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8.20 Resource Communication - Content

Patient Care Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson

An occurrence of information being transmitted; e.g. an alert that was sent to a responsible provider, a public health agency communication to a provider/reporter in response to a case report for a reportable condition.

Communication is one of the event resources in the FHIR workflow specification.

This resource is a record of a communication even if it is planned or has failed. A communication is a conveyance of information from one entity, a sender, to another entity, a receiver. The sender and receivers may be patients, practitioners, related persons, organizations, or devices. Communication use cases include:

  • A reminder or alert delivered to a responsible provider
  • A recorded notification from the nurse to the on-call physician (or any other specified person) that a patient's temperature exceeds a value
  • A response from a public health agency to a provider caring for a patient presenting with a communicable disease reportable to the public health agency
  • Patient educational material sent by a provider to a patient
  • Unable to deliver lab results to ordering physician

Non-patient specific communication use cases may include:

  • A nurse call from a hall bathroom
  • Advisory for battery service from a pump

This resource is a record of a communication that has occurred. It does not represent the actual flow of communication. While AuditEvent can track electronic disclosures of information, it cannot track conversations, phone calls, letters and other interactions that are not system-to-system. And even for system-to-system communications, the specific end recipients might not be known. Furthermore, AuditEvents are not considered to be "part" of the patient record, while Communication instances are. The Communication resource is not used as a general audit mechanism to track every disclosure of every record. Rather, it is used when a clinician or other user wants to ensure a record of a particular communication is itself maintained as part of the reviewable health record.

Flag resources represent a continuous ongoing "communication" alerting anyone dealing with the patient of certain precautions to take or issues to be aware of. The flags are continuously present as an ongoing reminder. This is distinct from Communication where there is a specific intended sender and receiver and the information is delivered only once.

When there is a need to organize clinical and administrative content into sections, the Composition resource should be used instead. For example, an initial case report to a public health agency may include organized sections for vital signs, immunizations, social history, etc.

Communication and Encounter

The Communication is about the transfer of information (which might or might not occur as part of an encounter), while Encounter is about the coming together (in person or virtually) of a Patient with a Practitioner. Communication does not deal with the duration of a call, it represents the fact that information was transferred at a particular point in time.

The phone calls involving the Patient should be handled using Encounter. Phone calls not involving the patient (e.g. between practitioners or practitioner to relative) that are tracked for billing or other purposes can use Communication to represent the information transferred but are not ideal to represent the call itself. A better mechanism for handling such calls will be explored in a future release.

This resource is referenced by itself.

This resource implements the Event pattern.

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Communication TUDomainResourceA record of information transmitted from a sender to a receiver
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierUnique identifier
... instantiatesCanonical Σ0..*canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire)Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(Any)Request fulfilled by this communication
... partOf Σ0..*Reference(Any)Part of referenced event (e.g. Communication, Procedure)
... inResponseTo 0..*Reference(Communication)Reply to
... status ?!Σ1..1codepreparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
EventStatus (Required)
... statusReason Σ0..1CodeableConceptReason for current status
CommunicationNotDoneReason (Example)
... category 0..*CodeableConceptMessage category
CommunicationCategory (Example)
... priority Σ0..1coderoutine | urgent | asap | stat
Request priority (Required)
... medium 0..*CodeableConceptA channel of communication
v3 Code System ParticipationMode (Example)
... subject Σ0..1Reference(Patient | Group)Focus of message
... topic 0..1CodeableConceptDescription of the purpose/content
CommunicationTopic (Example)
... about 0..*Reference(Any)Resources that pertain to this communication
... encounter Σ0..1Reference(Encounter)The Encounter during which this Communication was created
... sent 0..1dateTimeWhen sent
... received 0..1dateTimeWhen received
... recipient 0..*Reference(Participant)Who the information is shared with
... sender 0..1Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService)Who shares the information
... reasonCode Σ0..*CodeableConceptIndication for message
SNOMED CT Clinical Findings (Example)
... reasonReference Σ0..*Reference(Any)Why was communication done?
... payload 0..*BackboneElementMessage payload
.... content[x] 1..1Message part content
..... contentAttachmentAttachment
..... contentReferenceReference(Any)
..... contentCodeableConceptCodeableConcept
... note 0..*AnnotationComments made about the communication

doco Documentation for this format

UML Diagram (Legend)

