MedCom EKG Recording Conposition

This page describes how the MedCom Ekg Recording Composition profile is used within the MedCom EKG Recording standard.

The MedComDocumentComposition profile defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type is 'document', and any other resources referenced from Composition must be included as subsequent entries in the Bundle.entry element.

Purpose of the Profile

This resource links the various resources used for sharing EKG recordings. The specific resources are:

• Observation (MedComDocumentObservation)​
• Patient (MedComDocumentPatient)​
• Organization (MedComDocumentOrganization)​
• PractitionerRole (MedComDocumentPractitionerRole) and/or Practitioner (MedComDocumentPractitioner) (both optional)

The section.entry element MUST reference the MedComDocumentObservation that contains the EKG PDF-A attachment.

It is required to use the profiles MedComDocumentObservation (representing the EKG PDF-A file and an optional note), MedComDocumentPatient (the patient of the EKG recording) and MedComDocumentOrganization (the author organization of the EKG recording), whereas it is optional to include a MedComDocumentPractitionerRole and/or MedComDocumentPractitioner (representing the author person).

Profile identification and versioning (meta.profile)

The meta.profile element identifies the applied FHIR Composition profile, including the major and minor version of the MedCom document standard. Systems SHALL be able to receive and process documents where the minor version differs in this element, as long as the major version remains unchanged.

Mapping between XDS formatCode and FHIR Composition profile

The XDS formatCode urn:ad:dk:medcom:ekg-v[major].[minor]:full
maps to the FHIR Composition.meta.profile http://medcomfhir.dk/ig/ekg/StructureDefinition/medcom-ekg-recording-composition|[major].[minor].

The [major].[minor] version components are versioned in lockstep. Any change to either the major or minor version SHALL be reflected in both to maintain semantic alignment between the MedCom XDS Metadata and the FHIR representation.

Example (v1.0):

• XDS formatCode:
  urn:ad:dk:medcom:ekg-v1.0:full

• FHIR Composition.meta.profile:
  http://medcomfhir.dk/ig/ekg/StructureDefinition/medcom-ekg-recording-composition|1.0

Timestamps

Composition.event.period.start and Composition.event.period.end is used to represent the time interval of the EKG recording.

If Observation.effectivePeriod.start is known, this MUST be inserted as Composition.event.period.start.

If Observation.effectivePeriod.start is NOT known, Observation.effectiveDateTime MUST be inserted as Composition.event.period.start instead.

