MII IG Onkologie DE v2025
Tumorkonferenz: CarePlan
Dieses Profil beschreibt die Tumorkonferenz und die Therapieempfehlungen. Die Datenfelder sind seit der Version 2021 Teil des oBDS und werden in zwei verschiedenen Modulen erfasst. Da alle beteiligten Felder sehr gut über die FHIR CarePlan-Ressource abbildbar sind, wurden alle die Tumorkonferenz- und Therapieemfpehlungsfelder im Tumorkonferenz-Profil zusammengefasst.
Das Tumorkonferenz-Profil umfasst daher
- die Referenz auf Patient über
subject - die Referenz auf die Primärdiagnose über
addresses. - die Kategorie des Plans nach oBDS über
category - das Datum über
created - einzelne Empfehlungen (
activity)mit jeweils den folgenden Elementen:- die oBDS-Kodierung der vorgeschlagenen Therapiemaßnahme
code - Der Status der einzelnen Aktivitäten unter
statusgemäß den HL7 FHIR status codes - Bei Abbruch: Die Angabe, ob therapiespezifisch auf Wunsch des Patienten abgebrochen wurde, unter
statusReason
- die oBDS-Kodierung der vorgeschlagenen Therapiemaßnahme
Die CarePlan-Ressource sieht eine verpflichtende Angabe des status-Elements einer activity vor. Diese Informationen sind in dieser Form nicht im oBDS enthalten. Die tatsächlich erfolgten Therapien werden jedoch in den Krebsregisterdaten erfasst und SOLLEN über Procedure.basedOn(Reference(CarePlan)) auf die Tumorkonferenz-Ressource verweisen.
Die Statusangaben geben den tatsächlichen Stand der Therapieempfehlung wieder. Für alle Statusangaben gilt das offizielle FHIR CarePlanActivityStatus-CodeSet.
https://www.hl7.org/fhir/R4/valueset-care-plan-activity-status.html
Es SOLLTEN folgende Status-Codes verwendet werden:
completedbei abgeschlossener Therapie,on-holdbei Therapieunterbrechung für noch nicht gestartete Therapiestoppedbei Therapieunterbrechung für bereits gestarteter Therapieunknownfür unbekannt, soweit keine Informationen über den Status vorliegen.
Bei den Statusangaben on-hold und stopped SOLL das Feld statusReason mit den Angaben aus dem oBDS-Feld 'Therapieabweichung auf Wunsch des Patienten' befüllt werden.
Jede Tumorkonferenz mit Therapieempfehlung SOLL als einzelne Ressource gespeichert und über CarePlan.addresses(Reference(Condition)) auf die Primärdiagnose referenzieren.
Zukünftige Entwicklungen
Im Rahmen des MII-Erweiterungsmoduls Molekulares Tumorboard wurden die Modellierung der Therapieempfehlungen nochmal überarbeitet. In der derzzeitigen Profilierung werden die Empfehlungen alle explizit unter CarePlan.activity kodiert. Für die spätere Verwendung ist das insofern unpraktikabel, als dass diese nicht von außen logisch referenziert werden können. Es ist daher geplant, Änderungen an der CarePlan-Ressource aus der FHIR-Version R5 zu übernehmen, so dass die Empfehlungen nicht mehr explizit gelistet sind, sondern über CarePlan.plannedActivityReferenceals konkrete ServiceRequests bzw. MedicationRequest referenziert werden können. Auf die gleiche Art und Weise können tatsächlich stattgefundene Prozeduren und Medikationen unter CarePlan.performedActivity.
Es wird hier in der nächsten Version zu einer Umprofilierung kommen, die keinen breaking change vorraussetzt, aber die Informationen anders strukturiert und die Erschließung von neuen FHIR-Ressourcen und Suchparametern erfordert.
- Erstellung von Extensions für die Verwendung der R5-Elemente in R4
- Erstellung von Profile für Therapieempfehlungen (ServiceRequest / MedicationRequest)
- Erstellung eines RequestGroup-Profils zur Abbildung von Kombinationstherapien
| Name | Status | Version | Canonical | Basis |
|---|---|---|---|---|
| MII_PR_Onko_Tumorkonferenz | active | 2025.1.0 | https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-tumorkonferenz | http://hl7.org/fhir/StructureDefinition/CarePlan |
Inhalt
| MII_PR_Onko_Tumorkonferenz (CarePlan) | C | CarePlan | |
| id | Σ | 0..1 | string |
| meta | Σ | 0..1 | Meta |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| versionId | Σ | 0..1 | id |
| lastUpdated | Σ | 0..1 | instant |
| source | Σ | 0..1 | uri |
| profile | S Σ | 0..* | canonical(StructureDefinition) |
| security | Σ | 0..* | CodingBinding |
| tag | Σ | 0..* | Coding |
| implicitRules | Σ ?! | 0..1 | uri |
| language | 0..1 | codeBinding | |
| text | 0..1 | Narrative | |
| contained | 0..* | Resource | |
| extension | C | 0..* | Extension |
| modifierExtension | ?! C | 0..* | Extension |
| identifier | Σ | 0..* | Identifier |
| instantiatesCanonical | Σ | 0..* | canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) |
| instantiatesUri | Σ | 0..* | uri |
| basedOn | Σ C | 0..* | Reference(CarePlan) |
| replaces | Σ C | 0..* | Reference(CarePlan) |
| partOf | Σ C | 0..* | Reference(CarePlan) |
| status | S Σ ?! | 1..1 | codeBinding |
| intent | S Σ ?! | 1..1 | codeBindingPattern |
| category | S Σ | 1..1 | CodeableConcept |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| coding | S Σ | 1..* | CodingBinding |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| system | S Σ | 1..1 | uriPattern |
| version | Σ | 0..1 | string |
| code | S Σ | 1..1 | code |
| display | Σ | 0..1 | string |
| userSelected | Σ | 0..1 | boolean |
| text | Σ | 0..1 | string |
| title | Σ | 0..1 | string |
| description | Σ | 0..1 | string |
| subject | S Σ C | 1..1 | Reference(Patient) |
| encounter | S Σ C | 0..1 | Reference(Encounter) |
| period | Σ C | 0..1 | Period |
| created | S Σ | 1..1 | dateTime |
| author | Σ C | 0..1 | Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) |
| contributor | C | 0..* | Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) |
| careTeam | C | 0..* | Reference(CareTeam) |
| addresses | S Σ C | 0..* | Reference(MII_PR_Onko_Diagnose_Primaertumor) |
| supportingInfo | S C | 0..* | Reference(Resource) |
| goal | C | 0..* | Reference(Goal) |
| activity | S C | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| outcomeCodeableConcept | 0..* | CodeableConcept | |
| outcomeReference | C | 0..* | Reference(Resource) |
| progress | 0..* | Annotation | |
| reference | C | 0..1 | Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | ServiceRequest | Task | VisionPrescription) |
| detail | S C | 1..1 | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| kind | 0..1 | codeBinding | |
| instantiatesCanonical | 0..* | canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) | |
| instantiatesUri | 0..* | uri | |
| code | S | 1..1 | CodeableConceptBinding |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| coding | Σ | 0..* | Coding |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| system | S Σ | 1..1 | uriPattern |
| version | Σ | 0..1 | string |
| code | S Σ | 1..1 | code |
| display | Σ | 0..1 | string |
| userSelected | Σ | 0..1 | boolean |
| text | Σ | 0..1 | string |
| reasonCode | 0..* | CodeableConcept | |
| reasonReference | C | 0..* | Reference(Condition | DiagnosticReport | DocumentReference | Observation) |
| goal | C | 0..* | Reference(Goal) |
| status | S ?! | 1..1 | codeBinding |
| statusReason | S | 0..1 | CodeableConceptBinding |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| coding | S Σ | 0..* | Coding |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| system | Σ | 0..1 | uriPattern |
| version | Σ | 0..1 | string |
| code | S Σ | 0..1 | code |
| display | Σ | 0..1 | string |
| userSelected | Σ | 0..1 | boolean |
| text | Σ | 0..1 | string |
| doNotPerform | ?! | 0..1 | boolean |
| scheduled[x] | 0..1 | ||
| scheduledPeriod | Period | ||
| scheduledString | string | ||
| scheduledTiming | Timing | ||
| location | C | 0..1 | Reference(Location) |
| performer | C | 0..* | Reference(CareTeam | Device | HealthcareService | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) |
| product[x] | 0..1 | ||
| productCodeableConcept | CodeableConcept | ||
| productReference | Reference(Medication | Substance) | ||
| dailyAmount | C | 0..1 | SimpleQuantity |
| quantity | C | 0..1 | SimpleQuantity |
| description | 0..1 | string | |
| note | 0..* | Annotation |
Dieses Profil beschreibt die Tumorkonferenz und die Therapieempfehlungen |
| Feldname | Kurzbeschreibung |
|---|---|
| CarePlan.meta.profile | |
| CarePlan.status | |
| CarePlan.intent | |
| CarePlan.category | |
| CarePlan.category.coding | Art der Tumorkonferenz / Therapieplanung |
| CarePlan.category.coding.system | |
| CarePlan.category.coding.code | |
| CarePlan.subject | |
| CarePlan.encounter | |
| CarePlan.created | Datum der Tumorkonferenz / Therapieplanung |
| CarePlan.addresses | |
| CarePlan.supportingInfo | |
| CarePlan.activity | |
| CarePlan.activity.detail | |
| CarePlan.activity.detail.code | |
| CarePlan.activity.detail.code.coding.system | |
| CarePlan.activity.detail.code.coding.code | |
| CarePlan.activity.detail.status | Status der Therapieempfehlung |
| CarePlan.activity.detail.statusReason | Therapieabweichung aufgrund Patientenwunsch der Therapieempfehlung |
