Name Flags Card. Type Description & Constraints Communication <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R4conformance-rules.html#constraints" title="This element has or is affected by constraints (medcom-careCommunication-5, medcom-careCommunication-6, medcom-careCommunication-7, medcom-careCommunication-8, medcom-careCommunication-9, medcom-careCommunication-10)">C 0..* Communication A record of information transmitted from a sender to a receiver medcom-careCommunication-5: Priority is only allowed when Communication.category = 'regarding-referral' medcom-careCommunication-6: There shall exist a Communication.topic when Communication.category = 'other' medcom-careCommunication-7: There shall exist a practitioner role when using a PractitionerRole as author in a message segment. medcom-careCommunication-8: There shall exist a practitioner name when using a Practitioner as author in a message segment. medcom-careCommunication-9: When an attachment is included, it shall have an identifier medcom-careCommunication-10: The status shall be 'unknown' or 'entered-in-error'. Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url sender SΣ 0..1 Reference(MedComCorePractitionerRole | MedComCoreCareTeam) {b} SenderExtension URL: http://medcomfhir.dk/ig/carecommunication/StructureDefinition/medcom-carecommunication-sender-extension status S 1..1 code The status may be 'unknown' or 'entered-in-error', dependning on the type of message. status is required because of basic FHIR profile requirement category S 1..1 CodeableConcept The category (Danish: kategori) describes the overall content of the message. Binding: MedComCareCommunicationCategoryCodes (required) priority S 0..1 code Shall be present if the message priority is known to be ASAP, but is only allowed when the category is 'regarding referral', see medcom-careCommunication-5 Binding: MedComCareCommunicationRequestPriorityCodes (required) subject S 1..1 Reference(MedComCorePatient) {b} Focus of message topic S 0..1 CodeableConcept The topic (Danish: emne) may be added as a supplement to the category. encounter S 0..1 Reference(MedComCoreEncounter) {b} Shall contain an encounter with a reference to the episodeOfCare-identifier if reported to the Danish National Patient Registry recipient S 0..* Reference(MedComCorePractitionerRole | MedComCoreCareTeam) {b} Describes a more specific receiver than the MessageHeader.destination.reciever, called a recipient. It may be a careteam a homecare group in the municipality or a named general practitioner. Slices for payload 1..* BackboneElement Each payload corresponds to a message segment with a signature and a message text or attachment. At least one payload with a message text shall be included. Slice: Ordered, Open by type:$this.content payload:All Slices Content/Rules for all slices Slices for extension 3..* Extension Extension Slice: Unordered, Open by value:url date SΣ 1..1 dateTime PayloadDateTimeExtension URL: http://medcomfhir.dk/ig/carecommunication/StructureDefinition/medcom-carecommunication-datetime-extension author SΣ 1..1 Reference(MedComCorePractitionerRole) {b} PayloadAuthorExtension URL: http://medcomfhir.dk/ig/carecommunication/StructureDefinition/medcom-carecommunication-author-extension authorContact SΣ 1..1 ContactPoint PayloadAuthorContactExtension URL: http://medcomfhir.dk/ig/carecommunication/StructureDefinition/medcom-carecommunication-author-contact-extension identifier SΣ 0..1 MedComCareCommunicationAttachmentIdentifier AttachmentIdentifierExtension URL: http://medcomfhir.dk/ig/carecommunication/StructureDefinition/medcom-carecommunication-attachment-identifier-extension payload:string S 1..* BackboneElement xhtml content of the message date SΣ 1..1 dateTime PayloadDateTimeExtension URL: http://medcomfhir.dk/ig/carecommunication/StructureDefinition/medcom-carecommunication-datetime-extension author SΣ 1..1 Reference(MedComCorePractitionerRole) {b} PayloadAuthorExtension URL: http://medcomfhir.dk/ig/carecommunication/StructureDefinition/medcom-carecommunication-author-extension authorContact SΣ 1..1 ContactPoint PayloadAuthorContactExtension URL: http://medcomfhir.dk/ig/carecommunication/StructureDefinition/medcom-carecommunication-author-contact-extension content[x] S 1..1 string Message part content payload:attachment S 0..