Workflow

HL7 Norway proposed base profiles for Workflow resources in HL7 FHIR R4.

Only attributes with actual profiling is included in the information model diagram as well as any optional extensions provided as a part of the no-basis package. The model should be forward compatible to Appointment in R5 as far as possible.

Short notice on relationship between no-basis Appointment and no-basis-Encounter

Appointment and Encounter have dependencies as they both describe different aspects of the administrative relationship between patient and health care organizations.

Appointment (no:timeavtale; npr:planlagt episode) – describes a planned meeting between a patient and healthcare personell.

Encounter (no: kontakt, besøk, opphold, innleggelse, omsorgsepisode, poliklinisk konsultasjon etc) is defined as: “An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient”. An inpatient encounter (no:inneliggende) is an encounter that can consist of several sub-encounters – for example a radiology examination or a surgery. The national base profile have defined an extension in no-basis-Appointment to mirror this partOf-pattern in the encounter.

The normal scenario is that the Appointment resource is used until the patient is registered as arrived. After arrival the Encounter resource is used to share information about the interaction. Due to the fact that the Encounter resource contains more clinical related information than Appointment, some EHRs may use Encounter with status planned to share information about the interaction also before the patient is registered as arrived.

Inspection (no: tilsyn) are normally not registered as independent encounters in the EHR, but represents and interaction between patient and healthcare personell that is documented in an inspection note (no: tilsynsnotat). Local routines as each hospital can choose to register inspections as encounters, but in most cases such a practice will require too much manual registration in the EHR. An inspection can also be registered as a procedure.

EpisodeOfCare (no: henvisningsperiode) can encompass several ambulatory and inpatient encounters across several organizations. The challenge with tracing such patient trajectory (no: pasientforløp) is that the episode of care will encompass several service requests (no: henvisninger) and there are no common identifier that can be used to trace the patient trajectory across these encounters. Helsedirektoratet has earlier pointed to the need for such an identifier (forløpsidentifikator).

no-basis-Appointment

Base profile for Norwegian Appointment information. Defined by HL7 Norway. This profile identifies a set of minimum expectations for an Appointment resource when creating, searching and retrieving compositions by defining which coding system(s) must be present when using this profile.

The base profile is open, but derived profiles should close down the information elements according to specification relevant to the use-case.

The full documentation of the profile

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Resource content

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no-basis-AppointmentResponse

Base profile for Norwegian AppointmentResponse information. Defined by HL7 Norway. Should be used as a basis for further profiling in use-cases where specific appointment response information is needed. The basis profile is open, but derived profiles should close down the information elements according to specification relevant to the use-case.

