Validation Results for MedComDocument

Release Notes – Document IG

This release introduces substantial changes across a large number of MedCom Core profiles It includes adjustments and changes to better align the implementation guide with the parameters used in MedCom XDS metadata. The updates include among others revised cardinalities, adjusted Must Support (MS) requirements, added narrative obligations, and the restructuring of selected elements.

Note that changes inherited from IGs, that this IG has depenencies to, is not rewritten here.

The index page is updated with updated links to documentation and relevant governance. The diagram is also updated.

A tab is added in the menu bar that provides guidance for stakeholders who are exploring the idea of sharing files or other base64-encoded content as part of a MedCom FHIR standard.

The detailed, profile-specific changes are listed below.

Updated Dependencies

This implementation guide now depends on newer versions of the following packages:

• medcom.fhir.dk.terminology
• medcom.fhir.dk.core
• hl7.fhir.dk.core

In addition, this release introduces new dependencies:

• hl7.fhir.extensions.r5
• ihe.iti.mhd

Resource Identifiers in MedCom FHIR Documents

All resources included in a MedCom FHIR document MUST now carry an identifier element consisting of both a system and a value.

resource.id, resource.text and narrative obligations

All resources now has cardinality 1..1 and MS for the id element, as it must be used in the narrative. The text element is profiled more detailed to better describe the requirements for narrative content. All profiles except the MedComDocumentBundle is now profiled with narrative obligations.

MedComDocumentReference → MedComContainedDocumentReference

In this release, the profile MedComDocumentReference has been replaced by MedComContainedDocumentReference.

The new profile is intended for use in document-based exchanges and reflects a revised modelling approach aligned with MedCom XDS metadata and FHIR Document usage.

Key Changes

• Profile replacement
  MedComDocumentReference has been deprecated and replaced by MedComContainedDocumentReference.

• Changed inheritance
  MedComContainedDocumentReference now derives from DK Core DocumentReference, which is itself aligned with the ihe.iti.mhd profiling.
  This introduces closer alignment with XDS/MHD-based document exchange patterns.

• Contained usage
  The new profile is designed to be used as a contained resource within a document bundle, rather than as a standalone DocumentReference.

• Alignment with XDS metadata
  Elements, constraints, and narrative expectations have been adjusted to better match the metadata parameters used in MedCom XDS-based document workflows.

  Several element constraints, Must Support requirements, and narrative obligations differ from the previous profile to support document-centric usage and reduce unnecessary restrictions.

MedComDocumentBundle

• Invariant medcom-document-bundle-id-uuid added to id.
• Invariant medcom-datetime-has-time-offset-zulu added to timestamp.

MedComDocumentComposition

• date has MS added.
• medcom-uuid invariant is corrected.
• underlying type elements are profiled into further details.
• category is now profiled.
• event.period and event.period.start is changed to 1..1 MS.
• the author element is reprofiled to represent author institution and author person differently.
• meta.profile now includes an explicit version |x.y.z.

MedComDocumentPatient

• • identifier[x-ecpr] and identifier[d-ecpr] is changed to 0..0.

New profiles

The following profiles are added:

• MedComDocumentCareTeam, MedComDocumentObservation, MedComDocumentPractitionerRole,

Temporary representations of code systems and valuesets from the MedCom XDS Metadata IG

Due to inconsistencies between MedCom’s XDS Metadata Standard and FHIR representations of code systems and value sets, selected code systems and value sets from the MedCom XDS Metadata Standard IG are temporarily included in this Implementation Guide with necessary adaptations. They will be removed from this IG once these issues are resolved in version 2.0 of the MedCom XDS Metadata Standard.