# PractitionerRole Profile (Provider Registry) - Canadian Baseline v1.2.0

* [**Table of Contents**](toc.md)
* [**FHIR Artifacts**](allartifacts.md)
* [**Artifact List**](artifacts.md)
* **PractitionerRole Profile (Provider Registry)**

## Resource Profile: PractitionerRole Profile (Provider Registry) 

| | |
| :--- | :--- |
| *Official URL*:http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole-registry | *Version*:1.2.0 |
| Draft as of 2024-08-09 | *Computable Name*:PractitionerRoleProfileRegistry |

 
Proposed constraints and extensions on the PractitionerRole Resource for use by Provider Registry systems. 

# CA Baseline PractitionerRole Profile

This PractitionerRole profile sets minimum expectations for the PractitionerRole resource to record, search and fetch the recording of the location and types of services that Practitioner is able to provide for an organization.

This profile defines localization concepts for use in an Canadian context.

## Differences from US Core

This analysis is not applicable as this profile is a specialization of PractitionerRole for registry profiles and there is no equivalent in US Core R4 Implementation Guide, See the general PractitionerRole profile for differences.

## Mandatory Data Elements

All elements or attributes defined in FHIR have cardinality as part of their definition - a minimum number of required appearances and a maximum number.

Most elements in FHIR specification have a minimum cardinality of **0**, which means that they may be missing from a resource when it is exchanged between systems.

**Required elements:**

* reference to a practitioner

In addition to that, some optional elements (e.g., PractitionerRole.telecom, identifier data type) have required components that MUST be present if that optional element is provided.

### Data Absent Reason

In situations where the minimum cardinality of an element or attribute is **1** and information is missing and the Responder knows the precise reason for the absence of data, Responders SHALL send the reason for the missing information using values (such as [NullFlavor](https://www.hl7.org/fhir/extension-iso21090-nullflavor.html)) from the value set where they exist or using the [DataAbsentReason](http://hl7.org/fhir/StructureDefinition/data-absent-reason) extension.

## Must Support Data Elements

Some elements are labeled as MustSupport meaning that implementations that produce or consume resources SHALL provide "support" for the element in some meaningful way (see [Must Support](https://build.fhir.org/ig/HL7-Canada/ca-baseline/general-guidance.html#must-support) definition).

The following elements are marked as Must Support in the PractitionerRole-Registry profile:

**Must Support elements:**

* reference to a practitioner
* contact detail (e.g. a telephone number or an email address)
* specialty

## Best Practices/"Should" Support

**identifier**: It is recommended to have an identifier associated with PractitionerRole to assist in searches, however not every implementation (especially legacy implementations that combined both concepts of practitioner & practitionerRole) will include an identifier practitioner role. Given the scope and principles of the CA Baseline, the cardinality on this element was relaxed back to its base cardinality after receiving community feedback from FHIR Iguides that could not support the expectation in their existing implementation(s).

## Invariants

The invariant necessitating either code or specialty be present was removed after review against Canadian FHIR rpracititoner registry implementations identified challenges with some legacy systems (registry and otherwise) that have cpmmon use cases for PractitionerRole that do not include specialty or code.

## Extensions

**ext-rolestatus**: This PractitionerRole profile contains optional [RoleStatus](https://build.fhir.org/ig/HL7-Canada/ca-baseline/extension-ext-rolestatus.html) [modifier extension](https://www.hl7.org/fhir/extensibility.html#modifierExtension) to indicate the possible states of the Role as defined by the [HL7v3 Role](https://www.hl7.org/fhir/v3/RoleStatus/cs.html) class state machine.

This extension is labeled as modifier because the status code may provide additional knowledge about the PractitionerRole resource that modifies its meaning or interpretation.

**ext-statusreason**: In conjunction to the RoleStatus extension, this PractitionerRole profile includes an optional [StatusReason](https://build.fhir.org/ig/HL7-Canada/ca-baseline/extension-ext-statusreason.html) extension to provides a textual description for the status.

Note: Role status effective from/to dates go to **PractitionerRole.period** element.

## Usage Note

This PractitionerRole profile is intended to provide a foundation for a central or distributed Provider or Healthcare Directory. Additional work flow components and elements may be required for a particular implementation.

