Online Consultation to Community Pharmacy - Pilot Specification

• dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources
  contained.contained.empty()
• dom-1:If the resource is contained in another resource, it SHALL NOT contain any narrative
  contained.text.empty()
• dom-4: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-3:If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
  contained.where(('#'+id in %resource.descendants().reference).not()).empty()
• que-2:The link ids for groups and questions must be unique within the questionnaire
  descendants().linkId.isDistinct()

• rim:Entity. Role, or Act
• rim:Observation[moodCode=DEF]
• w5:infrastructure.information

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a

A human language.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A
• rim:Act.text?

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

• rim:Entity. Role, or Act
• rim:N/A

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.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1:Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim:n/a
• rim:N/A

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.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1:Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim:n/a
• rim:N/A

… This is the id that will be used to link a QuestionnaireResponse to the Questionnaire the response is for.

Can be a urn:uuid: or a urn:oid:, but real http: addresses are preferred. Multiple instances may share the same url if they have a distinct version.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.identifier[scope=BUSN;reliability=ISS]
• w5:id

Allows externally provided and/or usable business identifiers to be easily associated with the module.

Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, e.g., to identify this questionnaire outside of FHIR, where it is not possible to use the logical URI.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
• rim:II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
• servd:Identifier
• rim:.identifier
• objimpl:no-gen-base
• w5:id

There may be different questionnaire instances that have the same identifier but different versions. The version can be appended to the url in a reference to allow a refrence to a particular business version of the questionnaire with the format [url]|[version].

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A (to add?)
• w5:id.version

Support human navigation and code generation.

The name is not expected to be globally unique. The name should be a simple alpha-numeric type name to ensure that it is computable friendly.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A

This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.title

The lifecycle status of a Value Set or Concept Map.

Allows filtering of questionnaires that are appropriate for use vs. not.
This is labeled as "Is Modifier" because applications should not use a retired questionnaire without due consideration.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.status
• w5:status

Enables experimental content to be developed following the same lifecycle that would be used for a production-level questionnaire.

Allows filtering of questionnaire that are appropriate for use vs. not. This is labeled as "Is Modifier" because applications should not use an experimental questionnaire in production.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A
• w5:class

Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the questionnaire. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.participation[typeCode=AUT].time
• w5:when.recorded

Helps establish the "authority/credibility" of the questionnaire. May also allow for contact.

Usually an organization, but may be an individual. The publisher (or steward) of the questionnaire is the organization or individual primarily responsible for the maintenance and upkeep of the questionnaire. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the questionnaire. This item SHOULD be populated unless the information is available from context.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.participation[typeCode=AUT].role
• w5:who.witness

This description can be used to capture details such as why the questionnaire was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the questionnaire as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the profile is presumed to be the predominant language in the place the profile was created).

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.text

This element does not describe the usage of the questionnaire Instead it provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this questionnaire.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.reasonCode.text
• objimpl:no-gen-base
• w5:why

The 'date' element may be more recent than the approval date because of minor changes / editorial corrections.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.outboundRelationship[typeCode="SUBJ"].act[classCode=CACT;moodCode=EVN;code="approval"].effectiveTime
• objimpl:no-gen-base

Gives a sense of how "current" the content is. Resources that have not been reviewed in a long time may have a risk of being less appropriate/relevant.

If specified, this is usually after the approval date.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.outboundRelationship[typeCode="SUBJ"; subsetCode="RECENT"].act[classCode=CACT;moodCode=EVN;code="review"].effectiveTime
• objimpl:no-gen-base

Allows establishing a transition before a resource comes into effect and also allows for a sunsetting process when new versions of a the questionnaire are or are expected to be used instead.

The effective period for a questionnaire determines when the content is applicable for usage and is independent of publication and review dates. For example, a measure intended to be used for the year 2016 might be published in 2015.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• per-1:If present, start SHALL have a lower value than end
  start.empty() or end.empty() or (start <= end)

• rim:n/a
• v2:DR
• rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
• rim:N/A (to add?)
• objimpl:no-gen-base

Assist in searching for appropriate content.

When multiple useContexts are specified, there is no expectation whether all or any of the contexts apply.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A (to add?)

Countries and regions within which this artifact is targeted for use

It may be possible for the questionnaire to be used in jurisdictions other than those for which it was originally designed or intended.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• v2:CE/CNE/CWE
• rim:CD
• orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
• rim:N/A (to add?)

