Releases of the PS-CA Implementation Guide may be found on a table on the Home Page of this Project.
Data Type Profiles
Data types are profiled in order to enforce constraints on what elements within the data type are required and/or are expected for systems to be able to demonstrate support.
CodeableConcept
The package/structuredefinition-profile-codeableconcept-ca-ps.json
profile represents the constraint applied to the CodeableConcept
data type by the PS-CA project to use the package/structuredefinition-profile-coding-ca-ps.json
profile in a way that is informed by the constraints of the
Codeable Concept (IPS)
profile but removes the overarching expectation that all patient summary creators must demonstrate they can support codings for conformance.
| CodeableConcept | | | CodeableConcept | Element idShort description Concept - reference to a terminology or just text Definition A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.
For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text.
CodeableConcept Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idShort 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.
string Mappings |
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCodeableConcept.extension Additional content defined by implementations Alternate names extensions, user content 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.
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.
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()
|
| coding | Σ | 0..* | package/structuredefinition-profile-coding-ca-ps.json | Element idShort description A reference to a code defined by a terminology system Definition A reference to a code defined by a terminology system.
Allows for alternative encodings within a code system, and translations to other code systems.
While the IPS-UV specification considers this a Must Support element, some systems will not have the ability to support codings for every codeableConcept, further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance.
Implementers that support codings should still send the codings for codeable concepts if they are available and receivers should not produce failures or rejections if codings are included in the patient summary in the first release (a base tenet of FHIR).
Additionally vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content
package/structuredefinition-profile-coding-ca-ps.json Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
- rim: CV
- orim: fhir:Coding rdfs:subClassOf dt:CDCoding
- v2: C*E.1-8, C*E.10-22
- rim: union(., ./translation)
- orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
|
| text | S Σ | 0..1 | string | There are no (further) constraints on this element Element idShort description Plain text representation of the concept 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.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
Very often the text is the same as a displayName of one of the codings.
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: C*E.9. But note many systems use C*E.2 for this
- rim: ./originalText[mediaType/code="text/plain"]/data
- orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
|
Notes:
- This profile makes a significant change from the Codeable Concept (IPS)
data type profile by removing the Must Support flag from the
coding element.
- While
coding is not currently considered Must Support in Version 1.0, implementers that support codings should still send the codings for codeable concepts if they are available/appropriate and receivers should not produce failures or rejections if codings are included in the patient summary (a base tenet of FHIR).
- Additionally, vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content
- Implementors should also be aware that this constraint will be under consideration to be re-applied in PS-CA Version 2.0
CodeableConcept (Medication)
This profile applies specific constraints to the CodeableConcept data type within the context of medication code information. It is guided by the constraints used in the Codeable Concept (IPS)
data type profile, with adjustments to reflect the specific needs and feedback from the community regarding medication coding. The profile mandates the presence of a textual description for each CodeableConcept instance, emphasizing the importance of clarity and understandability in medication data.
| CodeableConcept | | | CodeableConcept | There are no (further) constraints on this element Element idShort description Concept - reference to a terminology or just text Definition A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.
For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text.
CodeableConcept Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idShort 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.
string Mappings |
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCodeableConcept.extension Additional content defined by implementations Alternate names extensions, user content 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.
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.
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()
|
| coding | S Σ | 0..* | package/structuredefinition-profile-coding-medication-ca-ps.json | Element idShort description A reference to a code defined by a terminology system Definition A reference to a code defined by a terminology system.
Allows for alternative encodings within a code system, and translations to other code systems.
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.
package/structuredefinition-profile-coding-medication-ca-ps.json Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
- rim: CV
- orim: fhir:Coding rdfs:subClassOf dt:CDCoding
- v2: C*E.1-8, C*E.10-22
- rim: union(., ./translation)
- orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
|
| text | S Σ | 1..1 | string | There are no (further) constraints on this element Element idShort description Plain text representation of the concept 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.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
Very often the text is the same as a displayName of one of the codings.
