eHealth Infrastructure (v2020.4)

StructureDefinition: ehealth-media - Detailed Descriptions

Definitions for the ehealth-media Profile.

1. Media
Definition

A photo, video, or audio recording acquired or used in healthcare. The actual content may be inline or provided by direct reference.

Control0..*
InvariantsDefined on this element
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (: contained.text.empty())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (: contained.where(('#'+id in %resource.descendants().reference).not()).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
mda-1: Height can only be used for a photo or video (: height.empty() or type != 'audio')
mda-2: Width can only be used for a photo or video (: width.empty() or type != 'audio')
mda-3: Frames can only be used for a photo (: frames.empty() or type = 'photo')
mda-4: Duration can only be used for an audio or a video (: duration.empty() or type != 'photo')
2. Media.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typeid
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

3. Media.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
4. Media.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

5. Media.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language.
The codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable
Max Binding: All Languages
Typecode
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

6. Media.text
Definition

A human-readable narrative that contains a summary of the resource, and may 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.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

7. Media.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

8. Media.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on Media.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
9. Media.extension:quality
SliceNamequality
Definition

The minimum requirements for qualities

Control0..* This element is affected by the following invariants: ele-1
TypeExtension(quality) (Extension Type: Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
10. Media.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

11. Media.identifier
Definition

Identifiers associated with the image - these may include identifiers for the image itself, identifiers for the context of its collection (e.g. series ids) and context ids such as accession numbers or other workflow identifiers.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Comments

The identifier label and use can be used to determine what kind of identifier it is.

12. Media.basedOn
Definition

A procedure that is fulfilled in whole or in part by the creation of this media.

Control1..1
TypeReference(ehealth-procedurerequest)
Requirements

Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

Alternate Namesfulfills
13. Media.type
Definition

Whether the media is a photo (still image), an audio recording, or a video recording.

Control1..1
BindingWhether the media is a photo, video, or audio
The codes SHALL be taken from DigitalMediaType
Typecode
14. Media.subtype
Definition

Details of the type of the media - usually, how it was acquired (what type of device). If images sourced from a DICOM system, are wrapped in a Media resource, then this is the modality.

Control0..1
BindingDetailed information about the type of the image - its kind, purpose, or the kind of equipment used to generate it
For example codes, see Media SubType
TypeCodeableConcept
15. Media.view
Definition

The name of the imaging view e.g. Lateral or Antero-posterior (AP).

Control0..1
BindingImaging view (projection) used when collecting an image
For example codes, see Media Collection View/Projection
TypeCodeableConcept
16. Media.subject
Definition

Who/What this Media is a record of.

Control1..1
TypeReference(ehealth-patient | ehealth-practitioner | Group | ehealth-device | Specimen)
17. Media.subject.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
18. Media.subject.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Media.subject.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
19. Media.subject.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control1..1 This element is affected by the following invariants: ref-1
Typestring
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

20. Media.subject.identifier
Definition

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

21. Media.subject.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control0..1
Typestring
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

22. Media.context
Definition

The encounter or episode of care that establishes the context for this media.

Control1..1
TypeReference(Encounter | ehealth-episodeofcare)
Requirements

Links the media to the Encounter context.

Alternate Namesencounter
Comments

This will typically be the encounter the media occurred within.

23. Media.occurrence[x]
Definition

The date and time(s) at which the media was collected.

Control1..1
TypeChoice of: dateTime, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Alternate Namestiming
24. Media.operator
Definition

The person who administered the collection of the image.

Control0..1
TypeReference(ehealth-practitioner)
25. Media.reasonCode
Definition

Describes why the event occurred in coded or textual form.

Control0..*
BindingThe reason for the media
For example codes, see Procedure Reason Codes
TypeCodeableConcept
Comments

Textual reasons can be caprued using reasonCode.text.

26. Media.bodySite
Definition

Indicates the site on the subject's body where the media was collected (i.e. the target site).

Control0..1
BindingCodes describing anatomical locations. May include laterality.
For example codes, see SNOMED CT Body Structures
TypeCodeableConcept
Comments

If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use The standard extension body-site-instance.

27. Media.device
Definition

The device used to collect the media.

Control0..1
TypeReference(ehealth-device | ehealth-devicemetric)
Comments

An extension should be used if further typing of the device is needed. Scondary devices used to support collecting a media can be represented using either extension or through the Observation.related element.

28. Media.height
Definition

Height of the image in pixels (photo/video).

Control0..1 This element is affected by the following invariants: mda-1
TypepositiveInt
29. Media.width
Definition

Width of the image in pixels (photo/video).

Control0..1 This element is affected by the following invariants: mda-2
TypepositiveInt
30. Media.frames
Definition

The number of frames in a photo. This is used with a multi-page fax, or an imaging acquisition context that takes multiple slices in a single image, or an animated gif. If there is more than one frame, this SHALL have a value in order to alert interface software that a multi-frame capable rendering widget is required.

Control0..1 This element is affected by the following invariants: mda-3
TypepositiveInt
Default Value1
31. Media.duration
Definition

The duration of the recording in seconds - for audio and video.

Control0..1 This element is affected by the following invariants: mda-4
TypeunsignedInt
Comments

The duration might differ from occurrencePeriod if recording was paused.

32. Media.content
Definition

The actual content of the media - inline or by direct reference to the media source file.

Control1..1
TypeAttachment
Comments

Recommended content types: image/jpeg, image/png, image/tiff, video/mpeg, audio/mp4, application/dicom. Application/dicom can contain the transfer syntax as a parameter. For an media that covers a period of time (video/sound), the content.creationTime is the end time. Creation time is used for tracking, organizing versions and searching.

33. Media.note
Definition

Comments made about the media by the performer, subject or other participants.

Control0..*
TypeAnnotation
34. Media.note.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
35. Media.note.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on Media.note.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
36. Media.note.author[x]
Definition

The individual responsible for making the annotation.

Control0..1
TypeChoice of: Reference(ehealth-practitioner | ehealth-patient | ehealth-relatedperson), string
[x] NoteSee Choice of Data Types for further information about how to use [x]
37. Media.note.time
Definition

Indicates when this particular annotation was made.

Control0..1
TypedateTime
38. Media.note.text
Definition

The text of the annotation.

Control1..1
Typestring