* BackboneElement The payload with an attachment shall contain all links or content attached to the message. date SΣ 1..1 dateTime PayloadDateTimeExtension URL: http://medcomfhir.dk/ig/carecommunication/StructureDefinition/medcom-carecommunication-datetime-extension author SΣ 1..1 Reference(MedComCorePractitionerRole) {b} PayloadAuthorExtension URL: http://medcomfhir.dk/ig/carecommunication/StructureDefinition/medcom-carecommunication-author-extension authorContact SΣ 1..1 ContactPoint PayloadAuthorContactExtension URL: http://medcomfhir.dk/ig/carecommunication/StructureDefinition/medcom-carecommunication-author-contact-extension content[x] S 1..1 Attachment Message part content Slice: Unordered, Open by type:$this contentAttachment S 1..1 Attachment Message part content contentType S 0..1 code The content type shall be present in case the content is provided as an attached document (data) or links to a document. Binding: MedComCoreAttachmentMimeTypes (required) data S 0..1 base64Binary Shall be present and contain the base64 encoded content if the attachment is an attached document url S 0..1 url Shall be present if the attachment is a link to a document or a web page title S 1..1 string Label to display in place of the data creation S 1..1 dateTime The time the attachment was created Documentation for this format
Care related communication between two or more parties in Danish healthcare
A record of information transmitted from a sender to a receiver
An occurrence of information being transmitted; e.g. an alert that was sent to a responsible provider, a public health agency that was notified about a reportable condition.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Priority is only allowed when Communication.category = 'regarding-referral'
where(category.coding.code != 'regarding-referral').priority.empty()
There shall exist a Communication.topic when Communication.category = 'other'
iif(category.coding.code != 'other', true, category.coding.code = 'other' and topic.exists())
There shall exist a practitioner role when using a PractitionerRole as author in a message segment.
There shall exist a practitioner name when using a Practitioner as author in a message segment.
When an attachment is included, it shall have an identifier
payload.where(content.data.exists()).extension('http://medcomfhir.dk/ig/carecommunication/StructureDefinition/medcom-carecommunication-attachment-identifier-extension').exists() or payload.content.data.exists().not()
The status shall be 'unknown' or 'entered-in-error'.
status='unknown' or status='entered-in-error'
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Reference to a more specfic sender of a CareCommunication message.
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Business identifiers assigned to this communication by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
This is a business identifier, not a resource identifier (see [discussion](http://hl7.org/fhir/R4/resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
Allows identification of the communication as it is known by various participating systems and in a way that remains consistent across servers.
Instantiates FHIR protocol or definition
The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication.
Instantiates external protocol or definition
The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication.
This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
An order, proposal or plan fulfilled in whole or in part by this Communication.
This must point to some sort of a 'Request' resource, such as CarePlan, CommunicationRequest, ServiceRequest, MedicationRequest, etc.
Prior communication that this communication is in response to.
The status may be 'unknown' or 'entered-in-error', dependning on the type of message. status is required because of basic FHIR profile requirement
This element is labeled as a modifier because the status contains the codes aborted and entered-in-error that mark the communication as not currently valid.
This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Captures the reason for the current state of the Communication.
This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.
Codes for the reason why a communication did not happen.
The category (Danish: kategori) describes the overall content of the message.
The type of message conveyed such as alert, notification, reminder, instruction, etc.
There may be multiple axes of categorization and one communication may serve multiple purposes.
Shall be present if the message priority is known to be ASAP, but is only allowed when the category is 'regarding referral', see medcom-careCommunication-5
Characterizes how quickly the planned or in progress communication must be addressed. Includes concepts such as stat, urgent, routine.
Used to prioritize workflow (such as which communication to read first) when the communication is planned or in progress.
If missing, this communication should be treated with normal priority
A channel that was used for this communication (e.g. email, fax).