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: C*E.9. But note many systems use C*E.2 for this
- rim: ./originalText[mediaType/code="text/plain"]/data
- orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
|
Notes:
- While the original package/structuredefinition-profile-codeableconcept-ca-ps.json
profile removed the Must Support flag for the coding element, this medication-specific profile expects implementations to support and include codings for medications wherever appropriate.
- In contrast to the general PS-CA CodeableConcept profile, the text element in this medication-specific profile is mandatory, ensuring that every coded concept is accompanied by a descriptive text.
Based on community feedback, the constraints and expectations of this profile may be reassessed and potentially applied to other coding elements and profiles within the PS-CA project.
Coding
The package/structuredefinition-profile-coding-ca-ps.json
profile ensures systems support important
Coding
elements, including system, code and display. Must support expectation will be removed from version in the package/structuredefinition-profile-coding-ca-ps.json
profile in 1.1.0 release in the interim with the intent to explore the topic with IPS and discuss with PSWG whether further guidance or constraints should be applied in future versions with respect to SNOMED CT country editions. It also raises awareness of the FHIR Core Translation standard extension.
This profile is informed by the constraints of the Coding with translations
profile. Unlike IPS, however, the PS-CA profile does not flag the translation extension as Must Support; this may change in future releases.
| Coding | | | Coding | There are no (further) constraints on this element Element idShort description A reference to a code defined by a terminology system Definition A reference to a code defined by a terminology system.
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.
Coding Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
- rim: CV
- orim: fhir:Coding rdfs:subClassOf dt:CDCoding
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idShort 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.
string Mappings |
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idShort description Additional content defined by implementations Alternate names extensions, user content 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.
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.
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()
|
| system | S Σ | 0..1 | uri | There are no (further) constraints on this element Element idShort description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code.
Need to be unambiguous about the source of the definition of the symbol.
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: C*E.3
- rim: ./codeSystem
- orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
|
| version | Σ | 0..1 | string | Element idShort description Version of the system - if relevant 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.
The Must Support flag was removed from this element in response to implementer feedback. Requirements for use in certain contexts (e.g., with SNOMED CT CA edition) need to be explored by the Patient Summary Working Group before the constraint will be re-considered for inclusion
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: C*E.7
- rim: ./codeSystemVersion
- orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
|
| code | S Σ | 0..1 | code | There are no (further) constraints on this element Element idShort description Symbol in syntax defined by the system 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).
Need to refer to a particular code in the system.
Note that FHIR strings SHALL NOT exceed 1MB in size
code Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: C*E.1
- rim: ./code
- orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
|
| display | S Σ | 0..1 | string | There are no (further) constraints on this element Element idShort description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system.
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Note that FHIR strings SHALL NOT exceed 1MB in size
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: C*E.2 - but note this is not well followed
- rim: CV.displayName
- orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idShort 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.
string Mappings |
| extension | I | 0..* | Extension | Element idShort description Additional content defined by implementations Alternate names extensions, user content 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.
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.
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()
|
| translation | I | 0..* | Extension(Complex) | Element idCoding.display.extension:translation Language Translation (Localization) Alternate names extensions, user content Definition Language translation from base language of resource to another language.
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.
Extension(Complex) Extension URL http://hl7.org/fhir/StructureDefinition/translation 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()
- rim: n/a
- rim: N/A
- rim: ST.translation
|
| value | | 0..1 | System.String | There are no (further) constraints on this element Element idShort description Primitive value for string Definition Primitive value for string
System.String Maximum string length |
| userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idShort description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
boolean Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: Sometimes implied by being first
- rim: CD.codingRationale
- orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
|
Notes:
- All Must Support elements in this profile are also Must Support in IPS-UV, and there are no differences in element cardinality. Constraints are carried over into a unique PS-CA data type profile to ensure that implementers have clarity and consistency in the expectations this guide puts forth when Must Support is claimed.
- Unlike IPS, the PS-CA profile does not make the
Coding element, itself, Must Support. (This has been identified as a modelling issue with IPS.)
- Earlier releases of this Implementation Guide included the Must Support flag on the
translation extension. Based on public feedback, the Must Support flag has been removed pending a comprehensive approach to multi-language support and conformance.
