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12.4 Logical Model event - Content

A pattern to be followed by resources that represent the performance of some activity, possibly in accordance with a request or service definition.

This is NOT a resource. It is not part of the FHIR schema and cannot appear directly in FHIR instances. It is a logical model that defines a pattern adhered to by other resources. This pattern serves two purposes:

  • It offers guidance to work groups designing resources and helps ensure consistency of content created by different work groups
  • It provides a standard "view" that might be useful for implementers in processing and manipulating all resources that adhere to the same pattern. (Tooling that supports this may become available in a future release.)

An "event" is any description of an activity that has already taken place or that is currently ongoing. It includes resources that primarily describe the "result" of an activity or what was found (e.g. a condition or observation). Examples include encounters, procedures, completed questionnaires, representations of state transitions, etc. It does not include resources that describe objects or roles (e.g. patient, device, location).

This logical model is one of three common workflow patterns. The other two patterns are Request and Definition. This pattern is followed by (or is intended to be followed by a number of other FHIR resources

Events are distinct from requests in that an event is primarily focused on what has occurred or is occurring while requests deal with what is "desired" to occur. While creating a request or definition can be seen as a type of event, the focus of those other resources is not the "creation" but the desire/intention.

Events are related to Task in that events can be performed in fulfillment of a task and performing an event may involve the execution of one or more tasks. Events do not track the fulfillment of any requests they may be associated with. Tracking of fulfillment is managed through the Task resource.

This model represents a pattern. It provides a standard list of data elements with cardinalities, data types, definitions, rationale and usage notes that will ideally be adhered to by resources that fall into the "event" workflow category. However, adherence to this pattern is not mandatory. Not all healthcare domains are the same. Concepts that may be generally applicable (and thus are included in this standard pattern) might still not be relevant everywhere or may be sufficiently uncommon that they are more appropriate to include as extensions than as core properties of the resource. Work groups are encouraged to adjust descriptions, usage notes and rationale to be specific to their resource (e.g. use the term "procedure" or "observation" rather than "event"). As well, design notes in the comments column marked with [square brackets] identifies areas where domain variation is expected and encouraged. Other variation, including differences in names, cardinalities, data types and the decision to omit an element outright are also possible, but should be discussed with the FHIR Infrastructure work group's Workflow project to ensure the rationale for non-alignment is understood, to confirm that the deviation is necessary and to identify whether any adjustments to the pattern are appropriate.

This pattern provides a linkage to the W5 list of standard data elements. Resources that adhere to this pattern should ensure their w5 mappings are consistent, as is their data element ordering.

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Event ILogicalEvent Pattern
+ reason elements can only be specified if status is NOT 'not-done'
+ Not Done Reason can only be specified if status is 'not-done'
... identifier Σ0..*IdentifierBusiness Identifier for {{title}}
... instantiates Σ0..*uriInstantiates protocol or definition
... basedOn Σ0..*Reference(Request)Fulfills plan, proposal or order
... partOf Σ0..*Reference(Event)Part of referenced event
... status ?!Σ1..1codepreparation | in-progress | not-done | suspended | aborted | completed | entered-in-error | unknown
EventStatus (Required)
... statusReason 0..1CodeableConceptReason for current status
... code Σ0..1CodeableConceptWhat was done
... subject Σ1..1Reference(Patient | Group)Individual service was done for/to
... context Σ0..1Reference(Encounter | EpisodeOfCare)Associated Encounter / Episode
... occurrence[x] Σ0..1When {{title}} occurred/is occurring
.... occurrenceDateTimedateTime
.... occurrencePeriodPeriod
.... occurrenceTimingTiming
... performer Σ0..*BackboneElementWho performed {{title}} and what they did
.... function Σ0..1CodeableConceptType of performance
.... actor Σ1..1Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson)Who performed {{title}}
... location Σ0..1Reference(Location)Where {{title}} occurred
... reasonCode Σ0..*CodeableConceptWhy was {{title}} performed?
... reasonReference Σ0..*Reference(Condition | Observation | DiagnosticReport | DocumentReference)Why was {{title}} performed?
... note 0..*AnnotationComments made about the event

doco Documentation for this format

UML Diagram (Legend)

Event (Logical)Identifiers assigned to this {{title}} by the performer or other systemsidentifier : Identifier [0..*]The URL pointing to a protocol, guideline, orderset or other definition that is adhered to in whole or in part by this {{title}}instantiates : uri [0..*]A plan, proposal or order that is fulfilled in whole or in part by this {{title}}basedOn : Reference [0..*] « Request »A larger event of which this particular {{title}} is a component or steppartOf : Reference [0..*] « Event »The current state of the {{title}} (this element modifies the meaning of other elements)status : code [1..1] « Codes identifying the stage lifecycle stage of a event (Strength=Required)EventStatus! »Captures the reason for the current state of the {{title}}statusReason : CodeableConcept [0..1]A code that identifies the specific service or action that was or is being performedcode : CodeableConcept [0..1]The individual or set of individuals the action is being or was performed onsubject : Reference [1..1] « Patient|Group »The encounter or episode of care that establishes the context for this {{title}}context : Reference [0..1] « Encounter|EpisodeOfCare »The date, period or timing when the {{title}} did occur or is occurringoccurrence[x] : Type [0..1] « dateTime|Period|Timing »The principle physical location where the {{title}} was performedlocation : Reference [0..1] « Location »Describes why the {{title}} occurred in coded or textual formreasonCode : CodeableConcept [0..*]Indicates another resource whose existence justifies this {{title}}reasonReference : Reference [0..*] « Condition|Observation| DiagnosticReport|DocumentReference »Comments made about the {{title}} by the performer, subject or other participantsnote : Annotation [0..*]PerformerDistinguishes the type of involvement of the performer in the {{title}}. [Consider adding examples]function : CodeableConcept [0..1]Indicates who or what performed the {{title}}actor : Reference [1..1] « Practitioner|PractitionerRole| Organization|CareTeam|Patient|Device|RelatedPerson »Indicates who or what performed the {{title}} and how they were involvedperformer[0..*]