If Observation.effectivePeriod.end is known, this MUST be inserted as Composition.event.period.end. If this is NOT known, this can be left empty, as it is optional.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition		0..*	MedComDocumentComposition	A set of resources composed into a single coherent clinical statement with clinical attestation
id	SOΣ	1..1	id	Logical id of this artifact
meta	SΣ	1..1	Meta	Metadata about the resource
profile	SOΣC	1..1	canonical(StructureDefinition)	[DocumentEntry.formatCode] The profile canonical SHALL include the major and minor version of the standard in the form `|x.y`. Constraints: medcom-canonical-semver, medcom-canonical-fixed-major
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	SO	1..1	code	[DocumentEntry.languageCode] Human language of the content Binding: IHE LanguageCode_TEMP (extensible) Fixed Value: da
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle. This profile does not constrain the narrative in regard to content, language, or traceability to data elements
status	S	1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	SC	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	The Composition identifier
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	[DocumentEntry.uniqueId] Sender organization OID (Object Identifier). Example: 1.2.208.184 (MedCom OID). Example General: http://www.acme.com/identifiers/patient
value	SΣC	1..1	string	[DocumentEntry.uniqueId] UUID. Constraints: medcom-uuid Example General: 123456
status	?!SOΣ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition. Required Pattern: final
type	SΣ	1..1	CodeableConcept	[DocumentEntry.typeCode] Kind of document Binding: IHE TypeCode_TEMP (required)
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SOΣ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	SOΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: 11524-6
display	SOΣ	1..1	string	Representation defined by the system Fixed Value: EKG study
category	SΣ	1..1	CodeableConcept	[DocumentEntry.classCode] Categorization of document Binding: IHE ClassCode_TEMP (extensible)
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SOΣ	1..1	uri	Identity of the terminology system Required Pattern: http://medcomfhir.dk/ig/xdsmetadata/CodeSystem/MedCom-ihe-classcode-CS
code	SOΣ	1..1	code	Symbol in syntax defined by the system Required Pattern: 001
display	SOΣ	1..1	string	Representation defined by the system Required Pattern: Klinisk rapport
subject	SOΣ	1..1	Reference(MedComDocumentPatient) {b}	Who and/or what the composition is about
date	SOΣ	1..1	dateTime	The clinical date and time when the clinical report represented by this Composition was finalized, typically equal to the event.period.end of the recorded EKG. If event.period.end is not available, use event.period.start or Observation.effectiveDateTime.
Slices for author	SOΣ	1..2	Reference(MedComDocumentOrganization | MedComDocumentPractitioner | MedComDocumentPractitionerRole) {b}	[DocumentEntry.author] The slice author:institution ensures one mandatory organizational author. Any author element that does not match this slice is interpreted as an author person. Slice: Unordered, Open by profile:$this.resolve()
author:institution	SOΣ	1..1	Reference(MedComDocumentOrganization) {b}	The organization who authored the document.
title	SOΣ	1..1	string	Title MUST be 'Elektrokardiogram-12-aflednings' Fixed Value: Elektrokardiogram-12-aflednings
confidentiality	SOΣ	1..1	code	As defined by affinity domain Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition. Fixed Value: N
attester	S	0..1	BackboneElement	Attests to accuracy of composition
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode	SO	1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
party	SO	0..1	Reference(MedComDocumentPractitioner) {b}	[DocumentEntry.legalAuthenticator] Who authenticated the document.
event	SΣ	1..1	BackboneElement	The clinical service(s) being documented
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SOΣ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	1..1	Period	[DocumentEntry.serviceStartTime, DocumentEntry.serviceStopTime] Time of service that is being documented.
start	SOΣC	1..1	dateTime	The end time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu
end	SOΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: medcom-datetime-has-time-offset-zulu
detail	SOΣ	0..*	Reference(Resource)	[DocumentEntry.referenceIdList] Related identifiers or resources
section	SC	1..*	BackboneElement	Composition is broken into sections Constraints: cmp-1, cmp-2
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
entry	SOC	1..*	Reference(MedComEkgRecordingObservation)	A reference to data that supports this section
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.language	extensible	Fixed Value: da http://medcomfhir.dk/ig/document/ValueSet/MedCom-ihe-core-languagecode-VS-TEMP
Composition.text.status	required	NarrativeStatus http://hl7.org/fhir/ValueSet/narrative-status|4.0.1 From the FHIR Standard
Composition.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Composition.status	required	Pattern Value: final http://hl7.org/fhir/ValueSet/composition-status|4.0.1 From the FHIR Standard
Composition.type	required	MedComIHE_CoreTypeCode_TEMP http://medcomfhir.dk/ig/document/ValueSet/MedCom-ihe-core-typecode-VS-TEMP
Composition.category	extensible	MedComIHE_CoreClassCode_TEMP http://medcomfhir.dk/ig/document/ValueSet/MedCom-ihe-core-classcode-VS-TEMP
Composition.confidentiality	required	Fixed Value: N http://terminology.hl7.org/ValueSet/v3-ConfidentialityClassification|2014-03-26 From the FHIR Standard
Composition.attester.mode	required	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 From the FHIR Standard
Composition.event.code	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-1	error	Composition.section	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	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()
dom-4	error	Composition	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()
dom-5	error	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
medcom-canonical-fixed-major	error	Composition.meta.profile	If a version is present in the canonical, MAJOR SHALL be a fixed value. : matches('^.*[|]1[.].*$')
medcom-canonical-semver	error	Composition.meta.profile	The canonical SHALL include an explicit semantic version (semver) with optional prerelease (-...) and build metadata (+...). : matches('^.*[|][0-9]+[.][0-9]+([.][0-9]+)?(-[0-9A-Za-z-]+([.][0-9A-Za-z-]+)*)?([+][0-9A-Za-z-]+([.][0-9A-Za-z-]+)*)?$')
medcom-datetime-has-time-offset-zulu	error	Composition.event.period.start, Composition.event.period.end	dateTime must include date, time, and time zone. : $this.toString().matches('^[0-9]{4}-(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])T([01][0-9]|2[0-3]):[0-5][0-9]:[0-5][0-9]([.][0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
medcom-uuid	error	Composition.identifier.value	The value shall correspond to the structure of an UUID : $this.matches('(?i)^urn:uuid:[0-9a-f]{8}-[0-9a-f]{4}-[45][0-9a-f]{3}-[89ab][0-9a-f]{3}-[0-9a-f]{12}$')
txt-1	error	Composition.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes : htmlChecks()
txt-2	error	Composition.text.div	The narrative SHALL have some non-whitespace content : htmlChecks()

