GP Connect - Update Record (ITK3)

• dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources
  contained.contained.empty()
• dom-1:If the resource is contained in another resource, it SHALL NOT contain any narrative
  contained.text.empty()
• dom-4:If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
  contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
• dom-3:If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
  contained.where(('#'+id in %resource.descendants().reference).not()).empty()
• con-4:If condition is abated, then clinicalStatus must be either inactive, resolved, or remission
  abatement.empty() or (abatement as boolean).not() or clinicalStatus='resolved' or clinicalStatus='remission' or clinicalStatus='inactive'
• con-3:Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error
  verificationStatus='entered-in-error' or clinicalStatus.exists()

• rim:Entity. Role, or Act
• sct-concept:< 243796009 |Situation with explicit context|: 246090004 |Associated finding| = ((< 404684003 |Clinical finding| MINUS << 420134006 |Propensity to adverse reactions| MINUS << 473010000 |Hypersensitivity condition| MINUS << 79899007 |Drug interaction| MINUS << 69449002 |Drug action| MINUS << 441742003 |Evaluation finding| MINUS << 307824009 |Administrative status| MINUS << 385356007 |Tumor stage finding|) OR < 272379006 |Event|)
• v2:PPR message
• rim:Observation[classCode=OBS, moodCode=EVN, code=ASSERTION, value<Diagnosis]
• w5:clinical.general

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

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

• rim:n/a

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

• rim:n/a
• rim:N/A

Note that FHIR strings may not exceed 1MB in size

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

• rim:n/a

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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

• rim:n/a
• rim:N/A

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

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

• rim:n/a

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant.

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

• rim:n/a

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

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

• rim:n/a

Security Labels from the Healthcare Privacy and Security Classification System.

The security labels can be updated without changing the stated version of the resource The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

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

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

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

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

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

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

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

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

• rim:n/a

A human language.

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

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

• rim:n/a

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

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

• rim:n/a
• rim:N/A
• rim:Act.text?

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

• rim:Entity. Role, or Act
• rim:N/A

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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

• rim:n/a
• rim:N/A

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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

• rim:n/a
• rim:N/A

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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

• rim:n/a
• rim:N/A

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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

• rim:n/a
• rim:N/A

Need to allow connection to a wider workflow.

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

• rim:n/a
• v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
• rim:II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
• servd:Identifier
• rim:.id
• w5:id

Note that FHIR strings may not exceed 1MB in size

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

• rim:n/a

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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

• rim:n/a
• rim:N/A

Identifies the purpose for this identifier, if known .

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

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

• rim:n/a
• v2:N/A
• rim:Role.code or implied by context

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Allows users to make use of identifiers when the identifier system is not known.

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.

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

• rim:n/a
• v2:CE/CNE/CWE
• rim:CD
• orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
• v2:CX.5
• rim:Role.code or implied by context

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.

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

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

• rim:n/a
• v2:CX.4 / EI-2-4
• rim:II.root or Role.id.root
• servd:./IdentifierType

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.

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

• rim:n/a
• v2:CX.1 / EI.1
• rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
• servd:./Value

This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. 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"). If duration is required, specify the type as Interval|Duration.

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

• rim:n/a
• v2:DR
• rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
• v2:CX.7 + CX.8
• rim:Role.effectiveTime or implied by context
• servd:./StartDate and ./EndDate

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.

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

• rim:n/a
• rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• v2:CX.4 / (CX.4,CX.9,CX.10)
• rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
• servd:./IdentifierIssuingAuthority

The clinical status of the condition or diagnosis.

This element is labeled as a modifier because the status contains codes that mark the condition as not currently valid or of concern.

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

• rim:n/a
• sct-concept:< 303105007 |Disease phases|
• v2:PRB-14 / DG1-6
• rim:Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value
• w5:status

The verification status to support or decline the clinical status of the condition or diagnosis.

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.

This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.

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

• rim:n/a
• sct-concept:< 410514004 |Finding context value|
• v2:PRB-13
• rim:Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value
• sct-attr:408729009
• w5:status

A category assigned to the condition.

The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

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

• rim:n/a
• v2:CE/CNE/CWE
• rim:CD
• orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
• sct-concept:< 404684003 |Clinical finding|
• v2:'problem' if from PRB-3. 'diagnosis' if from DG1 segment in PV1 message
• rim:.code
• w5:class

Note that FHIR strings may not exceed 1MB in size

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

• rim:n/a

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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

• rim:n/a
• rim:N/A

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

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.

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

• rim:n/a
• v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
• rim:CV
• orim:fhir:Coding rdfs:subClassOf dt:CDCoding
• v2:C*E.1-8, C*E.10-22
• rim:union(., ./translation)
• orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

Note that FHIR strings may not exceed 1MB in size

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

• rim:n/a

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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

• rim:n/a
• rim:N/A

Need to be unambiguous about the source of the definition of the symbol.

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 de-reference to some definition that establish the system clearly and unambiguously.

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

• rim:n/a
• v2:C*E.3
• rim:./codeSystem
• orim:fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

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.

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

• rim:n/a
• v2:C*E.7
• rim:./codeSystemVersion
• orim:fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

Need to refer to a particular code in the system.

Note that FHIR strings may not exceed 1MB in size

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

• rim:n/a
• v2:C*E.1
• rim:./code
• orim:fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Note that FHIR strings may not exceed 1MB in size

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

• rim:n/a
• v2:C*E.2 - but note this is not well followed
• rim:CV.displayName
• orim:fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

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.

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.

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

• rim:n/a
• v2:Sometimes implied by being first
• rim:CD.codingRationale
• orim:fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

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.

Very often the text is the same as a displayName of one of the codings.

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

• rim:n/a
• v2:C*E.9. But note many systems use C*E.2 for this
• rim:./originalText[mediaType/code="text/plain"]/data
• orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

A subjective assessment of the severity of the condition as evaluated by the clinician.

Coding of the severity with a terminology is preferred, where possible.

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

• rim:n/a
• v2:CE/CNE/CWE
• rim:CD
• orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
• sct-concept:< 272141005 |Severities|
• v2:PRB-26 / ABS-3
• rim:Can be pre/post-coordinated into value. Or ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="severity"].value
• sct-attr:246112005
• w5:grade

Note that FHIR strings may not exceed 1MB in size

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

• rim:n/a

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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

• rim:n/a
• rim:N/A

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

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.

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

• rim:n/a
• v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
• rim:CV
• orim:fhir:Coding rdfs:subClassOf dt:CDCoding
• v2:C*E.1-8, C*E.10-22
• rim:union(., ./translation)
• orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

Note that FHIR strings may not exceed 1MB in size

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

• rim:n/a