Implementation Guide for the NHS Genomics Medicine Service
Notice
Important: This guidance is under active development by NHS England and content may be added or updated on a regular basis.
This Implementation Guide is currently in Draft and SHOULD NOT be used for development or active implementation without express direction from the NHS England Genomics Unit.
Created by the central GMS infrastructure on any CRUD event.
Can be searched on for auditability and obtaining status history for Tasks (as an alternative to the Task _history option).
It is not expected or permitted that a client system would update or post AuditEvents to the central service.
AuditEvents are expected to be created for any CRUD events which affect resources on the server. Where resources do not exist on the server, e.g. empty SearchSets or failed POSTs, no AuditEvents will be created. Failed updates may still trigger creation of AuditEvent resources but the outcome.code will record that the event was unsuccessful.
AuditEvents for resources created by the server will record the server identity within the who element.
The below profile is therefore provided to support parsing for clients if returned through a GET request.
A record of an event made for purposes of maintaining a security log. Typical uses include detection of intrusion attempts and monitoring for inappropriate usage.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
There are no (further) constraints on this element
Element id
AuditEvent.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
AuditEvent.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
AuditEvent.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
AuditEvent.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
AuditEvent.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
AuditEvent.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
Identifier for a family of the event. For example, a menu item, program, rule, policy, function code, application name or URL. It identifies the performed function.
Requirements
This identifies the performed function. For "Execute" Event Action Code audit records, this identifies the application function performed.
Comments
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.
This field enables queries of messages by implementation-defined event categories.
Comments
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.
This ties an event to a specific date and time. Security audits typically require a consistent time base (e.g. UTC), to eliminate time-zone issues arising from geographical distribution.
Comments
In a distributed system, some sort of common time base (e.g. an NTP [RFC1305] server) is a good implementation tactic.
In some cases a "success" may be partial, for example, an incomplete or interrupted transfer of a radiological study. For the purpose of establishing accountability, these distinctions are not relevant.
The purposeOfUse (reason) that was used during the event being recorded.
Comments
Use AuditEvent.agent.purposeOfUse when you know that it is specific to the agent, otherwise use AuditEvent.purposeOfEvent. For example, during a machine-to-machine transfer it might not be obvious to the audit system who caused the event, but it does know why.
An actor taking an active role in the event or activity that is logged.
Requirements
An agent can be a person, an organization, software, device, or other actors that may be ascribed responsibility.
Comments
Several agents may be associated (i.e. have some responsibility for an activity) with an event or activity.
For example, an activity may be initiated by one user for other users or involve more than one user. However, only one user may be the initiator/requestor for the activity.
There are no (further) constraints on this element
Element id
AuditEvent.agent.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
AuditEvent.agent.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
Specification of the participation type the user plays when performing the event.
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.
The security role that the user was acting under, that come from local codes defined by the access control security system (e.g. RBAC, ABAC) used in the local context.
Requirements
This value ties an audited event to a user's role(s). It is an optional value that might be used to group events for analysis by user functional role categories.
Comments
Should be roles relevant to the event. Should not be an exhaustive list of roles.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Alternative agent Identifier. For a human, this should be a user identifier text string from authentication system. This identifier would be one known to a common authentication system (e.g. single sign-on), if available.
Requirements
In some situations, a human user may authenticate with one identity but, to access a specific application system, may use a synonymous identify. For example, some "single sign on" implementations will do this. The alternative identifier would then be the original identify used for authentication, and the User ID is the one known to and used by the application.
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
Indicator that the user is or is not the requestor, or initiator, for the event being audited.
Requirements
This value is used to distinguish between requestor-users and recipient-users. For example, one person may initiate a report-output to be sent to another user.
Comments
There can only be one initiator. If the initiator is not clear, then do not choose any one agent as the initiator.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.location
w5: FiveWs.where[x]
rim: * Role.Class =SDLOC
*Role.Code = ServiceDeliveryLocationRoleType
*Entity.Code = PlaceEntityType = df.Types of places for Entity.Class = PLC
*EntityClass = PLC = df.A physical place or site with its containing structure. May be natural or man-made. The geographic position of a place might or might not be constant.
The policy or plan that authorized the activity being recorded. Typically, a single activity may have multiple applicable policies, such as patient consent, guarantor funding, etc. The policy would also indicate the security token used.
Requirements
This value is used retrospectively to determine the authorization policies.
Comments
For example: Where an OAuth token authorizes, the unique identifier from the OAuth token is placed into the policy element Where a policy engine (e.g. XACML) holds policy logic, the unique policy identifier is placed into the policy element.
Type of media involved. Used when the event is about exporting/importing onto media.
Requirements
Usually, this is used instead of specifying a network address. This field is not used for Media Id (i.e. the serial number of a CD).
Comments
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.
There are no (further) constraints on this element
Element id
AuditEvent.agent.network.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
AuditEvent.agent.network.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
Identifier for the network access point of the user device
Definition
An identifier for the network access point of the user device for the audit event.
Requirements
This datum identifies the user's network access point, which may be distinct from the server that performed the action. It is an optional value that may be used to group events recorded on separate servers for analysis of a specific network access point's data access across all servers.
Comments
This could be a device id, IP address or some other identifier associated with a device.
An identifier for the type of network access point that originated the audit event.
Requirements
This datum identifies the type of network access point identifier of the user device for the audit event. It is an optional value that may be used to group events recorded on separate servers for analysis of access according to a network access point's type.
The reason (purpose of use), specific to this agent, that was used during the event being recorded.
Comments
Use AuditEvent.agent.purposeOfUse when you know that is specific to the agent, otherwise use AuditEvent.purposeOfEvent. For example, during a machine-to-machine transfer it might not be obvious to the audit system who caused the event, but it does know why.
Since multi-tier, distributed, or composite applications make source identification ambiguous, this collection of fields may repeat for each application or process actively involved in the event. For example, multiple value-sets can identify participating web servers, application processes, and database server threads in an n-tier distributed application. Passive event participants (e.g. low-level network transports) need not be identified.
There are no (further) constraints on this element
Element id
AuditEvent.source.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
AuditEvent.source.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
Logical source location within the healthcare enterprise network. For example, a hospital or other provider location within a multi-entity provider group.
Requirements
This value differentiates among the sites in a multi-site enterprise health information system.
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
Identifier of the source where the event was detected.
Requirements
This field ties the event to a specific source system. It may be used to group events for analysis according to where the event was detected.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Code specifying the type of source where event originated.
Requirements
This field indicates which type of source is identified by the Audit Source ID. It is an optional value that may be used to group events for analysis according to the type of source where the event occurred.
Comments
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.
Specific instances of data or objects that have been accessed.
Requirements
The event may have other entities involved.
Comments
Required unless the values for event identification, agent identification, and audit source identification are sufficient to document the entire auditable event. Because events may have more than one entity, this group can be a repeating set of values.
There are no (further) constraints on this element
Element id
AuditEvent.entity.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
AuditEvent.entity.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
Identifies a specific instance of the entity. The reference should be version specific.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.what[x]
rim: .id
dicom: ParticipantObjectID and ParticipantObjectIDTypeCode
The type of the object that was involved in this audit event.
Requirements
To describe the object being acted upon. In addition to queries on the subject of the action in an auditable event, it is also important to be able to query on the object type for the action.
Comments
This value is distinct from the user's role or any user relationship to the entity.
Code representing the role the entity played in the event being audited.
Requirements
For some detailed audit analysis it may be necessary to indicate a more granular type of entity, based on the application role it serves.
Comments
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.
Identifier for the data life-cycle stage for the entity.
Requirements
Institutional policies for privacy and security may optionally fall under different accountability rules based on data life cycle. This provides a differentiating value for those cases.
Comments
This can be used to provide an audit trail for data, over time, as it passes through the system.
Use only where entity can't be identified with an identifier.
Comments
This field may be used in a query/report to identify audit events for a specific person. For example, where multiple synonymous entity identifiers (patient number, medical record number, encounter number, etc.) have been used.
For query events, it may be necessary to capture the actual query input to the query process in order to identify the specific event. Because of differences among query implementations and data encoding for them, this is a base 64 encoded data blob. It may be subsequently decoded or interpreted by downstream audit analysis processing.
Comments
The meaning and secondary-encoding of the content of base64 encoded blob is specific to the AuditEvent.type, AuditEvent.subtype, AuditEvent.entity.type, and AuditEvent.entity.role. The base64 is a general-use and safe container for event specific data blobs regardless of the encoding used by the transaction being recorded. An AuditEvent consuming application must understand the event it is consuming and the formats used by the event. For example, if auditing an Oracle network database access, the Oracle formats must be understood as they will be simply encoded in the base64binary blob.
There are no (further) constraints on this element
Element id
AuditEvent.entity.detail.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
AuditEvent.entity.detail.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
w5: FiveWs.context
rim: .code
dicom: ParticipantObjectDetail.type
value[x]
1..1
Element id
AuditEvent.entity.detail.value[x]
Short description
Property value
Definition
The value of the extra detail.
Requirements
Should not duplicate the entity value unless absolutely necessary.
Comments
The value can be string when known to be a string, else base64 encoding should be used to protect binary or undefined content. The meaning and secondary-encoding of the content of base64 encoded blob is specific to the AuditEvent.type, AuditEvent.subtype, AuditEvent.entity.type, and AuditEvent.entity.role. The base64 is a general-use and safe container for event specific data blobs regardless of the encoding used by the transaction being recorded. An AuditEvent consuming application must understand the event it is consuming and the formats used by the event. For example if auditing an Oracle network database access, the Oracle formats must be understood as they will be simply encoded in the base64binary blob.
Conditions
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
SHALL be present. Code from base HL7 resource, only C (create), R (read) and U (update) would usually be expected.
"action": "U",
agent
SHOULD be present for any user initiated actions. Reference to the user or system that triggered the creation/read/update. Identity SHOULD be determined through the appropriate authentication token within the request header, e.g. CIS2 auth token.
The Genomics BodyStructure is currently based on the HL7 international version of the resource as a profile for BodyStructure does not exist in UKCore. Once this profile becomes active in UKCore its suitability for use and need for profiling within Genomics will be assessed.
The base BodyStructure resource is provided below for completeness.
Record details about an anatomical structure. This resource may be used when a coded concept does not provide the necessary detail needed for the use case.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
There are no (further) constraints on this element
Element id
BodyStructure.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
BodyStructure.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
BodyStructure.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
BodyStructure.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
BodyStructure.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
BodyStructure.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - 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]
The anatomical location or region of the specimen, lesion, or body structure.
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.
Qualifier to refine the anatomical location. These include qualifiers for laterality, relative location, directionality, number, and plane.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
w5: FiveWs.what[x]
v2: No distinct element defined in V2.x. The IHE Radiology Technical Framework directs the use of OBR-15-specimen source to contain laterality for imaging studies./SPM-9
When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Primary Sample - Solid tumour histological type (topography)
SPM-8
StructureDefinition Bundle
The Genomics Bundle resource is currently based on the core HL7 resource, without any need for profiling.
The base R4 Bundle is provided below for completeness.
Bundles within Genomics will be limited to Transactions for Test orders and updates; Transaction-responses for responses to transactions (housing sets of OperationOutcomes); or Searchsets, returned in response to search queries.
bdl-7: FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles) (type = 'history') or entry.where(fullUrl.exists()).select(fullUrl&resource.meta.versionId).isDistinct()
bdl-9: A document must have an identifier with a system and a value type = 'document' implies (identifier.system.exists() and identifier.value.exists())
bdl-3: entry.request mandatory for batch/transaction/history, otherwise prohibited entry.all(request.exists() = (%resource.type = 'batch' or %resource.type = 'transaction' or %resource.type = 'history'))
bdl-4: entry.response mandatory for batch-response/transaction-response/history, otherwise prohibited entry.all(response.exists() = (%resource.type = 'batch-response' or %resource.type = 'transaction-response' or %resource.type = 'history'))
bdl-12: A message must have a MessageHeader as the first resource type = 'message' implies entry.first().resource.is(MessageHeader)
bdl-1: total only when a search or history total.empty() or (type = 'searchset') or (type = 'history')
bdl-2: entry.search only when a search entry.search.empty() or (type = 'searchset')
bdl-11: A document must have a Composition as the first resource type = 'document' implies entry.first().resource.is(Composition)
bdl-10: A document must have a date type = 'document' implies (timestamp.hasValue())
There are no (further) constraints on this element
Element id
Bundle.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Bundle.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Bundle.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
A persistent identifier for the bundle that won't change as a bundle is copied from server to server.
Comments
Persistent identity generally only matters for batches of type Document, Message, and Collection. It would not normally be populated for search and history results and servers ignore Bundle.identifier when processing batches and transactions. For Documents the .identifier SHALL be populated such that the .identifier is globally unique.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - 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]
Indicates the purpose of this bundle - how it is intended to be used.
Comments
It's possible to use a bundle for other purposes (e.g. a document can be accepted as a transaction). This is primarily defined so that there can be specific rules for some of the bundle types.
The date/time that the bundle was assembled - i.e. when the resources were placed in the bundle.
Comments
For many bundles, the timestamp is equal to .meta.lastUpdated, because they are not stored (e.g. search results). When a bundle is placed in a persistent store, .meta.lastUpdated will be usually be changed by the server. When the bundle is a message, a middleware agent altering the message (even if not stored) SHOULD update .meta.lastUpdated. .timestamp is used to track the original time of the Bundle, and SHOULD be populated.
Usage:
document : the date the document was created. Note: the composition may predate the document, or be associated with multiple documents. The date of the composition - the authoring time - may be earlier than the document assembly time
message : the date that the content of the message was assembled. This date is not changed by middleware engines unless they add additional data that changes the meaning of the time of the message
history : the date that the history was assembled. This time would be used as the _since time to ask for subsequent updates
searchset : the time that the search set was assembled. Note that different pages MAY have different timestamps but need not. Having different timestamps does not imply that subsequent pages will represent or include changes made since the initial query
transaction | transaction-response | batch | batch-response | collection : no particular assigned meaning
The timestamp value should be greater than the lastUpdated and other timestamps in the resources in the bundle, and it should be equal or earlier than the .meta.lastUpdated on the Bundle itself.
If a set of search matches, this is the total number of entries of type 'match' across all pages in the search. It does not include search.mode = 'include' or 'outcome' entries and it does not provide a count of the number of entries in the Bundle.
Comments
Only used if the bundle is a search result set. The total does not include resources such as OperationOutcome and included resources, only the total number of matching resources.
A series of links that provide context to this bundle.
Comments
Both Bundle.link and Bundle.entry.link are defined to support providing additional context when Bundles are used (e.g. HATEOAS).
Bundle.entry.link corresponds to links found in the HTTP header if the resource in the entry was read directly.
This specification defines some specific uses of Bundle.link for searching and paging, but no specific uses for Bundle.entry.link, and no defined function in a transaction - the meaning is implementation specific.
There are no (further) constraints on this element
Element id
Bundle.link.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Bundle.link.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
Bundle.entry.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Bundle.entry.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
URI for resource (Absolute URL server address or URI for UUID/OID)
Definition
The Absolute URL for the resource. The fullUrl SHALL NOT disagree with the id in the resource - i.e. if the fullUrl is not a urn:uuid, the URL shall be version-independent URL consistent with the Resource.id. The fullUrl is a version independent reference to the resource. The fullUrl element SHALL have a value except that:
fullUrl can be empty on a POST (although it does not need to when specifying a temporary id for reference in the bundle)
Results from operations might involve resources that are not identified.
Comments
fullUrl might not be unique in the context of a resource. Note that since FHIR resources do not need to be served through the FHIR API, the fullURL might be a URN or an absolute URL that does not end with the logical id of the resource (Resource.id). However, but if the fullUrl does look like a RESTful server URL (e.g. meets the regex, then the 'id' portion of the fullUrl SHALL end with the Resource.id.
Note that the fullUrl is not the same as the canonical URL - it's an absolute url for an endpoint serving the resource (these will happen to have the same value on the canonical server for the resource with the canonical URL).
There are no (further) constraints on this element
Element id
Bundle.entry.search.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Bundle.entry.search.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
match | include | outcome - why this is in the result set
Definition
Why this entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
Comments
There is only one mode. In some corner cases, a resource may be included because it is both a match and an include. In these circumstances, 'match' takes precedence.
Why an entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
When searching, the server's search ranking score for the entry.
Comments
Servers are not required to return a ranking score. 1 is most relevant, and 0 is least relevant. Often, search results are sorted by score, but the client may specify a different sort order.
See Patient Match for the EMPI search which relates to this element.
Additional execution information (transaction/batch/history)
Definition
Additional information about how this entry should be processed as part of a transaction or batch. For history, it shows how the entry was processed to create the version contained in the entry.
There are no (further) constraints on this element
Element id
Bundle.entry.request.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Bundle.entry.request.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
The URL for this entry, relative to the root (the address to which the request is posted).
Comments
E.g. for a Patient Create, the method would be "POST" and the URL would be "Patient". For a Patient Update, the method would be PUT and the URL would be "Patient/[id]".
Only perform the operation if the last updated date matches. See the API documentation for "Conditional Read".
Comments
Note: This is intended for where precisely observed times are required, typically system logs etc., and not human-reported times - for them, see date and dateTime (which can be as precise as instant, but is not required to be) below. Time zone is always required
Instruct the server not to perform the create if a specified resource already exists. For further information, see the API documentation for "Conditional Create". This is just the query portion of the URL - what follows the "?" (not including the "?").
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
Indicates the results of processing the corresponding 'request' entry in the batch or transaction being responded to or what the results of an operation where when returning history.
There are no (further) constraints on this element
Element id
Bundle.entry.response.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Bundle.entry.response.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
The status code returned by processing this entry. The status SHALL start with a 3 digit HTTP code (e.g. 404) and may contain the standard HTTP description associated with the status code.
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
OperationOutcome with hints and warnings (for batch/transaction)
Definition
An OperationOutcome containing hints and warnings produced as part of processing this entry in a batch or transaction.
Comments
For a POST/PUT operation, this is the equivalent outcome that would be returned for prefer = operationoutcome - except that the resource is always returned whether or not the outcome is returned.
This outcome is not used for error responses in batch/transaction, only for hints and warnings. In a batch operation, the error will be in Bundle.entry.response, and for transaction, there will be a single OperationOutcome instead of a bundle in the case of an error.
Digital Signature - base64 encoded. XML-DSig or a JWT.
Requirements
A Signature holds an electronic representation of a signature and its supporting context in a FHIR accessible form. The signature may either be a cryptographic type (XML DigSig or a JWS), which is able to provide non-repudiation proof, or it may be a graphical image that represents a signature or a signature process. This element allows capturing signatures on documents, messages, transactions or even search responses, to support content-authentication, non-repudiation or other business cases. This is primarily relevant where the bundle may travel through multiple hops or via other mechanisms where HTTPS non-repudiation is insufficient.
Comments
The signature could be created by the "author" of the bundle or by the originating device. Requirements around inclusion of a signature, verification of signatures and treatment of signed/non-signed bundles is implementation-environment specific.
SHALL be present. The type of Bundle. This is expected to be `transaction` for Bundles POSTed to the central broker, `transaction-response` for responses to transaction Bundles returned by the broker and `searchset` for collections of resources returned in response to search (GET) requests, as per standard HTTP FHIR rules.
"type": "transaction",
total
Only relevant for searchset Bundles. Details the number of resources in the bundle matching the search criteria, not including resources included via the _include criteria.
"total": 3,
link
Only relevant for searchset bundles. Details the query string that resulted in the searchset (to allow future queries using the same parameters). `"relation": "self"` will only ever be used.
Links related to response pagination such as next/prev are pending Non-Functional Requirements finalisation for the order management central broker.
An entry in the bundle. For transaction Bundles, each entry SHOULD contain a fullURL to ensure resources in the Bundle can reference each other, these can be the locations within the source system or urn:uuids.
Resources are expected to contain ids to allow referencing within Bundles, though these will be replaced by server assigned ids when saved by the central broker. If additional identifiers need to be persisted e.g. NHS Number, these should be captured within the identifier field.
Transaction Bundle entries also SHALL contain a request object, specifying the method (either PUT for updates or POST for creates) and the url to send the resource to (equivalent to the resource type for the resource).
Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS
These Bundles are returned in response to transaction requests. These will only contain OperationOutcome resources (one for each recource contained in the transaction request). See Acknowledgements and responses for more information.
These entries will contain a response object detailing the response status of the individual resource operation and an OperationOutcome detailing any relevant diagnostics, such as validation messages.
Entries will also contain a location element, detailing the relative path of the resource, where the operation has resulted in a resource being created or updated. These URLs will be version specific (using the _history suffix to denote the version number of the resource) if the resource has been updated.
These Bundles are returned in response to GET requests without an ID. entries within these bundles will depend on the endpoint queried and the search parameters included.
Each entry is expected to include a fullUrl identifying the URL that can be used to retrieve the resource on the server; the resource itself; and a search element detailing whether the resource was included in the search response due to it matching the query parameters, "mode": "match", or whether it was included via the _include parameter, "mode": "include".
There are two use cases for Compositions within Genomics.
For Order Management, Compositions will be limited to documents generated by the central broker for capturing snapshots of Test orders and results in order to maintain historical accuracy, as per the DocumentReference generate OperationDefinition. These will typically form the first entry of a Document Bundle and as such will not be exposed via their own endpoint, nor allow creates, reads or updates from client systems on the resource itself.
Usage of the Compostion resource and generation of documents is pending internal review
To support cross border data sharing Compositions MAY be aligned to the HL7 EU Lab Composition profile as a wrap around structured reports, though use of this profile in production is currently under review.
For the Unified Genomic Record, Compositions will form the header or 'contents page' of the UGR itself. section elements will be used to emulate the UGR folders. CodeSystems/codes for the required sections of the UGR are currently under development.
A set of resources composed into a single coherent clinical statement with clinical attestation
Definition
A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition SHALL be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition SHALL be included as subsequent entries in the Bundle, for example Patient, Practitioner, Encounter, etc.
Comments
While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
Mappings
rim: Entity. Role, or Act
workflow: Event
rim: Document[classCode="DOC" and moodCode="EVN" and isNormalAct()]
cda: ClinicalDocument
fhirdocumentreference: when described by DocumentReference
There are no (further) constraints on this element
Element id
Composition.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Composition.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Composition.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Composition.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
Used to support the type of care setting associated with a composition or a list.
Alternate names
extensions, user content
Definition
The type of care setting associated with a composition or a list.
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.
There are no (further) constraints on this element
Element id
Composition.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
The workflow / clinical status of this composition.
Definition
The workflow/clinical status of this composition. The status is a marker for the clinical standing of the document.
Requirements
Need to be able to mark interim, amended, or withdrawn compositions or documents.
Comments
If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "entered-in-error" is why this element is labeled as a modifier of other elements.
Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
workflow: Event.status
w5: FiveWs.status
rim: interim: .completionCode="IN" & ./statusCode[isNormalDatatype()]="active"; final: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and not(./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct()]); amended: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and ./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct() and statusCode="completed"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]="obsolete"
Specifies the particular kind of composition (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the composition.
Requirements
Key metadata element describing the composition, used in searching/filtering.
