Composition (PS-CA)

Additional information on this profile (including the JSON & XML structure and detailed element descriptions) can be found at Composition (PS-CA)

Profile

textS0..1Narrative
versionNumberI0..1Extension(string)
identifierS Σ0..1Identifier
statusS Σ ?!1..1codeBinding
typeS Σ1..1CodeableConceptBinding
categoryΣ0..*CodeableConcept
referenceS Σ I1..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
encounterΣ I0..1Reference(Encounter)
dateS Σ1..1dateTime
authorS Σ I1..*Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Device | Patient (PS-CA) | RelatedPerson | Organization Profile)
titleS Σ1..1string
confidentialityS Σ0..1codeBinding
modeS1..1codeBinding
timeS0..1dateTime
partyS I0..1Reference(Patient (PS-CA) | RelatedPerson | Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile)
custodianS Σ I0..1Reference(Organization Profile)
codeS1..1codeBinding
targetIdentifierIdentifier
targetReferenceReference(Composition | Composition (PS-CA))
codeΣ0..*CodeableConcept
periodΣ I0..1Period
detailΣ I0..*Reference(Resource)
codeS Σ1..*CodeableConcept
periodS Σ I0..1Period
detailΣ I0..*Reference(Resource)
title0..1string
code0..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
entryI0..*Reference(Resource)
emptyReasonI0..1CodeableConceptBinding
sectionI0..*see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
medicationStatementI0..*Reference(Medication Statement (PS-CA))
medicationRequestI0..*Reference(Medication Request (PS-CA))
MedicationSectionNotSupportedI0..*Reference(Medication Statement Content Not Supported (PS-CA))
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
allergyOrIntoleranceI1..*Reference(Allergy Intolerance (PS-CA))
AllergySectionNotSupportedI0..*Reference(Allergy Intolerance Content Not Supported (PS-CA))
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
problemI0..*Reference(Condition (PS-CA))
ProblemSectionNotSupportedI0..*Reference(Condition Content Not Supported (PS-CA))
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
procedureS I1..*Reference(Procedure (PS-CA))
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
immunizationS I1..*Reference(Immunization (PS-CA))
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
deviceStatementS I1..*Reference(Device Use Statement (IPS))
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
results-observationS I0..*Reference(Observation Results: laboratory (IPS) | Observation Results: pathology (IPS) | Observation Results: radiology (IPS) | Observation Results (IPS))
results-diagnosticReportS I0..*Reference(DiagnosticReport (IPS))
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
vitalSignS I0..*Reference(Vital Signs Profile)
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
pastProblemS I1..*Reference(Condition (PS-CA))
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
disabilityS I0..*Reference(Condition (PS-CA))
functionalAssessmentS I0..*Reference(ClinicalImpression)
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
carePlanI0..*Reference(CarePlan)
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
smokingTobaccoUseS I0..1Reference(SHx Observation: Tobacco Use (PS-CA))
alcoholUseS I0..1Reference(SHx Observation: Alcohol Use (PS-CA))
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
pregnancyStatusS I0..*Reference(Observation (Pregnancy: status))
pregnancyOutcomeSummaryS I0..*Reference(Observation (Pregnancy: outcome))
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
advanceDirectivesConsentS I0..*Reference(Consent)
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)
titleS1..1string
codeS1..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
FamilyMemberHistoryS I0..*Reference(FamilyMemberHistory)
emptyReasonI0..0CodeableConceptBinding
sectionI0..0see (section)

Key Differences between the IPS-UV and PS-CA

Composition:

  • Across Composition: Removed redundant data type profiling on fixed/patterned codeable concepts, modified references to point to equivalent PS-CA profiles
  • Composition.event: Relax Must Support flag on event due to the scope of the PS-CA needing to support summaries that are generated outside a direct care event (e.g., including summaries that are machine-generated/on-demand)
  • Composition.encounter: Relax Must Support flag since policy has not been developed in Canada confirming the expectations under which a patient summary is created
    • Further discussion is required to determine if systems will be expected to show they can construct an encounter resource in order to be conformant to the specification
  • Composition.author, Composition.attester, Composition.custodian - Modified references to point towards Canadian Baseline profiles and the Patient (PS-CA) profile since the IPS-UV currently only offers profiles that are scoped to diagnostic result authoring practitioners, organizations, etc.
    • Further investigation into whether additional elements/PS-CA profiles are needed (beyond the CA Baseline constraints) to support the use of these elements