Communication (DomainResource)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 serveridentifier : Identifier [0..*]The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this CommunicationinstantiatesCanonical : canonical [0..*] « PlanDefinition| ActivityDefinition|Measure|OperationDefinition|Questionnaire »The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this CommunicationinstantiatesUri : uri [0..*]An order, proposal or plan fulfilled in whole or in part by this CommunicationbasedOn : Reference [0..*] « Any »A larger event (e.g. Communication, Procedure) of which this particular communication is a component or steppartOf : Reference [0..*] « Any »Prior communication that this communication is in response toinResponseTo : Reference [0..*] « Communication »The status of the transmission (this element modifies the meaning of other elements)status : code [1..1] « The status of the communication. (Strength=Required)EventStatus! »Captures the reason for the current state of the CommunicationstatusReason : CodeableConcept [0..1] « Codes for the reason why a communication did not happen. (Strength=Example)CommunicationNotDoneReason?? »The type of message conveyed such as alert, notification, reminder, instruction, etccategory : CodeableConcept [0..*] « Codes for general categories of communications such as alerts, instructions, etc. (Strength=Example)CommunicationCategory?? »Characterizes how quickly the planned or in progress communication must be addressed. Includes concepts such as stat, urgent, routinepriority : code [0..1] « Codes indicating the relative importance of a communication. (Strength=Required)RequestPriority! »A channel that was used for this communication (e.g. email, fax)medium : CodeableConcept [0..*] « Codes for communication mediums such as phone, fax, email, in person, etc. (Strength=Example)v3.ParticipationMode?? »The patient or group that was the focus of this communicationsubject : Reference [0..1] « Patient|Group »Description of the purpose/content, similar to a subject line in an emailtopic : CodeableConcept [0..1] « Codes describing the purpose or content of the communication. (Strength=Example)CommunicationTopic?? »Other resources that pertain to this communication and to which this communication should be associatedabout : Reference [0..*] « Any »The Encounter during which this Communication was created or to which the creation of this record is tightly associatedencounter : Reference [0..1] « Encounter »The time when this communication was sentsent : dateTime [0..1]The time when this communication arrived at the destinationreceived : dateTime [0..1]The entity (e.g. person, organization, clinical information system, care team or device) which is the target of the communicationrecipient : Reference [0..*] « Participant »The entity (e.g. person, organization, clinical information system, or device) which is the source of the communicationsender : Reference [0..1] « Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson|HealthcareService »The reason or justification for the communicationreasonCode : CodeableConcept [0..*] « Codes for describing reasons for the occurrence of a communication. (Strength=Example)SNOMEDCTClinicalFindings?? »Indicates another resource whose existence justifies this communicationreasonReference : Reference [0..*] « Any »Additional notes or commentary about the communication by the sender, receiver or other interested partiesnote : Annotation [0..*]PayloadA communicated content (or for multi-part communications, one portion of the communication)content[x] : Type [1..1] « Attachment|Reference(Any)|CodeableConcept »Text, attachment(s), or resource(s) that was communicated to the recipientpayload[0..*]

XML Template

<Communication xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Unique identifier --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|Measure|
   OperationDefinition|PlanDefinition|Questionnaire) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(Any) Request fulfilled by this communication --></basedOn>
 <partOf><!-- 0..* Reference(Any) Part of referenced event (e.g. Communication, Procedure) --></partOf>
 <inResponseTo><!-- 0..* Reference(Communication) Reply to --></inResponseTo>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown -->
 <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason>
 <category><!-- 0..* CodeableConcept Message category --></category>
 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <medium><!-- 0..* CodeableConcept A channel of communication --></medium>
 <subject><!-- 0..1 Reference(Group|Patient) Focus of message --></subject>
 <topic><!-- 0..1 CodeableConcept Description of the purpose/content --></topic>
 <about><!-- 0..* Reference(Any) Resources that pertain to this communication --></about>
 <encounter><!-- 0..1 Reference(Encounter) The Encounter during which this Communication was created --></encounter>
 <sent value="[dateTime]"/><!-- 0..1 When sent -->
 <received value="[dateTime]"/><!-- 0..1 When received -->
 <recipient><!-- 0..* Reference(CareTeam|Device|Group|HealthcareService|Location|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) Who the information is shared with --></recipient>
 <sender><!-- 0..1 Reference(Device|HealthcareService|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) Who shares the information --></sender>
 <reasonCode><!-- 0..* CodeableConcept Indication for message --></reasonCode>
 <reasonReference><!-- 0..* Reference(Any) Why was communication done? --></reasonReference>
 <payload>  <!-- 0..* Message payload -->
  <content[x]><!-- 1..1 Attachment|Reference(Any)|CodeableConcept Message part content --></content[x]>
 </payload>
 <note><!-- 0..* Annotation Comments made about the communication --></note>
</Communication>

