App State Profile

Canonical	../StructureDefinition/nexus-emr-core-appstate
Status	active · 1.26.0
Base	Basic (constraint)
Source	FSH · JSON

A profile for representing external application state in Nexus EMR.

Elements / Details

Every element this profile touches, with its full definition. Element names in the tables link here.

Basic

Short	Nexus EMR App State Core
Definition	Represents application state information for Nexus EMR applications, capturing key details like state type, content, and associated resources using standard Nexus EMR references. Uses instance-specific identifiers for tracking application state across systems.
Cardinality	0..*
Invariants	dom-2, dom-3, dom-4, dom-5, dom-6
Also called	Z-resource, Extension-resource, Custom-resource

Basic.id

Short	Logical id of this artifact
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
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.
Cardinality	0..1
Type	http://hl7.org/fhirpath/System.String

Basic.meta

Short	Metadata about the resource
Definition	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.
Cardinality	0..1
Type	Meta
Invariants	ele-1

Basic.meta.id

Short	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.
Cardinality	0..1
Type	http://hl7.org/fhirpath/System.String

Basic.meta.extension

Short	Additional content defined by implementations
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.
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
Invariants	ele-1, ext-1
Also called	extensions, user content

Basic.meta.versionId

Short	Version specific identifier
Definition	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.
Cardinality	0..1
Type	id
Invariants	ele-1

Basic.meta.lastUpdated

Short	When the resource version last changed
Definition	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.
Cardinality	0..1
Type	instant
Invariants	ele-1

Basic.meta.source

Short	Identifies EMR instance & pipeline version the resource came from
Definition	A URI that identifies the EMR pipeline and version from which this resource originated. This tells you which EMR instance (recommend using the instance identifier), and the version of the pipeline code/transformations.
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.
Cardinality	0..1
Type	uri
Must Support	yes
Invariants	ele-1

Basic.meta.profile

Short	Profiles this resource claims to conform to
Definition	A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.
Comments	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.
Cardinality	0..*
Type	canonical
Invariants	ele-1

Basic.meta.security

Short	Security Labels applied to this resource
Definition	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.
Cardinality	0..*
Type	Coding
Binding	security-labels (extensible)
Invariants	ele-1

Basic.meta.tag

Short	Tags applied to this resource
Definition	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.
Cardinality	0..*
Type	Coding
Binding	common-tags (example)
Invariants	ele-1

Basic.implicitRules

Short	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
Invariants	ele-1

Basic.language

Short	Language of the resource content
Definition	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).
Cardinality	0..1
Type	code
Binding	languages (preferred)
Invariants	ele-1

Basic.text

Short	Narrative
Definition	A human-readable narrative summary of the NexusEmrCoreAppState resource 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.
Cardinality	0..1
Type	Narrative
Must Support	yes
Invariants	ele-1
Also called	narrative, html, xhtml, display

Basic.contained

Short	Contained, inline Resources
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.
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.
Cardinality	0..*
Type	Resource
Also called	inline resources, anonymous resources, contained resources

Basic.extension

Short	The actual state value(s) - can have an arbitrary number of state values
Definition	Contains the application state values using type-specific extensions (string, boolean, etc.).
Comments	Different extension types support different value data types.
Cardinality	1..*
Type	Extension
Must Support	yes
Invariants	ele-1, ext-1
Also called	extensions, user content

Basic.extension.id

Short	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.
Cardinality	0..1
Type	http://hl7.org/fhirpath/System.String

Basic.extension.extension

Short	Additional content defined by implementations
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.
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
Invariants	ele-1, ext-1
Also called	extensions, user content

Basic.extension.url

Short	Extension type URL
Definition	Identifies which type of value extension is being used (string, boolean, etc.).
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Cardinality	1..1
Type	http://hl7.org/fhirpath/System.String
Must Support	yes

Basic.extension.value[x]

Short	Value of extension
Definition	Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Cardinality	0..1
Type	base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
Invariants	ele-1

Basic.extension:stringValue

Short	Namespaced string state value
Definition	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.
Cardinality	0..*
Type	Extension(App State String Value Extension)
Invariants	ele-1, ext-1
Also called	extensions, user content

Basic.extension:booleanValue

Short	Namespaced boolean state value
Definition	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.
Cardinality	0..*
Type	Extension(App State Boolean Value Extension)
Invariants	ele-1, ext-1
Also called	extensions, user content

Basic.modifierExtension

Short	Extensions that cannot be ignored
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 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
Invariants	ele-1, ext-1
Also called	extensions, user content