The full documentation of the profile no-basis-AppointmentResponse

Resource content

NoBasisAppointmentResponse (AppointmentResponse)	I		AppointmentResponse	There are no (further) constraints on this element Element id AppointmentResponse Short description A reply to an appointment request for a patient and/or practitioner(s), such as a confirmation or rejection Definition A reply to an appointment request for a patient and/or practitioner(s), such as a confirmation or rejection. Data type AppointmentResponse Constraints apr-1: Either the participantType or actor must be specified `participantType.exists() or actor.exists()` dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() inv-1: The 'shortNotice' extension can only be used when the 'actor' is of type 'Patient'. `extension.where(url = 'http://hl7.no/fhir/StructureDefinition/no-basis-shortnotice').value.exists() and actor.type.value = 'Patient'` Mappings rim: Entity. Role, or Act workflow: Request rim: Appointment[@moodCode <= 'PRMS'] ical: VEVENT
id	Σ	0..1	id	There are no (further) constraints on this element Element id AppointmentResponse.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type id
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id AppointmentResponse.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id AppointmentResponse.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id AppointmentResponse.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id AppointmentResponse.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id AppointmentResponse.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources 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. Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id AppointmentResponse.extension Short description Extension Definition An Extension Data type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
shortNotice	I	0..1	Extension(boolean)	There are no (further) constraints on this element Element id AppointmentResponse.extension:shortNotice Short description no-basis-shortnotice Definition Patient can come on short notice. Data type Extension(boolean) Extension URL http://hl7.no/fhir/StructureDefinition/no-basis-shortnotice Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
id		0..1	string	There are no (further) constraints on this element Element id AppointmentResponse.extension:shortNotice.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..0	Extension	There are no (further) constraints on this element Element id AppointmentResponse.extension:shortNotice.extension Short description Extension Definition An Extension Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id AppointmentResponse.extension:shortNotice.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value http://hl7.no/fhir/StructureDefinition/no-basis-shortnotice Mappings rim: N/A
value[x]		0..1		There are no (further) constraints on this element Element id AppointmentResponse.extension:shortNotice.value[x] Short description Patient can come on short notice. Definition Patient can come on short notice. Response is boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueBoolean			boolean	There are no (further) constraints on this element Data type boolean
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id AppointmentResponse.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id AppointmentResponse.identifier Short description External Ids for this item Definition This records identifiers associated with this appointment response concern that are defined by business processes and/ or used to refer to it when a direct URL reference to the resource itself is not appropriate. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.identifier w5: FiveWs.identifier rim: .id ical: UID
appointment	Σ	1..1	Reference(Appointment)	There are no (further) constraints on this element Element id AppointmentResponse.appointment Short description Appointment this response relates to Definition Appointment that this response is replying to. Data type Reference(Appointment) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.basedOn rim: scheduleRequest.ActAppointmentRequest[@moodCode <= 'ARQ']
start		0..1	instant	There are no (further) constraints on this element Element id AppointmentResponse.start Short description Time from appointment, or requested new start time Definition Date/Time that the appointment is to take place, or requested new start time. Comments This may be either the same as the appointment request to confirm the details of the appointment, or alternately a new time to request a re-negotiation of the start time. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] w5: FiveWs.init rim: .effectiveTime.low
end		0..1	instant	There are no (further) constraints on this element Element id AppointmentResponse.end Short description Time from appointment, or requested new end time Definition This may be either the same as the appointment request to confirm the details of the appointment, or alternately a new time to request a re-negotiation of the end time. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] w5: FiveWs.done[x] rim: .effectiveTime.high
participantType	Σ	0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id AppointmentResponse.participantType Short description Role of participant in the appointment Definition Role of participant in the appointment. Comments The role of the participant can be used to declare what the actor will be doing in the scope of the referenced appointment. If the actor is not specified, then it is expected that the actor will be filled in at a later stage of planning. This value SHALL be the same as specified on the referenced Appointment so that they can be matched, and subsequently updated. Data type CodeableConcept Binding Role of participant in encounter. ParticipantType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.performerType rim: (performer \| reusableDevice \| subject \| location).@typeCode ical: n/a
actor	Σ	0..1	Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Device \| HealthcareService \| Location)	There are no (further) constraints on this element Element id AppointmentResponse.actor Short description Person, Location, HealthcareService, or Device Definition A Person, Location, HealthcareService, or Device that is participating in the appointment. Data type Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Device \| HealthcareService \| Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.performer w5: FiveWs.who v2: PID-3-Patient ID List rim: performer.person \| reusableDevice.manufacturedDevice \| subject.patient \| location.serviceDeliveryLocation ical: ATTENDEE: (Need to provide the common name CN and also the MAILTO properties from the practitioner resource)
participantStatus	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id AppointmentResponse.participantStatus Short description accepted \| declined \| tentative \| needs-action Definition Participation status of the participant. When the status is declined or tentative if the start/end times are different to the appointment, then these times should be interpreted as a requested time change. When the status is accepted, the times can either be the time of the appointment (as a confirmation of the time) or can be empty. Comments This element is labeled as a modifier because the status contains the code entered-in-error that marks the participant as not currently valid. Data type code Binding The Participation status of an appointment. ParticipationStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.status rim: (performer \| reusableDevice \| subject \| location).statusCode ical: ATTENDEE;CN="Brian Postlethwaite";RSVP=TRUE:mailto:BPostlethwaite@data.com (rsvpparam \| partstatparam)
comment		0..1	string	There are no (further) constraints on this element Element id AppointmentResponse.comment Short description Additional comments Definition Additional comments about the appointment. Comments This comment is particularly important when the responder is declining, tentatively accepting or requesting another time to indicate the reasons why. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.note rim: .subjectOf.observation[@moodCode = 'EVN'][code = 'annotation'].value ical: COMMENT