| CarePlan.activity.detail.statusReason.coding | |
| CarePlan.activity.detail.statusReason.coding.code |
<url value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-tumorkonferenz" />
</telecom>
</contact>
</mapping>
<definition value="Describes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions." />
</base>
<human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
</constraint>
<human value="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" />
<expression value="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()" />
<xpath value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))" />
</constraint>
<human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
<xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" />
</constraint>
<human value="If a resource is contained in another resource, it SHALL NOT have a security label" />
</constraint>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
<valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." />
</extension>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
<comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation." />
</base>
</extension>
</type>
</element>
<definition value="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." />
</base>
</type>
</constraint>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted." />
<comment value="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." />
</base>
</type>
</constraint>
</element>
<comment value="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. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http.html#read) interaction." />
</base>
</type>
</constraint>
</element>
<definition value="A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc." />
<comment value="In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. \n\nThis element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL." />
</base>
</type>
</constraint>
</element>
<definition value="A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url)." />
<comment value="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." />
</base>
</type>
</constraint>
</element>
<definition value="Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure." />
<comment value="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." />
</base>
</type>
</constraint>
</extension>
</extension>
<description value="Security Labels from the Healthcare Privacy and Security Classification System." />
</binding>
</element>
<definition value="Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource." />
<comment value="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." />
</base>
</type>
</constraint>
</extension>
<description value="Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"." />
</binding>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
<isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation" />
</element>
<comment value="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)." />
</base>
</type>
</constraint>
</extension>
</extension>
</extension>
</binding>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</mapping>
</element>
<definition value="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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
<requirements value="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](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" />
</mapping>
</element>
<definition value="Business identifiers assigned to this care plan by the performer or other systems which remain constant as the resource is updated and propagates from server to server." />
<comment value="This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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." />
<requirements value="Allows identification of the care plan as it is known by various participating systems and in a way that remains consistent across servers." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan." />
<comment value="This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<requirements value="Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon." />
</base>
</extension>
</type>
</constraint>
</mapping>
</element>
<definition value="Completed or terminated care plan whose function is taken by this new care plan." />
<comment value="The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing." />
<requirements value="Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans." />
</base>
</extension>
</type>
</constraint>
</mapping>
</element>
<definition value="A larger care plan of which this particular care plan is a component or step." />
<comment value="Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed." />
</base>
</extension>
</type>
</constraint>
</element>
<definition value="Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record." />
<comment value="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 care plan.\n\nThis element is labeled as a modifier because the status contains the code entered-in-error that marks the plan as not currently valid." />
</base>
</type>
</constraint>
<isModifierReason value="This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" />
</extension>
<description value="Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record." />
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Indicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain." />
<comment value="This element is labeled as a modifier because the intent alters when and how the resource is actually applicable." />
<requirements value="Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain." />
</base>
</type>
</constraint>
<isModifierReason value="This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request"" />
</extension>
<description value="Codes indicating the degree of authority/intentionality associated with a care plan." />
</binding>
</mapping>
</element>
<definition value="Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc." />
<comment value="There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern." />
<requirements value="Used for filtering what plan(s) are retrieved and displayed to different types of users." />
</base>
</type>
</constraint>
</extension>
<description value="Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc." />
</binding>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
</extension>
</extension>
</extension>
</short>
</extension>
</extension>
</extension>
</definition>
<comment value="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." />
<requirements value="Allows for alternative encodings within a code system, and translations to other code systems." />
</base>
</type>
</constraint>
<valueSet value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-therapieplanung-typ" />
</binding>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="The identification of the code system that defines the meaning of the symbol in the code." />
<comment value="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." />
</base>
</type>
<patternUri value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapieplanung-typ" />
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="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)." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</extension>
<definition value="A representation of the meaning of the code in the system, following the rules of the system." />
<requirements value="Need to be able to carry a human-readable meaning of the code for readers that do not know the system." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays)." />
<comment value="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." />
<requirements value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
<map value="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 ]" />
</mapping>
</element>
</extension>
<definition value="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 value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</element>
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="Identifies the patient or group whose intended care is described by the plan." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The Encounter during which this CarePlan was created or to which the creation of this record is tightly associated." />
<comment value="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. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<comment value="Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition)." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</short>
</extension>
</extension>
</extension>
</definition>
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="When populated, the author is responsible for the care plan. The care plan is attributed to the author." />
