FHIR International Patient Summary (IPS)

Introduction

The FHIR International Patient Summary (IPS) is a standardized clinical document used to exchange essential patient health information across healthcare systems and countries.

IPS enables safe and efficient sharing of patient summaries for:

  • Emergency care
  • Cross-border treatment
  • Care continuity
  • Health information exchange

What is IPS?

IPS is a minimal yet clinically relevant dataset that provides a snapshot of a patient's health status.

Typical information includes:

  • Demographics
  • Allergies
  • Medical conditions
  • Medications
  • Immunizations
  • Procedures
  • Diagnostic results
  • Vital signs

IPS Architecture

FHIR IPS is implemented as a FHIR Document Bundle and the Composition resource acts as the table of contents referencing all clinical resources. R4 version is used.

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
identifierSO Σ1..1Identifier
typeΣ1..1codeBindingFixed Value
timestampSO Σ1..1instant
totalΣ C0..1unsignedInt
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
relationΣ1..1string
urlΣ1..1uri
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ0..1Resource
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1CompositionUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1PatientUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1AllergyIntoleranceUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ1..1CarePlan
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ1..1ClinicalImpression
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1ConditionUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ1..1Consent
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ1..1Device
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1DeviceUseStatementUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1DiagnosticReportUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ1..1DocumentReference
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1FlagAlertUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1ImagingStudyUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1ImmunizationUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ1..1ImmunizationRecommendation
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1MedicationIPS
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1MedicationRequestIPS
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1MedicationStatementIPS
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1PractitionerUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1PractitionerRoleUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1ProcedureUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1ObservationPregnancyEddUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1ObservationPregnancyOutcomeUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1ObservationPregnancyStatusUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1ObservationAlcoholUseUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1ObservationTobaccoUseUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1ObservationResultsLaboratoryPathologyUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1ObservationResultsRadiologyUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1observation-vitalsigns
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1OrganizationUvIps
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
fullUrlΣ1..1uri
resourceΣ C1..1SpecimenUvIps
signatureΣ0..1Signature
IPS_composition
idΣ0..1string
id0..1string
extensionC0..*Extension
versionIdΣ0..1id
lastUpdatedΣ0..1instant
sourceΣ0..1uri
profileSO Σ0..*canonical(StructureDefinition)
securityΣ0..*CodingBinding
tagΣ0..*Coding
implicitRulesΣ ?!0..1uri
language0..1codeBinding
textSO0..1Narrative
contained0..*Resource
extensionC0..*Extension
modifierExtension?! C0..*Extension
identifierSO Σ0..1Identifier
statusSO Σ ?!1..1codeBinding
typeSO Σ1..1CodeableConceptIPSBindingPattern
categoryΣ0..*CodeableConcept
id0..1string
extensionC0..*Extension
referenceSO Σ C1..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
encounterΣ C0..1Reference(Encounter)
dateSO Σ1..1dateTime
authorSO Σ C1..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
titleSO Σ1..1string
confidentialityΣ0..1codeBinding
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
modeSO1..1codeBinding
timeSO0..1dateTime
partySO C0..1Reference(Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
custodianSO Σ C0..1Reference(Organization)
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
code1..1codeBinding
targetIdentifierIdentifier
targetReferenceReference(Composition | CompositionUvIps)
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
codeΣ0..*CodeableConcept
periodΣ C0..1Period
detailΣ C0..*Reference(Resource)
id0..1string
extensionC0..*Extension
modifierExtensionΣ ?! C0..*Extension
codeSO Σ1..1CodeableConceptPattern
periodSO Σ C0..1Period
detailΣ C0..*Reference(Resource)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConcept
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
entryC0..*Reference(Resource)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
problemSO C0..*Reference(ConditionUvIps)
emptyReasonSO C0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
allergyOrIntoleranceSO C0..*Reference(AllergyIntoleranceUvIps)
emptyReasonSO C0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
medicationStatementOrRequestSO C0..*Reference(MedicationRequestIPS | MedicationStatementIPS)
emptyReasonSO C0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
immunizationSO C0..*Reference(ImmunizationUvIps)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
results-observation-laboratory-pathologySO C0..*Reference(ObservationResultsLaboratoryPathologyUvIps)
results-observation-radiologySO C0..*Reference(ObservationResultsRadiologyUvIps)
results-diagnosticReportSO C0..*Reference(DiagnosticReportUvIps)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
procedureSO C0..*Reference(ProcedureUvIps)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
deviceStatementSO C0..*Reference(DeviceUseStatementUvIps)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
advanceDirectivesConsentC0..*Reference(Consent)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
alertsFlagC0..*Reference(FlagAlertUvIps)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
disabilityC0..*Reference(ConditionUvIps)
functionalAssessmentC0..*Reference(ClinicalImpression)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
pastProblemC0..*Reference(ConditionUvIps)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
pregnancyStatusC0..*Reference(ObservationPregnancyStatusUvIps)
pregnancyOutcomeC0..*Reference(ObservationPregnancyOutcomeUvIps)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
entryC0..*Reference(Resource)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
carePlanC0..*Reference(CarePlan)
immunizationRecommendationC0..*Reference(ImmunizationRecommendation)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
smokingTobaccoUseC0..1Reference(ObservationTobaccoUseUvIps)
alcoholUseC0..1Reference(ObservationAlcoholUseUvIps)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)
id0..1string
section-noteC0..*Extension
modifierExtensionΣ ?! C0..*Extension
titleSO1..1string
codeSO1..1CodeableConceptPattern
authorC0..*Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
focusC0..1Reference(Resource)
textSO C1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
vitalSignC0..*Reference(observation-vitalsigns)
emptyReasonC0..1CodeableConceptBinding
sectionC0..0see (section)