Comments
For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.
A categorization for the type of the composition - helps for indexing and searching. This may be implied by or derived from the code specified in the Composition Type.
Requirements
Helps humans to assess whether the composition is of interest when viewing an index of compositions or documents.
Who or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).
Requirements
Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about.
Comments
For clinical documents, this is usually the patient.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
workflow: Event.context
w5: FiveWs.context
rim: unique(highest(./outboundRelationship[typeCode="SUBJ" and isNormalActRelationship()], priorityNumber)/target[moodCode="EVN" and classCode=("ENC", "PCPR") and isNormalAct])
There are no (further) constraints on this element
Element id
Composition.date
Short description
Composition editing time
Definition
The composition editing time, when the composition was last logically changed by the author.
Requirements
dateTime is used for tracking, organizing versions and searching. Note that this is the time of authoring. When packaged in a document, Bundle.timestamp is the date of packaging.
Comments
The Last Modified Date on the composition may be after the date of the document was attested without being changed.
There are no (further) constraints on this element
Element id
Composition.title
Short description
Human Readable name/title
Definition
Official human-readable label for the composition.
Comments
For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.
The code specifying the level of confidentiality of the Composition.
Definition
The code specifying the level of confidentiality of the Composition.
Comments
The exact use of this element, and enforcement and issues related to highly sensitive documents are out of scope for the base specification, and delegated to implementation profiles (see security section). This element is labeled as a modifier because highly confidential documents must not be treated as if they are not.
There are no (further) constraints on this element
Element id
Composition.attester.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Composition.attester.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
w5: FiveWs.witness
rim: ./role[classCode="ASSIGNED" and isNormalRole]/player[determinerCode="INST" and classCode=("DEV", "PSN") and isNormalEntity()] or ./role[classCode="ASSIGNED" and isNormalRole and not(player)]/scoper[determinerCode="INST" and classCode="ORG" and isNormalEntity()]
Identifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information.
Definition
Identifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information.
Requirements
Identifies where to go to find the current version, where to report issues, etc.
Comments
This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However, it is important that this information be known when working with a derived document, so providing a custodian is encouraged.
There are no (further) constraints on this element
Element id
Composition.relatesTo.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Composition.relatesTo.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
Composition.event.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Composition.event.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
Composition.event.code
Short description
Code(s) that apply to the event being documented
Definition
This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the typeCode, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.
Comments
An event can further specialize the act inherent in the typeCode, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more eventCodes are included, they SHALL NOT conflict with the values inherent in the classCode, practiceSettingCode or typeCode, as such a conflict would create an ambiguous situation. This short list of codes is provided to be used as key words for certain types of queries.
There are no (further) constraints on this element
Element id
Composition.event.period
Short description
The period covered by the documentation
Definition
The period of time covered by the documentation. There is no assertion that the documentation is a complete representation for this period, only that it documents events during this time.
There are no (further) constraints on this element
Element id
Composition.section.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Composition.section.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
Composition.section.title
Short description
Label for section (e.g. for ToC)
Alternate names
header, label, caption
Definition
The label for this particular section. This will be part of the rendered content for the document, and is often used to build a table of contents.
Requirements
Section headings are often standardized for different types of documents. They give guidance to humans on how the document is organized.
Comments
The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.
A code identifying the kind of content contained within the section. This must be consistent with the section title.
Requirements
Provides computable standardized labels to topics within the document.
Comments
The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document.
If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.
There are no (further) constraints on this element
Element id
Composition.section.focus
Short description
Who/what the section is about, when it is not about the subject of composition
Definition
The actual focus of the section when it is not the subject of the composition, but instead represents something or someone associated with the subject such as (for a patient subject) a spouse, parent, fetus, or donor. If not focus is specified, the focus is assumed to be focus of the parent section, or, for a section in the Composition itself, the subject of the composition. Sections with a focus SHALL only include resources where the logical subject (patient, subject, focus, etc.) matches the section focus, or the resources have no logical subject (few resources).
Comments
Typically, sections in a doument are about the subject of the document, whether that is a patient, or group of patients, location, or device, or whatever. For some kind of documents, some sections actually contain data about related entities. Typical examples are a section in a newborn discharge summary concerning the mother, or family history documents, with a section about each family member, though there are many other examples.
There are no (further) constraints on this element
Element id
Composition.section.text
Short description
Text summary of the section, for human interpretation
Definition
A human-readable narrative that contains the attested content of the section, used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative.
Comments
Document profiles may define what content should be represented in the narrative to ensure clinical safety.
There are no (further) constraints on this element
Element id
Composition.section.mode
Short description
working | snapshot | changes
Definition
How the entry list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted.
Requirements
Sections are used in various ways, and it must be known in what way it is safe to use the entries in them.
Comments
This element is labeled as a modifier because a change list must not be misunderstood as a complete list.
There are no (further) constraints on this element
Element id
Composition.section.orderedBy
Short description
Order of section entries
Definition
Specifies the order applied to the items in the section entries.
Requirements
Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries.
Comments
Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.
There are no (further) constraints on this element
Element id
Composition.section.emptyReason
Short description
Why the section is empty
Definition
If the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason.
Requirements
Allows capturing things like "none exist" or "not asked" which can be important for most lists.
Comments
The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.
TBC. Only relevant for EU Lab aligned reports (included in HL7 EU Laboratory Report: Composition Profile). A reference to the recipient for a report, could potentially be used to reference additional recipients over the subject and original requester for the request.
SHALL be the dateTime the Composition was generated by the central broker
"date": "2022-07-11T09:00:00Z",
author
Fixed to an identifier for the central broker (TBC). The author for the underlying ServiceRequest or DiagnosticReport can be retrieved by interrogating the appropriate resources.
SHALL match the SNOMED CT display used within Composition.type
"title": "Genetic report (record artifact)",
section
To conform to EU Lab, SHOULD include references to the results that form part of the genomic report.
For the UGR, will include sections that conform to the UGR folders, this work is currently in development.
For detailing any Condition related information about the proband/consultands within a test order.
It is expected that the information used to populate this resource SHOULD be sourced from the requesters EHR system. As
such, there is no limit on the amount of detail that can be provided, though at a minimum the code and subject fields
SHOULD be populated.
It is also highly preferred if the verificationStatus, onsetDateTime, recordedDate, recorded and abatementDateTime are
populated if applicable/known.
The primary condition, being tested for SHOULD be referenced via ServiceRequest.reasonReference, additional relevant
conditions SHOULD be referenced via ServiceRequest.supportingInfo.
For Suspected Diagnoses, it is expected that the following fields will be populated differently from a confirmed diagnosis:
Element
Value
clinicalStatus
Unpopulated
verificationStatus
Fixed to unconfirmed or one of its child codes
category
Do not use problem-list-item. Instead, presenting-complaint or encounter-diagnosis is expected
severity
Unpopulated
onset[x]
Unpopulated (details regarding observations/findings supporting the diagnosis, including dates, should be recorded under evidence
con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
Mappings
rim: Entity. Role, or Act
workflow: Event
sct-concept: < 243796009 |Situation with explicit context| : 246090004 |Associated finding| = ( ( < 404684003 |Clinical finding| MINUS ( << 420134006 |Propensity to adverse reactions| OR << 473010000 |Hypersensitivity condition| OR << 79899007 |Drug interaction| OR << 69449002 |Drug action| OR << 441742003 |Evaluation finding| OR << 307824009 |Administrative status| OR << 385356007 |Tumor stage finding|)) OR < 272379006 |Event|)
There are no (further) constraints on this element
Element id
Condition.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Condition.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Condition.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Condition.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
An extension to replicate the changes within R6 to support adding a reference to the body part affected by the diagnosed condition.
Alternate names
extensions, user content
Definition
Optional Extension Element - found in all resources.
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.
The episodicity value of the condition can be represented by one of the following codes: \nfirst | new | review | end.
Alternate names
extensions, user content
Definition
The episodicity status of a condition.
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.
There are no (further) constraints on this element
Element id
Condition.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
There are no (further) constraints on this element
Element id
Condition.identifier
Short description
External Ids for this condition
Definition
Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
Requirements
Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers.
Comments
This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.
The verification status to support the clinical status of the condition.
Definition
The verification status to support the clinical status of the condition.
Comments
verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status.
The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.
A code from the SNOMED Clinical Terminology UK with the expression (<404684003 |Clinical finding| OR <413350009 |Finding with explicit context| OR <272379006 |Event|).
The anatomical location where this condition manifests itself.
Comments
Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.
There are no (further) constraints on this element
Element id
Condition.encounter
Short description
Encounter created as part of
Definition
The Encounter during which this Condition was created or to which the creation of this record is tightly associated.
Comments
This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".
There are no (further) constraints on this element
Element id
Condition.abatement[x]
Short description
When in resolution/remission
Definition
The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.
Comments
There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.
Conditions
The cardinality or value of this element may be affected by these constraints: con-4
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
w5: FiveWs.done[x]
rim: .effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at remission"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed
There are no (further) constraints on this element
Element id
Condition.stage.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Condition.stage.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
Condition.evidence
Short description
Supporting evidence
Definition
Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.
Comments
The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.
There are no (further) constraints on this element
Element id
Condition.evidence.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Condition.evidence.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
Date of disease onset, Duration of hyperinsulism (when compared to abatementDateTime
for non OML messages PRB-16
Condition.evidence.detail( reference( FamilyMemberHistory, Media ) )
Pedigree details/diagram, Disease penetrance
N/A not in scope for HL7v2, could be added as additional DG1 segments related to relatives
(representation
of family history in HL7v2 still pending investigation)
Extension provided to allow users to ascribe topology and morphology items to conditions themselves. For collection of
body structure information for primary and secondary tumours separately, these should be referenced from conditions
associated with the primary and secondary tumour respectively.
SHOULD be present. SNOMED CT coding is preferred, though alternative codings MAY be provided where the code is not present in SNOMED CT, e.g. more specific test directory Clinical Indication codes MAY be used.
SHALL be present. Reference to the associated Patient. This MAY be through a resource reference if the ID on the central
service is known (or provided within the transaction bundle) or through NHS number where this is known and has been
traced through PDS
For recording additional information regarding the condition where this does not fit into the structured fields or
cannot be structured due to the way this information has been recorded in source systems.
"note": [
{
"text": "hearing loss since childhood (example)"
}
]
StructureDefinition Consent
Only expected to be used for wrapping Record of Discussion resources within the WGS pathway. Consent for testing is implied through submission of a test to the Genomic Order Management service. Consent for Data Access as part of the UGR SHOULD follow guidance provided within Consent guidance page and the IHE PCF Framework.
Only a minimal amount of mandatory information needs to be populated for Order Management recording of RoDs.
A healthcare consumer's choices to permit or deny recipients or roles to perform actions for specific purposes and periods of time
Definition
A record of a healthcare consumer’s choices, which permits or denies identified recipient(s) or recipient role(s) to perform one or more actions within a given policy context, for specific purposes and periods of time.
Comments
Broadly, there are 3 key areas of consent for patients: Consent around sharing information (aka Privacy Consent Directive - Authorization to Collect, Use, or Disclose information), consent for specific treatment, or kinds of treatment, and general advance care directives.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
ppc-4: IF Scope=adr, there must be a patient patient.exists() or scope.coding.where(system='something' and code='adr').exists().not()
ppc-5: IF Scope=treatment, there must be a patient patient.exists() or scope.coding.where(system='something' and code='treatment').exists().not()
ppc-2: IF Scope=privacy, there must be a patient patient.exists() or scope.coding.where(system='something' and code='patient-privacy').exists().not()
ppc-3: IF Scope=research, there must be a patient patient.exists() or scope.coding.where(system='something' and code='research').exists().not()
ppc-1: Either a Policy or PolicyRule policy.exists() or policyRule.exists()
There are no (further) constraints on this element
Element id
Consent.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Consent.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Consent.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Consent.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Consent.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
Consent.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
Unique identifier for this copy of the Consent Statement.
Comments
This identifier identifies this copy of the consent. Where this identifier is also used elsewhere as the identifier for a consent record (e.g. a CDA consent document) then the consent details are expected to be the same.
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - 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]
The Consent Directive that is pointed to might be in various lifecycle states, e.g., a revoked Consent Directive.
Comments
This element is labeled as a modifier because the status contains the codes rejected and entered-in-error that mark the Consent as not currently valid.
Which of the four areas this resource covers (extensible)
Definition
A selector of the type of consent being presented: ADR, Privacy, Treatment, Research. This list is now extensible.
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.
Classification of the consent statement - for indexing/retrieval
Definition
A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Either the Grantor, which is the entity responsible for granting the rights listed in a Consent Directive or the Grantee, which is the entity responsible for complying with the Consent Directive, including any obligations or limitations on authorizations and enforcement of prohibitions.
Comments
Commonly, the patient the consent pertains to is the consentor, but particularly for young and old people, it may be some other person - e.g. a legal guardian.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
The organization that manages the consent, and the framework within which it is executed.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.performer
w5: FiveWs.witness
source[x]
Σ
0..1
Element id
Consent.source[x]
Short description
Source from which this consent is taken
Definition
The source on which this consent statement is based. The source might be a scanned original paper form, or a reference to a consent that links back to such a source, a reference to a document repository (e.g. XDS) that stores the original consent document.
Comments
The source can be contained inline (Attachment), referenced directly (Consent), referenced in a consent repository (DocumentReference), or simply by an identifier (Identifier), e.g. a CDA document id.
Conditions
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: Field 19 Informational Material Supplied Indicator
The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.
There are no (further) constraints on this element
Element id
Consent.policy.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Consent.policy.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.
Comments
This element is for discoverability / documentation and does not modify or qualify the policy rules.
There are no (further) constraints on this element
Element id
Consent.verification.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Consent.verification.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
Who verified the instruction (Patient, Relative or other Authorized Person).
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Consent.provision.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Consent.provision.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Consent.provision.actor.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Consent.provision.actor.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
How the individual is involved in the resources content that is described in the exception.
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.
The resource that identifies the actor. To identify actors by type, use group to identify a set of actors by some property they share (e.g. 'admitting officers').
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Note that this is the direct action (not the grounds for the action covered in the purpose element). At present, the only action in the understood and tested scope of this resource is 'read'.
A security label, comprised of 0..* security label fields (Privacy tags), which define which resources are controlled by this exception.
Comments
If the consent specifies a security label of "R" then it applies to all resources that are labeled "R" or lower. E.g. for Confidentiality, it's a high water mark. For other kinds of security labels, subsumption logic applies. When the purpose of use tag is on the data, access request purpose of use shall not conflict.
The class of information covered by this rule. The type can be a FHIR resource type, a profile on a type, or a CDA document, or some other type that indicates what sort of information the consent relates to.
Comments
Multiple types are or'ed together. The intention of the contentType element is that the codes refer to profiles or document types defined in a standard or an implementation guide somewhere.
Clinical or Operational Relevant period of time that bounds the data controlled by this rule.
Comments
This has a different sense to the Consent.period - that is when the consent agreement holds. This is the time period of the data that is controlled by the agreement.
There are no (further) constraints on this element
Element id
Consent.provision.data.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Consent.provision.data.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
A reference to a specific resource that defines which resources are covered by this consent.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
SHALL be present. Fixed code of 'proposed' where consent discussion has taken place but RoD form has not been provided alongside test order. 'draft' if discussion has not yet taken place and 'active' for completed RoD, regardless of whether the patient has consented to information sharing (responses to specific consent statements SHOULD be recorded in the RoD itself).
"status": "proposed",
scope
For WGS RoD this SHALL be fixed to the below code:
SHALL be present. Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS.
SHALL be present for RoD entities. The Source element MAY either be a pointer to the location of the PDF version of the RoD, either hosted by the source/client system, accessed via NRL or embedded within the message payload, base64 encoded (using sourceAttachment), or a reference to a QuestionnaireResponse resource (using sourceReference), if this has been collected in a structured format, using the Questionnaire-Genomic Testing RoD template.
The requirements of a specific Genomics DiagnosticReport is currently under review.
The draft profile is provided below for completeness.
Currently, only requirements for initial Pathology reports, provided with a test order, have been reviewed. DiagnosticReports containing the results of genomic testing are expected to be attached/provided as PDF documents during the alpha phase of the GMS development programme.
It is expected structured DiagnosticReports will mimic the structure proposed within the HL7 International Genomic Reporting IG, though customizations for use within the UK still need to be investigated.
Additionally, to support sharing across borders, lab reports MAY additionally be aligned to the HL7 EU Lab Implementation guide, though requirement on suppliers to conform to this structure are still under review. details of elements of interest for alignment with the EU DiagnosticReport profile are provided below.
Genomic DiagnosticReports which have been updated post submission SHALL be accompanied by Provenance resources, referencing the DiagnosticReport which detail when the resource was changed, who made the change and why.
Whilst unstructured Diagnostic Reports can also be represented by DocumentReference resources, the DiagnosticReport resource is preferred for any documents constituting actual reports, as the resource allows capture of metadata not present in DocumentReference, such as the resultsInterpreter, specimen or conclusion, which would help in searching or for analytics. Use of DocumentReference resources is limited to other data files or documents.
A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports
Alternate names
Report, Test, Result, Results, Labs, Laboratory
Definition
The findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports.
Comments
This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
ukcore-diag-lab-002: If extension-DiagnosticReport.media.link R5 Backport is used then DiagnsoticReport.media.link reference SHALL be empty DiagnosticReport.media.extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.media.link').empty() or DiagnosticReport.media.link.reference.empty()
There are no (further) constraints on this element
Element id
DiagnosticReport.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
DiagnosticReport.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
DiagnosticReport.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
DiagnosticReport.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
A Composition reference for a DiagnosticReport. This is a R5 backport.
Alternate names
extensions, user content
Definition
A Reference to a Composition resource instance that provides structure for organizing the contents of the DiagnosticReport.
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.
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.
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.
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Comments about the diagnostic report. This is a R5 backport.
Alternate names
extensions, user content
Definition
May include general statements about the diagnostic report, or statements about significant, unexpected or unreliable results values contained within the diagnostic report, or information about its source when relevant to its interpretation.
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.
There are no (further) constraints on this element
Element id
DiagnosticReport.extension:noteR5.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
DiagnosticReport.extension:noteR5.url
Short description
identifies the meaning of the extension
Definition
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
May include general statements about the diagnostic report, or statements about significant, unexpected or unreliable results values contained within the diagnostic report, or information about its source when relevant to its interpretation.
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Additional info supporting the diagnostic report. This is a R5 backport.
Alternate names
extensions, user content
Definition
This backbone element contains supporting information that was used in the creation of the report not included in the results already included in the report.
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.
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.
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.
The code value for the role of the supporting information in the diagnostic report.
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.
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.
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.
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Who or what participated in the activities related to the family member history.
Alternate names
extensions, user content
Definition
The reference for the supporting information in the diagnostic report.
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.
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.
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.
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
There are no (further) constraints on this element
Element id
DiagnosticReport.extension:supportingInfoR5.url
Short description
identifies the meaning of the extension
Definition
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
There are no (further) constraints on this element
Element id
DiagnosticReport.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
There are no (further) constraints on this element
Element id
DiagnosticReport.identifier
Short description
Business identifier for report
Alternate names
ReportID, Filler ID, Placer ID
Definition
Identifiers assigned to this report by the performer or other systems.
Requirements
Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.
Comments
Usually assigned by the Information System of the diagnostic service provider (filler id).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
workflow: Event.identifier
w5: FiveWs.identifier
v2: OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4
There are no (further) constraints on this element
Element id
DiagnosticReport.basedOn
Short description
What was requested
Alternate names
Request
Definition
Details concerning a service requested.
Requirements
This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.
Comments
Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.
A code that classifies the clinical discipline, department or diagnostic service that created the report.
Alternate names
Department, Sub-department, Service, Discipline
Definition
A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.
Comments
Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.
The subject of the report - usually, but not always, the patient.
Alternate names
Patient
Definition
The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.
The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.
Requirements
Links the request to the Encounter context.
Comments
This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).
There are no (further) constraints on this element
Element id
DiagnosticReport.effective[x]
Short description
Clinically relevant time/time-period for report
Alternate names
Observation time, Effective Time, Occurrence
Definition
The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.
Requirements
Need to know where in the patient history to file/present this report.
Comments
If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Clinically relevant time / time-period for report.
Alternate names
Date published, Date Issued, Date Verified
Definition
The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.
Requirements
Clinicians need to be able to check the date that the report was released.
Comments
May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.
There are no (further) constraints on this element
Element id
DiagnosticReport.performer
Short description
Responsible Diagnostic Service
Alternate names
Laboratory, Service, Practitioner, Department, Company, Authorized by, Director
Definition
The diagnostic service that is responsible for issuing the report.
Requirements
Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.
Comments
This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.
There are no (further) constraints on this element
Element id
DiagnosticReport.performer.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
A reference to a Device which interprets / performs the results of the DiagnosticReport.
Alternate names
extensions, user content
Definition
An additional Device reference for a DiagnosticReport, to allow Software as a Medical Device to perform / interpret a DiagnosticReport
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.
There are no (further) constraints on this element
Element id
DiagnosticReport.performer.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Comments
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
There are no (further) constraints on this element
Element id
DiagnosticReport.performer.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
DiagnosticReport.performer.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Comments
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.
When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference
Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
There are no (further) constraints on this element
Element id
DiagnosticReport.performer.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
Comments
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
There are no (further) constraints on this element
Element id
DiagnosticReport.resultsInterpreter.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
A reference to a Device which interprets / performs the results of the DiagnosticReport.
Alternate names
extensions, user content
Definition
An additional Device reference for a DiagnosticReport, to allow Software as a Medical Device to perform / interpret a DiagnosticReport
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.
There are no (further) constraints on this element
Element id
DiagnosticReport.resultsInterpreter.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Comments
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
There are no (further) constraints on this element
Element id
DiagnosticReport.resultsInterpreter.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
DiagnosticReport.resultsInterpreter.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Comments
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.
When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference
Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
There are no (further) constraints on this element
Element id
DiagnosticReport.resultsInterpreter.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
Comments
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
There are no (further) constraints on this element
Element id
DiagnosticReport.specimen
Short description
Specimens this report is based on
Definition
Details about the specimens on which this diagnostic report is based.
Requirements
Need to be able to report information about the collected specimens on which the report is based.
Comments
If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.
There are no (further) constraints on this element
Element id
DiagnosticReport.imagingStudy
Short description
Reference to full details of imaging associated with the diagnostic report
Definition
One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.
Comments
ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.
There are no (further) constraints on this element
Element id
DiagnosticReport.media
Short description
Key images associated with this report
Alternate names
DICOM, Slides, Scans
Definition
A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).
Requirements
Many diagnostic services include images in the report as part of their service.
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.
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.
To use this element the R4 version of DiagnosticReport.media.link SHALL have the value as extension http://hl7.org/fhir/StructureDefinition/data-absent-reason and valueCode as "unsupported". See https://build.fhir.org/versions.html#extensions-examples-complex for more details
There are no (further) constraints on this element
Element id
DiagnosticReport.media.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
DiagnosticReport.media.comment
Short description
Comment about the image (e.g. explanation)
Definition
A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features.