<comment value="The author may also be a contributor. For example, an organization can be an author, but not listed as a contributor." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="Identifies the individual(s) or organization who provided the contents of the care plan." />
</base>
</type>
</constraint>
</element>
<definition value="Identifies all people and organizations who are expected to be involved in the care envisioned by this plan." />
<requirements value="Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan." />
<comment value="When the diagnosis is related to an allergy or intolerance, the Condition and AllergyIntolerance resources can both be used. However, to be actionable for decision support, using Condition alone is not sufficient as the allergy or intolerance condition needs to be represented as an AllergyIntolerance." />
<requirements value="Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like "at risk for hypertension" or "fall risk".) Also scopes plans - multiple plans may exist addressing different concerns." />
</base>
<targetProfile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-diagnose-primaertumor" />
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Identifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc." />
<requirements value="Identifies barriers and other considerations associated with the care plan." />
</base>
</type>
</constraint>
</mapping>
</element>
<comment value="Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline." />
<requirements value="Provides context for plan. Allows plan effectiveness to be evaluated by clinicians." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="Identifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc." />
<requirements value="Allows systems to prompt for performance of planned activities, and validate plans against best practice." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
<definition value="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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
<requirements value="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](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
</mapping>
</element>
<definition value="Identifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not)." />
<comment value="Note that this should not duplicate the activity status (e.g. completed or in progress)." />
</base>
</type>
</constraint>
</extension>
</binding>
</element>
<definition value="Details of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource)." />
<comment value="The activity outcome is independent of the outcome of the related goal(s). For example, if the goal is to achieve a target body weight of 150 lbs and an activity is defined to diet, then the activity outcome could be calories consumed whereas the goal outcome is an observation for the actual body weight measured." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<comment value="This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description." />
<requirements value="Can be used to capture information about adherence, progress, concerns, etc." />
</base>
</type>
</constraint>
</mapping>
<map value=".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value" />
</mapping>
</element>
<comment value="Standard extension exists ([resource-pertainsToGoal](extension-resource-pertainstogoal.html)) that allows goals to be referenced from any of the referenced resources in CarePlan.activity.reference. \nThe goal should be visible when the resource referenced by CarePlan.activity.reference is viewed independently from the CarePlan. Requests that are pointed to by a CarePlan using this element should *not* point to this CarePlan using the "basedOn" element. i.e. Requests that are part of a CarePlan are not "based on" the CarePlan." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="A simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc." />
</base>
</type>
</constraint>
<human value="Therapieabweichung aufgrund Patientenwunsch: Bei nichtangetretener oder abgebrochener Therapie ist anzugeben, ob dies dem Patientenwunsch entspricht oder ggfs. andere Gründe hat" />
<source value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-tumorkonferenz" />
</constraint>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
<definition value="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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
<requirements value="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](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
</mapping>
</element>
<short value="Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription" />
<definition value="A description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest." />
</base>
</type>
</constraint>
</extension>
<description value="Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity." />
</binding>
</mapping>
</element>
<definition value="The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity." />
<requirements value="Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity." />
<comment value="This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier." />
<requirements value="Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="Detailed description of the type of planned activity; e.g. what lab test, what procedure, what kind of encounter." />
<comment value="Tends to be less relevant for activities involving particular products. Codes should not convey negation - use "prohibited" instead." />
<requirements value="Allows matching performed to planned as well as validation against protocols." />
</base>
</type>
</constraint>
</extension>
<description value="Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter." />
<valueSet value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-therapieempfehlung-typ" />
</binding>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
</extension>
</extension>
</extension>
</short>
</extension>
</extension>
</extension>
</definition>
<comment value="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." />
<requirements value="Allows for alternative encodings within a code system, and translations to other code systems." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="The identification of the code system that defines the meaning of the symbol in the code." />
<comment value="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." />
</base>
</type>
<patternUri value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-typ" />
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="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)." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</extension>
<definition value="A representation of the meaning of the code in the system, following the rules of the system." />
<requirements value="Need to be able to carry a human-readable meaning of the code for readers that do not know the system." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays)." />
<comment value="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." />
<requirements value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
<map value="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 ]" />
</mapping>
</element>
</extension>
<definition value="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 value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Provides the rationale that drove the inclusion of this particular activity as part of the plan or the reason why the activity was prohibited." />
<comment value="This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonCondition instead." />
</base>
</type>
</constraint>
</extension>
<description value="Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc." />
</binding>
</mapping>
</element>
<definition value="Indicates another resource, such as the health condition(s), whose existence justifies this request and drove the inclusion of this particular activity as part of the plan." />
<comment value="Conditions can be identified at the activity level that are not identified as reasons for the overall plan." />
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="Internal reference that identifies the goals that this activity is intended to contribute towards meeting." />
</base>
</type>
</constraint>
</mapping>
</element>
</extension>
</extension>
</extension>
</short>
<definition value="Status der Therapieempfehlung nach HL7 FHIR CarePlanActivityStatus | not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error |">
</extension>
<valueString value="Status der Therapieempfehlung nach HL7 FHIR CarePlanActivityStatus | not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error |" />
</extension>
</extension>
</definition>
<comment value="Some aspects of status can be inferred based on the resources linked in actionTaken. Note that "status" is only as current as the plan was most recently updated. \nThe 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 activity." />