JSON Template

{doco
  "resourceType" : "Communication",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Unique identifier
  "instantiatesCanonical" : [{ canonical(ActivityDefinition|Measure|
   OperationDefinition|PlanDefinition|Questionnaire) }], // Instantiates FHIR protocol or definition
  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(Any) }], // Request fulfilled by this communication
  "partOf" : [{ Reference(Any) }], // Part of referenced event (e.g. Communication, Procedure)
  "inResponseTo" : [{ Reference(Communication) }], // Reply to
  "status" : "<code>", // R!  preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  "statusReason" : { CodeableConcept }, // Reason for current status
  "category" : [{ CodeableConcept }], // Message category
  "priority" : "<code>", // routine | urgent | asap | stat
  "medium" : [{ CodeableConcept }], // A channel of communication
  "subject" : { Reference(Group|Patient) }, // Focus of message
  "topic" : { CodeableConcept }, // Description of the purpose/content
  "about" : [{ Reference(Any) }], // Resources that pertain to this communication
  "encounter" : { Reference(Encounter) }, // The Encounter during which this Communication was created
  "sent" : "<dateTime>", // When sent
  "received" : "<dateTime>", // When received
  "recipient" : [{ Reference(CareTeam|Device|Group|HealthcareService|Location|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }], // Who the information is shared with
  "sender" : { Reference(Device|HealthcareService|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) }, // Who shares the information
  "reasonCode" : [{ CodeableConcept }], // Indication for message
  "reasonReference" : [{ Reference(Any) }], // Why was communication done?
  "payload" : [{ // Message payload
    // content[x]: Message part content. One of these 3:
    "contentAttachment" : { Attachment }
    "contentReference" : { Reference(Any) }
    "contentCodeableConcept" : { CodeableConcept }
  }],
  "note" : [{ Annotation }] // Comments made about the communication
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Communication;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Communication.identifier [ Identifier ], ... ; # 0..* Unique identifier
  fhir:Communication.instantiatesCanonical [ canonical(ActivityDefinition|Measure|OperationDefinition|PlanDefinition|Questionnaire) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:Communication.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:Communication.basedOn [ Reference(Any) ], ... ; # 0..* Request fulfilled by this communication
  fhir:Communication.partOf [ Reference(Any) ], ... ; # 0..* Part of referenced event (e.g. Communication, Procedure)
  fhir:Communication.inResponseTo [ Reference(Communication) ], ... ; # 0..* Reply to
  fhir:Communication.status [ code ]; # 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  fhir:Communication.statusReason [ CodeableConcept ]; # 0..1 Reason for current status
  fhir:Communication.category [ CodeableConcept ], ... ; # 0..* Message category
  fhir:Communication.priority [ code ]; # 0..1 routine | urgent | asap | stat
  fhir:Communication.medium [ CodeableConcept ], ... ; # 0..* A channel of communication
  fhir:Communication.subject [ Reference(Group|Patient) ]; # 0..1 Focus of message
  fhir:Communication.topic [ CodeableConcept ]; # 0..1 Description of the purpose/content
  fhir:Communication.about [ Reference(Any) ], ... ; # 0..* Resources that pertain to this communication
  fhir:Communication.encounter [ Reference(Encounter) ]; # 0..1 The Encounter during which this Communication was created
  fhir:Communication.sent [ dateTime ]; # 0..1 When sent
  fhir:Communication.received [ dateTime ]; # 0..1 When received
  fhir:Communication.recipient [ Reference(CareTeam|Device|Group|HealthcareService|Location|Organization|Patient|
  Practitioner|PractitionerRole|RelatedPerson) ], ... ; # 0..* Who the information is shared with
  fhir:Communication.sender [ Reference(Device|HealthcareService|Organization|Patient|Practitioner|PractitionerRole|
  RelatedPerson) ]; # 0..1 Who shares the information
  fhir:Communication.reasonCode [ CodeableConcept ], ... ; # 0..* Indication for message
  fhir:Communication.reasonReference [ Reference(Any) ], ... ; # 0..* Why was communication done?
  fhir:Communication.payload [ # 0..* Message payload
    # Communication.payload.content[x] : 1..1 Message part content. One of these 3
      fhir:Communication.payload.contentAttachment [ Attachment ]
      fhir:Communication.payload.contentReference [ Reference(Any) ]
      fhir:Communication.payload.contentCodeableConcept [ CodeableConcept ]
  ], ...;
  fhir:Communication.note [ Annotation ], ... ; # 0..* Comments made about the communication
]