Requirements
The provider of the report should make a comment about each image included in the report.
Comments
The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion.
There are no (further) constraints on this element
Element id
DiagnosticReport.presentedForm
Short description
Entire report as issued
Definition
Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.
Requirements
Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.
Comments
"application/pdf" is recommended as the most reliable and interoperable in this context.
PLCM activity - Date and time dataset created, PLCM activity - Turnaround time (calendar days), Previous genomic report - Test performed date, Previous non genomic report - Test performed date
Derived from OBR-7 in the ORU response message for the activity based on the OML request, OBX-19
DiagnosticReport.identifier
PLCM activity - Local report identifier, Previous genomic report - Report identifier, Previous non genomic report - Report identifier
OBR-3 for report
DiagnosticReport.result
PLCM activity - Test outcome code (Many), Previous non genomic report - Test result value comparator, Previous non genomic report - Test result value unit of measure, Previous non genomic report - Test result reference range low, Previous non genomic report - Test result reference range high, Previous non genomic report - Test result test method, Previous non genomic report - Test result reference range text, Previous non genomic report - Test result clinical summary
OBX-3 elements for resulting report, OBX-5, OBX-6, OBX-7 (before operator), OBX-7 (after operator), OBX-17, OBX-7, OBX-8
Previous genomic report - Report lab test number, Previous genomic report - Original requester full name, Previous genomic report - Original requester organisation ODS code, Previous genomic report - Original requester reason for request, Previous non genomic report - Original requester full name, Previous non genomic report - Original requester organisation ODS code, Previous non genomic report - Original requester reason for request
ORC-2, ORC-12, ORC-21.10, ORC-16
DiagnosticReport.conclusionCode
Previous genomic report - Report of genetic analysis, Previous non genomic report - Report result
OBR-5
DiagnosticReport.performer
Previous genomic report - Report performer full name, Previous genomic report - Report performer organisation ODS code, Previous non genomic report - Report performer full name, Previous non genomic report - Report performer organisation ODS code
TBC. Only relevant for structured genomic reports. Reference to DocumentReference resources pointing to the Genomic Data Files used as the basis for the report. Usage of this field over extension:supporting-info is pending further investigation.
TBC. Only relevant for structured genomic reports (included in the Genomic Report Profile in the Genomics Report IG). Reference to Task resource indicating recommended action to take in response to the report's result/conclusion.
TBC. Only relevant for structured genomic reports (included in the Genomic Report Profile in the Genomics Report IG). Reference to Procedure resources indicating the analyses performed as part the genomic test order.
TBC. Only relevant for structured genomic reports (included in the Genomic Report Profile in the Genomics Report IG). Reference to the genomic data files analysed as part of the test order, forming the report. Reference to DocumentReference resource which links to the binary data file.
TBC. Only relevant for structured genomic reports (included in Genomic Report Profile in the Genomics Report IG). A reference to the guidelines or other knowledge artifacts which were used to guide interpretation or recommended actions included within this DiagnosticReport.
If entries constitute published papers, they SHOULD be referenced using a known citation style, e.g. Vancouver/Harvard. Alternatively for online texts, these MAY be referenced via URL only.
A fixed value of 'citation' is expected for the type element, though this recommendation is pending further use cases.
SHALL use base HL7 codes for DiagnosticReport.status. A DiagnosticReport SHOULD only be marked as final if the report is complete and verified by an authorised person.
Codes for DiagnosticReport status and usage within Genomics are provided below:
Lvl
Code
Definition
Usage within Genomics
1
registered
The existence of the report is registered, but there is nothing yet available.
Not expected to be used within Genomics
1
partial
This is a partial (e.g. initial, interim or preliminary) report: data in the report may be incomplete or unverified.
MAY be used for interim reports, SHALL NOT be used for reports intended to be acted upon by clinicians
2
preliminary
Verified early results are available, but not all results are final.
MAY be used within Genomics
1
final
The report is complete and verified by an authorized person.
SHALL be used for final reports
1
amended
Subsequent to being final, the report has been modified. This includes any change in the results, diagnosis, narrative text, or other content of a report that has been issued.
SHOULD be used for resports ammended after submission of a final report
2
corrected
Subsequent to being final, the report has been modified to correct an error in the report or referenced results.
MAY be used in place of ammended for a correction to a finalised report
2
appended
Subsequent to being final, the report has been modified by adding new content. The existing content is unchanged.
Not expected to be used within Genomics but MAY be used where applicable, pending use case identification
1
cancelled
The report is unavailable because the measurement was not started or not completed (also sometimes called "aborted").
MAY be used where a lab submits a cancellation/failure report, pending use case identification and testing
1
entered-in-error
The report has been withdrawn following a previous final release. This electronic record should never have existed, though it is possible that real-world decisions were based on it. (If real-world activity has occurred, the status should be "cancelled" rather than "entered-in-error".).
Not expected to be used within Genomics
1
unknown
The authoring/source system does not know which of the status values currently applies for this observation. Note: This concept is not to be used for "other" - one of the listed statuses is presumed to apply, but the authoring/source system does not know which.
SHALL NOT be used within Genomics
"status": "final",
category
Potentially multiple categories to specify the specialty the report is relevant for. Different codings are expected by the Genomic Report and EU Lab profiles.
SHALL be present. Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS
If possible, unstructured reports wrapped within DiagnosticReports, SHOULD contain a conclusionCode element indicating the coded finding from the report, to aid analytics.
Genomic reports SHALL include a presentedForm element either referencing the location of the PDF report (located and accessible on either the source/client system or via NRL using appropriate authentication) or include the PDF report as a base64 encoded attachment within the message payload.
Note: this guidance may change in the future as work on Structured Reporting matures
The DocumentReference resource is used to reference data files generated as part of genomic testing and allow these files to be retrieved through the DRS API standard.
Primarily, the ServiceRequest SHALL be referenced via DiagnosticReport.basedOn. The DocumentReference then links back to the report via DocumentReference.context.related.
If following the Genomic Reporting IG, you could also reference the DocumentReference from the DiagnosticReport using the following chain:
DiagnosticReport.extension:genomic-study -> Procedure (Genomic Study).extension:genomic-study-analysis -> Procedure (Genomic Study Analysis).extension:output.extension:file.valueReference -> DocumentReference (Genomic Data File)
This requires use of the Genomic Study and Genomic Study Analysis profiles which have not yet been assessed for suitability in the UK. As such, this reference chain is only provided for reference.
The NHS England Genomics unit is also investigating backporting the R5 DiagnosticReport.media.link reference to DocumentReference to support referencing the data files from the DiagnosticReport directly. Until investigation is complete, DiagnosticReport resources MAY reference the DocumentReference for the data used by the report though the DiagnosticReport.extension:supporting-info element. In all cases the DocumentReference SHOULD reference the DNA Specimen from which the data originated and the ServiceRequest which triggered the capture of the data.
The Genomics-DocumentReference is currently based on the HL7 international version of the resource as the UKCore-DocumentReference profile is still in a draft status (and is pending use cases from the Unified Genomic Record project). Once this profile becomes active in UKCore its suitability for use and need for profiling within Genomics will be assessed.
The base DocumentReference resource is provided below for completeness.
A reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.
Comments
Usually, this is used for documents other than those defined by FHIR.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
There are no (further) constraints on this element
Element id
DocumentReference.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
DocumentReference.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
DocumentReference.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
DocumentReference.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
DocumentReference.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
DocumentReference.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
Document identifier as assigned by the source of the document. This identifier is specific to this version of the document. This unique identifier may be used elsewhere to identify this version of the document.
Requirements
The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.).
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - 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]
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - 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]
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
workflow: Event.status
w5: FiveWs.status
v2: TXA-19
rim: interim: .completionCode="IN" & ./statusCode[isNormalDatatype()]="active"; final: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and not(./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseDocument", code) and isNormalAct()]); amended: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and ./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseDocument", code) and isNormalAct() and statusCode="completed"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]="obsolete"
Specifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.
Comments
Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
workflow: Event.code
w5: FiveWs.class
fhircomposition: Composition.type
v2: TXA-2
rim: ./code
xds: DocumentEntry.type
cda: ClinicalDocument/code/@code
The typeCode should be mapped from the ClinicalDocument/code element to a set of document type codes configured in the affinity domain. One suggested coding system to use for typeCode is LOINC, in which case the mapping step can be omitted.
A categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.
Comments
Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.
cda: Derived from a mapping of /ClinicalDocument/code/@code to an Affinity Domain specified coded value to use and coding system. Affinity Domains are encouraged to use the appropriate value for Type of Service, based on the LOINC Type of Service (see Page 53 of the LOINC User's Manual). Must be consistent with /ClinicalDocument/code/@code
Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.subject
w5: FiveWs.subject[x]
fhircomposition: Composition.subject
v2: PID-3 (No standard way to define a Practitioner or Group subject in HL7 v2 MDM message)
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.performer.actor
fhircomposition: Composition.author
v2: TXA-9 (No standard way to indicate a Device in HL7 v2 MDM message)
Which person or organization authenticates that this document is valid.
Comments
Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Identifies the organization or group who is responsible for ongoing maintenance of and access to the document.
Comments
Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.performer.actor
fhircomposition: Composition.custodian
rim: .participation[typeCode="RCV"].role[classCode="CUST"].scoper[classCode="ORG" and determinerCode="INST"]
There are no (further) constraints on this element
Element id
DocumentReference.relatesTo.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
DocumentReference.relatesTo.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
A set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to.
Requirements
Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.
Comments
The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce.
In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects.
There are no (further) constraints on this element
Element id
DocumentReference.content.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
DocumentReference.content.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
The document or URL of the document along with critical metadata to prove content has integrity.
Comments
When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".
There are no (further) constraints on this element
Element id
DocumentReference.context.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
DocumentReference.context.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
Describes the clinical encounter or type of care that the document content is associated with.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.context
w5: FiveWs.context
fhircomposition: Composition.encounter
rim: unique(highest(./outboundRelationship[typeCode="SUBJ" and isNormalActRelationship()], priorityNumber)/target[moodCode="EVN" and classCode=("ENC", "PCPR") and isNormalAct])
This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the type Code, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.
Comments
An event can further specialize the act inherent in the type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more event codes are included, they shall not conflict with the values inherent in the class or type elements as such a conflict would create an ambiguous situation.
The time period over which the service that is described by the document was provided.
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
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.
Additional details about where the content was created (e.g. clinical specialty)
Definition
This property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.
Requirements
This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.
Comments
This element should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC.
The Patient Information as known when the document was published. May be a reference to a version specific, or contained.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
fhircomposition: Composition.event.detail
rim: ./outboundRelationship[typeCode="PERT" and isNormalActRelationship()] / target[isNormalAct]
SHOULD be present if related to a patient. Reference to the Patient this data file is pertaining to. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS
Human readable description for the data file. NOTE: this is being used in place of DocumentReference.type until suitable LOINC or SNOMED CT concepts are identified for the file types expected.
"description": "Phenotype Report",
content
SHOULD be a DRS compatible reference to the data file.
In all cases the DocumentReference SHOULD reference the DNA Specimen from which the data originated, where available, and the ServiceRequest which triggered the capture of the data.
The DiagnosticReport using the data file SHOULD reference the DocumentReference via the DiagnosticReport.extension:supporting-info element. This guidance will be updated upon release of the R5 backport of DiagnosticReport.media, allowing references to DocumentReference. Once backported, the DiagnosticReport.media.link SHOULD be used to reference the DocumentReference resources for data files analysed for the report instead.
For collecting relevant Family Member History to aid interpretation of Genomic results. This is limited to collection of Pedigree information. The FamilyMemberHistory resource is not to be used to record participants involved in testing, e.g. in the case of Duo/Trio scenarios (in this case the RelatedPerson resource SHOULD be used instead.
The Genomics FamilyMemberHistory is currently pending Clinical and Technical Assurance of the base UKCore resource. Once this profile becomes active in UKCore its suitability for use and need for profiling within Genomics will be assessed.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
fhs-1: Can have age[x] or born[x], but not both age.empty() or born.empty()
fhs-2: Can only have estimatedAge if age[x] is present age.exists() or estimatedAge.empty()
There are no (further) constraints on this element
Element id
FamilyMemberHistory.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
FamilyMemberHistory.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
FamilyMemberHistory.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
FamilyMemberHistory.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
This extension is used to reference an associated encounter.
Alternate names
extensions, user content
Definition
An associated encounter reference.
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.
Who or what participated in the activities related to the family member history. This is a R5 backport.
Alternate names
extensions, user content
Definition
An extension to record who or what participated in the activities related to the family member history.
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.
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.
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.
The type of involvement in the activities related to the family member history.
Alternate names
extensions, user content
Definition
Distinguishes the type of involvement of the actor in the activities related to the family member history.
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.
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.
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.
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
The type of involvement in the activities related to the family member history
Definition
This FHIR value set is comprised of Actor participation Type codes, which can be used to value FHIR agents, actors, and other role elements. The codes are intended to express how the agent participated in some activity. Sometimes referred to the agent functional-role relative to the activity.
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Who or what participated in the activities related to the family member history.
Alternate names
extensions, user content
Definition
Indicates who or what participated in the activities related to the family member history.
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.
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.
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.
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
There are no (further) constraints on this element
Element id
FamilyMemberHistory.extension:participantR5.url
Short description
identifies the meaning of the extension
Definition
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
There are no (further) constraints on this element
Element id
FamilyMemberHistory.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
There are no (further) constraints on this element
Element id
FamilyMemberHistory.identifier
Short description
External Id(s) for this record
Definition
Business identifiers assigned to this family member history by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
Requirements
Allows identification of the family member history as it is known by various participating systems and in a way that remains consistent across servers.
Comments
This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
There are no (further) constraints on this element
Element id
FamilyMemberHistory.instantiatesCanonical
Short description
Instantiates FHIR protocol or definition
Definition
The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this FamilyMemberHistory.
There are no (further) constraints on this element
Element id
FamilyMemberHistory.instantiatesUri
Short description
Instantiates external protocol or definition
Definition
The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this FamilyMemberHistory.
Comments
This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
There are no (further) constraints on this element
Element id
FamilyMemberHistory.sex
Short description
male | female | other | unknown
Definition
The birth sex of the family member.
Requirements
Not all relationship codes imply sex and the relative's sex can be relevant for risk assessments.
Comments
This element should ideally reflect whether the individual is genetically male or female. However, as reported information based on the knowledge of the patient or reporting friend/relative, there may be situations where the reported sex might not be totally accurate. E.g. 'Aunt Sue' might be XY rather than XX. Questions soliciting this information should be phrased to encourage capture of genetic sex where known. However, systems performing analysis should also allow for the possibility of imprecision with this element.
There are no (further) constraints on this element
Element id
FamilyMemberHistory.estimatedAge
Short description
Age is estimated?
Definition
If true, indicates that the age value specified is an estimated value.
Requirements
Clinicians often prefer to specify an estimaged age rather than an age range.
Comments
This element is labeled as a modifier because the fact that age is estimated can/should change the results of any algorithm that calculates based on the specified age.
Meaning when missing
It is unknown whether the age is an estimate or not
There are no (further) constraints on this element
Element id
FamilyMemberHistory.note
Short description
General note about related person
Definition
This property allows a non condition-specific note to the made about the related person. Ideally, the note would be in the condition property, but this is not always possible.
The significant Conditions (or condition) that the family member had. This is a repeating section to allow a system to represent more than one condition per resource, though there is nothing stopping multiple resources - one per condition.
There are no (further) constraints on this element
Element id
FamilyMemberHistory.condition.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
FamilyMemberHistory.condition.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
The actual condition specified. Could be a coded condition (like MI or Diabetes) or a less specific string like 'cancer' depending on how much is known about the condition and the capabilities of the creating system.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
onset[x]
0..1
There are no (further) constraints on this element
Element id
FamilyMemberHistory.condition.onset[x]
Short description
When condition first manifested
Definition
Either the age of onset, range of approximate age or descriptive string can be recorded. For conditions with multiple occurrences, this describes the first known occurrence.
Requirements
Age of onset of a condition in relatives is predictive of risk for the patient.
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="Subject Age at measurement", value<Diagnosis].value[@xsi:typeCode='TS' or 'IVL_TS'] Use originalText for string
N/A not in scope for HL7v2, could be added as additional DG1 segments related to relatives (representation of family history in HL7v2 still pending investigation)
This SHOULD be NHS number or local identifier (if NHS number is unavailable e.g. for non UK residents). If a local identifier is used, an assigner SHALL be provided.
The FamilyMemberHistory.identifier field SHALL match the identifier used for a RelatedPerson resource if the same person is being referenced.
Used to mark the completeness of a given family member's clinical history. If the history of a family member is expected but no history could be obtained, this element SHOULD be filled with 'health-unknown'.
SHALL be present. Reference to the associated proband Patient for which this family history is being obtained. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS
SHALL be present. Relationship between the person the FamilyMemberHistory references and the proband Patient. Clinical histories for each family member are expected to be recorded in separate FamilyMemberHistory resources. If multiple resources are required, both FamilyMemberHistory and related clinical artifacts such as Condition/Observation resources, these MAY be contained within a List resource to improve readability.
For recording patients which are part of a family unit, assigned a Pedigree Number by a clinical genetics service.
Pedigree numbers are generated upon referral of a patient to clinical genetics and are applied to all forms of correspondence from patient letters to genomic orders.
These are therefore owned by clinical genetics and referenced back by processing labs.
Some pedigree numbers reference the relationship between the family members to the original proband, other just have a general pedigree number which relates to all family members.
There is disparity in approach across the GU.
Patients can multiple pedigree numbers.
Single pedigree numbers can also span multiple families with a common patient.
Represents a defined collection of entities that may be discussed or acted upon collectively but which are not expected to act collectively, and are not formally or legally recognized; i.e. a collection of entities that isn't an Organization.
Comments
If both Group.characteristic and Group.member are present, then the members are the individuals who were found who met the characteristic. It's possible that there might be other candidate members who meet the characteristic and aren't (yet) in the list. All members SHALL have the listed characteristics.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
grp-1: Can only have members if group is "actual" member.empty() or (actual = true)
Mappings
rim: Entity. Role, or Act
rim: Entity[determinerCode="GRP" or determinerCode="GRP_KIND"]
There are no (further) constraints on this element
Element id
Group.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Group.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Group.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Group.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Group.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
Group.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - 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
w5: FiveWs.identifier
rim: unique(./id[displayable="true" and scope="OBJ"])
Indicates whether the record for the group is available for use or is merely being retained for historical purposes.
Requirements
Need to be able to mark a group record as not to be used because it was created in error or is otherwise no longer available (e.g. a herd that no longer exists).
Meaning when missing
This resource is generally assumed to be active if no value is provided for the active element
Identifies the broad classification of the kind of resources the group includes.
Requirements
Identifies what type of resources the group is made up of.
Comments
Group members SHALL be of the appropriate resource type (Patient for person or animal; or Practitioner, Device, Medication or Substance for the other types.).
If true, indicates that the resource refers to a specific group of real individuals. If false, the group defines a set of intended individuals.
Requirements
There are use-cases for groups that define specific collections of individuals, and other groups that define "types" of intended individuals. The requirements for both kinds of groups are similar, so we use a single resource, distinguished by this flag.
Entity that is the custodian of the Group's definition
Definition
Entity responsible for defining and maintaining Group characteristics and/or registered members.
Comments
This does not strictly align with ownership of a herd or flock, but may suffice to represent that relationship in simple cases. More complex cases will require an extension.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Group.characteristic.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Group.characteristic.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
A code that identifies the kind of trait being asserted.
Requirements
Need a formal way of identifying the characteristic being described.
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.
The period over which the characteristic is tested; e.g. the patient had an operation during the month of June.
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Group.member.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Group.member.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
A reference to the entity that is a member of the group. Must be consistent with Group.type. If the entity is another group, then the type must be the same.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
The period that the member was in the group, if known.
Requirements
Need to track who was in a group at a particular time.
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
SHALL be present. The Pedigree Number assigned by the clinical genetics service. The central pedigree NamingSystem SHOULD be used to support cross region sharing of pedigree/family unit information.
For Pedigrees a fixed value of "person" SHALL be used
"type": "person",
actual
For Pedigrees a fixed value of true SHALL be used
"actual": true,
member
SHALL be present. `entity` SHOULD be a reference to a Patient resource within the GOMS infrastructure or a unique identifier where this is not possible. `period` SHOULD record the date the member was added to the Group. `inactive` MAY be used to record entities which are no longer members of the group, though if an individual was added to a Group in error and should never have been part of the group, the entity SHALL be removed entirely.
Used to represent the bulk of clinical information to be sent alongside a Genomic Test Order, as well as clinical results included within structured Diagnostic Reports.
Observations within Genomics are used to represent a point-in-time observation made about a patient or specimen. This means Observations SHOULD NOT be updated post-submission unless the original Observation has been entered in error or incorrectly coded (in this case, the appropriate status SHALL be used, e.g. entered-in-error or corrected).
For new observations which invalidate previous observations made about a patient, a new Observation resource SHOULD be created, the new observation MAY reference the invalidated observation via the observation-replaces extension.
There are no (further) constraints on this element
Element id
Observation
Short description
Measurements and simple assertions
Alternate names
Vital Signs, Measurement, Results, Tests
Definition
Measurements and simple assertions made about a patient, device or other subject.
Comments
Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present dataAbsentReason.empty() or value.empty()
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
There are no (further) constraints on this element
Element id
Observation.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Observation.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Observation.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Observation.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
Identifies the observation(s) that triggered the performance of this observation.
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.
There are no (further) constraints on this element
Element id
Observation.extension:triggeredByR5.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
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.
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.
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.
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
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.
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.
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.
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Provides the reason why this observation was performed as a result of the observation(s) referenced.
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.
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.
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.
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
There are no (further) constraints on this element
Element id
Observation.extension:triggeredByR5.url
Short description
identifies the meaning of the extension
Definition
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Indicates the body structure on the subject's body where the observation was made (i.e. the target site).
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.
There are no (further) constraints on this element
Element id
Observation.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
workflow: Event.identifier
w5: FiveWs.identifier
v2: OBX.21 For OBX segments from systems without OBX-21 support a combination of ORC/OBR and OBX must be negotiated between trading partners to uniquely identify the OBX segment. Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4.
There are no (further) constraints on this element
Element id
Observation.basedOn
Short description
Fulfills plan, proposal or order
Alternate names
Fulfills
Definition
A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.
Requirements
Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
A code that classifies the general type of observation being made.
Definition
A code that classifies the general type of observation being made.
Requirements
Used for filtering what observations are retrieved and displayed.
Comments
In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.
Describes what was observed. Sometimes this is called the observation "name".
Requirements
Knowing what kind of observation is being made is essential to understanding the observation.
Comments
All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.
The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the focus element or the code itself specifies the actual focus of the observation.
Requirements
Observations have no value if you don't know who or what they're about.
Comments
One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.
There are no (further) constraints on this element
Element id
Observation.focus
Short description
What the observation is about, when it is not about the subject of record
Definition
The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.
Comments
Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use specimen if a reference to a specimen is required. If a code is required instead of a resource use either bodysite for bodysites or the standard extension focusCode.