This structure is derived from MedComDocumentComposition

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition			MedComDocumentComposition
meta
profile	C	1..1	canonical(StructureDefinition)	[DocumentEntry.formatCode] The profile canonical SHALL include the major and minor version of the standard in the form `|x.y`. Constraints: medcom-canonical-fixed-major
language		1..1	code	[DocumentEntry.languageCode] Human language of the content Fixed Value: da
type
coding
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 11524-6
display		1..1	string	Representation defined by the system Fixed Value: EKG study
category		1..1	CodeableConcept	[DocumentEntry.classCode] Categorization of document
coding
system		1..1	uri	Identity of the terminology system Required Pattern: http://medcomfhir.dk/ig/xdsmetadata/CodeSystem/MedCom-ihe-classcode-CS
code		1..1	code	Symbol in syntax defined by the system Required Pattern: 001
display		1..1	string	Representation defined by the system Required Pattern: Klinisk rapport
date		1..1	dateTime	The clinical date and time when the clinical report represented by this Composition was finalized, typically equal to the event.period.end of the recorded EKG. If event.period.end is not available, use event.period.start or Observation.effectiveDateTime.
author		1..2	Reference(MedComDocumentOrganization | MedComDocumentPractitioner | MedComDocumentPractitionerRole) {b}	[DocumentEntry.author] The slice author:institution ensures one mandatory organizational author. Any author element that does not match this slice is interpreted as an author person.
Slices for author				Content/Rules for all slices
author:institution		1..1	Reference(MedComDocumentOrganization) {b}	The organization who authored the document.
title		1..1	string	Title MUST be 'Elektrokardiogram-12-aflednings' Fixed Value: Elektrokardiogram-12-aflednings
confidentiality		1..1	code	As defined by affinity domain Fixed Value: N
event
period
start	C	1..1	dateTime	The end time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu
end	C	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: medcom-datetime-has-time-offset-zulu
section
entry		1..*	Reference(MedComEkgRecordingObservation)	A reference to data that supports this section
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
medcom-canonical-fixed-major	error	Composition.meta.profile	If a version is present in the canonical, MAJOR SHALL be a fixed value. : matches('^.*[|]1[.].*$')
medcom-datetime-has-time-offset-zulu	error	Composition.event.period.start, Composition.event.period.end	dateTime must include date, time, and time zone. : $this.toString().matches('^[0-9]{4}-(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])T([01][0-9]|2[0-3]):[0-5][0-9]:[0-5][0-9]([.][0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition		0..*	MedComDocumentComposition	A set of resources composed into a single coherent clinical statement with clinical attestation
id	SOΣ	1..1	id	Logical id of this artifact
meta	SΣ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	SOΣC	1..1	canonical(StructureDefinition)	[DocumentEntry.formatCode] The profile canonical SHALL include the major and minor version of the standard in the form `|x.y`. Constraints: medcom-canonical-semver, medcom-canonical-fixed-major
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	SO	1..1	code	[DocumentEntry.languageCode] Human language of the content Binding: IHE LanguageCode_TEMP (extensible) Fixed Value: da
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle. This profile does not constrain the narrative in regard to content, language, or traceability to data elements
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
status	S	1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	SC	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	The Composition identifier
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	[DocumentEntry.uniqueId] Sender organization OID (Object Identifier). Example: 1.2.208.184 (MedCom OID). Example General: http://www.acme.com/identifiers/patient
value	SΣC	1..1	string	[DocumentEntry.uniqueId] UUID. Constraints: medcom-uuid Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SOΣ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition. Required Pattern: final
type	SΣ	1..1	CodeableConcept	[DocumentEntry.typeCode] Kind of document Binding: IHE TypeCode_TEMP (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SOΣ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	SOΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: 11524-6
