{ "resourceType": "StructureDefinition", "id": "nexus-emr-core-communication", "extension": [ { "url": "https://fhir.apps.health/StructureDefinition/effective-date", "extension": [ { "url": "paths", "valueString": "sent | received" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "status" }, { "url": "expression", "valueString": "status" }, { "url": "type", "valueCode": "code" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "category" }, { "url": "expression", "valueString": "category" }, { "url": "type", "valueCode": "coded" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "date" }, { "url": "expression", "valueString": "sent | received" }, { "url": "type", "valueCode": "dateTime" } ] } ], "url": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-communication", "name": "NexusEmrCoreCommunication", "title": "Communication Profile", "status": "draft", "experimental": true, "description": "Nexus EMR profile for Communication, covering two distinct populations: WELL-internal staff chat about a patient, and eReferral correspondence passed through from or to external partners. First pass -- the pass-through boundary and message threading are not yet settled.", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "resource", "abstract": false, "type": "Communication", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Communication", "derivation": "constraint", "snapshot": { "element": [ { "id": "Communication", "path": "Communication", "short": "Nexus EMR Communication Core", "definition": "A message about a patient. Either WELL-internal staff chat, or eReferral correspondence\nexchanged with an external partner. `category` distinguishes them and readers should scope\non it -- the two populations have different authorities over their content.", "min": 0, "max": "*", "base": { "path": "Communication", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "xpath": "not(parent::f:contained and f:contained)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "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", "expression": "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()", "xpath": "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='#'])]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:security))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "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." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "xpath": "exists(f:text/h:div)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "nexus-note-extension-not-where-native", "severity": "error", "human": "The resource-note extension is not used on a resource that has a native `note` element -- that element is the home", "expression": "extension('https://fhir.apps.health/StructureDefinition/nexus-emr-resource-note').empty()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-communication" }, { "key": "communication-has-category", "severity": "warning", "human": "SHOULD carry a category identifying which population this Communication belongs to (internal chat vs external eReferral traffic) -- the two are otherwise indistinguishable to a reader", "expression": "category.exists()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-communication" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "workflow", "map": "Event" } ] }, { "id": "Communication.id", "path": "Communication.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.", "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": true }, { "id": "Communication.meta", "path": "Communication.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.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "Communication.meta.id", "path": "Communication.meta.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Communication.meta.extension", "path": "Communication.meta.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Communication.meta.versionId", "path": "Communication.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.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Meta.versionId", "min": 0, "max": "1" }, "type": [ { "code": "id" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "Communication.meta.lastUpdated", "path": "Communication.meta.lastUpdated", "short": "When the resource version last changed", "definition": "When the resource last changed - e.g. when the version changed.", "comment": "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](http.html#read) interaction.", "min": 0, "max": "1", "base": { "path": "Meta.lastUpdated", "min": 0, "max": "1" }, "type": [ { "code": "instant" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "Communication.meta.source", "path": "Communication.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.", "comment": "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. \n\nThis 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.", "min": 0, "max": "1", "base": { "path": "Meta.source", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true }, { "id": "Communication.meta.profile", "path": "Communication.meta.profile", "short": "Profiles this resource claims to conform to", "definition": "A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url).", "comment": "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.", "min": 0, "max": "*", "base": { "path": "Meta.profile", "min": 0, "max": "*" }, "type": [ { "code": "canonical", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/StructureDefinition" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "Communication.meta.security", "path": "Communication.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.", "comment": "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.", "min": 0, "max": "*", "base": { "path": "Meta.security", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "SecurityLabels" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "Security Labels from the Healthcare Privacy and Security Classification System.", "valueSet": "http://hl7.org/fhir/ValueSet/security-labels" } }, { "id": "Communication.meta.tag", "path": "Communication.