Releases of the PS-CA Implementation Guide may be found on a table on the Home Page of this Project.


Composition (PS-CA)

Additional information on this profile (including the JSON & XML structure and detailed element descriptions) can be found at package/structuredefinition-profile-composition-ca-ps.json

Profile

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
textS0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierS Σ0..1Identifier
statusS Σ ?!1..1codeBinding
typeS Σ1..1CodeableConceptBindingPattern
categoryΣ0..*CodeableConcept
id0..1string
extensionI0..*Extension
referenceS Σ I1..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
encounterΣ I0..1Reference(Encounter)
dateS Σ1..1dateTime
authorS Σ I1..*Reference(PractitionerProfile | PractitionerRoleProfile | Device | PatientPSCA | RelatedPerson | OrganizationProfile)
titleS Σ1..1string
confidentialityΣ0..1codeBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
modeS1..1codeBinding
timeS0..1dateTime
partyS I0..1Reference(PatientPSCA | RelatedPerson | PractitionerProfile | PractitionerRoleProfile | OrganizationProfile)
custodianS Σ I0..1Reference(OrganizationProfile)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
code1..1codeBinding
targetIdentifierIdentifier
targetReferenceReference(Composition | CompositionPSCA)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
codeΣ0..*CodeableConcept
periodΣ I0..1Period
detailΣ I0..*Reference(Resource)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
codeS Σ1..*CodeableConceptPattern
periodS Σ I0..1Period
detailΣ I0..*Reference(Resource)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
title0..1string
codeS1..1CodeableConceptPSCA
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textS I1..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
entryI0..*Reference(Resource)
emptyReasonI0..1CodeableConceptBinding
sectionI0..*see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
medicationStatementI0..*Reference(MedicationStatementPSCA)
medicationRequestI0..*Reference(MedicationRequestPSCA)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
allergyOrIntoleranceI0..*Reference(AllergyIntolerancePSCA)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
problemI0..*Reference(ConditionPSCA)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
procedureS I0..*Reference(ProcedurePSCA)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
immunizationS I0..*Reference(ImmunizationPSCA)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
deviceStatementS I0..*Reference(DeviceUseStatementUvIps)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
results-observation-laboratory-pathologyS I0..*Reference(ObservationResultsLaboratoryPathologyPSCA)
results-observation-radiologyS I0..*Reference(ObservationResultsRadiologyPSCA)
results-diagnosticReportS I0..*Reference(DiagnosticReportPSCA)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
BMII0..*Reference(observation-bmi)
BPI0..*Reference(observation-bp)
BodyHeightI0..*Reference(observation-bodyheight)
BodyTempI0..*Reference(observation-bodytemp)
BodyWeightI0..*Reference(observation-bodyweight)
HeadCircumI0..*Reference(observation-headcircum)
HeartRateI0..*Reference(observation-heartrate)
OxygenSatI0..*Reference(observation-oxygensat)
RespRateI0..*Reference(observation-resprate)
VitalsPanelI0..*Reference(observation-vitalspanel)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
pastProblemS I0..*Reference(ConditionPSCA)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
disabilityS I0..*Reference(ConditionPSCA)
functionalAssessmentS I0..*Reference(ClinicalImpression)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
carePlanI0..*Reference(CarePlan)
documentReferenceI0..*Reference(DocumentReference)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
generalSocialHistoryI0..*Reference(ObservationSocialHistoryPSCA)
smokingTobaccoUseI0..1Reference(ObservationTobaccoUsePSCA)
alcoholUseI0..1Reference(ObservationAlcoholUsePSCA)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
pregnancyStatusS I0..*Reference(ObservationPregnancyStatusUvIps)
pregnancyOutcomeSummaryS I0..*Reference(ObservationPregnancyOutcomeUvIps)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
section-noteI0..1Extension(Annotation)
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
advanceDirectivesConsentI0..*Reference(Consent)
advanceDirectivesDocumentReferenceI0..*Reference(DocumentReference)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
titleS1..1string
codeS1..1CodeableConceptPattern
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
FamilyMemberHistoryS I0..*Reference(FamilyMemberHistoryPSCA)
emptyReasonI0..1CodeableConceptBinding
sectionI0..0see (section)

Note: Previously, IPS-UV required a minimum cardinality of 1 and a maximum cardinality of 1 on section.entry for Medications, Allergies, and Problem sections. This prior constraint was intended to ensure these sections are always populated with some kind of entry (FHIR Resource). Through advocacy from Canadian implementers to ask for an alternative way to convey the lack of information/resources for a patient at the Composition level, IPS has shifted to a more nuanced approach.