Basic.identifier

Short	Business identifier for app state
Definition	Optional identifier for this application state entry.
Comments	Most app state entries are identified by their code and subject rather than explicit identifiers.
Cardinality	0..1
Type	Identifier
Invariants	ele-1

Basic.code

Short	Type and namespace of application state
Definition	Identifies what kind of application state this represents and which application namespace it belongs to.
Requirements	Must be able to distinguish different types of Basic resources.
Comments	The code acts as both a type discriminator and namespace identifier for the state data.
Cardinality	1..1
Type	CodeableConcept
Must Support	yes
Modifier	yes — This element determines what kind of resource is being represented which drives the meaning of all of the other elements.
Binding	basic-resource-type (example)
Invariants	ele-1

Basic.code.id

Short	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.
Cardinality	0..1
Type	http://hl7.org/fhirpath/System.String

Basic.code.extension

Short	Additional content defined by implementations
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.
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
Invariants	ele-1, ext-1
Also called	extensions, user content

Basic.code.coding

Short	Coded type of state
Definition	The coded representation of the application state type.
Requirements	Allows for alternative encodings within a code system, and translations to other code systems.
Comments	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.
Cardinality	1..1
Type	Coding
Must Support	yes
Invariants	ele-1, app-state-system-inv

Basic.code.coding.id

Short	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.
Cardinality	0..1
Type	http://hl7.org/fhirpath/System.String

Basic.code.coding.extension

Short	Additional content defined by implementations
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.
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
Invariants	ele-1, ext-1
Also called	extensions, user content

Basic.code.coding.system

Short	Application-specific CodeSystem URL
Definition	Must follow pattern: ../CodeSystem/[app-name]-app-state
Requirements	Need to be unambiguous about the source of the definition of the symbol.
Comments	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.
Cardinality	1..1
Type	uri
Must Support	yes
Invariants	ele-1

Basic.code.coding.version

Short	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.
Comments	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.
Cardinality	0..1
Type	string
Invariants	ele-1

Basic.code.coding.code

Short	Specific state type code
Definition	The specific type of state within the application's namespace.
Requirements	Need to refer to a particular code in the system.
Cardinality	1..1
Type	code
Must Support	yes
Invariants	ele-1

Basic.code.coding.display

Short	Human-readable state type name
Definition	A representation of the meaning of the code in the system, following the rules of the system.
Requirements	Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Cardinality	0..1
Type	string
Must Support	yes
Invariants	ele-1

Basic.code.coding.userSelected

Short	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).
Requirements	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.
Comments	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.
Cardinality	0..1
Type	boolean
Invariants	ele-1

Basic.code.text

Short	Plain text description of state type
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.
Requirements	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.
Comments	Very often the text is the same as a displayName of one of the codings.
Cardinality	0..1
Type	string
Must Support	yes
Invariants	ele-1

Basic.subject

Short	Resource this state is associated with
Definition	The FHIR resource (Patient, PractitionerRole, Organization, etc.) that this application state is associated with.
Requirements	Needed for partitioning the resource by Patient.
Comments	Application state is always linked to a specific resource for context.
Cardinality	1..1
Type	Reference(Patient Profile | PractitionerRole Profile | Practitioner Profile | Organization Profile)
Invariants	ele-1

Basic.subject.id

Short	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.
Cardinality	0..1
Type	http://hl7.org/fhirpath/System.String

Basic.subject.extension

Short	Additional content defined by implementations
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.
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
Invariants	ele-1, ext-1
Also called	extensions, user content

Basic.subject.reference

Short	Reference to the associated resource
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.
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.
Cardinality	0..1
Type	string
Must Support	yes
Invariants	ele-1

Basic.subject.type

Short	Type of resource referenced
Definition	The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Comments	This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Cardinality	0..1
Type	uri
Must Support	yes
Binding	resource-types (extensible)
Invariants	ele-1

Basic.subject.identifier

Short	Logical reference, when literal reference is not known
Definition	An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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.
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. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Cardinality	0..1
Type	Identifier
Invariants	ele-1

Basic.subject.display

Short	Display name of referenced resource
Definition	Plain text narrative that identifies the resource in addition to the resource reference.
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.
Cardinality	0..1
Type	string
Must Support	yes
Invariants	ele-1

Basic.created

Short	When created
Definition	Identifies when the resource was first created.
Requirements	Allows ordering resource instances by time.
Cardinality	0..1
Type	date
Invariants	ele-1

Basic.author

Short	Who created
Definition	Indicates who was responsible for creating the resource instance.
Requirements	Needed for partitioning the resource.
Cardinality	0..1
Type	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)
Invariants	ele-1