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.", "comment": "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.", "min": 0, "max": "*", "base": { "path": "Meta.tag", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Tags" } ], "strength": "example", "description": "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\".", "valueSet": "http://hl7.org/fhir/ValueSet/common-tags" } }, { "id": "Communication.implicitRules", "path": "Communication.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.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "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", "isSummary": true }, { "id": "Communication.language", "path": "Communication.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "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).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "preferred", "description": "A human language.", "valueSet": "http://hl7.org/fhir/ValueSet/languages" } }, { "id": "Communication.text", "path": "Communication.text", "short": "Narrative", "definition": "A human-readable narrative summary of the NexusEmrCoreCommunication resource for human interpretation.", "comment": "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.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "Act.text?" } ] }, { "id": "Communication.contained", "path": "Communication.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.", "comment": "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.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Communication.extension", "path": "Communication.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 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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Communication.modifierExtension", "path": "Communication.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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Communication.identifier", "path": "Communication.identifier", "short": "Business identifier(s) for the communication", "definition": "Unique identifiers for the communication.\n\nA business identifier is recommended but not required (identifier is 0..*). For eReferral traffic this is where the partner's own message identifier belongs -- it is the only governed way to correlate a reply with what it replies to across the boundary.\n\n⚠ HERITAGE EMR SITUATION -- UNRESOLVED. Heritage EMRs have internal messaging and inbox features, but they are NOT modelled as FHIR Communication: they are local message tables with their own threading, read/unread state, and per-user routing that has no FHIR equivalent. Nothing currently maps them into this resource. Two consequences: (1) a heritage-sourced message has no identifier this IG can name, so any ingest would have to mint one, and (2) migrating that history at all is an open decision -- the alternative is to leave heritage messages in the source system and have this resource cover only natively-authored traffic. Until that is decided, treat every Communication here as either WELL-internal-native or external eReferral, never heritage-migrated.\n\nIf no recognized system exists, implementers MAY invent a URI for the system.\n\nA source system's own identifier SHOULD be carried alongside this one, flagged `use = secondary`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "comment": "This is a business identifier, not a resource identifier (see [discussion](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.", "requirements": "Allows identification of the communication as it is known by various participating systems and in a way that remains consistent across servers.", "min": 0, "max": "*", "base": { "path": "Communication.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.identifier" }, { "identity": "w5", "map": "FiveWs.identifier" } ] }, { "id": "Communication.identifier.id", "path": "Communication.identifier.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Communication.identifier.extension", "path": "Communication.identifier.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Communication.identifier.use", "path": "Communication.identifier.use", "short": "usual | official | temp | secondary | old (If known)", "definition": "The purpose of this identifier.", "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.", "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.", "min": 0, "max": "1", "base": { "path": "Identifier.use", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierUse" } ], "strength": "required", "description": "Identifies the purpose for this identifier, if known .", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1" }, "mapping": [ { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Communication.identifier.type", "path": "Communication.identifier.type", "short": "Description of identifier", "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.", "comment": "This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.", "requirements": "Allows users to make use of identifiers when the identifier system is not known.", "min": 0, "max": "1", "base": { "path": "Identifier.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type" }, "mapping": [ { "identity": "v2", "map": "CX.5" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Communication.identifier.system", "path": "Communication.identifier.system", "short": "The namespace for the identifier value", "definition": "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.", "comment": "Identifier.system is always case sensitive.", "requirements": "There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.", "min": 1, "max": "1", "base": { "path": "Identifier.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "example": [ { "label": "General", "valueUri": "http://www.acme.com/identifiers/patient" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / EI-2-4" }, { "identity": "rim", "map": "II.root or Role.id.root" }, { "identity": "servd", "map": "./IdentifierType" } ] }, { "id": "Communication.identifier.value", "path": "Communication.identifier.value", "short": "The value that is unique", "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.", "comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.", "min": 1, "max": "1", "base": { "path": "Identifier.value", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "123456" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.1 / EI.1" }, { "identity": "rim", "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)" }, { "identity": "servd", "map": "./Value" } ] }, { "id": "Communication.identifier.period", "path": "Communication.identifier.period", "short": "Time period when id is/was valid for use", "definition": "Time period during which identifier is/was valid for use.", "min": 0, "max": "1", "base": { "path": "Identifier.