  • IPS UV now allows for Composition.section.emptyReason to be populated and using an invariant to require that either Composition.section.emptyReason or Composition.section.entry be populated for the required sections.

Key Differences between the IPS-UV and PS-CA

Composition:

  • Across Composition: Removed redundant data type profiling on fixed/patterned codeable concepts, modified references to point to equivalent PS-CA profiles
  • Composition.event:careProvisioningEvent: Relaxed Must Support flag on the CareProvisioningEvent slice due to the scope of the PS-CA needing to support summaries that are generated outside a direct care event (e.g., including summaries that are machine-generated/on-demand). This will continue to be advocated for resolution at the IPS level
  • Composition.event:careProvisioningEvent.code element has a cardinality of [1, 1] in IPS-UV and [1, *] in PS-CA.
  • Composition.attester - Relaxed Must Support flag on the element. This decision in this release reflects the understanding of the current variability in workflows among Canadian Jurisdictional implementers, some of whom may not have the capability to populate the attester field at all. Further assessment will be completed against requirements and use cases for PS-CA v2.0.0 DFT.
  • Composition.author, Composition.attester, Composition.custodian - Modified references to point towards Canadian Baseline profiles and the Patient (PS-CA) profile since the IPS-UV currently only offers profiles that are scoped to diagnostic result authoring practitioners, organizations, etc.
    • Further investigation into whether additional elements/PS-CA profiles are needed (beyond the CA Baseline constraints) to support the use of these elements

Note: Additionally, the use of CA Baseline Pratitioner, PractitionerRole, Organization profiles will be superseded by the CA Core profiles (or profiles that impose the CA Core) in furture releases but the current usage of CA Baseline profiles will be maintained until a further stabilized CA Core profile (or further Patient Summary requirements) exist.

Note: Since the previous release of this specification, the modelling in IPS-UV that prohibited the use of section.emptyReason has been removed. See note above.

Composition Sections

  • In all Composition sections, code elements are marked as MS in PS-CA, but not in IPS-UV.

Composition.sectionProceduresHx + Composition.sectionImmunizations + Composition.sectionResults + Composition.sectionMedicalDevices:

  • Removed Must Support flag from these sections according to principles found in Profiling Conventions and Approach

    • IPS-UV considers this a Must Support section. This constraint has been relaxed in the PS-CA to not put undue conformance expectations on jurisdictions who will not be including this domain/section in their initial implementation of patient summaries
    • Participating jurisdictions are expected to be able to receive this section in a patient summary (e.g., from another jurisdiction) without flagging an error
    • Vendors should anticipate that the Must Support flag may be re-evaluated for application in future releases
    • Additionally, vendors should expect that some jurisdictions may further constrain support of this section within the context of their own jurisdictional content
  • Note: Implementers are not expected to demonstrate support for these sections in v2.0.0 DFT, but the flags on the child elements have been maintained to ensure that if an implementer does produce these sections, they follow the expected patterning that is outlined in the IPS-UV and future PS-CA releases. See Must Support Definition.

  • Note: In earlier releases, IPS-UV has removed the Must Support flag on the following sections: Vital signs, PastIllnessHx, FunctionalStatus, PlanOfCare, Social History, PregnancyHx, AdvanceDirectives - bringing PS-CA into futher alignment with IPS-UV

Composition.sectionSocialHistory+ Composition.sectionFamilyMemberHistory:

  • Added FamilyMemberHistory section to meet the needs of jurisidctions wanting to pilot FamilyMemberHistory profile as part of their patient summary initiative
  • Expanded the sectionSocialHistory by including a new profile in addition to the Tobacco Use & Alcohol Use profiles to enable a more generalized social history profile to support implementers piloting a broader set of social history observations (not expected to be housed under the structured alcohol user and tobacco use profiles), and to house coded and non-coded lifestyle risk factors (e.g., amount of exercise, etc.)

Composition.sectionVitalSigns + Composition.sectionPastIllnessHx + Composition.sectionFunctionalStatus + Composition.sectionPlanOfCare + Composition.sectionSocialHistory + Composition.sectionPregnancyHx + Composition.sectionAdvanceDirectives + Composition.sectionFamilyHistory:

  • In these sections, title and entry elements are not MS in IPS-UV but are MS in PS-CA. Additionally, entry slices such as entry:pastProblem, entry:disability, entry:functionalAssessment, entry:pregnancyStatus, entry:pregnancyOutcomeSummary, entry:advanceDirectivesConsent and entry:FamilyMemberHistory are not MS in IPS-UV but are MS in PS-CA.

**Composition.sectionPatientStory + Composition.sectionAlerts:##

  • These sections have been added to ISO 27269 and IPS 2.0.0-ballot, but have not yet been introduced into PS-CA.