May be a web site, an email address, a telephone number, etc.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.participation[typeCode=CALLBCK].role

Consumers must be able to determine any legal restrictions on the use of the questionnaire and/or its content.

Systems are not required to have markdown support, and there is considerable variation in markdown syntax, so the text should be readable without markdown processing. The preferred markdown syntax is described here: http://daringfireball.net/projects/markdown/syntax (and tests here: http://daringfireball.net/projects/downloads/MarkdownTest_1.0.zip)

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A (to add?)
• objimpl:no-gen-base

Codes for questionnaires, groups and individual questions

Allows linking of the complete Questionnaire resources to formal terminologies. It's common for "panels" of questions to be identified by a code.

Codes may be defined very casually in enumerations or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
• rim:CV
• orim:fhir:Coding rdfs:subClassOf dt:CDCoding
• rim:.code

One of the resource types defined as part of FHIR.

If none are specified, then the subject is unlimited.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.outboundRelationship[typeCode=META].target[classCode=OBS, moodCode=DEFN, isCriterion=true].participation.role.classCode

The content of the questionnaire is constructed from an ordered, hierarchical collection of items.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• que-9:Read-only can't be specified for "display" items
  type!='display' or readOnly.empty()
• que-8:Default values can't be specified for groups or display items
  (type!='group' and type!='display') or initial.empty()
• que-6:Required and repeat aren't permitted for display items
  type!='display' or (required.empty() and repeats.empty())
• que-5:Only 'choice' items can have options
  (type ='choice' or type = 'open-choice') or (options.empty() and option.empty())
• que-4:A question cannot have both option and options
  option.empty() or options.empty()
• que-3:Display items cannot have a "code" asserted
  type!='display' or code.empty()
• que-10:Maximum length can only be declared for simple question types
  (type in ('boolean' | 'decimal' | 'integer' | 'string' | 'text' | 'url')) or maxLength.empty()
• que-1:Group items must have nested items, display items cannot have nested items
  (type='group' implies item.empty().not()) and (type.trace('type')='display' implies item.trace('item').empty())

• rim:n/a
• rim:.outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=DEF]

Note that FHIR strings may not exceed 1MB in size

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a

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.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1:Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim:n/a
• rim:N/A

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.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1:Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim:n/a
• rim:N/A

QuestionnaireResponse does not require omitted items to be included and may have some items that repeat, so linkage based on position alone is not sufficient.

This ''can'' be a meaningful identifier (e.g. a LOINC code) but is not intended to have any meaning. GUIDs or sequential numbers are appropriate here.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.id

A common pattern is to define a set of data elements and then build multiple questionnaires for different circumstances to gather the data. This element provides traceability to the common definition and allows the content for the question to come from the underlying definition.

the URI refers to an ElementDefinition in either a StructureDefinition or a DataElement, and always starts with the canonical URL for the target resource. When referring to a StructureDefinition, a fragment identifier is used to specify the element definition by its id Element.id. E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x]. In the absence of a fragment identifier, the first/root element definition in the target is the matching element definition. Note that LOINC codes implicitly define DataElement resources.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.outboundRelationship[typeCode=INST].target[classCode=OBS, moodCode=DEF]

Codes for questionnaires, groups and individual questions

Allows linking of groups of questions to formal terminologies.

The value may come from the ElementDefinition referred to by .definition.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
• rim:CV
• orim:fhir:Coding rdfs:subClassOf dt:CDCoding
• rim:.code

Separating the label from the question text allows improved rendering. Also, instructions will often refer to specific prefixes, so there's a need for the questionnaire design to have control over what labels are used.

These are generally unique within a questionnaire, though this is not guaranteed. Some questionnaires may have multiple questions with the same label with logic to control which gets exposed.

Typically these won't be used for "display" items, though such use is not prohibited.

Systems SHOULD NOT generate their own prefixes if prefixes are defined for any items within a Questionnaire.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:Not supported

Note that FHIR strings may not exceed 1MB in size

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:.text

Distinguishes groups from questions and display text and indicates data type for questions

Defines the format in which the user is to be prompted for the answer.