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.7 + CX.8" }, { "identity": "rim", "map": "Role.effectiveTime or implied by context" }, { "identity": "servd", "map": "./StartDate and ./EndDate" } ] }, { "id": "Communication.identifier.assigner", "path": "Communication.identifier.assigner", "short": "Organization that issued id (may be just text)", "definition": "Organization that issued/manages the identifier.", "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.", "min": 0, "max": "1", "base": { "path": "Identifier.assigner", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / (CX.4,CX.9,CX.10)" }, { "identity": "rim", "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper" }, { "identity": "servd", "map": "./IdentifierIssuingAuthority" } ] }, { "id": "Communication.instantiatesCanonical", "path": "Communication.instantiatesCanonical", "short": "Instantiates FHIR protocol or definition", "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.", "min": 0, "max": "*", "base": { "path": "Communication.instantiatesCanonical", "min": 0, "max": "*" }, "type": [ { "code": "canonical", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/PlanDefinition", "http://hl7.org/fhir/StructureDefinition/ActivityDefinition", "http://hl7.org/fhir/StructureDefinition/Measure", "http://hl7.org/fhir/StructureDefinition/OperationDefinition", "http://hl7.org/fhir/StructureDefinition/Questionnaire" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.instantiatesCanonical" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=DEFN].target" } ] }, { "id": "Communication.instantiatesUri", "path": "Communication.instantiatesUri", "short": "Instantiates external protocol or definition", "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.", "comment": "This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.", "min": 0, "max": "*", "base": { "path": "Communication.instantiatesUri", "min": 0, "max": "*" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.instantiatesUri" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=DEFN].target" } ] }, { "id": "Communication.basedOn", "path": "Communication.basedOn", "short": "Request fulfilled by this communication", "definition": "An order, proposal or plan fulfilled in whole or in part by this Communication.", "comment": "This must point to some sort of a 'Request' resource, such as CarePlan, CommunicationRequest, ServiceRequest, MedicationRequest, etc.", "alias": [ "fulfills" ], "min": 0, "max": "*", "base": { "path": "Communication.basedOn", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.basedOn" } ] }, { "id": "Communication.partOf", "path": "Communication.partOf", "short": "Part of this action", "definition": "Part of this action.", "alias": [ "container" ], "min": 0, "max": "*", "base": { "path": "Communication.partOf", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.partOf" } ] }, { "id": "Communication.inResponseTo", "path": "Communication.inResponseTo", "short": "The message this one replies to", "definition": "Prior communication that this communication is in response to.", "comment": "⚠ FIRST PASS. The chat panel currently threads by neither `inResponseTo` nor `partOf` -- conversation order is reconstructed from timestamps, which is why concurrent messages can interleave wrongly. Declaring the element here is the first step; deciding whether threads are `inResponseTo` chains or a `partOf` grouping is open.", "min": 0, "max": "*", "base": { "path": "Communication.inResponseTo", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-communication" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false }, { "id": "Communication.status", "path": "Communication.status", "short": "preparation | in-progress | not-done | completed | entered-in-error | ...", "definition": "The status of the transmission.", "comment": "Internal chat writes `completed` on send. For eReferral traffic the partner's lifecycle applies and `status` is pass-through -- do not infer local workflow state from it.", "min": 1, "max": "1", "base": { "path": "Communication.status", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": true, "isModifierReason": "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", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CommunicationStatus" } ], "strength": "required", "description": "The status of the communication.", "valueSet": "http://hl7.org/fhir/ValueSet/event-status|4.0.1" }, "mapping": [ { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "FiveWs.status" } ] }, { "id": "Communication.statusReason", "path": "Communication.statusReason", "short": "Reason for current status", "definition": "Captures the reason for the current state of the Communication.", "comment": "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.", "alias": [ "Suspended Reason", "Cancelled Reason" ], "min": 0, "max": "1", "base": { "path": "Communication.statusReason", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CommunicationNotDoneReason" } ], "strength": "example", "description": "Codes for the reason why a communication did not happen.", "valueSet": "http://hl7.org/fhir/ValueSet/communication-not-done-reason" }, "mapping": [ { "identity": "workflow", "map": "Event.statusReason" } ] }, { "id": "Communication.category", "path": "Communication.category", "short": "Which population: internal staff chat, or external eReferral correspondence", "definition": "Which population this Communication belongs to. Readers should scope on it -- internal chat and\nexternal eReferral correspondence have different authorities over their content, and a chat surface\nthat does not scope will surface partner correspondence into a panel never designed for it.