Changes since R3

Communication
Communication.status
  • Change value set from http://hl7.org/fhir/ValueSet/event-status|4.0.0 to http://hl7.org/fhir/ValueSet/event-status|4.1.0
Communication.priority
  • Change value set from http://hl7.org/fhir/ValueSet/request-priority|4.0.0 to http://hl7.org/fhir/ValueSet/request-priority|4.1.0
Communication.recipient
  • Type Reference: Added Target Type Location
Communication.reasonReference
  • Type Reference: Added Target Type Resource
  • Type Reference: Removed Target Types Condition, Observation, DiagnosticReport, DocumentReference
Communication.payload.content[x]
  • Add Type CodeableConcept
  • Remove Type string

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 3 tests that all execute ok. All tests pass round-trip testing and 2 r3 resources are invalid (0 errors).)

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Communication TUDomainResourceA record of information transmitted from a sender to a receiver
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierUnique identifier
... instantiatesCanonical Σ0..*canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire)Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(Any)Request fulfilled by this communication
... partOf Σ0..*Reference(Any)Part of referenced event (e.g. Communication, Procedure)
... inResponseTo 0..*Reference(Communication)Reply to
... status ?!Σ1..1codepreparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
EventStatus (Required)
... statusReason Σ0..1CodeableConceptReason for current status
CommunicationNotDoneReason (Example)
... category 0..*CodeableConceptMessage category
CommunicationCategory (Example)
... priority Σ0..1coderoutine | urgent | asap | stat
Request priority (Required)
... medium 0..*CodeableConceptA channel of communication
v3 Code System ParticipationMode (Example)
... subject Σ0..1Reference(Patient | Group)Focus of message
... topic 0..1CodeableConceptDescription of the purpose/content
CommunicationTopic (Example)
... about 0..*Reference(Any)Resources that pertain to this communication
... encounter Σ0..1Reference(Encounter)The Encounter during which this Communication was created
... sent 0..1dateTimeWhen sent
... received 0..1dateTimeWhen received
... recipient 0..*Reference(Participant)Who the information is shared with
... sender 0..1Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService)Who shares the information
... reasonCode Σ0..*CodeableConceptIndication for message
SNOMED CT Clinical Findings (Example)
... reasonReference Σ0..*Reference(Any)Why was communication done?
... payload 0..*BackboneElementMessage payload
.... content[x] 1..1Message part content
..... contentAttachmentAttachment
..... contentReferenceReference(Any)
..... contentCodeableConceptCodeableConcept
... note 0..*AnnotationComments made about the communication

doco Documentation for this format

UML Diagram (Legend)