Composition Sections

Composition.sectionMedications + Composition.sectionAllergies + Composition sectionProblems:

  • IPS-UV requires a minimum cardinality of 1 on these sections to ensure they are always populated with some kind of entry. This constraint has been maintainted in the PS-CA.
  • However, a new pattern has been developed for systems that wholistically cannot produce content for the profiles in these sections at the time of Version 1 of this specification.
    • Use a Content Not Supported Profiles (PS-CA) to communicate that the producing system does not currently support the referenced required profile
    • Systems which can support the clinical profiles referenced in these sections that do not have content for a given patient should use the absent/unknown pattern in the clinical profile.
    • This pattern is considered a temporary measure to allow for patient summaries to be exchanged in Canada (and internationally) while some systems work to meet the expectations for the full set of patient summary sections.
  • Note: Feedback is requested on the support of this pattern from the vendor/solution community to determine feasibility. This approach is likely to evolve as Canada and other national implementations work with the IPS-UV team to identify a pattern for national implementors to account for differing levels of domain prioritization early on in adoption.

Composition.sectionProceduresHx + Composition.sectionImmunizations + Composition.sectionVitalSigns + Composition.sectionPastIllenessHx + Composition.sectionSocialHistory:

  • Removed Must Support flag from these sections according to principles found in Profiling Conventions and Approach

    • IPS-UV considers this a Must Support section. This constraint has been relaxed in the PS-CA to not put undue conformance expectations on jurisdictions who will not be including this domain/section in their initial implementation of patient summaries.
    • Participating jurisdictions are expected to be able to receive this section in a patient summary without flagging an error.
    • Vendors should anticipate that the Must Support flag may be re-evaluated for application in future releases
    • Additionally, vendors should expect that some jurisdictions may further constrain support of this section within the context of their own jurisdictional content
  • Note: Implementers are not expected to demonstrate support for these sections in v1.0, but the flags on the child elements have been maintained to ensure that if an implementer does produce these sections, they follow the expected patterning that is outlined in the IPS-UV and future PS-CA releases.

Composition.sectionResults + Composition.sectionMedicalDevices + Composition.sectionFunctionalStatus + Composition.sectionPlanOfCare + Composition.sectionPregnancyHx + Composition.sectionAdvanceDirectives:

  • Removed Must Support flag from section according to principles found in Profiling Conventions and Approach
    • IPS-UV considers this a Must Support section, but this section is not considered in scope as for participating jurisdictions in the initial implementation. This constraint has been relaxed in the PS-CA to not put undue conformance expectations on jurisdictions who will not be including this domain/section in their initial implementation of patient summaries.
  • Note: Implementers are not expected to demonstrate support for these sections in v1.0, but the flags on the child elements have been maintained as well as the references to the IPS-UV profiles to ensure that if an implementer does produce these sections, they follow the expected patterning that is outlined in the IPS-UV and expected in future PS-CA releases.

Composition Section.Entries

Composition.sectionMedications.entry + Composition.sectionAllergies.entry + Composition sectionProblems.entry:

  • Broadened the profiles accepted in these entries to include Content Not Supported Profiles (PS-CA) as a way to communicate that a producing system does not support the referenced required profile.

    • Note: Feedback is requested on the support of this pattern from the vendor/solution community to determine feasibility. This approach is likely to evolve as Canada and other national implementations work with the IPS-UV team to identify a pattern for national implementors to account for differing levels of domain prioritization early on in adoption.
  • Composition.sectionMedications.entry: Broadened the expectations for this entry to also allow for jursidictions which can only produce MedicationRequest resources (e.g., from prescription information sources) to supply a MedicationRequest rather than improperly create a MedicationStatement when the statement on usage of the medication can not be verified

    • Minimum cardinality remains the same, but accepted profiles allow for MedicationStatements, MedicationRequests, or both.