\n\n⚠ HERITAGE EMR SITUATION -- UNRESOLVED. If heritage-EMR message history is ever migrated (see\n`identifier`), it becomes a THIRD population alongside internal chat and eReferral, and this element\nis where that distinction would have to live. No code for it exists, because the migration decision\nhas not been made. Anyone binding a value set here must resolve that first, or the binding will need\nwidening the moment migration is agreed.", "comment": "⚠ FIRST PASS -- no value set is bound yet, deliberately. Binding one requires deciding the pass-through boundary first (a partner-supplied category must remain conformant), and that decision is not made. Until then this is text-or-code and readers MUST tolerate text-only. A local NexusEmrCommunicationCategoryVS is the intended follow-up.", "min": 0, "max": "*", "base": { "path": "Communication.category", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CommunicationCategory" } ], "strength": "example", "description": "Codes for general categories of communications such as alerts, instructions, etc.", "valueSet": "http://hl7.org/fhir/ValueSet/communication-category" }, "mapping": [ { "identity": "w5", "map": "FiveWs.class" } ] }, { "id": "Communication.priority", "path": "Communication.priority", "short": "routine | urgent | asap | stat", "definition": "Characterizes how quickly the planned or in progress communication must be addressed. Includes concepts such as stat, urgent, routine.", "comment": "Used to prioritize workflow (such as which communication to read first) when the communication is planned or in progress.", "min": 0, "max": "1", "base": { "path": "Communication.priority", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "meaningWhenMissing": "If missing, this communication should be treated with normal priority", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CommunicationPriority" } ], "strength": "required", "description": "Codes indicating the relative importance of a communication.", "valueSet": "http://hl7.org/fhir/ValueSet/request-priority|4.0.1" }, "mapping": [ { "identity": "w5", "map": "FiveWs.grade" } ] }, { "id": "Communication.medium", "path": "Communication.medium", "short": "A channel of communication", "definition": "A channel that was used for this communication (e.g. email, fax).", "min": 0, "max": "*", "base": { "path": "Communication.medium", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CommunicationMedium" } ], "strength": "example", "description": "Codes for communication mediums such as phone, fax, email, in person, etc.", "valueSet": "http://terminology.hl7.org/ValueSet/v3-ParticipationMode" } }, { "id": "Communication.subject", "path": "Communication.subject", "short": "The patient the communication is about", "definition": "The patient or group that was the focus of this communication.", "comment": "0..1 per R4. Internal chat about a patient SHOULD carry it -- a chat message with no subject cannot be scoped to a chart, and cannot be filtered out of one either, which is the access-control concern.", "alias": [ "patient" ], "min": 0, "max": "1", "base": { "path": "Communication.subject", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.subject" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "w5", "map": "FiveWs.subject" } ] }, { "id": "Communication.topic", "path": "Communication.topic", "short": "Description of the purpose/content", "definition": "Description of the purpose/content, similar to a subject line in an email.", "comment": "Communication.topic.text can be used without any codings.", "min": 0, "max": "1", "base": { "path": "Communication.topic", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CommunicationTopic" } ], "strength": "example", "description": "Codes describing the purpose or content of the communication.", "valueSet": "http://hl7.org/fhir/ValueSet/communication-topic" }, "mapping": [ { "identity": "w5", "map": "FiveWs.context" } ] }, { "id": "Communication.about", "path": "Communication.about", "short": "Resources that pertain to this communication", "definition": "Other resources that pertain to this communication and to which this communication should be associated.", "comment": "Don't use Communication.about element when a more specific element exists, such as basedOn or reasonReference.", "min": 0, "max": "*", "base": { "path": "Communication.about", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "w5", "map": "FiveWs.context" } ] }, { "id": "Communication.encounter", "path": "Communication.encounter", "short": "Encounter created as part of", "definition": "The Encounter during which this Communication was created or to which the creation of this record is tightly associated.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Communication.encounter", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.context" }, { "identity": "w5", "map": "FiveWs.context" } ] }, { "id": "Communication.sent", "path": "Communication.sent", "short": "When the message was sent", "definition": "The time when this communication was sent.", "min": 0, "max": "1", "base": { "path": "Communication.sent", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Event.occurrence[x] {Invariant: maps to period.start}" }, { "identity": "w5", "map": "FiveWs.done[x]" } ] }, { "id": "Communication.received", "path": "Communication.received", "short": "When the message was received", "definition": "The time when this communication arrived at the destination.", "min": 0, "max": "1", "base": { "path": "Communication.received", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Event.occurrence[x] {Invariant: maps to period.end}" }, { "identity": "w5", "map": "FiveWs.done[x]" } ] }, { "id": "Communication.recipient", "path": "Communication.recipient", "short": "Who the message was addressed to", "definition": "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).", "min": 