display	SOΣ	1..1	string	Representation defined by the system Fixed Value: EKG study
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
category	SΣ	1..1	CodeableConcept	[DocumentEntry.classCode] Categorization of document Binding: IHE ClassCode_TEMP (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SOΣ	1..1	uri	Identity of the terminology system Required Pattern: http://medcomfhir.dk/ig/xdsmetadata/CodeSystem/MedCom-ihe-classcode-CS
version	Σ	0..1	string	Version of the system - if relevant
code	SOΣ	1..1	code	Symbol in syntax defined by the system Required Pattern: 001
display	SOΣ	1..1	string	Representation defined by the system Required Pattern: Klinisk rapport
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SOΣ	1..1	Reference(MedComDocumentPatient) {b}	Who and/or what the composition is about
encounter	Σ	0..1	Reference(Encounter)	Context of the Composition
date	SOΣ	1..1	dateTime	The clinical date and time when the clinical report represented by this Composition was finalized, typically equal to the event.period.end of the recorded EKG. If event.period.end is not available, use event.period.start or Observation.effectiveDateTime.
Slices for author	SOΣ	1..2	Reference(MedComDocumentOrganization | MedComDocumentPractitioner | MedComDocumentPractitionerRole) {b}	[DocumentEntry.author] The slice author:institution ensures one mandatory organizational author. Any author element that does not match this slice is interpreted as an author person. Slice: Unordered, Open by profile:$this.resolve()
author:institution	SOΣ	1..1	Reference(MedComDocumentOrganization) {b}	The organization who authored the document.
title	SOΣ	1..1	string	Title MUST be 'Elektrokardiogram-12-aflednings' Fixed Value: Elektrokardiogram-12-aflednings
confidentiality	SOΣ	1..1	code	As defined by affinity domain Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition. Fixed Value: N
attester	S	0..1	BackboneElement	Attests to accuracy of composition
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode	SO	1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time		0..1	dateTime	When the composition was attested
party	SO	0..1	Reference(MedComDocumentPractitioner) {b}	[DocumentEntry.legalAuthenticator] Who authenticated the document.
custodian	Σ	0..1	Reference(Organization)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	SΣ	1..1	BackboneElement	The clinical service(s) being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SOΣ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	1..1	Period	[DocumentEntry.serviceStartTime, DocumentEntry.serviceStopTime] Time of service that is being documented.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SOΣC	1..1	dateTime	The end time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu
end	SOΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: medcom-datetime-has-time-offset-zulu
detail	SOΣ	0..*	Reference(Resource)	[DocumentEntry.referenceIdList] Related identifiers or resources
section	SC	1..*	BackboneElement	Composition is broken into sections Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	SOC	1..*	Reference(MedComEkgRecordingObservation)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels|4.0.1 From the FHIR Standard
Composition.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags|4.0.1 From the FHIR Standard
Composition.language	extensible	Fixed Value: da http://medcomfhir.dk/ig/document/ValueSet/MedCom-ihe-core-languagecode-VS-TEMP
Composition.text.status	required	NarrativeStatus http://hl7.org/fhir/ValueSet/narrative-status|4.0.1 From the FHIR Standard
Composition.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Composition.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type|4.0.1 From the FHIR Standard
Composition.status	required	Pattern Value: final http://hl7.org/fhir/ValueSet/composition-status|4.0.1 From the FHIR Standard
Composition.type	required	MedComIHE_CoreTypeCode_TEMP http://medcomfhir.dk/ig/document/ValueSet/MedCom-ihe-core-typecode-VS-TEMP
Composition.category	extensible	MedComIHE_CoreClassCode_TEMP http://medcomfhir.dk/ig/document/ValueSet/MedCom-ihe-core-classcode-VS-TEMP
Composition.confidentiality	required	Fixed Value: N http://terminology.hl7.org/ValueSet/v3-ConfidentialityClassification|2014-03-26 From the FHIR Standard
Composition.attester.mode	required	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 From the FHIR Standard
Composition.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