Codes for communication mediums such as phone, fax, email, in person, etc.
The patient or group that was the focus of this communication.
The topic (Danish: emne) may be added as a supplement to the category.
Description of the purpose/content, similar to a subject line in an email.
Communication.topic.text can be used without any codings.
Codes describing the purpose or content of the communication.
Resources that pertain to this communication
Other resources that pertain to this communication and to which this communication should be associated.
Don't use Communication.about element when a more specific element exists, such as basedOn or reasonReference.
Shall contain an encounter with a reference to the episodeOfCare-identifier if reported to the Danish National Patient Registry
The Encounter during which this Communication was created or to which the creation of this record is tightly associated.
This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.
The time when this communication was sent.
Event.occurrence[x] {Invariant: maps to period.start}
The time when this communication arrived at the destination.
Event.occurrence[x] {Invariant: maps to period.end}
Describes a more specific receiver than the MessageHeader.destination.reciever, called a recipient. It may be a careteam a homecare group in the municipality or a named general practitioner.
The entity (e.g. person, organization, clinical information system, care team or device) which was the target of the communication. If receipts need to be tracked by an individual, a separate resource instance will need to be created for each recipient. Multiple recipient communications are intended where either receipts are not tracked (e.g. a mass mail-out) or a receipt is captured in aggregate (all emails confirmed received by a particular time).
The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication.
The reason or justification for the communication.
Textual reasons can be captured using reasonCode.text.
Codes for describing reasons for the occurrence of a communication.
Indicates another resource whose existence justifies this communication.
Each payload corresponds to a message segment with a signature and a message text or attachment. At least one payload with a message text shall be included.
Text, attachment(s), or resource(s) that was communicated to the recipient.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extension to contain the contact information tha author of the payload
An extension holding an attachment identifier
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
A communicated content (or for multi-part communications, one portion of the communication).
xhtml shall be used to markup a text. The xhtml shall be compliant with the narrative text format.
The payload with an attachment shall contain all links or content attached to the message.
Extensions are always sliced by (at least) url
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
The content type shall be present in case the content is provided as an attached document (data) or links to a document.
Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.
Processors of the data need to be able to know how to interpret the data.
ED.2+ED.3/RP.2+RP.3. Note conversion may be needed if old style values are being used
The human language of the content. The value can be any valid value according to BCP 47.
Users need to be able to choose between the languages in a set of attachments.
Shall be present and contain the base64 encoded content if the attachment is an attached document
The actual data of the attachment - a sequence of bytes, base64 encoded.
The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.
The data needs to able to be transmitted inline.
Shall be present if the attachment is a link to a document or a web page
A location where the data can be accessed.
If both data and url are provided, the url SHALL point to the same content as the data contains. Urls may be relative references or may reference transient locations such as a wrapping envelope using cid: though this has ramifications for using signatures. Relative URLs are interpreted relative to the service url, like a resource reference, rather than relative to the resource itself. If a URL is provided, it SHALL resolve to actual data.
The data needs to be transmitted by reference.
RP.1+RP.2 - if they refer to a URL (see v2.6)
Number of bytes of content (if url provided)
The number of bytes of data that make up this attachment (before base64 encoding, if that is done).
The number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a url reference.
Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.
The calculated hash of the data using SHA-1. Represented using base64.
The hash is calculated on the data prior to base64 encoding, if the data is based64 encoded. The hash is not intended to support digital signatures. Where protection against malicious threats a digital signature should be considered, see [Provenance.signature](http://hl7.org/fhir/R4/provenance-definitions.html#Provenance.signature) for mechanism to protect a resource with a digital signature.
Included so that applications can verify that the contents of a location have not changed due to technical failures (e.g., storage rot, transport glitch, incorrect version).
A label or set of text to display in place of the data.
Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.
The date that the attachment was first created.
This is often tracked as an integrity issue for use of the attachment.
Additional notes or commentary about the communication by the sender, receiver or other interested parties.