There are no (further) constraints on this element
Element id
Observation.encounter
Short description
Healthcare event during which this observation is made
Alternate names
Context
Definition
The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.
Requirements
For some observations it may be important to know the link between an observation and a particular encounter.
Comments
This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).
A clinically relevant time / time-period for observation.
Alternate names
Occurrence
Definition
The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.
Requirements
Knowing when an observation was deemed true is important to its relevance as well as determining trends.
Comments
At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
workflow: Event.occurrence[x]
w5: FiveWs.done[x]
v2: OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)
There are no (further) constraints on this element
Element id
Observation.issued
Short description
Date/Time this version was made available
Definition
The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.
Comments
For Observations that don’t require review and verification, it may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.
The information determined as a result of making the observation, if the information has a simple value.
Requirements
An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.
Comments
An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.
Conditions
The cardinality or value of this element may be affected by these constraints: obs-7
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
There are no (further) constraints on this element
Element id
Observation.dataAbsentReason
Short description
Why the result is missing
Definition
Provides a reason why the expected value in the element Observation.value[x] is missing.
Requirements
For many results it is necessary to handle exceptional values in measurements.
Comments
Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory".
The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.
There are no (further) constraints on this element
Element id
Observation.interpretation
Short description
High, low, normal, etc.
Alternate names
Abnormal Flag
Definition
A categorical assessment of an observation value. For example, high, low, normal.
Requirements
For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Comments
Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.
There are no (further) constraints on this element
Element id
Observation.note
Short description
Comments about the observation
Definition
Comments about the observation or the results.
Requirements
Need to be able to provide free text additional information.
Comments
May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.
Indicates the site on the subject's body where the observation was made (i.e. the target site).
Comments
Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component.
If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite.
There are no (further) constraints on this element
Element id
Observation.specimen
Short description
Specimen used for this observation
Definition
The specimen that was used when this observation was made.
Comments
Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).
There are no (further) constraints on this element
Element id
Observation.device
Short description
(Measurement) Device
Definition
The device used to generate the observation data.
Comments
Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.
There are no (further) constraints on this element
Element id
Observation.referenceRange
Short description
Provides guide for interpretation
Definition
Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two referenceRange elements would be used.
Requirements
Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.
Comments
Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
There are no (further) constraints on this element
Element id
Observation.referenceRange.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Observation.referenceRange.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
Observation.referenceRange.low
Short description
Low Range, if relevant
Definition
The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).
There are no (further) constraints on this element
Element id
Observation.referenceRange.high
Short description
High Range, if relevant
Definition
The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
sct-concept: < 260245000 |Findings values| OR
< 365860008 |General clinical state finding|
OR
< 250171008 |Clinical history or observation findings| OR
< 415229000 |Racial group| OR
< 365400002 |Finding of puberty stage| OR
< 443938003 |Procedure carried out on subject|
There are no (further) constraints on this element
Element id
Observation.referenceRange.appliesTo
Short description
Reference range population
Definition
Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple appliesTo are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.
Requirements
Need to be able to identify the target population for proper interpretation.
Comments
This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
sct-concept: < 260245000 |Findings values| OR
< 365860008 |General clinical state finding|
OR
< 250171008 |Clinical history or observation findings| OR
< 415229000 |Racial group| OR
< 365400002 |Finding of puberty stage| OR
< 443938003 |Procedure carried out on subject|
There are no (further) constraints on this element
Element id
Observation.referenceRange.text
Short description
Text based reference range in an observation
Definition
Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals".
There are no (further) constraints on this element
Element id
Observation.hasMember
Short description
Related resource that belongs to the Observation group
Definition
This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.
Comments
When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.
There are no (further) constraints on this element
Element id
Observation.derivedFrom
Short description
Related measurements the observation is made from
Definition
The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.
Comments
All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see Notes below.
Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.
Requirements
Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.
Comments
For a discussion on the ways Observations can be assembled in groups together see Notes below.
There are no (further) constraints on this element
Element id
Observation.component.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Observation.component.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
w5: FiveWs.what[x]
sct-concept: < 363787002 |Observable entity| OR
< 386053000 |Evaluation procedure|
v2: OBX-3
rim: code
value[x]
Σ
0..1
There are no (further) constraints on this element
Element id
Observation.component.value[x]
Short description
Actual component result
Definition
The information determined as a result of making the observation, if the information has a simple value.
Requirements
An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.
Comments
Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
There are no (further) constraints on this element
Element id
Observation.component.dataAbsentReason
Short description
Why the component result is missing
Definition
Provides a reason why the expected value in the element Observation.component.value[x] is missing.
Requirements
For many results it is necessary to handle exceptional values in measurements.
Comments
"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".
The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.
There are no (further) constraints on this element
Element id
Observation.component.interpretation
Short description
High, low, normal, etc.
Alternate names
Abnormal Flag
Definition
A categorical assessment of an observation value. For example, high, low, normal.
Requirements
For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Comments
Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.
There are no (further) constraints on this element
Element id
Observation.component.referenceRange
Short description
Provides guide for interpretation of component result
Definition
Guidance on how to interpret the value by comparison to a normal or recommended range.
Requirements
Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.
Comments
Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Raw specimen/biopsy - Additional specimen/biopsy information, Extracted specimen - Additional specimen information, Further clinical information
OBX segments (may be attached to SPM)
Observation.code
Patient - Sexual orientation, Patient - Karyotypic sex, Patient - Pregnancy status, Patient - Fetal karyotypic sex, Patient - Is from consanguinous union, Fetus - Karyotypic sex, Fetus - Is testing for fetal loss from 24 weeks of gestation, PLCM activity - DNA concentration, PLCM activity - DNA quantification, PLCM activity - Test outcome code (Many), Raw specimen/biopsy - Taken alive/post mortem, Diabetic complications, Has absent reflexes
OBX-14 (compared with other ORC segments), OBR segments with appropriate codes
Observation.value\[x\]
Patient - Height (m), Raw specimen/biopsy - Skin/Bone affected status, Raw specimen/biopsy - Blasts %, Raw specimen/biopsy - Neoplastic cell content (%), Raw specimen/biopsy - Necrosis, Raw specimen/biopsy - Nucleated cell count, Raw specimen/biopsy - Tumour cellularity, Raw specimen/biopsy - Maternal cell contamination (MCC), Previous non genomic report - Test result value comparator, Previous non genomic report - Test result value unit of measure, Genomic ethnicity, ISTH BAT score, MODY probability calculator score, Patient BMI at time of genomic test request, Patient BMI at time of diagnosis, Maternal BMI at time of request, Paternal BMI at time of request, Birth weight
OBX-5/6
Observation.referenceRange.low
Previous non genomic report - Test result reference range low
OBX-7 (before operator)
Observation.referenceRange.high
Previous non genomic report - Test result reference range high
OBX-7 (after operator)
Observation.method
Previous non genomic report - Test result test method
OBX-17
Observation.referenceRange.text
Previous non genomic report - Test result reference range text
OBX-7
Observation.interpretation
Previous non genomic report - Test result clinical summary
OBX-8
Observation.bodySite
Subcutaneous fat loss areas, Increased fat deposition areas
A core extension on the base HL7 International Observation resource. Used to link to previous Observation resources which have been invalidated by this Observation instance, e.g. for cases where a previously present HPO term is now no longer applicable. For new observations which invalidate previous observations made about a patient, the new Observation resource SHOULD be created, and MAY reference the invalidated observation via the observation-replaces extension.
SHOULD be marked as final for most observations unless corrected after submission. Observations within Genomics are used to represent a point-in-time observation made about a patient or specimen. This means Observations should not be updated post-submission unless the original Observation has been entered in error or incorrectly coded (in this case, the appropriate status SHALL be used, e.g. entered-in-error or corrected, respectively).
"status": "final",
code
SHALL be present. SNOMED CT coding is preferred, though it is expected that alternative codings will be used depending on the appropriateness for a particular observation e.g. HPO or other codings found within the HL7 International Genomic Reporting IG as their use may already be widespread within Genomics. If a SNOMED CT equivalent exists for a code regularly captured within another CodeSystem, additional 'coding' elements within 'code' SHOULD be provided to aid analytics.
SHALL be present. Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS
For recording the Specimen the observation relates to, when the observation is not related to the patient from which the sample was taken e.g. Sample nucleated cell count.
This can also be used for observations related to the state of the patient at the time of collection e.g. pregnancy status.
It is expected that all Observations SHOULD include the effective time the observation was made, if known, to aid interpretation.
"effectiveDateTime": "2022-07-11T09:00:00Z",
value[x]
The value element SHOULD use the most appropriate data type for the observation in question. Using preferred CodeSystems as specified within HL7 International FHIR R4 or the UK Core. For asserting absence of a particular condition/situation, the finding SHOULD be specified within the 'code' element and 'valueBoolean' set to 'false' or 'valueCodeableConcept' set to an appropriate qualifier value code from SNOMED CT. For an assertion of a particular situation being present, e.g. a Condition or Procedure having been performed, these SHOULD be collected within the relevant clinical resources, alongside additional information needed to inform interpretation.
SHOULD be used to group qualifiers of an observation. In particular, details regarding observations related to a pregnancy SHOULD be added as components on a pregnancy status observation.
Examples of how pregnancy information can be captured within Observations (pregnancy status with EDD, gestation etc. recorded as components) will be added to the Fetus Management Clinical Scenario.
The Genomics OperationOutcome is the same as provided within FHIR R4. The FHIR R4 OperationOutcome is provided below for completeness.
OperationOutcomes are expected for any create or update operations made on the server resulting in validation messages (or any create or update operations made within a transaction bundle). It is not expected that connecting systems would need to construct OperationOutcome resources or submit these to the server, though key elements within the resource are detailed here for receiving systems.
It is expected that all issue codes raised by the Genomic Medicine Service will fall under existing codes bound in the below resource. If further codes are needed, these will be promoted to UK Core for release in a future ballot/sprint.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
Mappings
rim: Entity. Role, or Act
rim: Grouping is handled through multiple repetitions from whatever context references the outcomes (no specific grouper required)
There are no (further) constraints on this element
Element id
OperationOutcome.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
OperationOutcome.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
OperationOutcome.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
OperationOutcome.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
OperationOutcome.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
OperationOutcome.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
There are no (further) constraints on this element
Element id
OperationOutcome.issue.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
OperationOutcome.issue.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
v2: ERR-4
rim: ./typeCode[parent::AcknowledgmentDetail] or unique(./inboundRelationship[parent::Observation and typeCode='SUBJ' and isNormalActRelationship()]/source[classCode="OBS" and moodCode="EVN" and implies(code, ActCode#SEV and isNormalAct())/value[xsi:type="CD"]
Describes the type of the issue. The system that creates an OperationOutcome SHALL choose the most applicable code from the IssueType value set, and may additional provide its own code for the error in the details element.
Requirements
Expresses the issue in a human and computer-friendly way, allowing the requesting system to behave differently based on the type of issue.
The required element provides a base level of computable interoperability across all systems for processing an outcome, allowing systems to respond appropriately regardless of the internal system error codes returned.
This element is deprecated because it is XML specific. It is replaced by issue.expression, which is format independent, and simpler to parse.
For resource issues, this will be a simple XPath limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised. For HTTP errors, will be "http." + the parameter name.
Requirements
Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily.
Comments
The root of the XPath is the resource or bundle that generated OperationOutcome. Each XPath SHALL resolve to a single node. This element is deprecated, and is being replaced by expression.
A simple subset of FHIRPath limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised.
Requirements
Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily.
Comments
The root of the FHIRPath is the resource or bundle that generated OperationOutcome. Each FHIRPath SHALL resolve to a single node.
An issue element will be included within the OperationOutcome for each issue that needs to be communicated to the requesting system, e.g. errors, warnings or informational messages. Appropriate 'severity' and 'code' codes will be assigned to help categorization of an messages returned, using the standard HL7 bound ValueSets.
The diagnostics field will be used to present a human readable version of the message and location will be used to detail the location within the request payload that resulted in the associated issue/message.
If an error or warning is returned, the 'details' element will be populated with any validation specific messages. Details of the systems and codes used for these messages will be determined by the validation package used by the central order management broker (this is still to be determined at the time of publication).
"issue":[
{
"severity":"error",
"code":"processing",
"details":{
"coding":[
{
"system": "http://terminology.hl7.org/CodeSystem/operation-outcome",
"code": "MSG_LOCAL_FAIL",
"display": "Unable to resolve local reference to resource Patient/Patient-MeirLieberman-Example"
}
]
},
"diagnostics": "Validation errors occurred during processing",
"location": [
"Bundle.entry[1].resource.ofType(ServiceRequest)"
]
}
]
StructureDefinition UKCore-Organization
Organization is not expected to be sent within Test Order or other interactions with the central GMS. Instead, client systems SHOULD strive to reference organizations via their ODS code and display name only.
The below profile is provided for information, if referencing by ODS code is intractable (though repeated issues with requester ability to reference via ODS code SHOULD be reported to the NHS England Genomic Unit for investigation).
There are no (further) constraints on this element
Element id
Organization
Short description
A grouping of people or organizations with a common purpose
Definition
A formally or informally recognized grouping of people or organizations formed for the purpose of achieving some form of collective action. Includes companies, institutions, corporations, departments, community groups, healthcare practice groups, payer/insurer, etc.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
org-1: The organization SHALL at least have a name or an identifier, and possibly more than one (identifier.count() + name.count()) > 0
There are no (further) constraints on this element
Element id
Organization.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Organization.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Organization.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Organization.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
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.
The date range that this organization SHOULD be considered available.
Alternate names
extensions, user content
Definition
The date range that this organization SHOULD be considered available.
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.
There are no (further) constraints on this element
Element id
Organization.extension:organizationPeriod.url
Short description
identifies the meaning of the extension
Definition
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
There are no (further) constraints on this element
Element id
Organization.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
Identifies this organization across multiple systems.
Definition
Identifier for the organization that is used to identify the organization across multiple disparate systems.
Requirements
Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization.
Identifier code supplier by the Organisation Data Service.
Requirements
Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization.
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.
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.
There are no (further) constraints on this element
Element id
Organization.identifier:odsOrganisationCode.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements
Allows users to make use of identifiers when the identifier system is not known.
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Organization.identifier:odsOrganisationCode.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ODS Site code to identify the organisation at site level
Definition
ODS Site code to identify the organisation at site level.
Requirements
Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization.
There are no (further) constraints on this element
Element id
Organization.identifier:odsSiteCode.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Organization.identifier:odsSiteCode.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements
Allows users to make use of identifiers when the identifier system is not known.
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Organization.identifier:odsSiteCode.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Organization.identifier:odsSiteCode.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Identifies this organization across multiple systems.
Definition
Whether the organization's record is still in active use.
Requirements
Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.
Comments
This active flag is not intended to be used to mark an organization as temporarily closed or under construction. Instead the Location(s) within the Organization should have the suspended status. If further details of the reason for the suspension are required, then an extension on this element should be used.
This element is labeled as a modifier because it may be used to mark that the resource was created in error.
Meaning when missing
This resource is generally assumed to be active if no value is provided for the active element
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
w5: FiveWs.status
v2: No equivalent in HL7 v2
rim: .status
servd: ./Status (however this concept in ServD more covers why the organization is active or not, could be delisted, deregistered, not operational yet) this could alternatively be derived from ./StartDate and ./EndDate and given a context date.
Need to be able to track the kind of organization that this is - different organization types have different uses.
Comments
Organizations can be corporations, wards, sections, clinical teams, government departments, etc. Note that code is generally a classifier of the type of organization; in many applications, codes are used to identity a particular organization (say, ward) as opposed to another of the same type - these are identifiers, not codes
When considering if multiple types are appropriate, you should evaluate if child organizations would be a more appropriate use of the concept, as different types likely are in different sub-areas of the organization. This is most likely to be used where type values have orthogonal values, such as a religious, academic and medical center.
We expect that some jurisdictions will profile this optionality to be a single cardinality.
There are no (further) constraints on this element
Element id
Organization.alias
Short description
A list of alternate names that the organization is known as, or was known as in the past
Definition
A list of alternate names that the organization is known as, or was known as in the past.
Requirements
Over time locations and organizations go through many changes and can be known by different names.
For searching knowing previous names that the organization was known by can be very useful.
Comments
There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the organization.
The use code 'home' is not to be used. Note that these contacts are not the contact details of people who are employed by or represent the organization, but official contacts for the organization itself.
There are no (further) constraints on this element
Element id
Organization.contact
Short description
Contact for the organization for a certain purpose
Definition
Contact for the organization for a certain purpose.
Requirements
Need to keep track of assigned contact points within bigger organization.
Comments
Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.
There are no (further) constraints on this element
Element id
Organization.contact.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Organization.contact.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
Organization.endpoint
Short description
Technical endpoints providing access to services operated for the organization
Definition
Technical endpoints providing access to services operated for the organization.
Requirements
Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.
The focal resource for recording who a test order and genomic report are for.
It is expected that client's will need to post Patient resources to the central GMS as some demographic information specific to Genomics will not have been captured within other systems such as PDS.
For patients included within PDS, it is expected source systems SHOULD only send genomic specific information not recorded against PDS, e.g. extensions, such as birthSex, genomic specific identifiers and a link to the PDS record, as well as the NHS number identifier. (NOTE: examples provided for patient resources are fully expanded to illustrate how information should be structured but any infomation already recorded by PDS SHOULD NOT be duplicated within the genomic order management services). Querying patient demographic information, will be supported using the search parameters provided by the Genomic Order Management Service, whch will pass through parameters to PDS where demographics are stored against this system. Client systems will then be required to follow the PDS link within the Genomics-Patient record to retrieve the PDS patient.
It is a requirement on source systems that patient NHS numbers are traced and verified with PDS, if the patient is registered with PDS, before creation of patient resources on the Genomic Order Management broker
For patients not included on PDS, e.g. private/overseas patients or fetal records, the requester SHOULD send all information necessary to facilitate testing and interpretation of the request. Where this patient is later registered on PDS, identified through assignment of an NHS number, demographic details SHALL be stripped from the genomic record to avoid data duplication.
Alternatively, systems MAY opt to include pointers to the Patient resource on their local system, though the mechanism preferred by the NHS England Genomics Unit has yet to be decided.
Restricted Patients: PDS guidance on managing the data of sensitive patient shall be followed. Some patients are tagged as restricted and are sometimes known as sensitive patients. Restricted patients can be retrieved; however, location-sensitive fields such as address, telecom and generalPractitioner are removed.
The restricted flag can be found in the data under meta/security on the patient resource. See in Example: Patient-SensitivePatient-Example
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
There are no (further) constraints on this element
Element id
Patient.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Patient.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Patient.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Patient.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
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.
There are no (further) constraints on this element
Element id
Patient.extension:birthPlace.url
Short description
identifies the meaning of the extension
Definition
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
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.
Flag indicating whether the patient authorized the donation of body parts after death.
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.
There are no (further) constraints on this element
Element id
Patient.extension:cadavericDonor.url
Short description
identifies the meaning of the extension
Definition
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
The preferred method of contact, contact times and written communication format given by a Patient or Related Person.
Alternate names
extensions, user content
Definition
The preferred method of contact, contact times and written communication format given by a Patient or Related Person.
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.
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.
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.
Typically used in maternity where the patient record may be created before the birth of the baby.
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.
The residential status of the patient. For example if this patient is a UK resident.
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.
Indicator showing whether the patient needs an interpreter.
Alternate names
extensions, user content
Definition
This Patient requires an interpreter to communicate healthcare information to the practitioner.
Comments
The Patient does not speak the default language of the organization, and hence requires an interpreter. If the patient has other languages in the Communications list, then that would be the type of interpreter required.
There are no (further) constraints on this element
Element id
Patient.extension:patientInterpreterRequired.url
Short description
identifies the meaning of the extension
Definition
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Reason why this Patient does not include an NHS Number identifier.
Alternate names
extensions, user content
Definition
The reason why a patient does not have an NHS Number. For example if this patient is an overseas patient.
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.
There are no (further) constraints on this element
Element id
Patient.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
There are no (further) constraints on this element
Element id
Patient.identifier:nhsNumber.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
The verification/tracing status of the NHS number.
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.
There are no (further) constraints on this element
Element id
Patient.identifier:nhsNumber.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Requirements
Allows users to make use of identifiers when the identifier system is not known.
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Patient.identifier:nhsNumber.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Patient.identifier:nhsNumber.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Whether this patient record is in active use.
Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.
It is often used to filter patient lists to exclude inactive patients
Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.
Requirements
Need to be able to mark a patient record as not to be used because it was created in error.
Comments
If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.
Meaning when missing
This resource is generally assumed to be active if no value is provided for the active element
Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
Comments
A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.
A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
Requirements
People have (primary) ways to contact them in some way such as phone, email.
Comments
A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).
There are no (further) constraints on this element
Element id
Patient.telecom.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
Information about other contact methods which could be used in addition to those listed in `ContactPoint.system`.
Alternate names
extensions, user content
Definition
Other contact system value which extends the system element in the ContactPoint datatype.
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.
There are no (further) constraints on this element
Element id
Patient.telecom.rank
Short description
Specify preferred order of use (1 = highest)
Definition
Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
Comments
Note that rank does not necessarily follow the order in which the contacts are represented in the instance.
The gender that the patient is considered to have for administration and record keeping purposes.
Definition
Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
Requirements
Needed for identification of the individual, in combination with (at least) name and birth date.
Comments
The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.
Age of the individual drives many clinical processes.
Comments
At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
The time of day that the patient was born. This SHOULD be included when the birth time is relevant.
Alternate names
extensions, user content
Definition
The time of day that the patient was born. This includes the date to ensure that the timezone information can be communicated effectively.
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.
There are no (further) constraints on this element
Element id
Patient.birthDate.extension:birthTime.url
Short description
identifies the meaning of the extension
Definition
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
There are no (further) constraints on this element
Element id
Patient.birthDate.value
Short description
Primitive value for date
Definition
The actual value
Data type
System.Date
deceased[x]
Σ?!
0..1
There are no (further) constraints on this element
Element id
Patient.deceased[x]
Short description
Indicates if the individual is deceased or not
Definition
Indicates if the individual is deceased or not.
Requirements
The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.
Comments
If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
v2: PID-30 (bool) and PID-29 (datetime)
rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime
There are no (further) constraints on this element
Element id
Patient.address.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
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.
There are no (further) constraints on this element
Element id
Patient.address.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
Patient.address.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
Requirements
A renderable, unencoded form.
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Patient.address.line
Short description
Street name, number, direction & P.O. Box etc.
Definition
This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.
There are no (further) constraints on this element
Element id
Patient.address.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
There are no (further) constraints on this element
Element id
Patient.address.state
Short description
Sub-unit of country (abbreviations ok)
Alternate names
Province, Territory
Definition
Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
v2: PID-16
rim: player[classCode=PSN]/maritalStatusCode
cda: .patient.maritalStatusCode
multipleBirth[x]
0..1
There are no (further) constraints on this element
Element id
Patient.multipleBirth[x]
Short description
Whether patient is part of a multiple birth
Definition
Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
Requirements
For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
Comments
Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
v2: PID-24 (bool), PID-25 (integer)
rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber
There are no (further) constraints on this element
Element id
Patient.contact
Short description
A contact party (e.g. guardian, partner, friend) for the patient
Definition
A contact party (e.g. guardian, partner, friend) for the patient.