<requirements value="Indicates progress against the plan, whether the activity is still relevant for the plan." />
</base>
</type>
</constraint>
<isModifierReason value="This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the activity should not be treated as valid" />
</extension>
<description value="Codes that reflect the current state of a care plan activity within its overall life cycle." />
</binding>
</mapping>
</mapping>
<map value=".statusCode not-started = new scheduled = not-started (and fulfillment relationship to appointent) in-progress = active on-hold = suspended completed = completed cancelled = aborted" />
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</short>
<definition value="wenn Therapieabweichung - z.B. status = cancelled - Aussage ob dies durch Patientenwunsch erfolgt ist gemäß 19.2 oBDS 2021.">
</extension>
<valueString value="wenn Therapieabweichung - z.B. status = cancelled - Aussage ob dies durch Patientenwunsch erfolgt ist gemäß 19.2 oBDS 2021." />
</extension>
</extension>
</definition>
<comment value="Will generally not be present if status is "complete". Be sure to prompt to update this (or at least remove the existing value) if the status is changed." />
</base>
</type>
</constraint>
<valueSet value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-therapieabweichung" />
</binding>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<comment value="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." />
<requirements value="Allows for alternative encodings within a code system, and translations to other code systems." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="The identification of the code system that defines the meaning of the symbol in the code." />
<comment value="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." />
</base>
</type>
<patternUri value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapieabweichung" />
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="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)." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
</extension>
<definition value="A representation of the meaning of the code in the system, following the rules of the system." />
<requirements value="Need to be able to carry a human-readable meaning of the code for readers that do not know the system." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays)." />
<comment value="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." />
<requirements value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
<map value="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 ]" />
</mapping>
</element>
</extension>
<definition value="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 value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="If true, indicates that the described activity is one that must NOT be engaged in when following the plan. If false, or missing, indicates that the described activity is one that should be engaged in when following the plan." />
<comment value="This element is labeled as a modifier because it marks an activity as an activity that is not to be performed." />
<requirements value="Captures intention to not do something that may have been previously typical." />
</base>
</type>
<meaningWhenMissing value="If missing indicates that the described activity is one that should be engaged in when following the plan." />
</constraint>
<isModifierReason value="If true this element negates the specified action. For example, instead of a request for a procedure, it is a request for the procedure to not occur." />
</mapping>
</mapping>
</element>
<definition value="The period, timing or frequency upon which the described activity is to occur." />
<requirements value="Allows prompting for activities and detection of missed planned activities." />
</base>
</type>
</type>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Identifies the facility where the activity will occur; e.g. home, hospital, specific clinic, etc." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
<map value="PRT-5 : ( PRV-4 = (provider participations)); PRT-5 : ( PRV-4 = (non-provider person participations )) ; PRT-5 : ( PRV-4 = (patient non-subject of care) ) ; PRT-8" />
</mapping>
</mapping>
</element>
<definition value="Identifies the food, drug or other product to be consumed or supplied in the activity." />
</base>
</type>
</type>
</constraint>
</extension>
</binding>
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="Identifies the quantity expected to be supplied, administered or consumed by the subject." />
</base>
</type>
</constraint>
<map value="RXO-11 / RXE-10 / RXD-4 / RXG-5 / RXA-6 / TQ1-2.1 *and* RXO-12 / RXE-11 / RXD-5 / RXG-7 / RXA-7 / TQ1-2.2" />
</mapping>
</mapping>
</element>
<definition value="This provides a textual description of constraints on the intended activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<requirements value="Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements." />
</base>
</type>
</constraint>
</mapping>
</mapping>
<map value=".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value" />
</mapping>
</element>
</snapshot>
</element>
</element>
</element>
</element>
</extension>
</extension>
</extension>
</short>
</extension>
</extension>
</extension>
</definition>
<valueSet value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-therapieplanung-typ" />
</binding>
</element>
<patternUri value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapieplanung-typ" />
</element>
</mapping>
</element>
</type>
</element>
</element>
</extension>
</extension>
</extension>
</short>
</extension>
</extension>
</extension>
</definition>
</mapping>
</element>
<targetProfile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-diagnose-primaertumor" />
</type>
</element>
</element>
</element>
<human value="Therapieabweichung aufgrund Patientenwunsch: Bei nichtangetretener oder abgebrochener Therapie ist anzugeben, ob dies dem Patientenwunsch entspricht oder ggfs. andere Gründe hat" />
<source value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-tumorkonferenz" />
</constraint>
</element>
<valueSet value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-therapieempfehlung-typ" />
</binding>
</element>
</extension>
</extension>
</extension>
</short>
</extension>
</extension>
</extension>
</definition>
</element>
<patternUri value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-typ" />
</element>
</mapping>
</element>
</extension>
</extension>
</extension>
</short>
<definition value="Status der Therapieempfehlung nach HL7 FHIR CarePlanActivityStatus | not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error |">
</extension>
<valueString value="Status der Therapieempfehlung nach HL7 FHIR CarePlanActivityStatus | not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error |" />
</extension>
</extension>
</definition>
</mapping>
</element>
</extension>
</extension>
</extension>
</short>
<definition value="wenn Therapieabweichung - z.B. status = cancelled - Aussage ob dies durch Patientenwunsch erfolgt ist gemäß 19.2 oBDS 2021.">
</extension>
<valueString value="wenn Therapieabweichung - z.B. status = cancelled - Aussage ob dies durch Patientenwunsch erfolgt ist gemäß 19.2 oBDS 2021." />
</extension>
</extension>
</definition>
<valueSet value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-therapieabweichung" />
</binding>
</element>
</mapping>
</element>
<patternUri value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapieabweichung" />
</element>
</element>
</differential>
</StructureDefinition>
{
"url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-tumorkonferenz",
],
],
{
"definition": "Describes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.",
"Care Team"
],
},
{
},
{
"human": "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",
"expression": "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()",
"xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
},
{
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
},
{
},
{
{
},
{
"valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
}
],
{
},
{
},
{
}
]
},
{
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
},
{
{
}
],
}
],
},
{
"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.",
},
],
{
}
],
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
],
},
"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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that 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",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"definition": "The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.",
"comment": "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.",
},
],
{
}
],
},
{