Sample IPS Bundle


Design Principles

  • most slicing is open, meaning predefined slices guide expected data structures but additional elements or profiles not explicitly defined can still be included as long as overall profile constraints are met.

  • human-readable narrative in every Composition section to ensure patient safety, legal attestation, and reliable understanding during cross-border exchange—even when structured data or language translations cannot be fully processed by receiving systems.

  • Composition sections may be empty, but required sections must state why data is missing using emptyReason (populated using ListEmptyReasons or an explicit “no information available” clinical statement, while all included sections must still provide human-readable narrative text.

  • IPS documents are generated as FHIR Bundles and can be accessed either via a $summary operation on the Patient resource for on-demand summary Bundles, or via a $docref operation on DocumentReference to create and retrieve persisted IPS Bundles; future guides may provide additional generation methods.

  • IPS documents support cross-border and lifetime patient care, but only current and relevant data—especially allergies, medications, and problems—are required, while other historical data may be selectively included based on clinical relevance.

  • IPS creation can leverage FHIR Resource.meta.security tags to identify and exclude highly sensitive or restricted health data based on patient consent or system policies, ensuring privacy while sharing summaries with authorized recipients.


Future Development

  1. Explore the adoption of the Provenance resource with the IPS (bundle level, composition level, or entry level) to document the IPS curation as documented in the first known issue above (see also the "International Patient Summary: Use Cases" Confluence page)

  2. Include additional guidance or references on approaches for selecting appropriate summary content, documenting algorithmic vs. human curation of data, and generating narrative representations. A draft page on the various Methods for IPS generation has been drafted on HL7 Confluence and may be a consideration for future version of this IPS FHIR Implementation Guide.

  3. Gather feedback on the IPS $summary operation introduced in STU1.1 of this guide.

  4. Gather feedback on how Provenance could be used in IPS FHIR-40610

  5. Loosen Observation profile for alcohol usage FHIR-40802

  6. Provide IPS viewing requirements FHIR-41630

  7. Remove identifying information requirements in IPS FHIR-43721

  8. Check value Set OID alignment between FHIR and CDA IPS IGs FHIR-46169

  9. Add NutritionIntake Observation profile in Social History FHIR-46923

  10. Add Patient Travel History FHIR-47930

  11. Add NUVA as additional vaccine binding FHIR-49146

  12. Add 'disability' to ValueSet: Problem Type - IPS FHIR-49218

  13. Add CarePlan (IPS) Profile, based on ISO 27269 FHIR-49905

  14. Guidance on laterality in IPS FHIR-50042

  15. Add a CareTeam section, and describe how to use it for patient advocate / legal power of attorney FHIR-50098

  16. Include more detail in section about identifier usage FHIR-51507

  17. Clarify intent and possible rules for separation between Current and Past problems FHIR-51511