Composition.event.code	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
Composition.section.code	example	DocumentSectionCodes http://hl7.org/fhir/ValueSet/doc-section-codes|4.0.1 From the FHIR Standard
Composition.section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order|4.0.1 From the FHIR Standard
Composition.section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-1	error	Composition.section	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	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()
dom-4	error	Composition	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()
dom-5	error	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
medcom-canonical-fixed-major	error	Composition.meta.profile	If a version is present in the canonical, MAJOR SHALL be a fixed value. : matches('^.*[|]1[.].*$')
medcom-canonical-semver	error	Composition.meta.profile	The canonical SHALL include an explicit semantic version (semver) with optional prerelease (-...) and build metadata (+...). : matches('^.*[|][0-9]+[.][0-9]+([.][0-9]+)?(-[0-9A-Za-z-]+([.][0-9A-Za-z-]+)*)?([+][0-9A-Za-z-]+([.][0-9A-Za-z-]+)*)?$')
medcom-datetime-has-time-offset-zulu	error	Composition.event.period.start, Composition.event.period.end	dateTime must include date, time, and time zone. : $this.toString().matches('^[0-9]{4}-(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])T([01][0-9]|2[0-3]):[0-5][0-9]:[0-5][0-9]([.][0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
medcom-uuid	error	Composition.identifier.value	The value shall correspond to the structure of an UUID : $this.matches('(?i)^urn:uuid:[0-9a-f]{8}-[0-9a-f]{4}-[45][0-9a-f]{3}-[89ab][0-9a-f]{3}-[0-9a-f]{12}$')
txt-1	error	Composition.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes : htmlChecks()
txt-2	error	Composition.text.div	The narrative SHALL have some non-whitespace content : htmlChecks()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition		0..*	MedComDocumentComposition	A set of resources composed into a single coherent clinical statement with clinical attestation
id	SOΣ	1..1	id	Logical id of this artifact
meta	SΣ	1..1	Meta	Metadata about the resource
profile	SOΣC	1..1	canonical(StructureDefinition)	[DocumentEntry.formatCode] The profile canonical SHALL include the major and minor version of the standard in the form `|x.y`. Constraints: medcom-canonical-semver, medcom-canonical-fixed-major
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	SO	1..1	code	[DocumentEntry.languageCode] Human language of the content Binding: IHE LanguageCode_TEMP (extensible) Fixed Value: da
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle. This profile does not constrain the narrative in regard to content, language, or traceability to data elements
status	S	1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	SC	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	The Composition identifier
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	[DocumentEntry.uniqueId] Sender organization OID (Object Identifier). Example: 1.2.208.184 (MedCom OID). Example General: http://www.acme.com/identifiers/patient
value	SΣC	1..1	string	[DocumentEntry.uniqueId] UUID. Constraints: medcom-uuid Example General: 123456
status	?!SOΣ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition. Required Pattern: final
type	SΣ	1..1	CodeableConcept	[DocumentEntry.typeCode] Kind of document Binding: IHE TypeCode_TEMP (required)
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SOΣ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	SOΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: 11524-6
display	SOΣ	1..1	string	Representation defined by the system Fixed Value: EKG study
category	SΣ	1..1	CodeableConcept	[DocumentEntry.classCode] Categorization of document Binding: IHE ClassCode_TEMP (extensible)
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SOΣ	1..1	uri	Identity of the terminology system Required Pattern: http://medcomfhir.dk/ig/xdsmetadata/CodeSystem/MedCom-ihe-classcode-CS
code	SOΣ	1..1	code	Symbol in syntax defined by the system Required Pattern: 001
display	SOΣ	1..1	string	Representation defined by the system Required Pattern: Klinisk rapport
subject	SOΣ	1..1	Reference(MedComDocumentPatient) {b}	Who and/or what the composition is about
date	SOΣ	1..1	dateTime	The clinical date and time when the clinical report represented by this Composition was finalized, typically equal to the event.period.end of the recorded EKG. If event.period.end is not available, use event.period.start or Observation.effectiveDateTime.