"comment": "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. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http.html#read) interaction.",
},
],
{
}
],
},
{
"definition": "A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.",
"comment": "In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. \n\nThis element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.",
},
],
{
}
],
},
{
"definition": "A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url).",
"comment": "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.",
},
{
"http://hl7.org/fhir/StructureDefinition/StructureDefinition"
]
}
],
{
}
],
},
{
"definition": "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.",
"comment": "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.",
},
],
{
}
],
{
},
{
}
],
}
},
{
"definition": "Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.",
"comment": "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.",
},
],
{
}
],
{
}
],
"description": "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\".",
}
},
{
"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.",
"comment": "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.",
},
],
{
}
],
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
},
{
"comment": "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).",
},
],
{
}
],
{
},
{
},
{
}
],
}
},
{
"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.",
"comment": "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.",
"narrative",
"html",
"xhtml",
"display"
],
},
],
{
}
],
]
},
{
"definition": "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.",
"comment": "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.",
"inline resources",
"anonymous resources",
"contained resources"
],
},
],
]
},
{
"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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that 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",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"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](extensibility.html#modifierExtension).",
"extensions",
"user content"
],
},
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
]
},
{
"definition": "Business identifiers assigned to this care plan by the performer or other systems which remain constant as the resource is updated and propagates from server to server.",
"comment": "This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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.",
"requirements": "Allows identification of the care plan as it is known by various participating systems and in a way that remains consistent across servers.",
},
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"definition": "The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.",
},
{
"http://hl7.org/fhir/StructureDefinition/PlanDefinition",
"http://hl7.org/fhir/StructureDefinition/Questionnaire",
"http://hl7.org/fhir/StructureDefinition/Measure",
"http://hl7.org/fhir/StructureDefinition/ActivityDefinition",
"http://hl7.org/fhir/StructureDefinition/OperationDefinition"
]
}
],
{
}
],
{
},
{
}
]
},
{
"definition": "The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.",
"comment": "This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.",
},
],
{
}
],
{
},
{
}
]
},
{
"requirements": "Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon.",
"fulfills"
],
},
{
{
}
],
"http://hl7.org/fhir/StructureDefinition/CarePlan"
]
}
],
{
}
],
]
},
{
"comment": "The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing.",
"requirements": "Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans.",
"supersedes"
],
},
{
{
}
],
"http://hl7.org/fhir/StructureDefinition/CarePlan"
]
}
],
{
}
],
]
},
{
"comment": "Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed.",
},
{
{
}
],
"http://hl7.org/fhir/StructureDefinition/CarePlan"
]
}
],
{
}
],
},
{
"definition": "Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.",
"comment": "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 care plan.\n\nThis element is labeled as a modifier because the status contains the code entered-in-error that marks the plan as not currently valid.",
},
],
{
}
],
"isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
{
}
],
"description": "Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.",
},
{
},
{
},
{
},
{
}
]
},
{
"definition": "Indicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain.",
"comment": "This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.",
"requirements": "Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain.",
},
],
{
}
],
"isModifierReason": "This element changes the interpretation of all descriptive attributes. For example \"the time the request is recommended to occur\" vs. \"the time the request is authorized to occur\" or \"who is recommended to perform the request\" vs. \"who is authorized to perform the request\"",
{
}
],
"description": "Codes indicating the degree of authority/intentionality associated with a care plan.",
},
]
},
{
"definition": "Identifies what \"kind\" of plan this is to support differentiation between multiple co-existing plans; e.g. \"Home health\", \"psychiatric\", \"asthma\", \"disease management\", \"wellness plan\", etc.",
"comment": "There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.",
"requirements": "Used for filtering what plan(s) are retrieved and displayed to different types of users.",
},
],
{
}
],
{
}
],
"description": "Identifies what \"kind\" of plan this is to support differentiation between multiple co-existing plans; e.g. \"Home health\", \"psychiatric\", \"asthma\", \"disease management\", etc.",
},
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
],
},
"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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that 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",
"user content"
],
},
],
{
},
{
}
],
]
},
{
{
{
},
{
}
],
}
]
},
{
{
},
{
}
],
}
]
},
"comment": "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.",
"requirements": "Allows for alternative encodings within a code system, and translations to other code systems.",
},
],
{
}
],
"valueSet": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-therapieplanung-typ"
},
{
},
{
},
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
],
},
"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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that 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",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"definition": "The identification of the code system that defines the meaning of the symbol in the code.",
"comment": "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.",
},
],
"patternUri": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapieplanung-typ",
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "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.",
"comment": "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.",
},
],
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "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).",
},
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
{
}
],
"definition": "A representation of the meaning of the code in the system, following the rules of the system.",
"requirements": "Need to be able to carry a human-readable meaning of the code for readers that do not know the system.",
},
],
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).",
"comment": "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.",
"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.",
},
],
{
}
],
{
},
{
},
{
"map": "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 ]"
}
]
},
{
{
}
],
"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.",
},
],
{
}
],
{
},
{
},
{
}
]
},
{
},
],
{
}
],
},
{
},
],
{
}
],
]
},
{
"patient"
],
},
],
{
}
],
{
},
{
},
{
},
{
},
{
}
]
},
{
"definition": "The Encounter during which this CarePlan was created or to which the creation of this record is tightly associated.",
"comment": "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. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters.",
},
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"comment": "Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition).",
"timing"
],
},
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
{
{
},
{
}
],
}
]
},
{
{
},
{
}
],
}
]
},
"authoredOn"
],
},
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"definition": "When populated, the author is responsible for the care plan. The care plan is attributed to the author.",
"comment": "The author may also be a contributor. For example, an organization can be an author, but not listed as a contributor.",
},
{
"http://hl7.org/fhir/StructureDefinition/Patient",
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Device",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson",
