A participant's answer to a booking: whether the person an appointment is for has accepted it, is still deciding, or has declined. Written by an integrating system outside the EMR and read wherever a booking's confirmation state is displayed, which is derived from participantStatus rather than from Appointment.status. An answer supersedes an earlier answer rather than amending it, and the latest one describes where the booking stands.
Elements / Details
Every element this profile touches, with its full definition. Element names in the tables link here.
Whether the participant an appointment names has accepted it, is still deciding, or has declined
it.
This is where a booking's confirmation state is recorded. It is a separate fact ABOUT an
appointment rather than a change to it: recording an answer does not alter the appointment, so a
refusal here leaves the slot booked in the schedule until somebody acts on it.
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.
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.
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.
The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
Comments
The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
When the resource last changed - e.g. when the version changed.
Comments
This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
Identifies EMR instance & pipeline version the resource came from
Definition
A URI that identifies the EMR pipeline and version from which this resource originated.
Comments
In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.
This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
Comments
The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
Comments
The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Comments
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Cardinality
0..1
Type
uri
Modifier
yes — 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.
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).
A human-readable narrative summary of the answer for human interpretation.
Comments
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Comments
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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.
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.
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Cardinality
0..*
Type
Extension
Modifier
yes — Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Unique identifiers for this answer, where the producing system has one.
Optional: an answer produced outside the estate may carry no identifier of its own, and nothing
here resolves one. Where the source system does have one, carry it rather than dropping it.
Comments
A source system's own identifier SHOULD be carried alongside this one, flagged use = secondary. See Carrying the raw code.
The booking whose confirmation state this answer describes. Required by base R4, and the only route from an answer back to the appointment it belongs to: a consumer indexes answers by this reference and reads the latest one per appointment.
Time from appointment, or requested new start time
Definition
Date/Time that the appointment is to take place, or requested new start time.
Comments
This may be either the same as the appointment request to confirm the details of the appointment, or alternately a new time to request a re-negotiation of the start time.
This may be either the same as the appointment request to confirm the details of the appointment, or alternately a new time to request a re-negotiation of the end time.
The role of the participant can be used to declare what the actor will be doing in the scope of the referenced appointment.
If the actor is not specified, then it is expected that the actor will be filled in at a later stage of planning.
This value SHALL be the same as specified on the referenced Appointment so that they can be matched, and subsequently updated.
The participant who answered -- usually the Patient the appointment is for, and a Practitioner, RelatedPerson, Device, HealthcareService or Location where a booking is answered on another party's behalf.
Comments
Optional, and an absent actor narrows how the answer can be found: a search scoped to one patient matches through this element, so an answer without it is returned only by a search naming the appointment. Populate it wherever the producing system knows who answered. The optionality is conditional, not free: R4's apr-1 invariant requires participantType or actor, so an answer that omits the actor SHALL state the participant role instead -- the generic PART where the producing system does not know it. An instance carrying neither is invalid against base R4.
The participant's answer to the booking.
A consumer should expect all four codes. accepted, tentative and declined each describe a
distinct state of a booking that has not yet happened; needs-action says the participant has been
asked and has not answered, which is what an unanswered booking already says.
Comments
An absent or blank status supplied by a producer is stored as tentative, because the element is mandatory in R4 and rejecting the resource would discard the answer entirely. tentative therefore means EITHER that the participant is still deciding OR that the producer said nothing, and the two are indistinguishable from the resource. A status a producer did supply is never rewritten.