
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TreatmentDirective2.SpecificationOther | |
Definition | Specification of the treatment decision when the decision is 'Other'. |
Cardinality | 0...1 |
Type | string |
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size |
Invariants |
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Mappings |
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TreatmentDirective2.MostRecentReviewDate | |
Definition | The date on which the treatment directive has been agreed is with the patient and / or his representative(s). This can be the first time that the treatment directive has been discussed, but an existing treatment directive may also have been discussed again. The content of the treatment directive may have changed or remained the same. |
Cardinality | 1...1 |
Type | dateTime |
Invariants |
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Mappings |
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TreatmentDirective2.DateExpired | |
Definition | The date on which the treatment directive has been withdrawn and therefore no longer applies. An explicit decision must be taken about the 'date expired', in consultation between the responsible care professional and the patient or his representative(s). Any future termination can only be entered as a condition. Often this will be linked to 1 or more events. |
Cardinality | 0...1 |
Type | dateTime |
Invariants |
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Mappings |
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TreatmentDirective2.ReasonForEnding | |
Definition | Reason why the agreement on a treatment directive no longer applies. |
Cardinality | 0...1 |
Type | string |
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size |
Invariants |
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Mappings |
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TreatmentDirective2.AdvanceDirective | |
Definition | A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter. |
Cardinality | 0...* |
Type | Reference(HdBe-AdvanceDirective) |
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. |
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Mappings |
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TreatmentDirective2.AgreementParty | |
Definition | Container of the Agreement concept. This container contains all data elements of the Agreement concept. |
Cardinality | 2...* |
Type | BackboneElement |
Invariants |
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Mappings |
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TreatmentDirective2.AgreementParty.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Cardinality | 0...1 |
Type | string |
Mappings |
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TreatmentDirective2.AgreementParty.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Cardinality | 0...* |
Type | Extension |
Alias | extensions, user content |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Slicing | Unordered, Open, by url(Value) |
Invariants |
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Mappings |
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TreatmentDirective2.AgreementParty.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Cardinality | 0...* |
Type | Extension |
Modifier | True |
Summary | True |
Alias | extensions, user content, modifiers |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
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Mappings |
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TreatmentDirective2.AgreementParty.Patient | |
Definition | Patient as the person with whom the agreement was made. |
Cardinality | 0...1 |
Type | Reference(HdBe-Patient) |
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. |
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TreatmentDirective2.AgreementParty.Representative | |
Definition | Person who represents the patient in health care matters and with whom the agreement has been made (too). |
Cardinality | 0...1 |
Type | Reference(HdBe-ContactPerson) |
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. |
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Mappings |
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TreatmentDirective2.AgreementParty.HealthProfessional | |
Definition | HealthProfessional who has made the agreement regarding the treatment directive. |
Cardinality | 0...1 |
Type | Reference(HdBe-HealthProfessional) |
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. |
Invariants |
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Mappings |
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TreatmentDirective2.Comment | |
Definition | The comment may include further information such as the reason why a treatment directive has been drawn up, persons who assisted the patient in agreeing the treatment directive but who are not otherwise involved in the agreement as a representative, etc. |
Cardinality | 0...1 |
Type | string |
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size |
Invariants |
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Mappings |
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Example instances
TreatmentDirective2 | |
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TreatmentDecision | 385643006 - To be done (code by SNOMED CT) |
Treatment | 305351004 - Admission to intensive care unit (code by SNOMED CT) |
SpecificationOther | |
MostRecentReviewDate | 2012-09-11 |
DateExpired | 2012-10-15 |
ReasonForEnding | Recovered and released from the hospital. |
AdvanceDirective | Reference to AdvanceDirective (Power of attorney granted) |
AgreementParty | --- |
AgreementParty.Patient | |
AgreementParty.Representative | Reference to ContactPerson (Jan Pieter Mark (Piet) van Putten) |
AgreementParty.HealthProfessional | Reference to HealthProfessional (J.H.R. Peters, Doctor) |
Comment |
TreatmentDirective2 | |
---|---|
TreatmentDecision | 74964007 - Other (code by SNOMED CT) |
Treatment | 89666000 - Cardiopulmonary resuscitation (code by SNOMED CT) |
SpecificationOther | First consult with husband |
MostRecentReviewDate | 2012-09-11 |
DateExpired | |
ReasonForEnding | |
AdvanceDirective | |
AgreementParty | --- |
AgreementParty.Patient | |
AgreementParty.Representative | Reference to ContactPerson (Jan Pieter Mark (Piet) van Putten) |
AgreementParty.HealthProfessional | |
Comment |
zib TreatmentDirective2-v1.0 difference
Concept | Category | Description |
---|---|---|
TreatmentDirective2 (root) |
naming | Renamed the root concept name TreatmentDirective to TreatmentDirective2 to align with the sdf-8 constraint. (zib ticket #1875) |
Treatment |
terminology | Changed binding strenght from Required to Extensible because it is very likely other codes may be relevant in the future. This is already the case with the zibs in release 2020 versus the pre-release of 2022 where new codes have been added. |
Treatment |
terminology | Changed codes to the one found in TreatmentDirective2-v2.0(2022EN). |
TreatmentDecision |
terminology | Replaced zib codes to SNOMED codes. |
description.concept | textual | Replaced 'patient or representative (s)' with 'patient or representative(s)'. |
MostRecentReviewDate |
textual | Replaced 'his representative (s)' with 'his representative(s)'. |
MostRecentReviewDate |
textual | Replaced 'treatment directive have' with 'treatment directive has'. |
AgreementParty |
textual | Replaced 'concept.This' with 'concept. This'. |
Terminology Bindings
Path | Name | Strength | URL |
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TreatmentDecision | TreatmentDecision | required | https://fhir.healthdata.be/ValueSet/TreatmentDecision |
Treatment | Treatment | extensible | https://fhir.healthdata.be/ValueSet/Treatment |