Requirements
Need to track people you can contact about the patient.
Comments
Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
pat-1: SHALL at least contain a contact's details or a reference to an organization name.exists() or telecom.exists() or address.exists() or organization.exists()
Mappings
rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]
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.
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.
The preferred ranking or order of contact applied to a contact on a Patient's contact list.
Alternate names
extensions, user content
Definition
The preferred ranking or order of contact applied to a contact on a patient's contact list.
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.
Indicates that a must be copied in to all related correspondence.
Alternate names
extensions, user content
Definition
Extension carrying a boolean indicator showing that a patient's contact or related person SHALL be copied in to patient correspondence.
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.
There are no (further) constraints on this element
Element id
Patient.contact.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
Patient.contact.telecom
Short description
A contact detail for the person
Definition
A contact detail for the person, e.g. a telephone number or an email address.
Requirements
People have (primary) ways to contact them in some way such as phone, email.
Comments
Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
There are no (further) constraints on this element
Element id
Patient.contact.telecom.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
Information about other contact methods which could be used in addition to those listed in `ContactPoint.system`.
Alternate names
extensions, user content
Definition
Other contact system value which extends the system element in the ContactPoint datatype.
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.
There are no (further) constraints on this element
Element id
Patient.contact.telecom.rank
Short description
Specify preferred order of use (1 = highest)
Definition
Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
Comments
Note that rank does not necessarily follow the order in which the contacts are represented in the instance.
There are no (further) constraints on this element
Element id
Patient.communication
Short description
A language which may be used to communicate with the patient about his or her health
Definition
A language which may be used to communicate with the patient about his or her health.
Requirements
If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.
Comments
If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.
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.
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.
The patient's proficiency level of the communication method.
Alternate names
extensions, user content
Definition
Proficiency level of the communication.
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.
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.
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.
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
There are no (further) constraints on this element
Element id
Patient.communication.extension:proficiency.url
Short description
identifies the meaning of the extension
Definition
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
There are no (further) constraints on this element
Element id
Patient.communication.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
A ValueSet that identifies the language used by a person.
Definition
A ValueSet that identifies the language used by a person.
Requirements
Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
Comments
The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
There are no (further) constraints on this element
Element id
Patient.communication.preferred
Short description
Language preference indicator
Definition
Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
Requirements
People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.
Comments
This language is specifically identified for communicating healthcare information.
There are no (further) constraints on this element
Element id
Patient.generalPractitioner
Short description
Patient's nominated primary care provider
Alternate names
careProvider
Definition
Patient's nominated care provider.
Comments
This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources.
Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.
Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.
There are no (further) constraints on this element
Element id
Patient.managingOrganization
Short description
Organization that is the custodian of the patient record
Definition
Organization that is the custodian of the patient record.
Requirements
Need to know who recognizes this patient record, manages and updates it.
Comments
There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).
There are no (further) constraints on this element
Element id
Patient.link.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Patient.link.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
SHALL be present for Patients within the Genomic Order Management ecosystem. It is preferred that all patients with an NHS number have this included within the Patient resource upon submission of a test order. Patient who do not have an NHS number SHOULD have a temporary one registered/assigned with PDS.
For patient records where the NHS number has been traced from PDS, the trace status SHOULD be provided within the NHS Number identifier slice.
Additional identifiers SHOULD include an appropriate naming system scheme which clearly identifies the assigner (to disambiguate the identifier from other resources where these are not nationally unique). Alternatively, the OID for local identifier MAY be used, with the 'assigner' organization explicitly referenced.
Where patients are registered with a General Practitioner within the UK, both the ODS code for the practice and GMP number for the practitioner SHOULD be provided, where known, as separate objects within the generalPractitioner array.
For patient records where additional information exists elsewhere, for example, within PDS or the source system EHR, this MAY be referenced through the link field, specifying the url through which the related patient information can be accessed.
Practitioner is not expected to be sent within Test Order or other interactions with the central GMS. Instead, client systems SHOULD strive to reference practitioners via their identifier within a national coding system and display name only.
The below profile is provided for information, if referencing by identifier is intractable (though repeated issues with requester ability to reference via identifier/code SHOULD be reported to the NHS England Genomic Unit for investigation).
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
There are no (further) constraints on this element
Element id
Practitioner.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Practitioner.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Practitioner.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Practitioner.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Practitioner.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
Practitioner.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
There are no (further) constraints on this element
Element id
Practitioner.active
Short description
Whether this practitioner's record is in active use
Definition
Whether this practitioner's record is in active use.
Requirements
Need to be able to mark a practitioner record as not to be used because it was created in error.
Comments
If the practitioner is not in use by one organization, then it should mark the period on the PractitonerRole with an end date (even if they are active) as they may be active in another role.
Meaning when missing
This resource is generally assumed to be active if no value is provided for the active element
The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.
Comments
The selection of the use property should ensure that there is a single usual name specified, and others use the nickname (alias), old, or other values as appropriate.
In general, select the value to be used in the ResourceReference.display based on this:
There is more than 1 name
Use = usual
Period is current to the date of the usage
Use = official
Other order as decided by internal business rules.
A contact detail for the practitioner (that apply to all roles).
Definition
A contact detail for the practitioner, e.g. a telephone number or an email address.
Requirements
Need to know how to reach a practitioner independent to any roles the practitioner may have.
Comments
Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.
There are no (further) constraints on this element
Element id
Practitioner.address
Short description
Address(es) of the practitioner that are not role specific (typically home address)
Definition
Address(es) of the practitioner that are not role specific (typically home address).
Work addresses are not typically entered in this property as they are usually role dependent.
Requirements
The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.
Comments
The PractitionerRole does not have an address value on it, as it is expected that the location property be used for this purpose (which has an address).
There are no (further) constraints on this element
Element id
Practitioner.qualification
Short description
Certification, licenses, or training pertaining to the provision of care
Definition
The official certifications, training, and licenses that authorize or otherwise pertain to the provision of care by the practitioner. For example, a medical license issued by a medical board authorizing the practitioner to practice medicine within a certian locality.
There are no (further) constraints on this element
Element id
Practitioner.qualification.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Practitioner.qualification.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
A language the practitioner can use in patient communication
Definition
A language the practitioner can use in patient communication.
Requirements
Knowing which language a practitioner speaks can help in facilitating communication with patients.
Comments
The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
Requestor - Full name, Additional contact - Full name, Patient - GP full name, Previous genomic report - Report performer full name, Previous genomic report - Original requester full name, Previous non genomic report - Report performer full name, Previous non genomic report - Original requester full name
ORC-12, PD1-4.2 and PD1-4.3, OBX-16, ORC-12
Practitioner.identifier
Requestor - Professional registration number, Additional contact - Professional registration number, Patient - GP GMC number
ORC-12.1, PD1-4.1
Practitioner.identifier.system, Additional contact - Professional registration number type
ODS/NACS Practitioner Code (retired). Included for backwards compatibility
No
No
Format
N = any number
A = any alpha
StructureDefinition UKCore-PractitionerRole
PractitionerRole resources SHOULD be used where information about both a practitioner and their role within a specific organization is required, e.g. as the ServiceRequest.requestor.
References to Practitioner and Organization resources SHOULD only be made via identifier, rather than appending Practitioner and Organization resources to test order bundles. Issues with referencing via identifier SHOULD be reported to the NHS England Genomics Unit for investigation.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
There are no (further) constraints on this element
Element id
PractitionerRole.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
PractitionerRole.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
PractitionerRole.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
PractitionerRole.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
PractitionerRole.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
PractitionerRole.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
Whether this practitioner role record is in active use.
Definition
Whether this practitioner role record is in active use.
Requirements
Need to be able to mark a practitioner role record as not to be used because it was created in error, or otherwise no longer in active use.
Comments
If this value is false, you may refer to the period to see when the role was in active use. If there is no period specified, no inference can be made about when it was active.
Meaning when missing
This resource is generally assumed to be active if no value is provided for the active element
servd: (ServD maps Practitioners and Organizations via another entity, so this concept is not available)<br/> However these are accessed via the Site.ServiceSite.ServiceSiteProvider record. (The Site has the location)
Contact details that are specific to the role/location/service.
Definition
Contact details that are specific to the role/location/service.
Requirements
Often practitioners have a dedicated line for each location (or service) that they work at, and need to be able to define separate contact details for each of these.
There are no (further) constraints on this element
Element id
PractitionerRole.availableTime.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
PractitionerRole.availableTime.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
PractitionerRole.notAvailable.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
PractitionerRole.notAvailable.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
PractitionerRole.availabilityExceptions
Short description
Description of availability exceptions
Definition
A description of site availability exceptions, e.g. public holiday availability. Succinctly describing all possible exceptions to normal site availability as details in the available Times and not available Times.
Requestor - Full name, Requestor - Professional registration number, Requestor - Professional registration number type, Additional contact - Full name, Additional contact - Professional registration number, Additional contact - Professional registration number type, Patient - GP full name, Patient - GP GMC number, Previous genomic report - Report performer full name, Previous genomic report - Original requester full name, Previous non genomic report - Report performer full name, Previous non genomic report - Original requester full name
ORC-12, ORC-12.1, ORC-12.9, PD1-4.2 and PD1-4.3, PD1-4.1, OBX-16, ORC-12
PractitionerRole.code
Requestor - Job Title, Additional contact - Job Title
CTD-1
PractitionerRole.specialty
Requestor - Current Specialty, Requestor - Department name, Additional contact - Current Specialty, Additional contact - Department name
Additional CTD-1 segments
PractitionerRole.telecom
Requestor - Phone, Requestor - Email address, Requestor - Genomic report delivery method, Requestor - Central email for address and reporting (many), Additional contact - Phone, Additional contact - Email address, Additional contact - Genomic report delivery method, Additional contact - Central email for address and reporting (many)
SHALL be present. Users SHOULD reference practitioners using an appropriate naming system as defined within the NHS England IG , this has been copied below for convenience. Display name MAY be included to aid readability and verification of included identifiers.
Note: The SDS User Id is the preferred identifier naming scheme and SHOULD be sourced from NHS Identity (SmartCard), this is also held within the Spine Directory Service LDAP database. Where the SDS User ID cannot be obtained, or is not applicable for the healthcare worker, one of the professional codes below MAY be used.
SHALL be present. Users SHOULD reference organizations using an ODS code. Display name MAY be included to aid readability and verification of included identifiers. Requester ODS codes SHOULD use the lowest level site code rather than trust code (most granular code available) where possible, to aid contact retrieval.
The specialty field SHOULD be used to record department for the requesting clinician, issues with the use of this field, including issues with the [bound UK Core ValueSet](https://fhir.hl7.org.uk/CodeSystem/UKCore-PracticeSettingCode) not representing certain departments SHOULD be reported to the NHS England Genomics Unit
"specialty": [
{
"coding": [
{
"system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-PracticeSettingCode",
"code": "120",
"display": "Ear Nose and Throat"
}
]
}
],
telecom
The telecom field SHOULD be used to record contact details for the practitioner. For central mailboxes, e.g. those used for providing reports back to the requester, these SHOULD be marked with an appropriate 'contactpoint-comment' extension.
Additionally, where are there multiple Practitioners involved in providing care, the contact details for each Practitioners for that location (or service) SHOULD be specified.
Used for detailing information on procedures the patient has had performed, to aid interpretation of Genomic test results.
Assertion of an absence of a procedure being performed SHOULD be recorded using an Observation resource, as described in Profile-UKCore-Observation
At a minimum, Procedure resources are expected to contain the status, code, subject and performedDateTime, though additional information conforming to the FHIR profile below MAY be included if relevant.
Genomic Study and Genomic Study Analysis profiles on Procedure may also be used as part of structured reporting. Mandated usage of these profiles is pending data standard discovery work to identify the items required within Genomic Test Reporting. As such, elements called out, and guidance suggested on this page, may be subject to change.
There are no (further) constraints on this element
Element id
Procedure
Short description
An action that is being or was performed on a patient
Definition
An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
There are no (further) constraints on this element
Element id
Procedure.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Procedure.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Procedure.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Procedure.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Procedure.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
Procedure.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
There are no (further) constraints on this element
Element id
Procedure.identifier
Short description
External Identifiers for this procedure
Definition
Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server.
Requirements
Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers.
Comments
This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and Person resource instances might share the same social insurance number.
There are no (further) constraints on this element
Element id
Procedure.instantiatesUri
Short description
Instantiates external protocol or definition
Definition
The URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.
Comments
This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
There are no (further) constraints on this element
Element id
Procedure.partOf
Short description
Part of referenced event
Alternate names
container
Definition
A larger event of which this particular procedure is a component or step.
Comments
The MedicationAdministration resource has a partOf reference to Procedure, but this is not a circular reference. For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure). For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration).
A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.
Comments
The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
There are no (further) constraints on this element
Element id
Procedure.statusReason
Short description
Reason for current status
Alternate names
Suspended Reason, Cancelled Reason
Definition
Captures the reason for the current state of the procedure.
Comments
This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.
There are no (further) constraints on this element
Element id
Procedure.encounter
Short description
Encounter created as part of
Definition
The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.
Comments
This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.
Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.
Comments
Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
There are no (further) constraints on this element
Element id
Procedure.performer.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Procedure.performer.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
Procedure.performer.onBehalfOf
Short description
Organization the device or practitioner was acting for
Definition
The organization the device or practitioner was acting on behalf of.
Requirements
Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.
There are no (further) constraints on this element
Element id
Procedure.reasonCode
Short description
Coded reason procedure performed
Definition
The coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text.
Comments
Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.
There are no (further) constraints on this element
Element id
Procedure.reasonReference
Short description
The justification that the procedure was performed
Definition
The justification of why the procedure was performed.
Comments
It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use).
Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.
Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.
Comments
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure.
There are no (further) constraints on this element
Element id
Procedure.report
Short description
Any report resulting from the procedure
Definition
This could be a histology result, pathology report, surgical report, etc.
Comments
There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.
Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.
Comments
If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text.
A code from the SNOMED Clinical Terminology UK with the expression (<404684003 |Clinical finding| OR <413350009 |Finding with explicit context| OR <272379006 |Event|).
There are no (further) constraints on this element
Element id
Procedure.followUp
Short description
Instructions for follow up
Definition
If the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used.
There are no (further) constraints on this element
Element id
Procedure.focalDevice
Short description
Manipulated, implanted, or removed device
Definition
A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.
There are no (further) constraints on this element
Element id
Procedure.focalDevice.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Procedure.focalDevice.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
Patient - Pregnancy type, Patient - Type of transplant, Patient - Type of transfusion, Neonatal hypoglycemia treatment details, Current exocrine pancreatic treatment
OBR segments with appropriate codes, OBR-44, OBR/RXA segments
Procedure.performedPeriod.start
Neonatal hypoglycemia treatment start date, Exocrine pancreatic treatment start date
TBC. From the Genomic Reporting IG Genomic Study profile. Reference to the Genomic Study Analysis resource, detailing the analyses performed as part of genomic test.
TBC. From the Genomic Reporting IG Genomic Study Analysis profile. Various extensions covering the metadata related to a genomic test, e.g. regions studied, change types tested for etc. For the full list of extensions, please see the linked profile page.
Use of the profile and its extensions is pending further discovery of the data standards required for Genomic Reporting in the UK.
Status SHALL use the codes recommended in the base Procedure resource, appropriately tagging procedures as having been completed or in-progress etc. depending on the actual status of the procedure.
"status": "completed",
code
SHALL be present. SNOMED CT coding is preferred, though alternative codings MAY be provided subject to review of the Coding system by the NHS England Genomics Unit.
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "23719005",
"display": "Transplantation of bone marrow"
}
]
},
subject
SHALL be present. Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS.
performed SHOULD be provided wherever possible, using the appropriate data type, to aid in interpretation of Genomic test results.
"performedDateTime": "2020-01-19"
StructureDefinition Provenance
The Genomics Provenance SHOULD be provided alongside updates to controlled documents such as ServiceRequests and DiagnosticReports by integrated systems on any update operation to ensure auditability for any changes to resources.
It is not expected that updates which do not affect the clinical content of the document will need associated Provenance resources, e.g. addition of local identifiers (though for the purporses of the Genomic Order Management Alpha, all updates to ServiceRequest and DiagnosticReport resources will be expected to have accompanying Provenance resources). On material changes to controlled resources, ServiceRequest and DiagnosticReport, users SHOULD use the transaction endpoint on the server to bundle the updated resource and Provenance event into a single transaction.
The HL7 FHIR specification also provides the capability to attach a Provenance resource using a custom header parameter. Using this mechanism would allow clients to submit requests to the resource specific PUT enpoints for ServiceRequests and DiagnosticReports, while still aloowing changes to be captured within a Provenance resource using a single interaction. This mechanism will not be supported within the Genomic Order Management Alpha but will be investigated by the NHS England Genomics Unit for implementation in future phases.
Provenance of a resource is a record that describes entities and processes involved in producing and delivering or otherwise influencing that resource. Provenance provides a critical foundation for assessing authenticity, enabling trust, and allowing reproducibility. Provenance assertions are a form of contextual metadata and can themselves become important records with their own provenance. Provenance statement indicates clinical significance in terms of confidence in authenticity, reliability, and trustworthiness, integrity, and stage in lifecycle (e.g. Document Completion - has the artifact been legally authenticated), all of which may impact security, privacy, and trust policies.
Comments
Some parties may be duplicated between the target resource and its provenance. For instance, the prescriber is usually (but not always) the author of the prescription resource. This resource is defined with close consideration for W3C Provenance.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
Mappings
rim: Entity. Role, or Act
workflow: Event
rim: ControlAct[isNormalAct() and subsumes(CACT, classCode) and moodCode=EVN]
There are no (further) constraints on this element
Element id
Provenance.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Provenance.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Provenance.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Provenance.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Provenance.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
Provenance.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
The Reference(s) that were generated or updated by the activity described in this resource. A provenance can point to more than one target if multiple resources were created/updated by the same activity.
Comments
Target references are usually version specific, but might not be, if a version has not been assigned or if the provenance information is part of the set of resources being maintained (i.e. a document). When using the RESTful API, the identity of the resource might not be known (especially not the version specific one); the client may either submit the resource first, and then the provenance, or it may submit both using a single transaction. See the notes on transaction for further discussion.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.what[x]
rim: ./outboundRelationship[isNormalActRelationship() and typeCode=SUBJ]/target OR ./participation[isNormalParticipation() and typeCode=SBJ]/role OR ./participation[isNormalParticipation() and typeCode=SBJ]/role[isNormalRole()]/player
fhirauditevent: AuditEvent.entity.reference
w3c.prov: Entity Created/Updated
occurred[x]
0..1
Element id
Provenance.occurred[x]
Short description
When the activity occurred
Definition
The period during which the activity occurred.
Comments
The period can be a little arbitrary; where possible, the time should correspond to human assessment of the activity time.
Conditions
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
The instant of time at which the activity was recorded.
Comments
This can be a little different from the time stamp on the resource if there is a delay between recording the event and updating the provenance and target resource.
Policy or plan the activity was defined by. Typically, a single activity may have multiple applicable policy documents, such as patient consent, guarantor funding, etc.
Comments
For example: Where an OAuth token authorizes, the unique identifier from the OAuth token is placed into the policy element Where a policy engine (e.g. XACML) holds policy logic, the unique policy identifier is placed into the policy element.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: ./inboundRelationship[isNormalActRelationship() and typeCode="SUBJ"]/source[isNormalAct and subsumes(POLICY, classCode) and moodCode=EVN]/text[typeCode='ED'/tel
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.location
w5: FiveWs.where[x]
rim: unique(./participation[isNormalParticipation() and typeCode=LOC]/role[isNormalRole() and subsumes(SDLOC, classCode)]/player[isNormalEntity and classCode="LOC" and determinerCode="INST"]
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.
An activity is something that occurs over a period of time and acts upon or with entities; it may include consuming, processing, transforming, modifying, relocating, using, or generating entities.
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.
There are no (further) constraints on this element
Element id
Provenance.agent.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Provenance.agent.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
rim: Person, Practitioner, Organization, Device :* .role [classCode = RoleClassMutualRelationship; role.code and * .scopes[Role](classCode=IDENT) and *.plays [Role.Code]
There are no (further) constraints on this element
Element id
Provenance.entity.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Provenance.entity.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Provenance.entity.agent
Short description
Entity is attributed to this agent
Definition
The entity is attributed to an agent to express the agent's responsibility for that entity, possibly along with other agents. This description can be understood as shorthand for saying that the agent was responsible for the activity which generated the entity.
Comments
A usecase where one Provenance.entity.agent is used where the Entity that was used in the creation/updating of the Target, is not in the context of the same custodianship as the Target, and thus the meaning of Provenance.entity.agent is to say that the entity referenced is managed elsewhere and that this Agent provided access to it. This would be similar to where the Entity being referenced is managed outside FHIR, such as through HL7 v2, v3, or XDS. This might be where the Entity being referenced is managed in another FHIR resource server. Thus it explains the Provenance of that Entity's use in the context of this Provenance activity.
A digital signature on the target Reference(s). The signer should match a Provenance.agent. The purpose of the signature is indicated.
Comments
The elements of the Signature Resource are for ease of access of these elements. For digital signatures (Xml DigSig, JWS), the non-repudiation proof comes from the Signature validation, which includes validation of the referenced objects (e.g. Resources) (a.k.a., Content) in the XML-Signature Detached form.
SHALL be provided, the date/time when the update took place.
"recorded": "2023-08-10T11:10:00Z",
reason
The reason why the update took place. If the codes provided by HL7 are not granular enough, or additional notes need to be recorded detailing the reasoning behind a change, this SHOULD be added as text to 'reason.text'.
Signed, encrypted copy of the document, for validation that the document has not been tampered with (the requirement to include this field has not yet been validated).
The Genomics Questionnaire resource is currently based on the core HL7 resource, without any need for profiling. The base R4 Questionnaire profile is provided below for completeness.
It is not expected that any Questionnaire resources will be submitted to the central service, instead the GMS solution will contain a library of Questionnaires relevant to Genomics that it can use to validate QuestionnaireReponses (such as the example Record of Discussion Questionnaire).
A structured set of questions intended to guide the collection of answers from end-users. Questionnaires provide detailed control over order, presentation, phraseology and grouping to allow coherent, consistent data collection.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
que-2: The link ids for groups and questions must be unique within the questionnaire descendants().linkId.isDistinct()
que-0: Name should be usable as an identifier for the module by machine processing applications such as code generation name.matches('[A-Z]([A-Za-z0-9_]){0,254}')
There are no (further) constraints on this element
Element id
Questionnaire.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Questionnaire.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Questionnaire.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Questionnaire.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Questionnaire.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
Questionnaire.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
Canonical identifier for this questionnaire, represented as a URI (globally unique)
Definition
An absolute URI that is used to identify this questionnaire when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which at which an authoritative instance of this questionnaire is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the questionnaire is stored on different servers.
Requirements
… This is the id that will be used to link a QuestionnaireResponse to the Questionnaire the response is for.
Comments
The name of the referenced questionnaire can be conveyed using the http://hl7.org/fhir/StructureDefinition/display extension.