Slices for author	SOΣ	1..2	Reference(MedComDocumentOrganization | MedComDocumentPractitioner | MedComDocumentPractitionerRole) {b}	[DocumentEntry.author] The slice author:institution ensures one mandatory organizational author. Any author element that does not match this slice is interpreted as an author person. Slice: Unordered, Open by profile:$this.resolve()
author:institution	SOΣ	1..1	Reference(MedComDocumentOrganization) {b}	The organization who authored the document.
title	SOΣ	1..1	string	Title MUST be 'Elektrokardiogram-12-aflednings' Fixed Value: Elektrokardiogram-12-aflednings
confidentiality	SOΣ	1..1	code	As defined by affinity domain Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition. Fixed Value: N
attester	S	0..1	BackboneElement	Attests to accuracy of composition
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode	SO	1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
party	SO	0..1	Reference(MedComDocumentPractitioner) {b}	[DocumentEntry.legalAuthenticator] Who authenticated the document.
event	SΣ	1..1	BackboneElement	The clinical service(s) being documented
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SOΣ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	1..1	Period	[DocumentEntry.serviceStartTime, DocumentEntry.serviceStopTime] Time of service that is being documented.
start	SOΣC	1..1	dateTime	The end time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu
end	SOΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: medcom-datetime-has-time-offset-zulu
detail	SOΣ	0..*	Reference(Resource)	[DocumentEntry.referenceIdList] Related identifiers or resources
section	SC	1..*	BackboneElement	Composition is broken into sections Constraints: cmp-1, cmp-2
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
entry	SOC	1..*	Reference(MedComEkgRecordingObservation)	A reference to data that supports this section
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.language	extensible	Fixed Value: da http://medcomfhir.dk/ig/document/ValueSet/MedCom-ihe-core-languagecode-VS-TEMP
Composition.text.status	required	NarrativeStatus http://hl7.org/fhir/ValueSet/narrative-status|4.0.1 From the FHIR Standard
Composition.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Composition.status	required	Pattern Value: final http://hl7.org/fhir/ValueSet/composition-status|4.0.1 From the FHIR Standard
Composition.type	required	MedComIHE_CoreTypeCode_TEMP http://medcomfhir.dk/ig/document/ValueSet/MedCom-ihe-core-typecode-VS-TEMP
Composition.category	extensible	MedComIHE_CoreClassCode_TEMP http://medcomfhir.dk/ig/document/ValueSet/MedCom-ihe-core-classcode-VS-TEMP
Composition.confidentiality	required	Fixed Value: N http://terminology.hl7.org/ValueSet/v3-ConfidentialityClassification|2014-03-26 From the FHIR Standard
Composition.attester.mode	required	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 From the FHIR Standard
Composition.event.code	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-1	error	Composition.section	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	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()
dom-4	error	Composition	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()
dom-5	error	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
medcom-canonical-fixed-major	error	Composition.meta.profile	If a version is present in the canonical, MAJOR SHALL be a fixed value. : matches('^.*[|]1[.].*$')
medcom-canonical-semver	error	Composition.meta.profile	The canonical SHALL include an explicit semantic version (semver) with optional prerelease (-...) and build metadata (+...). : matches('^.*[|][0-9]+[.][0-9]+([.][0-9]+)?(-[0-9A-Za-z-]+([.][0-9A-Za-z-]+)*)?([+][0-9A-Za-z-]+([.][0-9A-Za-z-]+)*)?$')
medcom-datetime-has-time-offset-zulu	error	Composition.event.period.start, Composition.event.period.end	dateTime must include date, time, and time zone. : $this.toString().matches('^[0-9]{4}-(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])T([01][0-9]|2[0-3]):[0-5][0-9]:[0-5][0-9]([.][0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
medcom-uuid	error	Composition.identifier.value	The value shall correspond to the structure of an UUID : $this.matches('(?i)^urn:uuid:[0-9a-f]{8}-[0-9a-f]{4}-[45][0-9a-f]{3}-[89ab][0-9a-f]{3}-[0-9a-f]{12}$')
txt-1	error	Composition.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes : htmlChecks()
txt-2	error	Composition.text.div	The narrative SHALL have some non-whitespace content : htmlChecks()