"http://hl7.org/fhir/StructureDefinition/Organization",
"http://hl7.org/fhir/StructureDefinition/CareTeam"
]
}
],
{
}
],
{
},
{
}
]
},
{
"definition": "Identifies the individual(s) or organization who provided the contents of the care plan.",
},
{
"http://hl7.org/fhir/StructureDefinition/Patient",
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Device",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson",
"http://hl7.org/fhir/StructureDefinition/Organization",
"http://hl7.org/fhir/StructureDefinition/CareTeam"
]
}
],
{
}
],
},
{
"definition": "Identifies all people and organizations who are expected to be involved in the care envisioned by this plan.",
"requirements": "Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions.",
},
],
{
}
],
{
},
{
}
]
},
{
"definition": "Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan.",
"comment": "When the diagnosis is related to an allergy or intolerance, the Condition and AllergyIntolerance resources can both be used. However, to be actionable for decision support, using Condition alone is not sufficient as the allergy or intolerance condition needs to be represented as an AllergyIntolerance.",
"requirements": "Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like \"at risk for hypertension\" or \"fall risk\".) Also scopes plans - multiple plans may exist addressing different concerns.",
},
{
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-diagnose-primaertumor"
]
}
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"definition": "Identifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc.",
},
],
{
}
],
]
},
{
"comment": "Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.",
"requirements": "Provides context for plan. Allows plan effectiveness to be evaluated by clinicians.",
},
],
{
}
],
{
},
{
}
]
},
{
"definition": "Identifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc.",
"requirements": "Allows systems to prompt for performance of planned activities, and validate plans against best practice.",
},
],
{
},
{
}
],
{
},
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
"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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that 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",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"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](extensibility.html#modifierExtension).",
"extensions",
"user content",
"modifiers"
],
},
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
]
},
{
"definition": "Identifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not).",
"comment": "Note that this should not duplicate the activity status (e.g. completed or in progress).",
},
],
{
}
],
{
}
],
}
},
{
"definition": "Details of the outcome or action resulting from the activity. The reference to an \"event\" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource).",
"comment": "The activity outcome is independent of the outcome of the related goal(s). For example, if the goal is to achieve a target body weight of 150 lbs and an activity is defined to diet, then the activity outcome could be calories consumed whereas the goal outcome is an observation for the actual body weight measured.",
},
],
{
}
],
{
},
{
}
]
},
{
"comment": "This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description.",
},
],
{
}
],
{
},
{
"map": ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"annotation\"].value"
}
]
},
{
"comment": "Standard extension exists ([resource-pertainsToGoal](extension-resource-pertainstogoal.html)) that allows goals to be referenced from any of the referenced resources in CarePlan.activity.reference. \nThe goal should be visible when the resource referenced by CarePlan.activity.reference is viewed independently from the CarePlan. Requests that are pointed to by a CarePlan using this element should *not* point to this CarePlan using the \"basedOn\" element. i.e. Requests that are part of a CarePlan are not \"based on\" the CarePlan.",
},
{
"http://hl7.org/fhir/StructureDefinition/Appointment",
"http://hl7.org/fhir/StructureDefinition/CommunicationRequest",
"http://hl7.org/fhir/StructureDefinition/DeviceRequest",
"http://hl7.org/fhir/StructureDefinition/MedicationRequest",
"http://hl7.org/fhir/StructureDefinition/NutritionOrder",
"http://hl7.org/fhir/StructureDefinition/Task",
"http://hl7.org/fhir/StructureDefinition/ServiceRequest",
"http://hl7.org/fhir/StructureDefinition/VisionPrescription",
"http://hl7.org/fhir/StructureDefinition/RequestGroup"
]
}
],
"cpl-3"
],
{
}
],
{
},
{
}
]
},
{
"definition": "A simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc.",
},
],
"cpl-3"
],
{
},
{
"human": "Therapieabweichung aufgrund Patientenwunsch: Bei nichtangetretener oder abgebrochener Therapie ist anzugeben, ob dies dem Patientenwunsch entspricht oder ggfs. andere Gründe hat",
"source": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-tumorkonferenz"
}
],
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
"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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that 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",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"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](extensibility.html#modifierExtension).",
"extensions",
"user content",
"modifiers"
],
},
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
]
},
{
"short": "Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription",
"definition": "A description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest.",
},
],
{
}
],
{
}
],
"description": "Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity.",
},
]
},
{
"definition": "The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.",
"requirements": "Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity.",
},
{
"http://hl7.org/fhir/StructureDefinition/PlanDefinition",
"http://hl7.org/fhir/StructureDefinition/ActivityDefinition",
"http://hl7.org/fhir/StructureDefinition/Questionnaire",
"http://hl7.org/fhir/StructureDefinition/Measure",
"http://hl7.org/fhir/StructureDefinition/OperationDefinition"
]
}
],
{
}
],
{
},
{
}
]
},
{
"definition": "The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.",
"comment": "This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.",
"requirements": "Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity.",
},
],
{
}
],
{
},
{
}
]
},
{
"definition": "Detailed description of the type of planned activity; e.g. what lab test, what procedure, what kind of encounter.",
"comment": "Tends to be less relevant for activities involving particular products. Codes should not convey negation - use \"prohibited\" instead.",
},
],
{
}
],
{
}
],
"description": "Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter.",
"valueSet": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-therapieempfehlung-typ"
},
{
},
{
},
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
],
},
"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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that 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",
"user content"
],
},
],
{
},
{
}
],
]
},
{
{
{
},
{
}
],
}
]
},
{
{
},
{
}
],
}
]
},
"comment": "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.",
"requirements": "Allows for alternative encodings within a code system, and translations to other code systems.",
},
],
{
}
],
{
},
{
},
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
],
},
"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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that 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",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"definition": "The identification of the code system that defines the meaning of the symbol in the code.",
"comment": "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.",
},
],
"patternUri": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-typ",
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "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.",
"comment": "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.",
},
],
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "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).",
},
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
{
}
],
"definition": "A representation of the meaning of the code in the system, following the rules of the system.",
"requirements": "Need to be able to carry a human-readable meaning of the code for readers that do not know the system.",
},
],
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).",
"comment": "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.",
"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.",
},
],
{
}
],
{
},
{
},
{
"map": "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 ]"
}
]
},
{
{
}
],