A formal identifier that is used to identify this questionnaire when it is represented in other formats, or referenced in a specification, model, design or an instance.
Requirements
Allows externally provided and/or usable business identifiers to be easily associated with the module.
Comments
Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this questionnaire outside of FHIR, where it is not possible to use the logical URI.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - 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]
The identifier that is used to identify this version of the questionnaire when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the questionnaire author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence.
Comments
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 reference to a particular business version of the questionnaire with the format [url]|[version].
A natural language name identifying the questionnaire. This name should be usable as an identifier for the module by machine processing applications such as code generation.
Requirements
Support human navigation and code generation.
Comments
The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.
A Boolean value to indicate that this questionnaire is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usage.
Requirements
Enables experimental content to be developed following the same lifecycle that would be used for a production-level questionnaire.
Comments
Allows filtering of questionnaires that are appropriate for use versus not.
The date (and optionally time) when the questionnaire was published. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the questionnaire changes.
Comments
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.
Name of the publisher (organization or individual)
Definition
The name of the organization or individual that published the questionnaire.
Requirements
Helps establish the "authority/credibility" of the questionnaire. May also allow for contact.
Comments
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.
A free text natural language description of the questionnaire from a consumer's perspective.
Comments
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 questionnaire is presumed to be the predominant language in the place the questionnaire was created).
The context that the content is intended to support
Definition
The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate questionnaire instances.
Requirements
Assist in searching for appropriate content.
Comments
When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.
Explanation of why this questionnaire is needed and why it has been designed as it has.
Comments
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.
A copyright statement relating to the questionnaire and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the questionnaire.
Requirements
Consumers must be able to determine any legal restrictions on the use of the questionnaire and/or its content.
Comments
Systems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/
The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.
Requirements
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.
Comments
If specified, this date follows the original approval date.
The period during which the questionnaire content was or is planned to be in active use.
Requirements
Allows establishing a transition before a resource comes into effect and also allows for a sunsetting process when new versions of the questionnaire are or are expected to be used instead.
Comments
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.
An identifier for this question or group of questions in a particular terminology such as LOINC.
Requirements
Allows linking of the complete Questionnaire resources to formal terminologies. It's common for "panels" of questions to be identified by a code.
Comments
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.
The cardinality or value of this element may be affected by these constraints: ele-1, que-3
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
que-9: Read-only can't be specified for "display" items type!='display' or readOnly.empty()
que-8: Initial 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' and 'open-choice' items can have answerValueSet (type ='choice' or type = 'open-choice' or type = 'decimal' or type = 'integer' or type = 'date' or type = 'dateTime' or type = 'time' or type = 'string' or type = 'quantity') or (answerValueSet.empty() and answerOption.empty())
que-4: A question cannot have both answerOption and answerValueSet answerOption.empty() or answerValueSet.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' | 'open-choice')) 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())
que-13: Can only have multiple initial values for repeating items repeats=true or initial.count() <= 1
que-11: If one or more answerOption is present, initial[x] must be missing answerOption.empty() or initial.empty()
que-12: If there are more than one enableWhen, enableBehavior must be specified enableWhen.count() > 2 implies enableBehavior.exists()
There are no (further) constraints on this element
Element id
Questionnaire.item.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Questionnaire.item.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
An identifier that is unique within the Questionnaire allowing linkage to the equivalent item in a QuestionnaireResponse resource.
Requirements
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.
Comments
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.
This element is a URI that refers to an ElementDefinition that provides information about this item, including information that might otherwise be included in the instance of the Questionnaire resource. A detailed description of the construction of the URI is shown in Comments, below. If this element is present then the following element values MAY be derived from the Element Definition if the corresponding elements of this Questionnaire resource instance have no value:
code (ElementDefinition.code)
type (ElementDefinition.type)
required (ElementDefinition.min)
repeats (ElementDefinition.max)
maxLength (ElementDefinition.maxLength)
answerValueSet (ElementDefinition.binding)
options (ElementDefinition.binding).
Requirements
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.
Comments
The uri refers to an ElementDefinition in a StructureDefinition 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.
A short label for a particular group, question or set of display text within the questionnaire used for reference by the individual completing the questionnaire.
Requirements
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.
Comments
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.
The name of a section, the text of a question or text content for a display item.
Comments
When using this element to represent the name of a section, use group type item and also make sure to limit the text element to a short string suitable for display as a section heading. Group item instructions should be included as a display type item within the group.
group | display | boolean | decimal | integer | date | dateTime +
Definition
The type of questionnaire item this is - whether text for display, a grouping of other items or a particular type of data to be captured (string, integer, coded choice, etc.).
Requirements
Defines the format in which the user is to be prompted for the answer.
Comments
Additional constraints on the type of answer can be conveyed by extensions. The value may come from the ElementDefinition referred to by .definition.
A constraint indicating that this item should only be enabled (displayed/allow answers to be captured) when the specified condition is true.
Requirements
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.
Comments
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. When an item is disabled, all of its descendants are disabled, regardless of what their own enableWhen logic might evaluate to.
There are no (further) constraints on this element
Element id
Questionnaire.item.enableWhen.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Questionnaire.item.enableWhen.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
The linkId for the question whose answer (or lack of answer) governs whether this item is enabled.
Comments
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.
An indication, if true, that the item must be present in a "completed" QuestionnaireResponse. If false, the item may be skipped when answering the questionnaire.
Comments
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.
Meaning when missing
Items are generally assumed not to be required unless explicitly specified. Systems SHOULD always populate this value
An indication, if true, that the item may occur multiple times in the response, collecting multiple answers for questions or multiple sets of answers for groups.
Requirements
Items may be used to create set of (related) questions that can be repeated to give multiple answers to such a set.
Comments
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 (i.e. "repeat the question") or to simply allow entry/selection of multiple answers for the question (repeat the answers). Which is most appropriate visually may depend on the type of answer as well as whether there are nested items.
The resulting QuestionnaireResponse will be populated the same way regardless of rendering - one 'question' item with multiple answer values.
The value may come from the ElementDefinition referred to by .definition.
Meaning when missing
Items are generally assumed not to repeat unless explicitly specified. Systems SHOULD always populate this value
An indication, when true, that the value cannot be changed by a human respondent to the Questionnaire.
Requirements
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.
Comments
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.
The maximum number of characters that are permitted in the answer to be considered a "valid" QuestionnaireResponse.
Comments
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.
A reference to a value set containing a list of codes representing permitted answers for a "choice" or "open-choice" question.
Comments
LOINC defines many useful value sets for questionnaire responses. See LOINC Answer Lists. The value may come from the ElementDefinition referred to by .definition.
One of the permitted answers for a "choice" or "open-choice" question.
Comments
This element can be used when the value set machinery of answerValueSet is deemed too cumbersome or when there's a need to capture possible answers that are not codes.
There are no (further) constraints on this element
Element id
Questionnaire.item.answerOption.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Questionnaire.item.answerOption.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
One or more values that should be pre-populated in the answer when initially rendering the questionnaire for user input.
Requirements
In some workflows, having defaults saves time.
Comments
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 initial values can influence results. The data type of initial[x] must agree with the item.type, and only repeating items can have more then one initial value.
There are no (further) constraints on this element
Element id
Questionnaire.item.initial.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Questionnaire.item.initial.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
Questionnaire.item.item
Short description
Nested questionnaire items
Definition
Text, questions and other groups to be nested beneath a question or group.
Requirements
Reports can consist of complex nested groups.
Comments
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.
Conditions
The cardinality or value of this element may be affected by these constraints: que-1
The Genomics QuestionnaireResponse is currently based on the core HL7 resource, without any need for profiling.
The profile for QuestionnaireResponse is provided below for completeness.
No additional guidance has been provided on this page as there are no Genomic-specific considerations which need to be made. However, all QuestionnaireResponses submitted to the central service SHALL reference a Questionnaire definition in order to aid validation and presentation of the response content.
A structured set of questions and their answers. The questions are ordered and grouped into coherent subsets, corresponding to the structure of the grouping of the questionnaire being responded to.
Comments
The QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on. I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
There are no (further) constraints on this element
Element id
QuestionnaireResponse.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
QuestionnaireResponse.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
QuestionnaireResponse.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
QuestionnaireResponse.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
QuestionnaireResponse.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
QuestionnaireResponse.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - 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]
The order, proposal or plan that is fulfilled in whole or in part by this QuestionnaireResponse. For example, a ServiceRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression.
Requirements
Supports traceability of responsibility for the action and allows linkage of an action to the recommendations acted upon.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
A procedure or observation that this questionnaire was performed as part of the execution of. For example, the surgery a checklist was executed as part of.
Comments
Composition of questionnaire responses will be handled by the parent questionnaire having answers that reference the child questionnaire. For relationships to referrals, and other types of requests, use basedOn.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
The Questionnaire that defines and organizes the questions for which answers are being provided.
Requirements
Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.
Comments
If a QuestionnaireResponse references a Questionnaire, then the QuestionnaireResponse structure must be consistent with the Questionnaire (i.e. questions must be organized into the same groups, nested questions must still be nested, etc.).
The subject of the questionnaire response. This could be a patient, organization, practitioner, device, etc. This is who/what the answers apply to, but is not necessarily the source of information.
Requirements
Allows linking the answers to the individual the answers describe. May also affect access control.
Comments
If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
The Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated.
Requirements
Provides context for the information that was captured. May also affect access control.
Comments
This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Date Created, Date published, Date Issued, Date updated
Definition
The date and/or time that this set of answers were last changed.
Requirements
Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers.
Comments
May be different from the lastUpdateTime of the resource itself, because that reflects when the data was known to the server, not when the data was captured.
This element is optional to allow for systems that might not know the value, however it SHOULD be populated if possible.
Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system.
Requirements
Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.
Comments
Mapping a subject's answers to multiple choice options and determining what to put in the textual answer is a matter of interpretation. Authoring by device would indicate that some portion of the questionnaire had been auto-populated.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
A group or question item from the original questionnaire for which answers are provided.
Comments
Groups cannot have answers and therefore must nest directly within item. When dealing with questions, nesting must occur within each answer because some questions may have multiple answers (and the nesting occurs for each answer).
There are no (further) constraints on this element
Element id
QuestionnaireResponse.item.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
QuestionnaireResponse.item.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
A reference to an ElementDefinition that provides the details for the item.
Requirements
A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.
Comments
The ElementDefinition must be in a StructureDefinition, and must have a fragment identifier that identifies the specific data element by its id (Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x].
There is no need for this element if the item pointed to by the linkId has a definition listed.
There are no (further) constraints on this element
Element id
QuestionnaireResponse.item.answer.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both extension.exists() != value.exists()
Mappings
rim: N/A
value[x]
0..1
Element id
QuestionnaireResponse.item.answer.value[x]
Short description
Single-valued answer to the question
Definition
The answer (or one of the answers) provided by the respondent to the question.
Requirements
Ability to retain a single-valued answer to a question.
Comments
More complex structures (Attachment, Resource and Quantity) will typically be limited to electronic forms that can expose an appropriate user interface to capture the components and enforce the constraints of a complex data type. Additional complex types can be introduced through extensions. Must match the datatype specified by Questionnaire.item.type in the corresponding Questionnaire.
Binding
Code indicating the response provided for a question.
RoD questions with appropriate linkId: RoD - Patient category, Test type, RoD - Research opt out reason, RoD - Remote consent, RoD - Recording clinician, RoD - Responsible clinician, RoD - Patient choice status, RoD - Has research participation been discussed, RoD - Signature
CON (for OML, included in RoD, referenced from NTE-3)
StructureDefinition UKCore-RelatedPerson
Used for linking Patients with other participants of a test order, e.g. in the case of proband and consultand within duo and trio testing.
For instances where clinical/demographic information for the related person are required, a Patient resource for the related person (consultand) SHOULD be included, with the Patient.link field referencing the RelatedPerson resource for the same individual. Elements duplicated across both the Patient and RelatedPerson for the same individual SHOULD in this case be captured within the Patient resource only. The RelatedPerson resource then references the proband Patient resource through the RelatedPerson.patient field.
A diagram illustrating the links between resources is provided below (Duo Scenario):
Further use cases surrounding the use of RelatedPerson are pending further Duo/Trio scenarios.
There are no (further) constraints on this element
Element id
RelatedPerson
Short description
A person that is related to a patient, but who is not a direct target of care
Definition
Information about a person that is involved in the care for a patient, but who is not the target of healthcare, nor has a formal responsibility in the care process.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
There are no (further) constraints on this element
Element id
RelatedPerson.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
RelatedPerson.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
RelatedPerson.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
RelatedPerson.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
The preferred method of contact, contact times and written communication format given by a Patient or Related Person.
Alternate names
extensions, user content
Definition
The preferred method of contact, contact times and written communication format given by a Patient or Related Person.
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.
Indicates that a Patient contact or RelatedPerson must be copied in to Patient correspondence.
Alternate names
extensions, user content
Definition
Extension carrying a boolean indicator showing that a patient's contact or related person SHALL be copied in to patient correspondence.
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.
There are no (further) constraints on this element
Element id
RelatedPerson.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
There are no (further) constraints on this element
Element id
RelatedPerson.identifier
Short description
A human identifier for this person
Definition
Identifier for a person within a particular scope.
Requirements
People are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the patient. Examples are national person identifier and local identifier.
A contact detail for the person, e.g. a telephone number or an email address.
Requirements
People have (primary) ways to contact them in some way such as phone, email.
Comments
Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
There are no (further) constraints on this element
Element id
RelatedPerson.telecom.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
Information about other contact methods which could be used in addition to those listed in `ContactPoint.system`.
Alternate names
extensions, user content
Definition
Other contact system value which extends the system element in the ContactPoint datatype.
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.
There are no (further) constraints on this element
Element id
RelatedPerson.telecom.rank
Short description
Specify preferred order of use (1 = highest)
Definition
Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
Comments
Note that rank does not necessarily follow the order in which the contacts are represented in the instance.
There are no (further) constraints on this element
Element id
RelatedPerson.communication
Short description
A language which may be used to communicate with about the patient's health
Definition
A language which may be used to communicate with about the patient's health.
Requirements
If a related person does not speak the local language, interpreters may be required, so languages spoken and proficiency is an important things to keep track of both for patient and other persons of interest.
Comments
If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple RelatedPerson.Communication associations. If the RelatedPerson does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.
There are no (further) constraints on this element
Element id
RelatedPerson.communication.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
RelatedPerson.communication.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
The language which can be used to communicate with the patient about his or her health
Definition
The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.
Requirements
Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
Comments
The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
There are no (further) constraints on this element
Element id
RelatedPerson.communication.preferred
Short description
Language preference indicator
Definition
Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
Requirements
People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.
Comments
This language is specifically identified for communicating healthcare information.
SHALL be provided. This SHOULD be a reference to the Patient resource and/or the identifier, e.g. NHS number, for the patient constituting the target of the relationship. This can be visualised using the nomenclature:
{Source (identifier)} is the {Relationship type (relationship)} of {Target (patient)}
'Ryanne Boulder' is the 'natural mother' of 'Fetus of Ryanne Boulder'
In this case the fetal identifier should be used in the patient element.
SHALL be provided. This SHOULD be NHS number or local identifier (if NHS number is unavailable e.g. for non UK residents) for the source of the relationship. This can be visualised using the nomenclature:
{Source (identifier)} is the {Relationship type (relationship)} of {Target (patient)}
'Ryanne Boulder' is the 'natural mother' of 'Fetus of Ryanne Boulder'
In this case the Ryanne Boulder's identifier should be used for the RelatedPerson.identifier.
If a local identifier is used, an assigner SHALL be provided.
The RelatedPerson.identifier field SHALL match the identifier used for a FamilyMemberHistory or Patient resource if these resources are about the same person.
NOTE: As a single individual MAY be related to a number of Patients the identifier used will not be unique across RelatedPerson resources. As such, both the identifier and patient elements SHOULD be used in conjunction to uniquely identify a relationship
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
There are no (further) constraints on this element
Element id
ResearchSubject.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
ResearchSubject.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
ResearchSubject.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
ResearchSubject.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
ResearchSubject.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
ResearchSubject.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - 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]
The dates the subject began and ended their participation in the study.
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
Reference to the study the subject is participating in.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
The record of the person or animal who is involved in the study.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
A record of the patient's informed agreement to participate in the study.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
BRIDG5.1: ResearchStudy.consent is related to PerformedStudySubjectMilestone.informedConsentIndicator in that the informedConsentIndicator can be derived from the data in the Consent resource.
StructureDefinition UKCore-ServiceRequest
Focal resource for test order messages. All additional information or resources SHOULD be linked back to the ServiceRequest or be referenced from the ServiceRequest directly.
ServiceRequests which have been updated post submission SHALL be accompanied by Provenance resources, referencing the ServiceRequest which detail when the resource was changed, who made the change and why.
Note on inheritance from prior requests
It is expected that the ServiceRequest.basedOn SHALL reference a parent request where this ServiceRequest is based a previous request, e.g. in the case of reanalysis (where prior outputs/data are used) and cascade testing (where processing of a prior request has triggered the current request), or Germline Late tests in the Tumour First/Germline Late scenario (to link tests which need to be processed together).
It is expected that the prior request should be referenced from ServiceRequest.basedOn if data or outputs from the prior request are required in order to properly interpret the current request. If a banked sample needs to be processed, e.g. in the case of a request on Stored DNA, it is expected that this would be referenced directly from ServiceRequest.specimen.
Where multiple samples are associated with a previous request, it is expected only one would be active, e.g. marked as available. Additionally, in most cases the data is required, rather than reprocessing of the sample itself, in which case referencing the previous request is sufficient. However, if there are multiple active samples associated with a previous request, and a subset of the samples need to be reprocessed, the sample(s) itself SHOULD be referenced from ServiceRequest.specimen as above. If multiple outputs, i.e. data from multiple samples, are associated with a previous request, a ServiceRequest MAY reference the data to be reinterpreted/reanalysed through ServiceRequest.supportingInfo.
An illustrative diagram of the links between ServiceRequests and other resources is provided below.
Note: not all resource links are represented, to increase legibility of the diagram.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
prr-1: orderDetail SHALL only be present if code is present orderDetail.empty() or code.exists()
There are no (further) constraints on this element
Element id
ServiceRequest.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
ServiceRequest.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
ServiceRequest.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
ServiceRequest.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
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.
Supports recording of additional contacts, who should be contacted regarding questions arising from the service request. This differs from the requester and responsibleClinician.
Alternate names
extensions, user content
Definition
Details of an additional contact, who should be contacted regarding questions arising from the service request.
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.
Supports the exchange of information describing the method of funding for the Service Request.
Alternate names
extensions, user content
Definition
The funding category for the Service Request.
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.
There are no (further) constraints on this element
Element id
ServiceRequest.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
There are no (further) constraints on this element
Element id
ServiceRequest.identifier
Short description
Identifiers assigned to this order
Definition
Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.
Comments
The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.
There are no (further) constraints on this element
Element id
ServiceRequest.instantiatesCanonical
Short description
Instantiates FHIR protocol or definition
Definition
The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.
Comments
Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
There are no (further) constraints on this element
Element id
ServiceRequest.instantiatesUri
Short description
Instantiates external protocol or definition
Definition
The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.
Comments
This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
There are no (further) constraints on this element
Element id
ServiceRequest.requisition
Short description
Composite Request ID
Alternate names
grouperId, groupIdentifier
Definition
A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.
Requirements
Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.
Comments
Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.
A code that classifies the service for searching, sorting and display purposes.
Definition
A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure").
Requirements
Used for filtering what service request are retrieved and displayed.
Comments
There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.
A code that classifies the service for Genomics, whether it is a Whole Case Genome Sequencing or non-Whole Genome Sequencing for cancer or rare diseases
Requirements
Used for filtering what service request are retrieved and displayed.
Comments
There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.
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.
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.
A reference to a code defined by a terminology system.
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
Comments
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. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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.
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.
The identification of the code system that defines the meaning of the symbol in the code.
Requirements
Need to be unambiguous about the source of the definition of the symbol.
Comments
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Comments
Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Requirements
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
Comments
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Requirements
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
Comments
Very often the text is the same as a displayName of one of the codings.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
Supports the underlying reason why a Service Request is urgent.
Alternate names
extensions, user content
Definition
A SNOMED CT concept representing the reason a Service Request is urgent
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.
There are no (further) constraints on this element
Element id
ServiceRequest.doNotPerform
Short description
True if service/procedure should not be performed
Definition
Set this to true if the record is saying that the service/procedure should NOT be performed.
Requirements
Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.
Comments
In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.
Meaning when missing
If missing, the request is a positive request e.g. "do perform"
A code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested.
Comments
Many laboratory and radiology procedure codes embed the specimen/organ system in the test order name, for example, serum or serum/plasma glucose, or a chest x-ray. The specimen might not be recorded separately from the test code.
Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.
Comments
For information from the medical record intended to support the delivery of the requested services, use the supportingInformation element.
The cardinality or value of this element may be affected by these constraints: prr-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
v2: NTE
rim: .code
quick: Procedure.procedureCode
quantity[x]
Σ
0..1
There are no (further) constraints on this element
Element id
ServiceRequest.quantity[x]
Short description
Service amount
Definition
An amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).
Requirements
When ordering a service the number of service items may need to be specified separately from the the service item.
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
The individual or entity the service is ordered for.
Definition
On whom or what the service is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans).
The individual who initiated the request and has responsibility for its activation.
Comments
This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.
There are no (further) constraints on this element
Element id
ServiceRequest.performerType
Short description
Performer role
Alternate names
specialty
Definition
Desired type of performer for doing the requested service.
Comments
This is a role, not a participation type. In other words, does not describe the task but describes the capacity. For example, “compounding pharmacy”, “psychiatrist” or “internal referral”.
There are no (further) constraints on this element
Element id
ServiceRequest.performer
Short description
Requested performer
Alternate names
request recipient
Definition
The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc.
Comments
If multiple performers are present, it is interpreted as a list of alternative performers without any preference regardless of order. If order of preference is needed use the request-performerOrder extension. Use CareTeam to represent a group of performers (for example, Practitioner A and Practitioner B).
Explanation/Justification for procedure or service
Definition
An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supportingInfo.
Comments
This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use CodeableConcept.text element if the data is free (uncoded) text as shown in the CT Scan example.
There are no (further) constraints on this element
Element id
ServiceRequest.reasonReference
Short description
Explanation/Justification for service or service
Definition
Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in supportingInfo.
Comments
This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode. When using a reference to DocumentReference, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in ServiceRequest.reasonCode if the data is free (uncoded) text as shown in the CT Scan example.
There are no (further) constraints on this element
Element id
ServiceRequest.supportingInfo
Short description
Additional clinical information
Alternate names
Ask at order entry question, AOE
Definition
Additional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements.
Comments
To represent information about how the services are to be delivered use the instructions element.
There are no (further) constraints on this element
Element id
ServiceRequest.specimen
Short description
Procedure Samples
Definition
One or more specimens that the laboratory procedure will use.
Comments
Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the Specimen resource points to the ServiceRequest.
Anatomic location where the procedure should be performed. This is the target site.
Requirements
Knowing where the procedure is performed is important for tracking if multiple sites are possible.