0, "max": "*", "base": { "path": "Communication.recipient", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-relatedperson", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-organization", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-careteam" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Event.performer.actor" }, { "identity": "w5", "map": "FiveWs.actor" } ] }, { "id": "Communication.sender", "path": "Communication.sender", "short": "Who sent the message", "definition": "The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication.", "comment": "Practitioner is the primary provider identity in this IG. Organization covers a partner-system sender on inbound eReferral traffic; Device covers system-generated messages. RelatedPerson covers a SUBSTITUTE DECISION-MAKER acting for the patient -- a distinct fact from the patient acting themselves, and one that must not be flattened onto Patient: where a right over the record is exercised by proxy, the record has to show that authority was delegated, because that is what is checked when the exercise is challenged.", "min": 0, "max": "1", "base": { "path": "Communication.sender", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-relatedperson", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-organization", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-appdevice" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Event.performer.actor" }, { "identity": "w5", "map": "FiveWs.actor" } ] }, { "id": "Communication.reasonCode", "path": "Communication.reasonCode", "short": "Indication for message", "definition": "The reason or justification for the communication.", "comment": "Textual reasons can be captured using reasonCode.text.", "min": 0, "max": "*", "base": { "path": "Communication.reasonCode", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "CommunicationReason" } ], "strength": "example", "description": "Codes for describing reasons for the occurrence of a communication.", "valueSet": "http://hl7.org/fhir/ValueSet/clinical-findings" }, "mapping": [ { "identity": "workflow", "map": "Event.reasonCode" }, { "identity": "w5", "map": "FiveWs.why[x]" }, { "identity": "rim", "map": ".reasonCode" } ] }, { "id": "Communication.reasonReference", "path": "Communication.reasonReference", "short": "Why was communication done?", "definition": "Indicates another resource whose existence justifies this communication.", "min": 0, "max": "*", "base": { "path": "Communication.reasonReference", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Condition", "http://hl7.org/fhir/StructureDefinition/Observation", "http://hl7.org/fhir/StructureDefinition/DiagnosticReport", "http://hl7.org/fhir/StructureDefinition/DocumentReference" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.reasonReference" }, { "identity": "w5", "map": "FiveWs.why[x]" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=RSON].target" } ] }, { "id": "Communication.payload", "path": "Communication.payload", "short": "The message content", "definition": "Text, attachment(s), or resource(s) that was communicated to the recipient.", "comment": "Internal chat writes `contentString`. eReferral traffic may carry `contentAttachment` or `contentReference` -- a reader that assumes contentString will silently render an empty message. Handle all three.", "min": 0, "max": "*", "base": { "path": "Communication.payload", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false }, { "id": "Communication.payload.id", "path": "Communication.payload.id", "representation": [ "xmlAttr" ], "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.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Communication.payload.extension", "path": "Communication.payload.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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Communication.payload.modifierExtension", "path": "Communication.payload.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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.", "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Communication.payload.content[x]", "path": "Communication.payload.content[x]", "short": "Message part content", "definition": "A communicated content (or for multi-part communications, one portion of the communication).", "min": 1, "max": "1", "base": { "path": "Communication.payload.content[x]", "min": 1, "max": "1" }, "type": [ { "code": "string" }, { "code": "Attachment" }, { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false }, { "id": "Communication.note", "path": "Communication.note", "short": "Comments made about the communication", "definition": "Additional notes or commentary about the communication by the sender, receiver or other interested parties.", "min": 0, "max": "*", "base": { "path": "Communication.note", "min": 0, "max": "*" }, "type": [ { "code": "Annotation" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Event.note" } ] } ] }, "differential": { "element": [ { "id": "Communication", "path": "Communication", "short": "Nexus EMR Communication Core", "definition": "A message about a patient. Either WELL-internal staff chat, or eReferral correspondence\nexchanged with an external partner. `category` distinguishes them and readers should scope\non it -- the two populations have different authorities over their content.", "constraint": [ { "key": "nexus-note-extension-not-where-native", "severity": "error", "human": "The resource-note extension is not used on a resource that has a native `note` element -- that element is the home", "expression": "extension('https://fhir.apps.health/StructureDefinition/nexus-emr-resource-note').empty()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-communication" }, { "key": "communication-has-category", "severity": "warning", "human": "SHOULD carry a category identifying which population this Communication belongs to (internal chat vs external eReferral traffic) -- the two are otherwise indistinguishable to a reader", "expression": "category.exists()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-communication" } ] }, { "id": "Communication.meta.source", "path": "Communication.