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Event ILogicalEvent Pattern
+ reason elements can only be specified if status is NOT 'not-done'
+ Not Done Reason can only be specified if status is 'not-done'
... identifier Σ0..*IdentifierBusiness Identifier for {{title}}
... instantiates Σ0..*uriInstantiates protocol or definition
... basedOn Σ0..*Reference(Request)Fulfills plan, proposal or order
... partOf Σ0..*Reference(Event)Part of referenced event
... status ?!Σ1..1codepreparation | in-progress | not-done | suspended | aborted | completed | entered-in-error | unknown
EventStatus (Required)
... statusReason 0..1CodeableConceptReason for current status
... code Σ0..1CodeableConceptWhat was done
... subject Σ1..1Reference(Patient | Group)Individual service was done for/to
... context Σ0..1Reference(Encounter | EpisodeOfCare)Associated Encounter / Episode
... occurrence[x] Σ0..1When {{title}} occurred/is occurring
.... occurrenceDateTimedateTime
.... occurrencePeriodPeriod
.... occurrenceTimingTiming
... performer Σ0..*BackboneElementWho performed {{title}} and what they did
.... function Σ0..1CodeableConceptType of performance
.... actor Σ1..1Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson)Who performed {{title}}
... location Σ0..1Reference(Location)Where {{title}} occurred
... reasonCode Σ0..*CodeableConceptWhy was {{title}} performed?
... reasonReference Σ0..*Reference(Condition | Observation | DiagnosticReport | DocumentReference)Why was {{title}} performed?
... note 0..*AnnotationComments made about the event

doco Documentation for this format

UML Diagram (Legend)

Event (Logical)Identifiers assigned to this {{title}} by the performer or other systemsidentifier : Identifier [0..*]The URL pointing to a protocol, guideline, orderset or other definition that is adhered to in whole or in part by this {{title}}instantiates : uri [0..*]A plan, proposal or order that is fulfilled in whole or in part by this {{title}}basedOn : Reference [0..*] « Request »A larger event of which this particular {{title}} is a component or steppartOf : Reference [0..*] « Event »The current state of the {{title}} (this element modifies the meaning of other elements)status : code [1..1] « Codes identifying the stage lifecycle stage of a event (Strength=Required)EventStatus! »Captures the reason for the current state of the {{title}}statusReason : CodeableConcept [0..1]A code that identifies the specific service or action that was or is being performedcode : CodeableConcept [0..1]The individual or set of individuals the action is being or was performed onsubject : Reference [1..1] « Patient|Group »The encounter or episode of care that establishes the context for this {{title}}context : Reference [0..1] « Encounter|EpisodeOfCare »The date, period or timing when the {{title}} did occur or is occurringoccurrence[x] : Type [0..1] « dateTime|Period|Timing »The principle physical location where the {{title}} was performedlocation : Reference [0..1] « Location »Describes why the {{title}} occurred in coded or textual formreasonCode : CodeableConcept [0..*]Indicates another resource whose existence justifies this {{title}}reasonReference : Reference [0..*] « Condition|Observation| DiagnosticReport|DocumentReference »Comments made about the {{title}} by the performer, subject or other participantsnote : Annotation [0..*]PerformerDistinguishes the type of involvement of the performer in the {{title}}. [Consider adding examples]function : CodeableConcept [0..1]Indicates who or what performed the {{title}}actor : Reference [1..1] « Practitioner|PractitionerRole| Organization|CareTeam|Patient|Device|RelatedPerson »Indicates who or what performed the {{title}} and how they were involvedperformer[0..*]

 

PathDefinitionTypeReference
Event.status Codes identifying the stage lifecycle stage of a eventRequiredEventStatus
Event.statusReason Codes identifying the reason for the current state of an eventUnknownNo details provided yet
Event.code Codes indicating the details of what is/was done. These will vary significantly based on the type of request resource and will often be example/preferred rather than extensible/required.UnknownNo details provided yet
Event.performer.function Codes that describe the specific involvement of a performer in an event. E.g. Primary vs. secondary vs. supervising, etc.UnknownNo details provided yet
Event.reasonCode Codes identifying why this event was necessary. These may be clinical reasons (e.g. diagnoses, symptoms) and/or administrative reasons. While the detailed constraints of relevant reasons will vary by resource, some degree of consistency across resources around recommended codes would be desirable.UnknownNo details provided yet

  • inv-1: Not Done Reason can only be specified if status is 'not-done' (expression : status='not-done' or notDoneReason.exists().not())
  • inv-2: reason elements can only be specified if status is NOT 'not-done' (expression : status!='not-done' or (reasonCode.exists().not() and reasonReference.exists().not()))

The following diagram shows the "typical" state machine diagram for resources following the Event pattern. Note that not all resources will support all states, some resources may choose different names for certain states and some resources may introduce sub-states to the listed states. As well, additional transitions may be supported, including from terminal nodes (e.g. from "completed" back to "in-progress"). That said, most resources should align with this state machine fairly well.

Typical state machine diagram for resources following 
  the Event pattern