Additional constraints on the type of answer can be conveyed by extensions. The value may come from the ElementDefinition referred to by .definition.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A - MIF rather than RIM level

Allows questionnaires to adapt based on answers to other questions. E.g. If physical gender is specified as a male, no need to capture pregnancy history. Also allows conditional display of instructions or groups of questions.

If multiple repetitions of this extension are present, the item should be enabled when the condition for any of the repetitions is true. I.e. treat "enableWhen"s as being joined by an "or" clause.

This element is a modifier because if enableWhen is present for an item, "required" is ignored unless one of the enableWhen conditions is met.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• que-7:enableWhen must contain either a 'answer' or a 'hasAnswer' element
  hasAnswer.exists() xor answer.exists()

• rim:n/a
• rim:N/A - MIF rather than RIM level

Note that FHIR strings may not exceed 1MB in size

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a

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.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1:Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim:n/a
• rim:N/A

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.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1:Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim:n/a
• rim:N/A

If multiple question occurrences are present for the same question (same linkId), then this refers to the nearest question occurrence reachable by tracing first the "ancestor" axis and then the "preceding" axis and then the "following" axis.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A - MIF rather than RIM level

If answered=false and answer values are also provided, then they are treated as "or". I.e. "Enable if the question is unanswered or the answer is one of the specified values". If answered=true and answers are present, one of the specified answers must be met. (So there's little reason to specify answered=true if answers are present.).

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A - MIF rather than RIM level

Allowed values to answer questions.

Multiple answers are treated as "or". E.g. Enable if question 1 = A, C or E.

Components not specified in the answer do not need to match. For example, if enableWhen specifies code + system for a Coding, it is ok if the answer has a "display" element. I.e. treat the answer as a 'pattern'.

The dataType of this element must be the same as the data type of the question being referenced.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A - MIF rather than RIM level

Questionnaire.item.required only has meaning for elements that are conditionally enabled with enableWhen if the condition evaluates to true. If an item that contains other items is marked as required, that does not automatically make the contained elements required (though required groups must contain at least one child element). The value may come from the ElementDefinition referred to by .definition.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A - MIF rather than RIM level

Items may be used to create set of (related) questions that can be repeated to give multiple answers to such a set.

If a question is marked as repeats=true, then multiple answers can be provided for the question in the corresponding QuestionnaireResponse. When rendering the questionnaire, it is up to the rendering software whether to render the question text for each answer repetition or to simply list each of the answers beneath the question. (Which is most appropriate visually may depend on the type of answer as well as whether there are nested items.). The value may come from the ElementDefinition referred to by .definition.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A - MIF rather than RIM level

Allows certain information to be phrased (and rendered) as a question and an answer, while keeping users from changing it. May also be useful for preventing changes to pre-populated portions of a questionnaire, for calculated values, etc.

The value of readOnly elements can be established by asserting extensions for defaultValues, linkages that support pre-population and/or extensions that support calculation based on other answers.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A - MIF rather than RIM level

For base64binary, reflects the number of characters representing the encoded data, not the number of bytes of the binary data. The value may come from the ElementDefinition referred to by .definition.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• v2:N/A
• rim:N/A - MIF rather than RIM level

LOINC defines many useful value sets for questionnaire responses. See LOINC Answer Lists. The value may come from the ElementDefinition referred to by .definition.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ref-1:SHALL have a contained resource if a local reference is provided
  reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))

• rim:n/a
• rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• rim:N/A - MIF rather than RIM level

This element can be used when the value set machinery of options is deemed too cumbersome or when there's a need to capture options that are not codes.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A - MIF rather than RIM level

Note that FHIR strings may not exceed 1MB in size

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a

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.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1:Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim:n/a
• rim:N/A

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.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1:Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim:n/a
• rim:N/A

Allowed values to answer questions.

The data type of the value must agree with the item.type.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A - MIF rather than RIM level

Allowed values to answer questions.

In some workflows, having defaults saves time.

The user is allowed to change the value and override the default (unless marked as read-only). If the user doesn't change the value, then this initial value will be persisted when the QuestionnaireResponse is initially created. Note that default values can influence results.

The data type of initial[x] must agree with the item.type.

• ele-1:All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim:n/a
• rim:N/A - MIF rather than RIM level

Reports can consist of complex nested groups.

There is no specified limit to the depth of nesting. However, Questionnaire authors are encouraged to consider the impact on the user and user interface of overly deep nesting.

• rim:.outboundRelationship[typeCode=COMP].target