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.", "mustSupport": true }, { "id": "Communication.text", "path": "Communication.text", "short": "Narrative", "definition": "A human-readable narrative summary of the NexusEmrCoreCommunication resource for human interpretation.", "mustSupport": true }, { "id": "Communication.identifier", "path": "Communication.identifier", "short": "Business identifier(s) for the communication", "definition": "Unique identifiers for the communication.\n\nA business identifier is recommended but not required (identifier is 0..*). For eReferral traffic this is where the partner's own message identifier belongs -- it is the only governed way to correlate a reply with what it replies to across the boundary.\n\n⚠ HERITAGE EMR SITUATION -- UNRESOLVED. Heritage EMRs have internal messaging and inbox features, but they are NOT modelled as FHIR Communication: they are local message tables with their own threading, read/unread state, and per-user routing that has no FHIR equivalent. Nothing currently maps them into this resource. Two consequences: (1) a heritage-sourced message has no identifier this IG can name, so any ingest would have to mint one, and (2) migrating that history at all is an open decision -- the alternative is to leave heritage messages in the source system and have this resource cover only natively-authored traffic. Until that is decided, treat every Communication here as either WELL-internal-native or external eReferral, never heritage-migrated.\n\nIf no recognized system exists, implementers MAY invent a URI for the system.\n\nA source system's own identifier SHOULD be carried alongside this one, flagged `use = secondary`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html)." }, { "id": "Communication.identifier.system", "path": "Communication.identifier.system", "min": 1 }, { "id": "Communication.identifier.value", "path": "Communication.identifier.value", "min": 1 }, { "id": "Communication.inResponseTo", "path": "Communication.inResponseTo", "short": "The message this one replies to", "comment": "⚠ FIRST PASS. The chat panel currently threads by neither `inResponseTo` nor `partOf` -- conversation order is reconstructed from timestamps, which is why concurrent messages can interleave wrongly. Declaring the element here is the first step; deciding whether threads are `inResponseTo` chains or a `partOf` grouping is open.", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-communication" ] } ], "mustSupport": true }, { "id": "Communication.status", "path": "Communication.status", "short": "preparation | in-progress | not-done | completed | entered-in-error | ...", "comment": "Internal chat writes `completed` on send. For eReferral traffic the partner's lifecycle applies and `status` is pass-through -- do not infer local workflow state from it.", "mustSupport": true }, { "id": "Communication.category", "path": "Communication.category", "short": "Which population: internal staff chat, or external eReferral correspondence", "definition": "Which population this Communication belongs to. Readers should scope on it -- internal chat and\nexternal eReferral correspondence have different authorities over their content, and a chat surface\nthat does not scope will surface partner correspondence into a panel never designed for it.\n\n⚠ HERITAGE EMR SITUATION -- UNRESOLVED. If heritage-EMR message history is ever migrated (see\n`identifier`), it becomes a THIRD population alongside internal chat and eReferral, and this element\nis where that distinction would have to live. No code for it exists, because the migration decision\nhas not been made. Anyone binding a value set here must resolve that first, or the binding will need\nwidening the moment migration is agreed.", "comment": "⚠ FIRST PASS -- no value set is bound yet, deliberately. Binding one requires deciding the pass-through boundary first (a partner-supplied category must remain conformant), and that decision is not made. Until then this is text-or-code and readers MUST tolerate text-only. A local NexusEmrCommunicationCategoryVS is the intended follow-up.", "mustSupport": true }, { "id": "Communication.subject", "path": "Communication.subject", "short": "The patient the communication is about", "comment": "0..1 per R4. Internal chat about a patient SHOULD carry it -- a chat message with no subject cannot be scoped to a chart, and cannot be filtered out of one either, which is the access-control concern.", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" ] } ], "mustSupport": true }, { "id": "Communication.sent", "path": "Communication.sent", "short": "When the message was sent", "mustSupport": true }, { "id": "Communication.received", "path": "Communication.received", "short": "When the message was received", "mustSupport": true }, { "id": "Communication.recipient", "path": "Communication.recipient", "short": "Who the message was addressed to", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-relatedperson", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-organization", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-careteam" ] } ], "mustSupport": true }, { "id": "Communication.sender", "path": "Communication.sender", "short": "Who sent the message", "comment": "Practitioner is the primary provider identity in this IG. Organization covers a partner-system sender on inbound eReferral traffic; Device covers system-generated messages. RelatedPerson covers a SUBSTITUTE DECISION-MAKER acting for the patient -- a distinct fact from the patient acting themselves, and one that must not be flattened onto Patient: where a right over the record is exercised by proxy, the record has to show that authority was delegated, because that is what is checked when the exercise is challenged.", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-relatedperson", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-organization", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-appdevice" ] } ], "mustSupport": true }, { "id": "Communication.payload", "path": "Communication.payload", "short": "The message content", "comment": "Internal chat writes `contentString`. eReferral traffic may carry `contentAttachment` or `contentReference` -- a reader that assumes contentString will silently render an empty message. Handle all three.", "mustSupport": true } ] } }