"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.",
},
],
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "Provides the rationale that drove the inclusion of this particular activity as part of the plan or the reason why the activity was prohibited.",
"comment": "This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonCondition instead.",
},
],
{
}
],
{
}
],
"description": "Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as \"general wellness\", prophylaxis, surgical preparation, etc.",
},
]
},
{
"definition": "Indicates another resource, such as the health condition(s), whose existence justifies this request and drove the inclusion of this particular activity as part of the plan.",
"comment": "Conditions can be identified at the activity level that are not identified as reasons for the overall plan.",
},
{
"http://hl7.org/fhir/StructureDefinition/Condition",
"http://hl7.org/fhir/StructureDefinition/Observation",
"http://hl7.org/fhir/StructureDefinition/DiagnosticReport",
"http://hl7.org/fhir/StructureDefinition/DocumentReference"
]
}
],
{
}
],
]
},
{
"definition": "Internal reference that identifies the goals that this activity is intended to contribute towards meeting.",
},
],
{
}
],
]
},
{
{
{
},
{
}
],
}
]
},
"definition": "Status der Therapieempfehlung nach HL7 FHIR CarePlanActivityStatus | not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error |",
{
{
},
{
"valueString": "Status der Therapieempfehlung nach HL7 FHIR CarePlanActivityStatus | not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error |"
}
],
}
]
},
"comment": "Some aspects of status can be inferred based on the resources linked in actionTaken. Note that \"status\" is only as current as the plan was most recently updated. \nThe 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 activity.",
"requirements": "Indicates progress against the plan, whether the activity is still relevant for the plan.",
},
],
{
}
],
"isModifierReason": "This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the activity should not be treated as valid",
{
}
],
"description": "Codes that reflect the current state of a care plan activity within its overall life cycle.",
},
{
},
{
},
{
"map": ".statusCode not-started = new scheduled = not-started (and fulfillment relationship to appointent) in-progress = active on-hold = suspended completed = completed cancelled = aborted"
},
{
}
]
},
{
{
{
},
{
}
],
}
]
},
"definition": "wenn Therapieabweichung - z.B. status = cancelled - Aussage ob dies durch Patientenwunsch erfolgt ist gemäß 19.2 oBDS 2021.",
{
{
},
{
"valueString": "wenn Therapieabweichung - z.B. status = cancelled - Aussage ob dies durch Patientenwunsch erfolgt ist gemäß 19.2 oBDS 2021."
}
],
}
]
},
"comment": "Will generally not be present if status is \"complete\". Be sure to prompt to update this (or at least remove the existing value) if the status is changed.",
},
],
{
}
],
"valueSet": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-therapieabweichung"
},
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
],
},
"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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that 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",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"comment": "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.",
"requirements": "Allows for alternative encodings within a code system, and translations to other code systems.",
},
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
],
},
"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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that 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",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"definition": "The identification of the code system that defines the meaning of the symbol in the code.",
"comment": "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.",
},
],
"patternUri": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapieabweichung",
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "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.",
"comment": "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.",
},
],
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "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).",
},
],
{
}
],
{
},
{
},
{
}
]
},
{
{
}
],
"definition": "A representation of the meaning of the code in the system, following the rules of the system.",
"requirements": "Need to be able to carry a human-readable meaning of the code for readers that do not know the system.",
},
],
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).",
"comment": "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.",
"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.",
},
],
{
}
],
{
},
{
},
{
"map": "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 ]"
}
]
},
{
{
}
],
"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.",
},
],
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "If true, indicates that the described activity is one that must NOT be engaged in when following the plan. If false, or missing, indicates that the described activity is one that should be engaged in when following the plan.",
"comment": "This element is labeled as a modifier because it marks an activity as an activity that is not to be performed.",
},
],
"meaningWhenMissing": "If missing indicates that the described activity is one that should be engaged in when following the plan.",
{
}
],
"isModifierReason": "If true this element negates the specified action. For example, instead of a request for a procedure, it is a request for the procedure to not occur.",
{
},
{
}
]
},
{
},
],
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "Identifies the facility where the activity will occur; e.g. home, hospital, specific clinic, etc.",
},
],
{
}
],
{
},
{
}
]
},
{
},
{
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson",
"http://hl7.org/fhir/StructureDefinition/Patient",
"http://hl7.org/fhir/StructureDefinition/CareTeam",
"http://hl7.org/fhir/StructureDefinition/HealthcareService",
"http://hl7.org/fhir/StructureDefinition/Device"
]
}
],
{
}
],
{
},
{
"map": "PRT-5 : ( PRV-4 = (provider participations)); PRT-5 : ( PRV-4 = (non-provider person participations )) ; PRT-5 : ( PRV-4 = (patient non-subject of care) ) ; PRT-8"
},
{
}
]
},
{
"definition": "Identifies the food, drug or other product to be consumed or supplied in the activity.",
},
{
},
{
"http://hl7.org/fhir/StructureDefinition/Medication",
"http://hl7.org/fhir/StructureDefinition/Substance"
]
}
],
{
}
],
{
}
],
},
{
},
{
}
]
},
{
"daily dose"
],
},
],
{
}
],
{
},
{
}
]
},
{
"definition": "Identifies the quantity expected to be supplied, administered or consumed by the subject.",
},
],
{
}
],
{
"map": "RXO-11 / RXE-10 / RXD-4 / RXG-5 / RXA-6 / TQ1-2.1 *and* RXO-12 / RXE-11 / RXD-5 / RXG-7 / RXA-7 / TQ1-2.2"
},
{
}
]
},
{
"definition": "This provides a textual description of constraints on the intended activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc.",
},
],
{
}
],
]
},
{
"requirements": "Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements.",
},
],
{
}
],
{
},
{
},
{
"map": ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"annotation\"].value"
}
]
}
]
},
{
},
{
},
{
},
{
},
{
{
{
},
{
}
],
}
]
},
{
{
},
{
}
],
}
]
},
"valueSet": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-therapieplanung-typ"
}
},
{
"patternUri": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapieplanung-typ",
},
{
]
},
{
],
},
{
},
{
{
{
},
{
}
],
}
]
},
{
{
},
{
}
],
}
]
},
]
},
{
{
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-diagnose-primaertumor"
]
}
],
},
{
},
{
},
{
{
"human": "Therapieabweichung aufgrund Patientenwunsch: Bei nichtangetretener oder abgebrochener Therapie ist anzugeben, ob dies dem Patientenwunsch entspricht oder ggfs. andere Gründe hat",
"source": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-tumorkonferenz"
}
],
},
{
"valueSet": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-therapieempfehlung-typ"
}
},
{
{
{
},
{
}
],
}
]
},
{
{
},
{
}
],
}
]
}
},
{
"patternUri": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-typ",
},
{
]
},
{
{
{
},
{
}
],
}
]
},
"definition": "Status der Therapieempfehlung nach HL7 FHIR CarePlanActivityStatus | not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error |",
{
{
},
{
"valueString": "Status der Therapieempfehlung nach HL7 FHIR CarePlanActivityStatus | not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error |"
}
],
}
]
},
{
}
]
},
{
{
{
},
{
}
],
}
]
},
"definition": "wenn Therapieabweichung - z.B. status = cancelled - Aussage ob dies durch Patientenwunsch erfolgt ist gemäß 19.2 oBDS 2021.",
{
{
},
{
"valueString": "wenn Therapieabweichung - z.B. status = cancelled - Aussage ob dies durch Patientenwunsch erfolgt ist gemäß 19.2 oBDS 2021."