Comments
Only used if not implicit in the code found in ServiceRequest.code. If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension procedure-targetBodyStructure.
There are no (further) constraints on this element
Element id
ServiceRequest.relevantHistory
Short description
Request provenance
Definition
Key events in the history of the request.
Comments
This might not include provenances for all versions of the request – only those deemed “relevant” or important.
This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude
All Provenances should have some historical version of this Request as their subject.
Requester (more details in PractitionerRole resource mappings), PLCM activity - Commissioned service category code, Previous genomic report - Original requester full name, Previous genomic report - Original requester organisation ODS code, Previous genomic report - Original requester reason for request, Previous non genomic report - Original requester full name, Previous non genomic report - Original requester organisation ODS code, Previous non genomic report - Original requester reason for request
Various ORC/STF segments
ServiceRequest.extension:additionalContact
Additional Contact (more details in PractitionerRole resource mappings)
Various STF segments
ServiceRequest.subject
Patient (more details in Patient resource mappings), Patient - Is relative
First PID segment in OML message, relatives referenced through NK1 segments
ServiceRequest.identifier
Test request - Test request id, PLCM activity - NGIS referral identifier, Previous genomic report - Report lab test number
ORC-2, ORC-3
ServiceRequest.extension:coverage
Test request - Payment status
IN1-15
ServiceRequest.authoredOn
Test request - Date and time request sent, PLCM activity - Financial month, PLCM activity - Financial year, PLCM activity - Turnaround time (calendar days)
ORC-9 (for TAT subtracted from OBR-7)
ServiceRequest.priority
Test request - Is urgent
TQ1-9
ServiceRequest.extension:priorityReason
Test request - Urgency reason
N/A could possibly use TQ1-10
ServiceRequest.code.coding.system
Test request - Test Directory version
OBR-4.3
ServiceRequest.code
Test request - CI code, Test request - CITT code, PLCM activity - Service code, PLCM activity - Point of delivery code, PLCM activity - Local point of delivery code, PLCM activity - Test method code
OBR-4
ServiceRequest.orderDetail
Test request - CI code for multipurpose CITT, Test request - Type of reanalysis, Test request - DNA storage information
NTE segment attached to OBR
ServiceRequest.category
Test request - Reason for testing, Test request - Reason for reanalysis
Likely ORC-29
ServiceRequest.supportingInfo
Test request - Detail of reason for reanalysis, Test request - Further information
NTE segments linked to OBR segment for reanalysis reason, Additional segments attached to ORC/OBR
ServiceRequest.occurrenceDateTime
Test request - Date report required by
OBR-8
ServiceRequest.performer
PLCM activity - ODS code of organisation commissioned to deliver requested test
Extension used for recording additional personnel who should be contacted regarding questions related to a test order. This is separate from the requester or reporting address.
The additional contact SHOULD be a reference to a PractitionerRole resource wherever possible and SHALL contain contact details for the practitioner.
Additionally, where are there multiple practitioners involved in providing care who need to be listed as contacts, the contact details for each practitioner (or service) SHOULD be specified through additional additionalContact entries.
SHALL be present for Genomic Order Management test orders. Extension for recording how work against the test order is being funded. The ValueSet bound to this extension is currently under review by the NHS England Genomics Informatics Working Advisory Group and subject to change.
Automatically assigned by the central service, though source systems MAY provide a local identifier for tracking within their own system, in which case the central order number is appended to the identifiers array.
SHALL reference a parent request where this ServiceRequest is based on a previous request, e.g. in the case of reanalysis (where prior outputs/data are used) and cascade testing (where processing of a prior request has triggered the current request), or Germline Late tests in the Tumour First/Germline Late scenario (to link tests which need to be processed together).
It is expected that the prior request should be referenced from ServiceRequest.basedOn if data or outputs from the prior request are required in order to properly interpret the current request. If a banked sample needs to be processed, e.g. in the case of a request on Stored DNA, it is expected that this would be referenced directly from ServiceRequest.specimen.
Where multiple samples are associated with a previous request, it is expected only one would be active, e.g. marked as available. Additionally, in most cases the data is required, rather than reprocessing of the sample itself, in which case referencing the previous request is sufficient. However, if there are multiple active samples associated with a previous request, and a subset of the samples need to be reprocessed, the sample(s) itself SHOULD be referenced from ServiceRequest.specimen as above. If multiple outputs, i.e. data from multiple samples, are associated with a previous request, a ServiceRequest MAY reference the data to be reinterpreted/reanalysed through ServiceRequest.supportingInfo.
SHALL be provided. ServiceRequests SHOULD be marked as `draft` until ready to be acted upon, after which the user should mark the ServiceRequest as `active`.
A ServiceRequest with the status of draft is assumed to be incomplete, i.e. missing information required for further processing. As such, a central order management broker SHOULD refrain from adding Tasks for the ServiceRequest until it is marked as active, at which time the necessary Tasks are spun up automatically by the broker (this is to be tested within the Genomic Order Management beta). Keeping a ServiceRequest in the draft state allows other parties to populate additional data required, such as phenotypic information from a dedicated service, or further information via a web portal. It is expected that draft ServiceRequests will be purged from the system after a period of inactivity with appropriate warnings (yet to be determined) to avoid stale orders from obscuring live tests/results.
A ServiceRequest may be marked as 'on-hold' if work against it cannot continue temporarily, e.g. due to certain prerequisite information not being provided. A ServiceRequest SHOULD be marked as 'revoked' if cancelled, either by the lab performing work against the order or at the request of the requesting clinician, though in each case a Provenance resource SHALL be provided to capture why the state change has occurred. The requesting clinician may also mark the ServiceRequest as entered-in-error, though implications for work already in progress needs to be investigated further.
A ServiceRequest SHOULD only be marked as completed by the requesting clinician upon receipt and review of the resulting DiagnosticReport.
For the full list of expected/supported ServiceRequest statuses, please see the table below:
Status
Description
Genomic workflow usage
Draft
The request has been created but is not yet complete or ready for action.
Saved but not submitted to central service (out of scope for Alpha).
Active
The request is in force and ready to be acted upon.
Submitted to central service.
On Hold
The request (and any implicit authorization to act) has been temporarily withdrawn but is expected to resume in the future.
Issue with the authorization for the test (potentially recoverable), not expected to be driven by on-hold statuses of Tasks.
Revoked
The request (and any implicit authorization to act) has been terminated prior to the known full completion of the intended actions. No further activity should occur.
Unrecoverable issue with order. Either used when the test is no longer needed or there is an is an unrecoverable failure with its fulfillment (driven by the requesting clinician). This status will propagate down to any Tasks which have not already moved into in-progress, Tasks not started will be marked with the status of cancelled.
Completed
The activity described by the request has been fully performed. No further activity will occur.
Completed order, marked by requestor once DiagnosticReport is received and accepted.
Entered in Error
This request should never have existed and should be considered 'void'. (It is possible that real-world decisions were based on it. If real-world activity has occurred, the status should be "revoked" rather than "entered-in-error".)
MAY be used for ServiceRequests created in error, can only be set if no Tasks have been started. If a Task has been moved out of its initial state, the status of Revoked SHOULD be used instead. This status will propagate down to Tasks, marking the tasks as entered-in-error.
Unknown
The authoring/source system does not know which of the status values currently applies for this request. Note: This concept is not to be used for "other" - one of the listed statuses is presumed to apply, but the authoring/source system does not know which.
Should not be used.
For the Genomic Order Management Service central broker, in some instances the ServiceRequest.status value is cascaded down to Tasks which are generated to fulfill that request.
The list of automated state transitions from ServiceRequests to all Tasks pointing to the ServiceRequest via Task.focus are provided in the table below:
ServiceRequest.status
Task.status
Note
active
requested
Not implemented within alpha, however it is expected the transition of a ServiceRequest from draft to active will allow Tasks to be spun up with a default state of requested
revoked
cancelled
Only tasks which have not moved to in-progress or subsequent stages can be automatically marked as cancelled, as these Tasks will require the owners to perform sone form of closure activities upon revokation of a request
entered-in-error
entered-in-error
This status transition is only permissible if none of the Tasks have moved into in-progress or their subsequent states, if this is the case, the ServiceRequest will need to be marked as revoked instead
on-hold
on-hold
TBC Not implemented within the alpha but Tasks may be automatically moved to on-hold of the focal request is marked as on-hold, to stop unneccessary processing/work against tasks
completed
completed
TBC Not implemented within the alpha but Tasks may be automatically moved to completed if the focal request is marked as completed, to reduce orphaned Tasks
It is not expected that Task statuses will propagate up to the ServiceRequest status, though certain task failure types may require revokation of the authorising request (pending investigation).
"status": "active",
intent
SHALL be provided. ServiceRequests SHOULD be marked as 'order' unless they have been raised by a lab in response to an existing ServiceRequest, in which case they SHOULD be marked as 'reflex-order'. For reflex orders, the ServiceRequest.basedOn field SHALL be populated with the original ServiceRequest, for traceability.
"intent": "order",
category
ServiceRequests SHOULD use the [Genomics Sequencing Category](https://simplifier.net/resolve?scope=fhir.r4.ukcore.stu3.currentbuild@0.0.6-pre-release&filepath=package/ValueSet-UKCore-GenomeSequencingCategory.json) ValueSet when categorising the test order in order to aid analytics (e.g. PLCM). This list is pending review from the Informatics Working Advisory Group, after which a full list of possible categorisations will be finalised.
Category SHOULD additionally be populated with the type of request being ordered e.g. Diagnostic, Carrier, Predictive, Stored DNA etc. The final list of applicable codes which can be selected is still under review, the Genomic-Reason-for-Testing CodeSystem SHOULD be used for this categorisation.
ServiceRequests marked as urgent (i.e. not routine) SHOULD populate the extension:priorityReason with why an urgent test is being requested. This SHOULD ideally be coded using SNOMED CT concepts. Multiple priorityReason extensions are allowed within a single ServiceRequest in order to aid post-coordination.
For the purposes of Genomic Test Ordering, the doNotPerform field SHALL NOT be used. All ServiceRequests requests received by the system will be assumed to be orders for services/testing.
code
SHALL be provided. Code SHOULD contain the CI or CITT Test Directory code, currently available at https://www.england.nhs.uk/publication/national-genomic-test-directories/. There is currently no CodeSystem or queryable API for retrieving codes but work to address this is underway within the NHS England Genomics Unit.
Codes from the Genomic Test Directory SHOULD also specify the version number of the test directory at the time the test is being ordered, to ensure the test methods used are consistent with that version of the directory.
If multiple codes are being requested within one Test Order, these SHOULD be represented using the 'orderDetail' field, with the main indication captured using the 'code' field above. If completely separate pathways/samples etc. are required for processing against the codes, it is expected these would be requested via multiple ServiceRequests instead of a single ServiceRequest with multiple orderDetail codes. The exact cut-off for when orderDetail vs. multiple ServiceRequest should be used is still being investigated.
An appropriate code(Panel codes) SHOULD come from the following NamingSystem: England-GenomicTestPanelCode
Extension-GenomicTestCode-Version:
The DGTS (Genomic Test Services) and PanelApp both maintain release versions and individual test code versions. The Extension-GenomicTestCode-Version has been provided to record specific test code version number, as shown in the snippet below:
SHALL be provided. Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS
If a result is required by a specific date, this MAY be indicated though occurrenceDateTime, though there is no guarantee from the GMS that the ServiceRequest will be processed in the time frame specified.
"occurrenceDateTime": "2023-08-25",
authoredOn
SHALL be populated by the client upon submission, either manually by the user or automatically by the system integrating with the central GMS.
"authoredOn": "2023-08-05",
requester
SHALL be populated on all ServiceRequests submitted to the central GMS. This SHALL reference a PractitionerRole resource also submitted to the system (either within a single transaction or previously POSTed).
Allows a requester to assign processing of the ServiceRequest to a particular organization (e.g. a remote GLH). The performer field SHOULD be populated with the ODS code for the managing organization/GLH.
In the future state, ServiceRequests may be kept open, by not specifying a performer, allowing them to be picked up by the local GLH or otherwise routed based on by test routing (TBC).
Any clinical information provided about the patient for whom the testing is being requested SHALL be referenced though the supportingInfo field, to ensure all the information relevant to the ServiceRequest can be easily retrieved. This includes Observations, Conditions, Procedures, FamilyMemberHistories etc.
This also includes resources related to family members included as part of testing (consultands), e.g. in Duo/Trio scenarios. In this instance, RelatedPerson and Patient resource references for the consultands SHALL be added to the supportingInfo array, as well as any clinical resources related to these individuals. This is to ensure the number of participants for a given test can be calculated correctly, e.g. through counting the number of RelatedPerson resources referenced from ServiceRequest.supportingInfo plus the subject of the ServiceRequest itself (the proband).
For WGS testing, where Records of Discussion are required in order to process the test, Consent resources SHOULD also be added to the supportingInfo array once available.
ServiceRequests where the required samples already exist, e.g. in the case where a specimen already in storage needs to be processed, SHOULD reference these samples through the ServiceRequest.specimen field. Where samples need to be collected to support testing, these SHOULD instead reference the ServiceRequest, through Specimen.request (i.e. the service request has prompted collection of the sample), and these Specimen resources do not need to be referenced from within ServiceRequest.supportingInfo. The referenced Specimen resources SHOULD either be contained within the test order transaction bundle or already exist on the central GMS.
In the case of Reanalysis or Reinterpretation tests, Specimens related to previous ServiceRequest are not required to be added to the new test request. The links from the previous ServiceRequest can be followed to identify the Specimens that resulted in the data being reanalysed, e.g. (reanalysis) ServiceRequest.basedOn -> (prior) ServiceRequest, (prior) ServiceRequest <- (original) Specimen.request
Any information which cannot be readily be structured SHOULD be entered into the note field, though prolific use of the field to capture clinical information which better fits in level 3/4 FHIR resources is discouraged.
To support disambiguation of notes originating from different fields in a client system, the AnnotationType extension MAY be used, specifying the UI element name in text (coded elements for the full list of free text UI elements expected within Test Order forms is pending finalisation and addition to the Genomic Order Management MDS). The author element MAY also be used to reference a Practitioner, by identifier or name (string), indicating the person who created the note.
"note": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/annotationType",
"valueCodeableConcept": {
"text": "Has any other members of the family previously had genomic testing (e.g. BRACA, NIPD testing etc)?"
}
}
],
"authorReference": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/sds-user-id",
"value": "9999999999"
},
"display": "Dr. Gene Smith"
},
"text": "No family history of genomic testing"
}
]
StructureDefinition UKCore-Specimen
Used to capture information on Samples which will undergo or have undergone processing for genomic testing.
Within FHIR R4, there is no way to capture location against a sample to aid tracking, one of the key requirements of the Genomic Medicine Service. Investigation of a possible solution through backporting the container.location element within R5 is currently being investigated. Until this backport is adopted by UK Core, the location of samples, including interactions to manage and track samples, will be performed through changes to Task resources generated on submission of a ServiceRequest.
A diagram illustrating the links between resources is provided below (Duo Scenario)
Note: links from ServiceRequest.supportingInfo to samples collected after submission are pending further investigation
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
There are no (further) constraints on this element
Element id
Specimen.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Specimen.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Specimen.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Specimen.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
This extension allows the recording of the category of a sample for use within Genomics, whether it is a tumour or germline sample.
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.
There are no (further) constraints on this element
Element id
Specimen.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
There are no (further) constraints on this element
Element id
Specimen.accessionIdentifier
Short description
Identifier assigned by the lab
Definition
The identifier assigned by the lab when accessioning specimen(s). This is not necessarily the same as the specimen identifier, depending on local lab procedures.
The type can change the way that a specimen is handled and drives what kind of analyses can properly be performed on the specimen. It is frequently used in diagnostic work flow decision making systems.
Where the specimen came from. This may be from patient(s), from a location (e.g., the source of an environmental sample), or a sampling of a substance or a device.
There are no (further) constraints on this element
Element id
Specimen.parent
Short description
Specimen from which this specimen originated
Definition
Reference to the parent (source) specimen which is used when the specimen was either derived from or a component of another specimen.
Comments
The parent specimen could be the source from which the current specimen is derived by some processing step (e.g. an aliquot or isolate or extracted nucleic acids from clinical samples) or one of many specimens that were combined to create a pooled sample.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ukcore-spec-001: Only one of Specimen.collection.collector or Specimen.collection.extension:collectorR5 can be populated at a time. collector.reference.empty() or collector.extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Specimen.collection.collector').empty()
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.
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.
This SHOULD be included if there is a high contamination risk reason for a sample / biopsy.
Alternate names
extensions, user content
Definition
Special handling during the collection, transport, or storage of the specimen.
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.
There are no (further) constraints on this element
Element id
Specimen.collection.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
Anatomical location from which the specimen was collected (if subject is a patient). This is the target site. This element is not used for environmental specimens.
Comments
If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension bodySite.
There are no (further) constraints on this element
Element id
Specimen.collection.bodySite.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
An extension to allow referencing to a BodyStructure.
Alternate names
extensions, user content
Definition
An extension to replicate the changes within R5 altering the data type of Specimen.collection.bodySite from CodeableConcept to CodeableReference (bodyStructure).
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.
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.
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.
Source of the definition for the extension code - a logical name or a URL.
Comments
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
There are no (further) constraints on this element
Element id
Specimen.collection.bodySite.coding
Short description
Code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
Comments
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. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
There are no (further) constraints on this element
Element id
Specimen.collection.bodySite.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Requirements
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Specimen.collection.fastingStatus[x]
Short description
Whether or how long patient abstained from food and/or drink
Definition
Abstinence or reduction from some or all food, drink, or both, for a period of time prior to sample collection.
Requirements
Many diagnostic tests require fasting to facilitate accurate interpretation.
Comments
Representing fasting status using this element is preferred to representing it with an observation using a 'pre-coordinated code' such as LOINC 2005-7 (Calcium [Moles/time] in 2 hour Urine --12 hours fasting), or using a component observation such asObservation.component code` = LOINC 49541-6 (Fasting status - Reported).
Binding
Codes describing the fasting status of the patient.
There are no (further) constraints on this element
Element id
Specimen.processing.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Specimen.processing.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
Specimen.processing.time[x]
Short description
Date and time of specimen processing
Definition
A record of the time or period when the specimen processing occurred. For example the time of sample fixation or the period of time the sample was in formalin.
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
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.
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.
The device resource for the the container holding the specimen. If the container is in a holder then the referenced device will point to a parent device.
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.
The location of the container holding the specimen.
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.
There are no (further) constraints on this element
Element id
Specimen.container.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
There are no (further) constraints on this element
Element id
Specimen.container.identifier
Short description
Id for the container
Definition
Id for container. There may be multiple; a manufacturer's bar code, lab assigned identifier, etc. The container ID may differ from the specimen id in some circumstances.
A mode or state of being that describes the nature of the specimen.
Requirements
The specimen condition can be used to assess its quality or appropriateness for a specific test.
Comments
Specimen condition is an observation made about the specimen. It's a point-in-time assessment. It can be used to assess its quality or appropriateness for a specific test.
Fetus - Is sample for fetal or unregistered neonate, Raw specimen/biopsy - Family member provided by
PID segment attached to SPM
Specimen.collection.quantity
PLCM activity - Sample volume, Raw specimen/biopsy - Volume
SPM-12
Specimen.type
PLCM activity - Sample category code
SPM-4
Specimen.identifier.assigner
Raw specimen/biopsy - Id assigning authority ODS code (many), Raw specimen/biopsy - Is assigning authority a histopathology laboratory (many), Extracted specimen - Id assigning authority ODS code (many)
SPM-2.1.2
Specimen.identifier.value
Raw specimen/biopsy - Id (many), Extracted specimen - Id (many)
SPM-2
Specimen.container.identifier
Raw specimen/biopsy - Sample well identifier
SAC-3
Specimen.note
Raw specimen/biopsy - Location details (will use backported R5 container.location once released), Extracted specimen - Location details, Raw specimen/biopsy - Sample to follow reason, Raw specimen/biopsy - Additional specimen/biopsy information, Extracted specimen - Additional specimen information
SAC-15, NTE segment attached to ORC, OBX segments attached to SPM
Specimen.extension:sampleCategory
Raw specimen/biopsy - WGS specimen type category
SPM-5
Specimen.type
Raw specimen/biopsy - Type, Raw specimen/biopsy - Blood component, Extracted specimen - Type
SPM-4
Specimen.condition
Raw specimen/biopsy - State
SPM-24
Specimen.processing
Raw specimen/biopsy - Sample preparation (submitted to GLH)
Combination of SPM-6/SPM-24 or NTE segments if other processing
Allows the categorisation of a sample into either tumour or germline. Only required for WGS Cancer Testing, not currently part of the Order Management MDS. Additional terms may be added upon review though the valueCodeableConcept.text field MAY be used as a free text representation if needed.
Multiple identifiers MAY be assigned to a sample as it travels between labs. Each lab SHOULD append their local identifier to the identifier array if needed, ensuring either the system or assigner, is able to disambiguate any identifiers from possibly overlapping numbers from other organizations. Assigner is preferred in this case (see identifier example on the UKCore-Patient page for further guidance)
Note: accessionIdentifier is unused by the Genomic Medicine Service to facilitate movement of samples across organizational boundaries.
If a Specimen has not been collected, the status SHOULD be marked as 'unavailable'. If the quality of the Specimen is such that it cannot be processed, the status SHOULD be 'unsatisfactory' (this is equivalent to a QC status of Failed). If the Specimen passes quality control, the status SHOULD be set as 'available
"status": "unsatisfactory",
type
The sample type, SNOMED CT preferred. Used to differentiate between raw and extracted (DNA) samples.
ConceptMaps for the allowed values for primary (raw) and final (extracted DNA) samples upon release of MDSv1.04, to aid identification of whether a sample is primary vs. final
SHALL be provided. This SHOULD be a reference to the Patient resource or the identifier, NHS number, for the patient.
Samples collected from a Fetus SHOULD reference a Patient resource for the Fetus. This should then be linked to relevant maternal/paternal resources through the RelatedPerson resource. Further information can be found on the Fetus Management clinical scenario. It is not envisaged that samples would need to be linked to more than one person e.g. both fetus and mother, though this assumption will be tested within the Alpha phase of the Genomic Medicine Service.
SHOULD be updated upon receipt at a destination lab
"receivedTime": "2023-09-18T18:30:00Z"
parent
If a sample has been split into multiple parts, such as DNA being extracted from a primary sample, each SHOULD be represented using an additional Specimen resource, referencing the parent sample through the parent element.
The central Order Management broker will only create Tasks for Specimen resources which do not have a parent element, i.e. primary samples. If required, clients can create Tasks for processing of derivative samples manually.
SHALL be provided. This SHOULD be a reference to the request which initiated collection of the sample. SHALL NOT be updated if the sample is used for another test e.g. for re-analysis. In the case that a Specimen needs to be processed as part of a new request, e.g. using a sample in storage, the ServiceRequest SHALL reference the pre-existing sample via ServiceRequest.specimen.