Differential View

This structure is derived from MedComDocumentComposition

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition			MedComDocumentComposition
meta
profile	C	1..1	canonical(StructureDefinition)	[DocumentEntry.formatCode] The profile canonical SHALL include the major and minor version of the standard in the form `|x.y`. Constraints: medcom-canonical-fixed-major
language		1..1	code	[DocumentEntry.languageCode] Human language of the content Fixed Value: da
type
coding
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 11524-6
display		1..1	string	Representation defined by the system Fixed Value: EKG study
category		1..1	CodeableConcept	[DocumentEntry.classCode] Categorization of document
coding
system		1..1	uri	Identity of the terminology system Required Pattern: http://medcomfhir.dk/ig/xdsmetadata/CodeSystem/MedCom-ihe-classcode-CS
code		1..1	code	Symbol in syntax defined by the system Required Pattern: 001
display		1..1	string	Representation defined by the system Required Pattern: Klinisk rapport
date		1..1	dateTime	The clinical date and time when the clinical report represented by this Composition was finalized, typically equal to the event.period.end of the recorded EKG. If event.period.end is not available, use event.period.start or Observation.effectiveDateTime.
author		1..2	Reference(MedComDocumentOrganization | MedComDocumentPractitioner | MedComDocumentPractitionerRole) {b}	[DocumentEntry.author] The slice author:institution ensures one mandatory organizational author. Any author element that does not match this slice is interpreted as an author person.
Slices for author				Content/Rules for all slices
author:institution		1..1	Reference(MedComDocumentOrganization) {b}	The organization who authored the document.
title		1..1	string	Title MUST be 'Elektrokardiogram-12-aflednings' Fixed Value: Elektrokardiogram-12-aflednings
confidentiality		1..1	code	As defined by affinity domain Fixed Value: N
event
period
start	C	1..1	dateTime	The end time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu
end	C	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: medcom-datetime-has-time-offset-zulu
section
entry		1..*	Reference(MedComEkgRecordingObservation)	A reference to data that supports this section
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
medcom-canonical-fixed-major	error	Composition.meta.profile	If a version is present in the canonical, MAJOR SHALL be a fixed value. : matches('^.*[|]1[.].*$')
medcom-datetime-has-time-offset-zulu	error	Composition.event.period.start, Composition.event.period.end	dateTime must include date, time, and time zone. : $this.toString().matches('^[0-9]{4}-(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])T([01][0-9]|2[0-3]):[0-5][0-9]:[0-5][0-9]([.][0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition		0..*	MedComDocumentComposition	A set of resources composed into a single coherent clinical statement with clinical attestation
id	SOΣ	1..1	id	Logical id of this artifact
meta	SΣ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	SOΣC	1..1	canonical(StructureDefinition)	[DocumentEntry.formatCode] The profile canonical SHALL include the major and minor version of the standard in the form `|x.y`. Constraints: medcom-canonical-semver, medcom-canonical-fixed-major
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	SO	1..1	code	[DocumentEntry.languageCode] Human language of the content Binding: IHE LanguageCode_TEMP (extensible) Fixed Value: da
text	S	1..1	Narrative	The narrative text SHALL always be included when exchanging a MedCom FHIR Bundle. This profile does not constrain the narrative in regard to content, language, or traceability to data elements
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
status	S	1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required): The status of a resource narrative.
div	SC	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	The Composition identifier
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	[DocumentEntry.uniqueId] Sender organization OID (Object Identifier). Example: 1.2.208.184 (MedCom OID). Example General: http://www.acme.com/identifiers/patient
value	SΣC	1..1	string	[DocumentEntry.uniqueId] UUID. Constraints: medcom-uuid Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SOΣ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition. Required Pattern: final
type	SΣ	1..1	CodeableConcept	[DocumentEntry.typeCode] Kind of document Binding: IHE TypeCode_TEMP (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SOΣ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	SOΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: 11524-6
display	SOΣ	1..1	string	Representation defined by the system Fixed Value: EKG study
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
category	SΣ	1..1	CodeableConcept	[DocumentEntry.classCode] Categorization of document Binding: IHE ClassCode_TEMP (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SOΣ	1..1	uri	Identity of the terminology system Required Pattern: http://medcomfhir.dk/ig/xdsmetadata/CodeSystem/MedCom-ihe-classcode-CS
version	Σ	0..1	string	Version of the system - if relevant
code	SOΣ	1..1	code	Symbol in syntax defined by the system Required Pattern: 001
display	SOΣ	1..1	string	Representation defined by the system Required Pattern: Klinisk rapport
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SOΣ	1..1	Reference(MedComDocumentPatient) {b}	Who and/or what the composition is about
encounter	Σ	0..1	Reference(Encounter)	Context of the Composition
date	SOΣ	1..1	dateTime	The clinical date and time when the clinical report represented by this Composition was finalized, typically equal to the event.period.end of the recorded EKG. If event.period.end is not available, use event.period.start or Observation.effectiveDateTime.