Extensions
This profile uses the following extensions:
Coding (Medication)
The package/structuredefinition-profile-coding-medication-ca-ps.json
profile introduces constraints for the Coding data type specifically designed for the medication use-case within the PS-CA project. It closely aligns with the principles of the IPS-UV Coding profile, but emphasizes the mandatory inclusion of the system and code elements.
| Coding | | | Coding | There are no (further) constraints on this element Element idShort description A reference to a code defined by a terminology system Definition A reference to a code defined by a terminology system.
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.
Coding Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
- rim: CV
- orim: fhir:Coding rdfs:subClassOf dt:CDCoding
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idShort 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.
string Mappings |
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idShort description Additional content defined by implementations Alternate names extensions, user content 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.
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.
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()
|
| system | S Σ | 1..1 | uri | There are no (further) constraints on this element Element idShort description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code.
Need to be unambiguous about the source of the definition of the symbol.
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: C*E.3
- rim: ./codeSystem
- orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
|
| version | Σ | 0..1 | string | There are no (further) constraints on this element Element idShort description Version of the system - if relevant 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.
The Must Support flag was removed from this element in response to implementer feedback. Requirements for use in certain contexts (e.g., with SNOMED CT CA edition) need to be explored by the Patient Summary Working Group before the constraint will be re-considered for inclusion
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: C*E.7
- rim: ./codeSystemVersion
- orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
|
| code | S Σ | 1..1 | code | There are no (further) constraints on this element Element idShort description Symbol in syntax defined by the system 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).
Need to refer to a particular code in the system.
Note that FHIR strings SHALL NOT exceed 1MB in size
code Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: C*E.1
- rim: ./code
- orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
|
| display | S Σ | 0..1 | string | There are no (further) constraints on this element Element idShort description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system.
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Note that FHIR strings SHALL NOT exceed 1MB in size
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: C*E.2 - but note this is not well followed
- rim: CV.displayName
- orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idShort 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.
string Mappings |
| extension | I | 0..* | Extension | Element idShort description Additional content defined by implementations Alternate names extensions, user content 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.
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.
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()
|
| translation | I | 0..* | Extension(Complex) | There are no (further) constraints on this element Element idCoding.display.extension:translation Language Translation (Localization) Alternate names extensions, user content Definition Language translation from base language of resource to another language.
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.
Extension(Complex) Extension URL http://hl7.org/fhir/StructureDefinition/translation 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()
- rim: n/a
- rim: N/A
- rim: ST.translation
|
| value | | 0..1 | System.String | There are no (further) constraints on this element Element idShort description Primitive value for string Definition Primitive value for string
System.String Maximum string length |
| userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idShort description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
boolean Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: Sometimes implied by being first
- rim: CD.codingRationale
- orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
|
Notes:
- Implementers should ensure that
Coding for medications always includes both the system and code elements.
- While not mandatory, the inclusion of the
display element is encouraged to support better understanding and communication of medication information among healthcare providers and patients.
While initially focused on medication coding, the principles and structure of this profile may inform future adaptations for other coding use-cases within the PS-CA project.
Quantity
The package/structuredefinition-profile-quantity-ca-ps.json
profile represents the constraint applied to the
Quantity
data type by the PS-CA project to use UCUM as the code system for units. Informed by the constraints of the Quantity (IPS)
profile.
| Quantity | I | | Quantity | Element idShort description A measured amount using UCUM Definition A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.
This profile imposes that the code system for units be UCUM.
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Quantity Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
- rim: n/a
- v2: SN (see also Range) or CQ
- rim: PQ, IVL<PQ>, MO, CO, depending on the values
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idShort 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.
string Mappings |
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idShort description Additional content defined by implementations Alternate names extensions, user content 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.
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.
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()
|
| value | Σ | 0..1 | decimal | There are no (further) constraints on this element Element idShort description Numerical value (with implicit precision) Definition The value of the measured amount. The value includes an implicit precision in the presentation of the value.
Precision is handled implicitly in almost all cases of measurement.
The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
decimal Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: SN.2 / CQ - N/A
- rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
|
| comparator | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idShort description < | <= | >= | > - how to understand the value Definition How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.
Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
Note that FHIR strings SHALL NOT exceed 1MB in size
If there is no comparator, then there is no modification of the value
code Binding How the Quantity should be understood and represented.
- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: SN.1 / CQ.1
- rim: IVL properties
|
| unit | Σ | 0..1 | string | There are no (further) constraints on this element Element idShort description Unit representation Definition A human-readable form of the unit.
There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
Note that FHIR strings SHALL NOT exceed 1MB in size
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: (see OBX.6 etc.) / CQ.2
- rim: PQ.unit
|
| system | S Σ I | 1..1 | uriFixed Value | Element idShort description UCUM system for units Definition The identification of the system that provides the coded form of the unit.
Need to know the system that defines the coded form of the unit.
see http://en.wikipedia.org/wiki/Uniform_resource_identifier
uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
http://unitsofmeasure.org - rim: n/a
- v2: (see OBX.6 etc.) / CQ.2
- rim: CO.codeSystem, PQ.translation.codeSystem
|
| code | S Σ | 1..1 | code | There are no (further) constraints on this element Element idShort description Coded form of the unit Definition A computer processable form of the unit in some unit representation system.
Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.
The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
code Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: (see OBX.6 etc.) / CQ.2
- rim: PQ.code, MO.currency, PQ.translation.code
|
Notes:
- All Must Support elements in this profile are also Must Support in IPS-UV, and there are no differences in element cardinality. Constraints are carried over into a unique PS-CA data type profile to ensure that implementers have clarity and consistency in the expectations this guide puts forth when Must Support is claimed.
- Unlike IPS, the PS-CA profile does not make the
Quantity element, itself, Must Support. (This has been identified as a modelling issue with IPS.)
SimpleQuantity
The package/structuredefinition-profile-simplequantity-ca-ps.json
profile represents the constraint applied to the
SimpleQuantity
data type by the PS-CA project to use UCUM as the code system for units in a way that is informed by the constraints of the SimpleQuantity (IPS)
profile.
| Quantity | I | | Quantity | Element idShort description A measured amount using UCUM Definition A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.
This profile imposes that the code system for units be UCUM.
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Quantity Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists() - sqty-1: The comparator is not used on a SimpleQuantity
comparator.empty()
- rim: n/a
- v2: SN (see also Range) or CQ
- rim: PQ, IVL<PQ>, MO, CO, depending on the values
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idShort 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.
string Mappings |
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idShort description Additional content defined by implementations Alternate names extensions, user content 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.
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.
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()
|
| value | Σ | 0..1 | decimal | There are no (further) constraints on this element Element idShort description Numerical value (with implicit precision) Definition The value of the measured amount. The value includes an implicit precision in the presentation of the value.
Precision is handled implicitly in almost all cases of measurement.
The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
decimal Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: SN.2 / CQ - N/A
- rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
|
| comparator | Σ ?! | 0..0 | codeBinding | There are no (further) constraints on this element Element idShort description < | <= | >= | > - how to understand the value Definition Not allowed to be used in this context
Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
Note that FHIR strings SHALL NOT exceed 1MB in size
If there is no comparator, then there is no modification of the value
code Binding How the Quantity should be understood and represented.
- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: SN.1 / CQ.1
- rim: IVL properties
|
| unit | Σ | 0..1 | string | There are no (further) constraints on this element Element idShort description Unit representation Definition A human-readable form of the unit.
There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
Note that FHIR strings SHALL NOT exceed 1MB in size
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: (see OBX.6 etc.) / CQ.2
- rim: PQ.unit
|
| system | S Σ I | 1..1 | uriFixed Value | Element idShort description UCUM system for units Definition The identification of the system that provides the coded form of the unit.
Need to know the system that defines the coded form of the unit.
see http://en.wikipedia.org/wiki/Uniform_resource_identifier
uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
http://unitsofmeasure.org - rim: n/a
- v2: (see OBX.6 etc.) / CQ.2
- rim: CO.codeSystem, PQ.translation.codeSystem
|
| code | S Σ | 1..1 | code | There are no (further) constraints on this element Element idShort description Coded form of the unit Definition A computer processable form of the unit in some unit representation system.
Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.
The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
code Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
- rim: n/a
- v2: (see OBX.6 etc.) / CQ.2
- rim: PQ.code, MO.currency, PQ.translation.code
|
Ratio
The package/structuredefinition-profile-ratio-ca-ps.json
profile represents the constraint applied to the
Ratio
data type by the PS-CA project to use UCUM as the code system for units in a way that is informed by the constraints of the Ratio (IPS)
profile.
| Ratio | I | | Ratio | There are no (further) constraints on this element Element idShort description A ratio of two Quantity values - a numerator and a denominator Definition A relationship of two Quantity values - expressed as a numerator and a denominator.
The Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to "1", Quantity should be used instead of Ratio.
Ratio Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present
(numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists())
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idShort 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.
string Mappings |
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idShort description Additional content defined by implementations Alternate names extensions, user content 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.
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.
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()
|
| numerator | S Σ I | 0..1 | package/structuredefinition-profile-quantity-ca-ps.json | Element idShort description A measured amount using UCUM Definition A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.
This profile imposes that the code system for units be UCUM.
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
package/structuredefinition-profile-quantity-ca-ps.json Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
- rim: n/a
- v2: SN (see also Range) or CQ
- rim: PQ, IVL<PQ>, MO, CO, depending on the values
- rim: .numerator
|
| denominator | S Σ I | 0..1 | package/structuredefinition-profile-quantity-ca-ps.json | Element idShort description A measured amount using UCUM Definition A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.
This profile imposes that the code system for units be UCUM.
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
package/structuredefinition-profile-quantity-ca-ps.json Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
- rim: n/a
- v2: SN (see also Range) or CQ
- rim: PQ, IVL<PQ>, MO, CO, depending on the values
- rim: .denominator
|
Notes:
- All Must Support elements in this profile are also Must Support in IPS-UV, and there are no differences in element cardinality. Constraints are carried over into a unique PS-CA data type profile to ensure that implementers have clarity and consistency in the expectations this guide puts forth when Must Support is claimed.
- Unlike IPS, the PS-CA profile does not make the
Ratio element, itself, Must Support. (This has been identified as a modelling issue with IPS.)
Range
The package/structuredefinition-profile-range-ca-ps.json
profile represents the constraint applied to the
Range
data type by the PS-CA project to supply SimpleQuantity values in a way that is informed by the constraints of the Range (IPS)
profile.
| Range | I | | Range | There are no (further) constraints on this element Element idShort description Set of values bounded by low and high Definition A set of ordered Quantities defined by a low and high limit.
The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.
Range Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - rng-2: If present, low SHALL have a lower value than high
low.empty() or high.empty() or (low <= high)
- rim: n/a
- v2: NR and also possibly SN (but see also quantity)
- rim: IVL<QTY[not(type="TS")]> [lowClosed="true" and highClosed="true"]or URG<QTY[not(type="TS")]>
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idShort 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.
string Mappings |
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idShort description Additional content defined by implementations Alternate names extensions, user content 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.
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.
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()
|
| low | S Σ I | 0..1 | package/structuredefinition-profile-simplequantity-ca-ps.json | Element idShort description A measured amount using UCUM Definition A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.
This profile imposes that the code system for units be UCUM.
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
package/structuredefinition-profile-simplequantity-ca-ps.json Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists() - sqty-1: The comparator is not used on a SimpleQuantity
comparator.empty()
- rim: n/a
- v2: SN (see also Range) or CQ
- rim: PQ, IVL<PQ>, MO, CO, depending on the values
- v2: NR.1
- rim: ./low
|
| high | S Σ I | 0..1 | package/structuredefinition-profile-simplequantity-ca-ps.json | Element idShort description A measured amount using UCUM Definition A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.
This profile imposes that the code system for units be UCUM.
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
package/structuredefinition-profile-simplequantity-ca-ps.json Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists() - sqty-1: The comparator is not used on a SimpleQuantity
comparator.empty()
- rim: n/a
- v2: SN (see also Range) or CQ
- rim: PQ, IVL<PQ>, MO, CO, depending on the values
- v2: NR.2
- rim: ./high
|