Communication (DomainResource)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 serveridentifier : Identifier [0..*]The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this CommunicationinstantiatesCanonical : canonical [0..*] « PlanDefinition| ActivityDefinition|Measure|OperationDefinition|Questionnaire »The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this CommunicationinstantiatesUri : uri [0..*]An order, proposal or plan fulfilled in whole or in part by this CommunicationbasedOn : Reference [0..*] « Any »A larger event (e.g. Communication, Procedure) of which this particular communication is a component or steppartOf : Reference [0..*] « Any »Prior communication that this communication is in response toinResponseTo : Reference [0..*] « Communication »The status of the transmission (this element modifies the meaning of other elements)status : code [1..1] « The status of the communication. (Strength=Required)EventStatus! »Captures the reason for the current state of the CommunicationstatusReason : CodeableConcept [0..1] « Codes for the reason why a communication did not happen. (Strength=Example)CommunicationNotDoneReason?? »The type of message conveyed such as alert, notification, reminder, instruction, etccategory : CodeableConcept [0..*] « Codes for general categories of communications such as alerts, instructions, etc. (Strength=Example)CommunicationCategory?? »Characterizes how quickly the planned or in progress communication must be addressed. Includes concepts such as stat, urgent, routinepriority : code [0..1] « Codes indicating the relative importance of a communication. (Strength=Required)RequestPriority! »A channel that was used for this communication (e.g. email, fax)medium : CodeableConcept [0..*] « Codes for communication mediums such as phone, fax, email, in person, etc. (Strength=Example)v3.ParticipationMode?? »The patient or group that was the focus of this communicationsubject : Reference [0..1] « Patient|Group »Description of the purpose/content, similar to a subject line in an emailtopic : CodeableConcept [0..1] « Codes describing the purpose or content of the communication. (Strength=Example)CommunicationTopic?? »Other resources that pertain to this communication and to which this communication should be associatedabout : Reference [0..*] « Any »The Encounter during which this Communication was created or to which the creation of this record is tightly associatedencounter : Reference [0..1] « Encounter »The time when this communication was sentsent : dateTime [0..1]The time when this communication arrived at the destinationreceived : dateTime [0..1]The entity (e.g. person, organization, clinical information system, care team or device) which is the target of the communicationrecipient : Reference [0..*] « Participant »The entity (e.g. person, organization, clinical information system, or device) which is the source of the communicationsender : Reference [0..1] « Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson|HealthcareService »The reason or justification for the communicationreasonCode : CodeableConcept [0..*] « Codes for describing reasons for the occurrence of a communication. (Strength=Example)SNOMEDCTClinicalFindings?? »Indicates another resource whose existence justifies this communicationreasonReference : Reference [0..*] « Any »Additional notes or commentary about the communication by the sender, receiver or other interested partiesnote : Annotation [0..*]PayloadA communicated content (or for multi-part communications, one portion of the communication)content[x] : Type [1..1] « Attachment|Reference(Any)|CodeableConcept »Text, attachment(s), or resource(s) that was communicated to the recipientpayload[0..*]

XML Template

<Communication xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Unique identifier --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|Measure|
   OperationDefinition|PlanDefinition|Questionnaire) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(Any) Request fulfilled by this communication --></basedOn>
 <partOf><!-- 0..* Reference(Any) Part of referenced event (e.g. Communication, Procedure) --></partOf>
 <inResponseTo><!-- 0..* Reference(Communication) Reply to --></inResponseTo>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown -->
 <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason>
 <category><!-- 0..* CodeableConcept Message category --></category>
 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <medium><!-- 0..* CodeableConcept A channel of communication --></medium>
 <subject><!-- 0..1 Reference(Group|Patient) Focus of message --></subject>
 <topic><!-- 0..1 CodeableConcept Description of the purpose/content --></topic>
 <about><!-- 0..* Reference(Any) Resources that pertain to this communication --></about>
 <encounter><!-- 0..1 Reference(Encounter) The Encounter during which this Communication was created --></encounter>
 <sent value="[dateTime]"/><!-- 0..1 When sent -->
 <received value="[dateTime]"/><!-- 0..1 When received -->
 <recipient><!-- 0..* Reference(CareTeam|Device|Group|HealthcareService|Location|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) Who the information is shared with --></recipient>
 <sender><!-- 0..1 Reference(Device|HealthcareService|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) Who shares the information --></sender>
 <reasonCode><!-- 0..* CodeableConcept Indication for message --></reasonCode>
 <reasonReference><!-- 0..* Reference(Any) Why was communication done? --></reasonReference>
 <payload>  <!-- 0..* Message payload -->
  <content[x]><!-- 1..1 Attachment|Reference(Any)|CodeableConcept Message part content --></content[x]>
 </payload>
 <note><!-- 0..* Annotation Comments made about the communication --></note>
</Communication>