Slices for author	SOΣ	1..2	Reference(MedComDocumentOrganization | MedComDocumentPractitioner | MedComDocumentPractitionerRole) {b}	[DocumentEntry.author] The slice author:institution ensures one mandatory organizational author. Any author element that does not match this slice is interpreted as an author person. Slice: Unordered, Open by profile:$this.resolve()
author:institution	SOΣ	1..1	Reference(MedComDocumentOrganization) {b}	The organization who authored the document.
title	SOΣ	1..1	string	Title MUST be 'Elektrokardiogram-12-aflednings' Fixed Value: Elektrokardiogram-12-aflednings
confidentiality	SOΣ	1..1	code	As defined by affinity domain Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition. Fixed Value: N
attester	S	0..1	BackboneElement	Attests to accuracy of composition
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode	SO	1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time		0..1	dateTime	When the composition was attested
party	SO	0..1	Reference(MedComDocumentPractitioner) {b}	[DocumentEntry.legalAuthenticator] Who authenticated the document.
custodian	Σ	0..1	Reference(Organization)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	SΣ	1..1	BackboneElement	The clinical service(s) being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SOΣ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	1..1	Period	[DocumentEntry.serviceStartTime, DocumentEntry.serviceStopTime] Time of service that is being documented.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SOΣC	1..1	dateTime	The end time of the EKG recording Constraints: medcom-datetime-has-time-offset-zulu
end	SOΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: medcom-datetime-has-time-offset-zulu
detail	SOΣ	0..*	Reference(Resource)	[DocumentEntry.referenceIdList] Related identifiers or resources
section	SC	1..*	BackboneElement	Composition is broken into sections Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	SOC	1..*	Reference(MedComEkgRecordingObservation)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels|4.0.1 From the FHIR Standard
Composition.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags|4.0.1 From the FHIR Standard
Composition.language	extensible	Fixed Value: da http://medcomfhir.dk/ig/document/ValueSet/MedCom-ihe-core-languagecode-VS-TEMP
Composition.text.status	required	NarrativeStatus http://hl7.org/fhir/ValueSet/narrative-status|4.0.1 From the FHIR Standard
Composition.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Composition.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type|4.0.1 From the FHIR Standard
Composition.status	required	Pattern Value: final http://hl7.org/fhir/ValueSet/composition-status|4.0.1 From the FHIR Standard
Composition.type	required	MedComIHE_CoreTypeCode_TEMP http://medcomfhir.dk/ig/document/ValueSet/MedCom-ihe-core-typecode-VS-TEMP
Composition.category	extensible	MedComIHE_CoreClassCode_TEMP http://medcomfhir.dk/ig/document/ValueSet/MedCom-ihe-core-classcode-VS-TEMP
Composition.confidentiality	required	Fixed Value: N http://terminology.hl7.org/ValueSet/v3-ConfidentialityClassification|2014-03-26 From the FHIR Standard
Composition.attester.mode	required	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 From the FHIR Standard
Composition.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
Composition.event.code	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
Composition.section.code	example	DocumentSectionCodes http://hl7.org/fhir/ValueSet/doc-section-codes|4.0.1 From the FHIR Standard
Composition.section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order|4.0.1 From the FHIR Standard
Composition.section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-1	error	Composition.section	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	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()
dom-4	error	Composition	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()
dom-5	error	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
medcom-canonical-fixed-major	error	Composition.meta.profile	If a version is present in the canonical, MAJOR SHALL be a fixed value. : matches('^.*[|]1[.].*$')
medcom-canonical-semver	error	Composition.meta.profile	The canonical SHALL include an explicit semantic version (semver) with optional prerelease (-...) and build metadata (+...). : matches('^.*[|][0-9]+[.][0-9]+([.][0-9]+)?(-[0-9A-Za-z-]+([.][0-9A-Za-z-]+)*)?([+][0-9A-Za-z-]+([.][0-9A-Za-z-]+)*)?$')
medcom-datetime-has-time-offset-zulu	error	Composition.event.period.start, Composition.event.period.end	dateTime must include date, time, and time zone. : $this.toString().matches('^[0-9]{4}-(0[1-9]|1[0-2])-(0[1-9]|[12][0-9]|3[01])T([01][0-9]|2[0-3]):[0-5][0-9]:[0-5][0-9]([.][0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
medcom-uuid	error	Composition.identifier.value	The value shall correspond to the structure of an UUID : $this.matches('(?i)^urn:uuid:[0-9a-f]{8}-[0-9a-f]{4}-[45][0-9a-f]{3}-[89ab][0-9a-f]{3}-[0-9a-f]{12}$')
txt-1	error	Composition.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes : htmlChecks()
txt-2	error	Composition.text.div	The narrative SHALL have some non-whitespace content : htmlChecks()

This structure is derived from MedComDocumentComposition

Summary

Mandatory: 2 elements
Fixed: 6 elements

Structures

This structure refers to these other structures:

• MedComDocumentOrganization (http://medcomfhir.dk/ig/document/StructureDefinition/medcom-document-organization)
• MedComDocumentPractitioner (http://medcomfhir.dk/ig/document/StructureDefinition/medcom-document-practitioner)
• MedComDocumentPractitionerRole (http://medcomfhir.dk/ig/document/StructureDefinition/medcom-document-practitionerrole)
• MedComEkgRecordingObservation (http://medcomfhir.dk/ig/ekg/StructureDefinition/medcom-ekg-recording-observation)