Name Flags Card. Type Description & Constraints Communication C 0..* Communication A record of information transmitted from a sender to a receiver nemsms-invariant: If communication resource is a NemSMS payload cannot exceed 160 note-invariant: Category note invariant notification-invariant: Category notification invariant message-invariant: Category message invariant advice-invariant: Category advice invariant Slices for extension 1..* Extension Extension Slice: Unordered, Open by value:url episodeOfCare 0..1 Reference(EpisodeOfCare) Associated Encounter episode of care URL: http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare recipientCareTeam 0..1 Reference(ehealth-careteam) {r} CareTeam message recipient URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-communication-recipientCareTeam senderCareTeam 0..1 Reference(ehealth-careteam) {r} CareTeam message sender URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-communication-senderCareTeam restrictionCategory 0..* CodeableConcept Restriction category URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-restriction-category Binding: Restriction Category (required) threadId 0..1 string Thread id URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-thread-id period 0..* Period Specifies the temporal validity of an ehealth/message instance URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-period administrativeStatus 1..1 Coding The administrative status of how a message recipient has handled a message URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-administrative-status Binding: Administrative Status (required) title 0..1 string Message title URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-title priority 0..1 code The priority of a message URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-priority Binding: Priority (required) groupId 0..1 string Logical id identifying a set of messages with the same recipient URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-group-id onBehalfOf S 0..1 Reference(ehealth-careteam) {r} On behalf of URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-on-behalf-of partOf 0..* Reference(CarePlan) {r} Part of this action Slices for category 1..* CodeableConcept Message category Slice: Unordered, Open by value:coding.system category:DkTmCategory 1..1 CodeableConcept Message category coding system 1..1 uri Identity of the terminology system Required Pattern: http://ehealth.sundhed.dk/cs/message-category code 0..1 code Symbol in syntax defined by the system Binding: MessageCategory (required) Slices for medium 0..* CodeableConcept A channel of communication Slice: Unordered, Open by value:coding.system medium:DkTmMedium 0..1 CodeableConcept A channel of communication coding system 1..1 uri Identity of the terminology system Required Pattern: http://ehealth.sundhed.dk/cs/message-medium code 0..1 code Symbol in syntax defined by the system Binding: MessageMedium (required) recipient 0..1 Reference(Patient | Practitioner) {r} Message recipient sender 0..1 Reference(Device | Patient | Practitioner) {r, c} Message sender reasonCode 0..* CodeableConcept Indication for message Binding: eHealth Message Reason Code (required) reasonReference 0..* Reference(Condition | Observation) {r} Why was communication done? payload 0..1 BackboneElement Message payload Slices for content[x] 1..1 string Message part content Slice: Unordered, Closed by type:$this content[x]:contentString 1..1 string Message part content note Slices for author[x] 0..1 Reference(Practitioner | Patient | RelatedPerson | Organization), string Individual responsible for the annotation Slice: Unordered, Open by type:$this author[x]:authorReference 0..1 Reference(ehealth-practitioner | ehealth-patient | ehealth-relatedperson) Individual responsible for the annotation author[x]:authorString 0..1 string Individual responsible for the annotation Documentation for this format
Den telemedicinske infrastruktur (eHealth Infrastructure)
A record of information transmitted from a sender to a receiver
An occurrence of information being transmitted; e.g. an alert that was sent to a responsible provider, a public health agency that was notified about a reportable condition.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
If communication resource is a NemSMS payload cannot exceed 160
medium.coding.where(code = 'nemsms').exists() implies payload.contentString.length() <= 160
category.coding.code = 'note' implies (sender.reference = recipient.reference) or (recipient.reference.exists().not() and extension.where(url = 'http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-communication-recipientCareTeam').valueReference.exists())
category.coding.code = 'notification' implies (recipient.reference.contains('Patient/') or extension.where(url = 'http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-communication-recipientCareTeam').valueReference.exists()) and ( sender.reference.contains('Device/') or contained.ofType(Device).where('#' + id = %resource.sender.reference).empty().not())
category.coding.code = 'message' implies (recipient.reference.contains('Patient/') and ( extension.where(url = 'http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-communication-senderCareTeam').valueReference.exists())) or (( extension.where(url = 'http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-communication-recipientCareTeam').valueReference.exists()) and (sender.reference.contains('Patient/')) or (extension.where(url = 'http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-communication-recipientCareTeam').valueReference.exists() and extension.where(url = 'http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-communication-senderCareTeam').valueReference.exists() ))
category.coding.code = 'advice' implies (recipient.reference.contains('Patient/') or extension.where(url = 'http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-communication-recipientCareTeam').valueReference.exists()) and ( sender.reference.contains('Device/') or contained.ofType(Device).where('#' + id = %resource.sender.reference).empty().not())
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
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.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
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.