JSON Template

{doco
  "resourceType" : "Communication",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Unique identifier
  "instantiatesCanonical" : [{ canonical(ActivityDefinition|Measure|
   OperationDefinition|PlanDefinition|Questionnaire) }], // Instantiates FHIR protocol or definition
  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(Any) }], // Request fulfilled by this communication
  "partOf" : [{ Reference(Any) }], // Part of referenced event (e.g. Communication, Procedure)
  "inResponseTo" : [{ Reference(Communication) }], // Reply to
  "status" : "<code>", // R!  preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  "statusReason" : { CodeableConcept }, // Reason for current status
  "category" : [{ CodeableConcept }], // Message category
  "priority" : "<code>", // routine | urgent | asap | stat
  "medium" : [{ CodeableConcept }], // A channel of communication
  "subject" : { Reference(Group|Patient) }, // Focus of message
  "topic" : { CodeableConcept }, // Description of the purpose/content
  "about" : [{ Reference(Any) }], // Resources that pertain to this communication
  "encounter" : { Reference(Encounter) }, // The Encounter during which this Communication was created
  "sent" : "<dateTime>", // When sent
  "received" : "<dateTime>", // When received
  "recipient" : [{ Reference(CareTeam|Device|Group|HealthcareService|Location|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }], // Who the information is shared with
  "sender" : { Reference(Device|HealthcareService|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) }, // Who shares the information
  "reasonCode" : [{ CodeableConcept }], // Indication for message
  "reasonReference" : [{ Reference(Any) }], // Why was communication done?
  "payload" : [{ // Message payload
    // content[x]: Message part content. One of these 3:
    "contentAttachment" : { Attachment }
    "contentReference" : { Reference(Any) }
    "contentCodeableConcept" : { CodeableConcept }
  }],
  "note" : [{ Annotation }] // Comments made about the communication
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Communication;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Communication.identifier [ Identifier ], ... ; # 0..* Unique identifier
  fhir:Communication.instantiatesCanonical [ canonical(ActivityDefinition|Measure|OperationDefinition|PlanDefinition|Questionnaire) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:Communication.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:Communication.basedOn [ Reference(Any) ], ... ; # 0..* Request fulfilled by this communication
  fhir:Communication.partOf [ Reference(Any) ], ... ; # 0..* Part of referenced event (e.g. Communication, Procedure)
  fhir:Communication.inResponseTo [ Reference(Communication) ], ... ; # 0..* Reply to
  fhir:Communication.status [ code ]; # 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  fhir:Communication.statusReason [ CodeableConcept ]; # 0..1 Reason for current status
  fhir:Communication.category [ CodeableConcept ], ... ; # 0..* Message category
  fhir:Communication.priority [ code ]; # 0..1 routine | urgent | asap | stat
  fhir:Communication.medium [ CodeableConcept ], ... ; # 0..* A channel of communication
  fhir:Communication.subject [ Reference(Group|Patient) ]; # 0..1 Focus of message
  fhir:Communication.topic [ CodeableConcept ]; # 0..1 Description of the purpose/content
  fhir:Communication.about [ Reference(Any) ], ... ; # 0..* Resources that pertain to this communication
  fhir:Communication.encounter [ Reference(Encounter) ]; # 0..1 The Encounter during which this Communication was created
  fhir:Communication.sent [ dateTime ]; # 0..1 When sent
  fhir:Communication.received [ dateTime ]; # 0..1 When received
  fhir:Communication.recipient [ Reference(CareTeam|Device|Group|HealthcareService|Location|Organization|Patient|
  Practitioner|PractitionerRole|RelatedPerson) ], ... ; # 0..* Who the information is shared with
  fhir:Communication.sender [ Reference(Device|HealthcareService|Organization|Patient|Practitioner|PractitionerRole|
  RelatedPerson) ]; # 0..1 Who shares the information
  fhir:Communication.reasonCode [ CodeableConcept ], ... ; # 0..* Indication for message
  fhir:Communication.reasonReference [ Reference(Any) ], ... ; # 0..* Why was communication done?
  fhir:Communication.payload [ # 0..* Message payload
    # Communication.payload.content[x] : 1..1 Message part content. One of these 3
      fhir:Communication.payload.contentAttachment [ Attachment ]
      fhir:Communication.payload.contentReference [ Reference(Any) ]
      fhir:Communication.payload.contentCodeableConcept [ CodeableConcept ]
  ], ...;
  fhir:Communication.note [ Annotation ], ... ; # 0..* Comments made about the communication
]

