Composition (PS-CA)


This version of the PS-CA Implementation Guide has been superseded by a newer version. A full list of versions & releases of the PS-CA Implementation Guide may be found at Guides.


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(http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner | http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole | Device | Patient (PS-CA) | RelatedPerson | http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-organization)
titleS Σ1..1string
confidentialityS Σ0..1codeBinding
modeS1..1codeBinding
timeS0..1dateTime
partyS I0..1Reference(Patient (PS-CA) | RelatedPerson | http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner | http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole | http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-organization)
custodianS Σ I0..1Reference(http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-organization)
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
medicationInformationS I1..*Reference(Medication Statement (PS-CA) | Medication Request (PS-CA) | 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
allergyOrIntoleranceS I1..*Reference(Allergy Intolerance (PS-CA) | 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
problemS I1..*Reference(Condition (PS-CA) | 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 MS 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 MS 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 PS-CA patient profile since the IPS-UV currently points to profiles that are improperly 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 this section to ensure it is 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.
    • This new pattern involves the use of the "contentNotSupported" profile to communicate if the producing system does not support the referenced required profile at the time of initial implementation

      • Systems that can support the clinical profiles referenced in these section 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: This guide is specifically seeking feedback on the support of this pattern from the vendor/solution community to determine its feasibility before the V1 Trial Implementation. 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 section according to principles found in Profiling Conventions and Approach
    • IPS-UV considers this an MS 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

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 an MS 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.

Composition Section.Entries

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

  • Broadened the profiles accepted in these entries to include additional "contentNotSupported" profile as a way to communicate if the producing system does not support the referenced required profile at the time of initial implementation

    • Note: This guide is specifically seeking feedback on the support of this pattern from the vendor/solution community to determine its feasibility before the V1 Trial Implementation. 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 who can only produce medicationRequest resources (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.
    • Note: This is currently considered a break in compliance with the IPS-UV (since that specification requires a medicationStatement be present). This pattern is being recommended to the IPS-UV team for a correction in the global specification