Additional information which can be collected about the circumstances under which as sample was collected, if relevant. This include extensions for specialHandling of the sample, e.g. due to high risk of infection, as well as an extension to bodySite to extend the coding to a BodyStructure reference, for more detailed collection of structural information e.g. where tumour morphology and topography need to be collected.
Where the collector is an Organization, or where the individual is not known, ODS codes MAY be used as identifiers in place of SDS-User-IDs. However, if referencing a resource, the PractitionerRole resource SHOULD still be referenced. In this case the PractitionerRole.identifier and PractitionerRole.practitioner reference would not be filled, leaving only the reference to an Organization from PractitionerRole.organization.
Note on quanitities
The Specimen.collection.quantity is the amount of the sample collected at collection time. This quantity does not change as the sample is processed.
The Specimen.container.specimenQuantity is the amount of sample remaining in a container, this is equivalent to GEL 1001 banked volume. This value should be updated as the specimen is used.
If a specimen is split, additional specimen resources SHOULD be created (referencing the parent specimen), with individual container.specimenQuantity values.
SHOULD be updated if processing occurs on the sample which affects later use, e.g. additives added
"processing": [
{
"description": "Acidify to pH < 3.0 with 6 N HCl.",
"procedure": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0373",
"code": "ACID"
}
]
},
"additive": [
{
"display": "6 N HCl"
}
],
"timeDateTime": "2015-08-18T08:10:00Z"
}
],
container
The UK Core STU3 version of Specimen backports the R5 changes to the container BackboneElement to support capturing of storage location for a sample (through `container.location`) and recursive capture of device identifiers (e.g. tube, well, rack, freezer through `container.device`).
The container.identifier should match the identifier associated with the barcode for the tube/collection device. This can be searched using the container-id SearchParameter.
Additional examples/guidance will be provided within this IG once use of the fields has been appropriately tested.
Sample tracking information SHOULD be added to Tasks acting on Specimen resources, e.g. Tasks marked SamplePreparation or SampleProcessing, on either the output or input elements. This information MAY include consignment number, destination, date sent etc.
If known, the container type SHOULD be populated, using the example bound ValueSet, in SNOMED CT. If an appropraite code cannot be found, the specimen container type should be populated using free text, in Specimen.container.type.text. Additional container elements, such as capacity or specimenQuantity MAY be populated if known.
The Genomics Subscription is currently pending Clinical and Technical Assurance of the base UKCore resource. Once this profile becomes active in UKCore its suitability for use and need for profiling within Genomics will be assessed.
The profile for the NHSDigital/England Subscription is provided below for completeness.
In the Alpha build of the Genomic Medicine Service, MESH/email will be used as the primary notification procedure though a FHIR native solution is being investigated.
The subscription resource is used to define a push-based subscription from a server to another system. Once a subscription is registered with the server, the server checks every resource that is created or updated, and if the resource matches the given criteria, it sends a message on the defined "channel" so that another system can take an appropriate action.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
There are no (further) constraints on this element
Element id
Subscription.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Subscription.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Subscription.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Subscription.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Subscription.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
Subscription.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
The status of the subscription, which marks the server state for managing the subscription.
Comments
A client can only submit subscription resources in the requested or off state. Only the server can move a subscription from requested to active, and then to error. Either the server or the client can turn a subscription off.
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
There are no (further) constraints on this element
Element id
Subscription.channel.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Subscription.channel.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
The url that describes the actual end-point to send messages to.
Comments
For rest-hook, and websocket, the end-point must be an http: or https: URL; for email, a mailto: url, for sms, a tel: url, and for message the endpoint can be in any form of url the server understands (usually, http: or mllp:). The URI is allowed to be relative; in which case, it is relative to the server end-point (since there may be more than one, clients should avoid using relative URIs).
The mime type to send the payload in - either application/fhir+xml, or application/fhir+json. If the payload is not present, then there is no payload in the notification, just a notification. The mime type "text/plain" may also be used for Email and SMS subscriptions.
Comments
Sending the payload has obvious security implications. The server is responsible for ensuring that the content is appropriately secured.
Additional headers / information to send as part of the notification.
Comments
Exactly what these mean depend on the channel type. They can convey additional information to the recipient and/or meet security requirements; for example, support of multiple headers in the outgoing notifications for rest-hook type subscriptions.
The core workflow resource for managing processing of a ServiceRequest from order through to delivery of a DiagnosticReport and completion is Task. Task tracking is a core requirement of the central Genomic Medicine Service.
Each ServiceRequest submitted will instantiate a series of High Level Tasks, which MAY be assigned to different organizations for managing the test request e.g. Sample Processing, Interpretation, Reporting etc. The full list of possible Task types/codes, their associated business statuses, and status reasons is pending internal review.
Tasks will be automatically created by the central broker but updates to statuses and attachment of input/output resources is the responsibility of the assigned organizations.
An illustrative diagram of the links between ServiceRequests and Tasks are provided below (for the initial sample processing). Note: not all resource links are represented, to increase legibility of the diagram. In most cases, the full library of 10 tasks, as defined within Genomic-Task-Code, will be 'spun-up', on submission of a Test order. Tasks related to Samples may be duplicated per Sample to allow tracking of work related to individual Samples as part of the same test request, or equally, may be omitted as in the case of Re-Analysis or Re-Interpretation where data from an existing sample is used, eliminating the need for additional wet-work. For the full cardinality breakdown see further guidance for the Task.code element.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
inv-1: Last modified date must be greater than or equal to authored-on date. lastModified.exists().not() or authoredOn.exists().not() or lastModified >= authoredOn
There are no (further) constraints on this element
Element id
Task.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Task.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Task.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
Comments
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).
There are no (further) constraints on this element
Element id
Task.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Comments
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Task.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
There are no (further) constraints on this element
Element id
Task.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - 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]
The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Task.
Requirements
Enables a formal definition of how he task is to be performed (e.g. using BPMN, BPEL, XPDL or other formal notation to be associated with a task), enabling automation.
Comments
see http://en.wikipedia.org/wiki/Uniform_resource_identifier
BasedOn refers to a higher-level authorization that triggered the creation of the task. It references a "request" resource such as a ServiceRequest, MedicationRequest, ServiceRequest, CarePlan, etc. which is distinct from the "request" resource the task is seeking to fulfill. This latter resource is referenced by FocusOn. For example, based on a ServiceRequest (= BasedOn), a task is created to fulfill a procedureRequest ( = FocusOn ) to collect a specimen from a 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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - 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]
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Contains business-specific nuances of the business state.
Requirements
There's often a need to track substates of a task - this is often variable by specific workflow implementation.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
The entity who benefits from the performance of the service specified in the task (e.g., the patient).
Requirements
Used to track tasks outstanding for a beneficiary. Do not use to track the task owner or creator (see owner and creator respectively). This can also affect access control.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Healthcare event during which this task originated
Definition
The healthcare event (e.g. a patient and healthcare provider interaction) during which this task was created.
Requirements
For some tasks it may be important to know the link between the encounter the task originated within.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Identifies the time action was first taken against the task (start) and/or the time final action was taken against the task prior to marking it as completed (end).
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
Period is not used for a duration (a measure of elapsed time). See Duration.
Identifies who created this task. May be used by access control mechanisms (e.g., to ensure that only the creator can cancel a task).
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
The kind of participant that should perform the task.
Requirements
Use to distinguish tasks on different activity queues.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Principal physical location where the this task is performed.
Requirements
Ties the event to where the records are likely kept and provides context around the event occurrence (e.g. if it occurred inside or outside a dedicated healthcare setting).
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
A resource reference indicating why this task needs to be performed.
Comments
Tasks might be justified based on an Observation, a Condition, a past or planned procedure, etc. This should only be included if there is no focus or if it differs from the reason indicated on the focus. Use the CodeableConcept text element in Task.reasonCode if the data is free (uncoded) text.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be relevant to the Task.
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Free-text information captured about the task as it progresses.
Comments
For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).
Links to Provenance records for past versions of this Task that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the task.
Comments
This element does not point to the Provenance associated with the current version of the resource - as it would be created after this version existed. The Provenance for the current version can be retrieved with a _revinclude.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
If the Task.focus is a request resource and the task is seeking fulfillment (i.e. is asking for the request to be actioned), this element identifies any limitations on what parts of the referenced request should be actioned.
Requirements
Sometimes when fulfillment is sought, you don't want full fulfillment.
There are no (further) constraints on this element
Element id
Task.restriction.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Task.restriction.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
For requests that are targeted to more than on potential recipient/target, for whom is fulfillment sought?
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.
The cardinality or value of this element may be affected by these constraints: ele-1
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (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 %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Additional information that may be needed in the execution of the task.
Requirements
Resources and data used to perform the task. This data is used in the business logic of task execution, and is stored separately because it varies between workflows.
There are no (further) constraints on this element
Element id
Task.input.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Task.input.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
Codes to identify types of input parameters. These will typically be specific to a particular workflow. E.g. "Comparison source", "Applicable consent", "Concomitent Medications", etc.
Resources and data produced during the execution the task. This data is generated by the business logic of task execution, and is stored separately because it varies between workflows.
There are no (further) constraints on this element
Element id
Task.output.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
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.
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.
There are no (further) constraints on this element
Element id
Task.output.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
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).
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.
Outputs are named to enable task automation to bind data and pass it from one task to the next.
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.
Codes to identify types of input parameters. These will typically be specific to a particular workflow. E.g. "Identified issues", "Preliminary results", "Filler order", "Final results", etc.
Derived from TQ1-7 in the ORL response message for the activity based on the OML request
Task.executionPeriod.end
PLCM activity - Activity end date and time
Derived from TQ1-8 in the ORL response message for the activity based on the OML request
Task.owner
PLCM activity - ODS code of organisation submitting to PLCM, PLCM activity - ODS code of organisation delivering requested test, PLCM activity - ODS code of the laboratory site delivering requested test
OBR-32.7 if sourced from principle results interpreter, OBX-32.10, AFF-2.10 associated with performing organization
Task.status
PLCM activity - Sample plating quality control
Implied through status recorded in ORC-25 indicating plating quality control had passed
Task.statusReason
PLCM activity - Sample plating quality control fail code
This element will not be used within the Genomic Medicine Service. The ServiceRequest a Task is seeking to fulfill SHALL be referenced through the `focus` element. Specimen resources being acted upon by tasks related to specimen prep/processing SHOULD be referenced through the `Task.input` element.
status
Initially, automatically populated by the central service upon instantiation. Tasks will be first marked as 'draft' until their prerequisites have been satisfied, after which they will be marked as 'requested' until accepted/claimed by an organization. Upon acceptance, the owning organization is responsible for updating the status up until completion (or if the owning organization is not integrated into the GMS, the organization who has referred the task to the unintegrated org).
If a ServiceRequest is cancelled, any Tasks which have not already moved into in-progress SHALL be moved into the cancelled state, any in-progress Tasks will require lab processes to manage closure of the Task and appropriate reimbursement. For a full list of possible automatic cascading of ServiceRequest.status to Task.status please see additional guidance on the status element on the UKCore-ServiceRequest profile page.
It is not expected that Task statuses will propagate up to the ServiceRequest status, though certain task failure types may require revokation of the authorising request (pending investigation).
For the full list of expected Task statuses in use by the GMS, please refer to the table below. For the allowed Task status transitions, please see the FHIR R4 Task state machine model.
Status
Description
Genomic workflow usage
Draft
The task is not yet ready to be acted upon.
Initial state for Tasks. Used for tasks which require prerequisite tasks to be completed first.
Requested
The task is ready to be acted upon and action is sought.
Status indicating a task can be worked on/claimed, all prerequisites have been satisfied.
Received
A potential performer has claimed ownership of the task and is evaluating whether to perform it.
NOT USED within Genomics as Tasks will be polled for rather than being sent out to assigned organizations. Most likely not used unless tasks are automatically assigned and organizations are notified by the central service, e.g. to GLH.
Accepted
The potential performer has agreed to execute the task but has not yet started work.
Used when an assigned owner has accepted the task after being assigned.
Rejected
The potential performer who claimed ownership of the task has decided not to execute it prior to performing any action.
Used if an organization was assigned to a task but is unable to perform work against it. It is expected if an alternative organization can be assigned, this is done as an owner update rather than marking the task as rejected. If subsequent work does occur, a duplicate task will need to be created as the 'rejected' state is a terminal one.
Ready
The task is ready to be performed, but no action has yet been taken. Used in place of requested/received/accepted/rejected when request assignment and acceptance is a given.
NOT USED within Genomics as it is not assumed that Tasks will be automatically accepted when prerequisites are satisfied.
Cancelled
The task was not completed.
Used when a task has been created but later identified as unneeded, e.g. due to modifications to test order such as the ServiceRequest being cancelled. Automatically set by the central broker.
In Progress
The task has been started but is not yet complete.
When work has commenced.
On Hold
The task has been started but work has been paused.
A holding state where work is expected to continue but is being blocked through some external issue. Suppliers will need to state reason why work is on hold through the statusReason field e.g. Awaiting Sample.
Failed
The task was attempted but could not be completed due to some error.
Indicates the task cannot continue and is unrcoverable without external intervention. If modifications to the test order allow the task to be resumed, a new task should be created e.g. a new sample is provided to replace a previous sample which has failed quality control. If the Task results in an unrecoverable error, the ServiceRequest may need to be revoked.
Completed
The task has been completed.
Marked once all actions against a task are complete, and follow on Tasks can commence.
Entered in Error
The task should never have existed and is retained only because of the possibility it may have used.
May be used if user created Tasks are created in error, e.g. duplicate Tasks, or Tasks have been created by the central broker and the ServiceRequest has subsequently been marked as entered-in-error.
"status": "rejected",
statusReason
Reasons why a Task has been marked as on-hold, cancelled etc. SHOULD use the Genomic-Task-StatusReason CodeSystem. NOTE: The list of appropriate statusReasons is pending finalization.
If a code from the linked CodeSystem is not applicable, the code of other SHOULD be used, with a free text reason captured within Task.statusReason.text.
Genomic specific business statuses for capturing more granular information as part of processing the task. SHOULD use the Genomic-Business-Status CodeSystem. NOTE: The list of appropriate buinessStatuses is pending finalization. Mapping business statuses to the high level container Tasks and statuses is still ongoing.
If a code from the linked CodeSystem is not applicable, the code of other SHOULD be used, with a free text status captured within Task.businessStatus.text.
High level coding for the Task, matches the NGTP stages for genomic test processing. Clients SHOULD use the Genomic-Task-Code CodeSystem. NOTE: The list of appropriate codes is pending finalization.
The currently allowed code list and their definition is provided in the table below. The table also provides the cardinality of each Task per ServiceRequest or Sample attached to the request as generated by the central broker on submission of a test request. Note: the cardinalities listed reflect the number of concurrent active tasks per service request at any one time, there may be cases where additional Tasks need to be spun up manually, e.g. on failure such as when a new sample needs to be processed after a previous sample fails Quality Control, or when further preparation is required. This cardinality supports the use cases for both requests with multiple participants, e.g. Duo/Trio, and multiple samples per participant e.g. Cancer testing.
Task.code display
Definition of work within Task
Cardinality (general case)
Cardinality (Reanalysis/Reinterpretation)
Cardinality (DNA Storage)
Process Genomic Test Request
Test code requested is ratified by the lab against provided patient information (checking eligibility)
1..1 (per ServiceRequest)
1..1
1..1
Request & Sample Alignment
The lab confirms/validates the data and sample(s) required for given test type are present
1..* (1 per Specimen referenced from or referencing the ServiceRequest)
1..1 (At least 1 will always be required, e.g. for validation of data in the No Sample scenario)
1..* (per Sample)
Sample Preparation
Sample is prepared, as appropriate for the selected test type, and DNA extracted. May have multiples if further preparation is required
1..* (1 per Sample)
0..0 (Not required for Reanalysis/Reinterpretation requests where a sample does not need to be prepared)
1..* (1 per Sample)
Sample Processing
DNA sample(s) are sequenced, generating read/sequence data to feed into analysis
1..* (1 per Sample or extracted DNA sample)
0..0 (Not required for Reanalysis/Reinterpretation requests where a sample does not need to be sequenced)
0..0 (Not required for DNA storage where a sample does not need to be sequenced)
Genetic/Genomic Data Processing
Sequence data is passed through a bio-pipeline, generates variant priorities lists for analysis
1..* (1 per Sample or read data)
0..* (For Reanalysis, should match the number of Samples for the parent request. Not required for Reinterpretation requests)
0..0 (Not required for DNA storage requests)
Interpretation
Results analysis is organised and interpreted by a Clincial Scientist
1..* (1 per Sample or variant priorities list)
1..* (For Reanalysis/Reinterpretation, should match the number of Samples for the parent request
0..0 (Not required for DNA storage requests)
Produce Interim Report
A report is created and deemed interim pending MDT, if necessary
1..* (1 per Sample. TBC whether one interim report would be generated per sample/set of genetic data or 1 per request)
1..* (For Reanalysis/Reinterpretation, should match the number of Samples for the parent request
0..0 (Not required for DNA storage requests)
Genomic MDT
Multi-Diciplinary-Team consults on the interim report
1..1 (max 1 per ServiceRequest, for the purposes of the Alpha an MDT task will always be created, even if not needed)
1..1
0..0 (Not required for DNA storage requests)
Produce Final Report
Interim report is deemed final or is updated following MDT
1..1 (per ServiceRequest)
1..1
1..1
Distribute Report
Final report is distributed or marked as distributable/available
1..1 (per ServiceRequest or Final Report)
1..1
1..1
Rendered within a diagram, the Task cardinalities and their inputs are illustrated in the diagram below:
A reference to the Patient resource or the identifier, NHS number, for the patient for whom the Task is for. Autopopulated by the central service if the Task is automatically generated.
If a Task is created by client system or user interaction, for SHALL be populated with a reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS.
MAY be used to capture start and end DateTimes associated with execution of a Task. It is expected the start time will be populated as a Task is moved to in-progress and the end time will be populated as a Task is marked as completed. Usage of this field will be investigated during the Alpha phase of the Genomic Order Management project as timelines for task execution can also be derived from the AuditEvents recorded as Tasks are updated.
Autopopulated by the central service if a performer is assigned at Test submission. By default, this will the Home GLH for the submitting organization, unless an alternative is specified. The Home GLH/original performer (managing entity) SHOULD remain the owner for the Process Genomic Test Task, throughout the test order-fulfillment process.
This field can be updated by the organization claiming the task (though this could also be autopopulated if automated per test routing tables are integrated into the central service functionality). Owner SHOULD be populated using organization ODS code references.
The responsibility for routing/reassigning ownership of Tasks lies with the current owner following the transfers of responsibility as per the National Genomic Testing Process (NGTP). The different scenarios for how follow-on routing may be achieved is summarised in the points below:
In most cases, by default the test will be routed to the home GLH (or other lab/GLH as dictated by the initial routing table).
This would mean all Tasks by default would have this organization, e.g. home GLH, as the initial owner, it would then be the responsibility of the GLH to reassign tasks to other organizations, where they 'send away' or commission work.
Once that work is complete, the send-away organization can choose to reassign the current Task (where another organization needs to conduct work against the same Task before it can be marked as complete)/or assign the follow-on Task (where the current task can be marked as complete) to the next organization, if this is known.
If the next organization to send work to is unknown, responsibility should lie with the original/previous owner e.g. Home GLH to reassign the task to the next organization that needs to complete work. This should be captured by having the current owner reassign the task back to the GLH (or organization which assigned the task to them) if further work needs to occur within the current task; or the next task in the NGTP moves from the draft state into the requested state (indicating all its prerequisites have been satisfied). The owner of that task, e.g home GLH, then either starts work or assigns this to the relevant organization.
In further phases, a routing advice service may be provided by NHS England to aid organizations in identifying which organization should be assigned, after completing their work.
Tasks assigned to a particular organization SHOULD be searched for using the owner search parameter with the :identifier modifier i.e. [base]/Task?owner:identifier=8J834 or [base]/Task?owner:identifier=https://fhir.nhs.uk/Id/ods-organization-code|8J834
Used for messaging between owner and other orgnizations e.g. during handover of task or requesting information from requesting clinician.
"note": [
{
"text": "Sample has not been received within 4 week window. Task will be closed unless further communication is received"
}
]
input
Used to attach inputs to a Task, if relevant. e.g. references to Specimen's which a Sample Processing task is acting on. No CodeSystem exists for this field as of publication but this will be investigated as future work.
Specimen references SHOULD be added to Tasks acting on Specimen resources, e.g. Tasks marked SamplePreparation or SampleProcessing. This is to clearly disambiguate which specimen a task is acting on, where multiple specimens are necessary for processing the test request.
The table below provides possible inputs that could be provided for certain Tasks as part of fulfillment of a test order. A finalised list is pending business analysis work to identify the operational data generated as fulfilment against a test order progresses and the need for this data to pass between organizations.
Task.code display
Possible Task.input
Process Genomic Test Request
N/A, all information required should be part of or refernced from the ServiceRequest
Request & Sample Alignment
Specimen resource to be aligned and potentially Consent resources where these are captured post submission of a test request
Sample Preparation
Specimen resource to be prepared as part of this Task
Sample Processing
DNA Specimen resource to be sequenced as part of this Task as well as Consignment, Rack and Well identifiers to allow for specimen tracking
Genetic/Genomic Data Processing
Sequence data generated from the previous Task, potentially referenced using DocumentReference resources, these SHOULD reference the Specimen from which the data originated
Interpretation
Variant Priorities lists generated from the previous Task, the representation of these lists is still under investigation
Produce Interim Report
Guidance/Recommendations generated though data interpretation, the representation of these items is still under investigation
Genomic MDT
Interim reports, references to Diagnostic report resources containing either structured Genomic reports or binary representations of the reports
Produce Final Report
Interim reports and potentially recommendations from the MDT, whether these are represented within the DiagnosticReport itself or contained as other resource types is still under investigation
Used to attach outputs from a Task, if relevant. e.g. VUS files during processing or a DiagnosticReport upon completion of reporting stage. No CodeSystem exists for this field as of publication but this will be investigated as future work.
Sample tracking information SHOULD be added to Tasks acting on Specimen resources, e.g. Tasks marked SamplePreparation or SampleProcessing, on either the output or input elements. This information MAY include consignment number, destination, date sent etc. Further modelling of the types/format expected are pending clinical scenarios.
The table below provides possible outputs that could be generated by certain Tasks as part of fulfillment of a test order. A finalised list is pending business analysis work to identify the operational data generated as fulfilment against a test order progresses and the need for this data to pass between organizations.
Task.code display
Possible Task.output
Process Genomic Test Request
N/A, may result in updates to the ServiceRequest if codes or supporting information needs to change
Request & Sample Alignment
Aligned Specimen resource for request (except for Reanalysis/Reinterpretation)
Sample Preparation
DNA Specimen resource as well as Consignment, Rack and Well identifiers to allow for specimen tracking
Sample Processing
Sequence/Read data
Genetic/Genomic Data Processing
Variant information
Interpretation
Potentially structured guidance/recommendations
Produce Interim Report
Interim reports
Genomic MDT
Potentially ammended Interim/combined report or recommendations from MDT
Produce Final Report
Final Report
Distribute Report
N/A, final report will be included as input to Task