Changes since Release 3

Communication
Communication.status
  • Change value set from http://hl7.org/fhir/ValueSet/event-status|4.0.0 to http://hl7.org/fhir/ValueSet/event-status|4.1.0
Communication.priority
  • Change value set from http://hl7.org/fhir/ValueSet/request-priority|4.0.0 to http://hl7.org/fhir/ValueSet/request-priority|4.1.0
Communication.recipient
  • Type Reference: Added Target Type Location
Communication.reasonReference
  • Type Reference: Added Target Type Resource
  • Type Reference: Removed Target Types Condition, Observation, DiagnosticReport, DocumentReference
Communication.payload.content[x]
  • Add Type CodeableConcept
  • Remove Type string

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 3 tests that all execute ok. All tests pass round-trip testing and 2 r3 resources are invalid (0 errors).)

 

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis a

PathDefinitionTypeReference
Communication.status The status of the communication.RequiredEventStatus
Communication.statusReason Codes for the reason why a communication did not happen.ExampleCommunicationNotDoneReason
Communication.category Codes for general categories of communications such as alerts, instructions, etc.ExampleCommunicationCategory
Communication.priority Codes indicating the relative importance of a communication.RequiredRequestPriority
Communication.medium Codes for communication mediums such as phone, fax, email, in person, etc.Examplev3.ParticipationMode
Communication.topic Codes describing the purpose or content of the communication.ExampleCommunicationTopic
Communication.reasonCode Codes for describing reasons for the occurrence of a communication.ExampleSNOMEDCTClinicalFindings

Notes to reviewers:

At this time, the code bindings are placeholders to be fleshed out upon further review by the community.

Communication.sender allows Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService and Communication.recipient allows Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Group | CareTeam | HealthcareService - but it is not unusual to have a communication target - even a defined one - where it is unknown what kind of role the person is playing.

If the communication is to or from an individual whose role is not known (practitioner, patient or related person) - for example, only email address is captured in the system - then RelatedPerson should be used by default.

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
based-onreferenceRequest fulfilled by this communicationCommunication.basedOn
(Any)
categorytokenMessage categoryCommunication.category
encounterreferenceThe Encounter during which this Communication was createdCommunication.encounter
(Encounter)
identifiertokenUnique identifierCommunication.identifier
instantiates-canonicalreferenceInstantiates FHIR protocol or definitionCommunication.instantiatesCanonical
(Questionnaire, Measure, PlanDefinition, OperationDefinition, ActivityDefinition)
instantiates-uriuriInstantiates external protocol or definitionCommunication.instantiatesUri
mediumtokenA channel of communicationCommunication.medium
part-ofreferencePart of referenced event (e.g. Communication, Procedure)Communication.partOf
(Any)
patientreferenceFocus of messageCommunication.subject.where(resolve() is Patient)
(Patient)
receiveddateWhen receivedCommunication.received
recipientreferenceWho the information is shared withCommunication.recipient
(Practitioner, Group, Organization, CareTeam, Device, Patient, HealthcareService, PractitionerRole, RelatedPerson, Location)
senderreferenceWho shares the informationCommunication.sender
(Practitioner, Organization, Device, Patient, HealthcareService, PractitionerRole, RelatedPerson)
sentdateWhen sentCommunication.sent
statustokenpreparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknownCommunication.status
subjectreferenceFocus of messageCommunication.subject
(Group, Patient)
topictokenDescription of the purpose/contentCommunication.topic