}
],
}
]
},
"valueSet": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/ValueSet/mii-vs-onko-therapieabweichung"
}
},
{
{
}
]
},
{
"patternUri": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapieabweichung"
},
{
}
]
}
}
Mapping Datensatz zu FHIR
| Datensatz | Erklaerung | FHIR |
|---|---|---|
| Tumorkonferenz und Therapieempfehlung | Tumorkonferenz und Therapieempfehlung | |
| Tumorkonferenz Therapieplanung Datum | Datum der Durchführung der Tumorkonferenz bzw. der sonstigen Therapieplanung. | CarePlan.created |
| Tumorkonferenz Therapieplanung Typ | Typ der Tumorkonferenz bzw. der sonstigen Therapieplanung. | CarePlan.category |
| Tumorkonferenz Therapieempfehlung Typ | Typ der Therapieempfehlung der Tumorkonferenz. | CarePlan.activity.detail.code |
| Tumorkonferenz/Therapieempfehlung Therapieabweichung auf Wunsch des Patienten | Abweichung auf Wunsch des Patienten. | CarePlan.activity.detail.status & statusReason |
Mapping Einheitlicher onkologischer Basisdatensatz (oBDS) zu FHIR
| oBDS | Definition | FHIR |
|---|---|---|
| 18.2 | Tumorkonferenz Therapieplanung Typ | CarePlan.category.coding.code |
| 18.1 | Tumorkonferenz Therapieplanung Datum | CarePlan.created |
| 19.1 | Tumorkonferenz Therapieempfehlung Typ | CarePlan.activity.detail.code.coding.code |
| 19.2 | Tumorkonferenz/Therapieempfehlung Therapieabweichung auf Wunsch des Patienten | CarePlan.activity.detail.status |
| 19.2 | Tumorkonferenz/Therapieempfehlung Therapieabweichung auf Wunsch des Patienten | CarePlan.activity.detail.statusReason.coding |
Suchparameter
Folgende Suchparameter sind für das Modul Onkologie relevant, auch in Kombination:
Der Suchparameter
_idMUSS unterstützt werden:Beispiele:
GET [base]/CarePlan?_id=1234Anwendungshinweise: Weitere Informationen zur Suche nach "_id" finden sich in der FHIR-Basisspezifikation - Abschnitt "Parameters for all resources".
Der Suchparameter
_profileMUSS unterstützt werden:Beispiele:
GET [base]/CarePlan?_profile=https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-tumorkonferenzAnwendungshinweise: Weitere Informationen zur Suche nach "_profile" finden sich in der FHIR-Basisspezifikation - Abschnitt "token".
Der Suchparameter
identifierMUSS unterstützt werden:Beispiele:
GET [base]/CarePlan?identifier=Tumorkonferenz_1Anwendungshinweise: Weitere Informationen zur Suche nach "_profile" finden sich in der [FHIR-Basisspezifikation - Abschnitt "token"].
Der Suchparameter
categoryMUSS unterstützt werden: Beispiele:GET [base]/CarePlan?category=http://snomed.info/sct|734163000Anwendungshinweise: Weitere Informationen zur Suche nach "_profile" finden sich in der [FHIR-Basisspezifikation - Abschnitt "token"].
Der Suchparameter
subjectMUSS unterstützt werden: Beispiele:GET [base]/CarePlan?subject=Patient/exampleAnwendungshinweise: Weitere Informationen zur Suche nach "_profile" finden sich in der [FHIR-Basisspezifikation - Abschnitt "identifier" oder Abschnitt "[type]"].
Der Suchparameter
periodMUSS unterstützt werden: Beispiele:GET [base]/CarePlan?date=eq2022-01-01Anwendungshinweise: Weitere Informationen zur Suche nach "_profile" finden sich in der [FHIR-Basisspezifikation - Abschnitt "date"].
Der Suchparameter
contributorMUSS unterstützt werden: Beispiele:GET [base]/CarePlan?contributor=Practitioner/exampleAnwendungshinweise: Weitere Informationen zur Suche nach "_profile" finden sich in der [FHIR-Basisspezifikation - Abschnitt "identifier" oder Abschnitt "[type]"].
Der Suchparameter
addressesMUSS unterstützt werden: Beispiele:GET [base]/CarePlan?addresses=Condition/exampleAnwendungshinweise: Weitere Informationen zur Suche nach "_profile" finden sich in der [FHIR-Basisspezifikation - Abschnitt "identifier" oder Abschnitt "[type]"].
Der Suchparameter
activity-codeMUSS unterstützt werden: Beispiele:GET [base]/CarePlan?activity-code=https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-therapieempfehlung-typ|OPAnwendungshinweise: Weitere Informationen zur Suche nach "_profile" finden sich in der [FHIR-Basisspezifikation - Abschnitt "token"].
Beispiele
{
"https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-tumorkonferenz|2026.0.0"
]
},
],
{
{
"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapieplanung-typ",
}
]
}
],
},
{
{
"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-therapie-typ",
}
]
},
}
}
]
}