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.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
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).
Text summary of the resource, for human interpretation
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.
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.
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.
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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Identifies the episode(s) of care that this resource is relevant to. Establishes the EpisodeOfCare as a 'grouper' of resources that are relevant to that episode.
.inboundRelationship(typeCode=COMP].source[classCode<=PCPR, moodCode=EVN]
CareTeam that is a recipient of a Communication
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
CareTeam that is a sender of a Communication
The resource is intended for certain category of workflow/responsibility only
A logical id identifying a set of messages, which are grouped in a thread. Can be supplied by the client, eg. as a UUID
Specifies the temporal validity of an ehealth/message instance
Specifies the temporal validity of an ehealth/message instance. Contains a period, eg. specifying temporal validity
The administrative status of how a message recipient has handled a message
Logical id identifying a set of messages with the same recipient
A logical id identifying a set of messages, which have the same recipient (considered a 'group message'). Must be supplied by the client, eg. as a UUID
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).
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.
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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Business identifiers assigned to this communication by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
This is a business identifier, not a resource identifier (see [discussion](http://hl7.org/fhir/R4/resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
Allows identification of the communication as it is known by various participating systems and in a way that remains consistent across servers.
Instantiates FHIR protocol or definition
The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication.
Instantiates external protocol or definition
The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication.
This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
An order, proposal or plan fulfilled in whole or in part by this Communication.
This must point to some sort of a 'Request' resource, such as CarePlan, CommunicationRequest, ServiceRequest, MedicationRequest, etc.
Prior communication that this communication is in response to.
preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
This element is labeled as a modifier because the status contains the codes aborted and entered-in-error that mark the communication as not currently valid.
This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Captures the reason for the current state of the Communication.
This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.
Codes for the reason why a communication did not happen.
The type of message conveyed such as alert, notification, reminder, instruction, etc.
There may be multiple axes of categorization and one communication may serve multiple purposes.
Codes for general categories of communications such as alerts, instructions, etc.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
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.
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. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
The identification of the code system that defines the meaning of the symbol in the code.
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.
Need to be unambiguous about the source of the definition of the symbol.
fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
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.
Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
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.
fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
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.
C*E.2 - but note this is not well followed
fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
If this coding was chosen directly by the user
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
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.
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.
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 ]
Plain text representation of the concept
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.
Very often the text is the same as a displayName of one of the codings.
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.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Characterizes how quickly the planned or in progress communication must be addressed. Includes concepts such as stat, urgent, routine.
Used to prioritize workflow (such as which communication to read first) when the communication is planned or in progress.
If missing, this communication should be treated with normal priority
Codes indicating the relative importance of a communication.
A channel that was used for this communication (e.g. email, fax).
Codes for communication mediums such as phone, fax, email, in person, etc.
The patient or group that was the focus of this communication.
Description of the purpose/content, similar to a subject line in an email.
Communication.topic.text can be used without any codings.
Codes describing the purpose or content of the communication.
Resources that pertain to this communication
Other resources that pertain to this communication and to which this communication should be associated.
Don't use Communication.about element when a more specific element exists, such as basedOn or reasonReference.
The Encounter during which this Communication was created or to which the creation of this record is tightly associated.
This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.
The time when this communication was sent.
Event.occurrence[x] {Invariant: maps to period.start}
The time when this communication arrived at the destination.
Event.occurrence[x] {Invariant: maps to period.end}
The entity (e.g. person, organization, clinical information system, care team or device) which was the target of the communication. If receipts need to be tracked by an individual, a separate resource instance will need to be created for each recipient. Multiple recipient communications are intended where either receipts are not tracked (e.g. a mass mail-out) or a receipt is captured in aggregate (all emails confirmed received by a particular time).
The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication.
The reason or justification for the communication.
Textual reasons can be captured using reasonCode.text.
Indicates another resource whose existence justifies this communication.
Text, attachment(s), or resource(s) that was communicated to the recipient.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
A communicated content (or for multi-part communications, one portion of the communication).
Additional notes or commentary about the communication by the sender, receiver or other interested parties.
Individual responsible for the annotation
The individual responsible for making the annotation.
Organization is used when there's no need for specific attribution as to who made the comment.
Indicates when this particular annotation was made.
The annotation - text content (as markdown)
The text of the annotation in markdown format.