**Usages:**

* This Profile is not used by any profiles in this Implementation Guide

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/hl7.fhir.ca.baseline|current/StructureDefinition/profile-practitionerrole-registry)

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-profile-practitionerrole-registry.csv), [Excel](StructureDefinition-profile-practitionerrole-registry.xlsx), [Schematron](StructureDefinition-profile-practitionerrole-registry.sch) 

### Notes:

## Identifiers

Multiple types of provider identifiers may be used in PractitionerRole.identifier element in the Canadian context:

* Provincial health plan provider/ Billing number
* Licence Number
* Medical Doctor Number

Implementers may use other identifiers to capture in a more specific way such as internal provider number, jurisdictions providing credentials. The full list of possible identifier types is in [Canadian URI Registry](https://simplifier.net/canadianuriregistry/~resources?category=NamingSystem)

In some cases, the same license number can be used as the provider identifier and provider's qualification identifier.

## Telecom

A provider may have multiple ways to be contacted with different uses or applicable periods. This PractitionerRole profile allows multiple contact points (e.g. a telephone number or an email address) by which the individual may be contacted.

To indicate the preferred way to contact use Practitioner.telecom.rank attribute (i.e., the [ContactPoint.rank](https://www.hl7.org/fhir/datatypes.html#contactpoint) component) that specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.

### Role

Roles which this practitioner is authorized to perform for the organization are defined by Canadian [HealthcareProviderRoleType](https://tgateway.infoway-inforoute.ca/singlesubset.html?id=2.16.840.1.113883.2.20.3.48&versionid=20190813) value set as the coded representation of the provider's credentials. Credential defines a role type that is used to categorize an entity that delivers health care in an expected and professional manner to an entity in need of health care services.

The binding strength for the **PractitionerRole.code** element is [Preferred](https://www.hl7.org/fhir/terminologies.html#preferred) meaning that implementers are encouraged to draw codes from the specified code system for interoperability purposes but are not required to do so to be considered conformant.

### Specialty

Specific specialty of the practitioner defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient. This profile recommends to use Canadian [PractitionerSpecialty](https://tgateway.infoway-inforoute.ca/singlesubset.html?id=2.16.840.1.113883.3.239.12.38) value set for speciality codes.

The binding strength for the **PractitionerRole.speciality** element is [Preferred](https://www.hl7.org/fhir/terminologies.html#preferred) meaning that implementers are encouraged to draw codes from the specified code system for interoperability purposes but are not required to do so to be considered conformant.



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "profile-practitionerrole-registry",
  "url" : "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole-registry",
  "version" : "1.2.0",
  "name" : "PractitionerRoleProfileRegistry",
  "title" : "PractitionerRole Profile (Provider Registry)",
  "status" : "draft",
  "date" : "2024-08-09",
  "publisher" : "HL7 Canada - FHIR Implementation Work Group",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://infocentral.infoway-inforoute.ca/en/collaboration/wg/fhir-implementations"
        }
      ]
    }
  ],
  "description" : "Proposed constraints and extensions on the PractitionerRole Resource for use by Provider Registry systems.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "CA"
        }
      ]
    }
  ],
  "fhirVersion" : "4.0.1",
  "mapping" : [
    {
      "identity" : "v2",
      "uri" : "http://hl7.org/v2",
      "name" : "HL7 v2 Mapping"
    },
    {
      "identity" : "rim",
      "uri" : "http://hl7.org/v3",
      "name" : "RIM Mapping"
    },
    {
      "identity" : "servd",
      "uri" : "http://www.omg.org/spec/ServD/1.0/",
      "name" : "ServD"
    },
    {
      "identity" : "w5",
      "uri" : "http://hl7.org/fhir/fivews",
      "name" : "FiveWs Pattern Mapping"
    }
  ],
  "kind" : "resource",
  "abstract" : false,
  "type" : "PractitionerRole",
  "baseDefinition" : "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole",
  "derivation" : "constraint",
  "differential" : {
    "element" : [
      {
        "id" : "PractitionerRole",
        "path" : "PractitionerRole",
        "short" : "PractitionerRole Registry Profile",
        "definition" : "The PractitionerRoleRegistry Profile is based upon the CA Baseline FHIR PractitionerRole profile for general use"
      },
      {
        "id" : "PractitionerRole.extension",
        "path" : "PractitionerRole.extension",
        "slicing" : {
          "discriminator" : [
            {
              "type" : "value",
              "path" : "url"
            }
          ],
          "rules" : "open"
        }
      },
      {
        "id" : "PractitionerRole.extension:status",
        "path" : "PractitionerRole.extension",
        "sliceName" : "status",
        "short" : "Role status extension",
        "definition" : "Represents the defined possible states of the Role, as defined by the HL7v3 Role class state machine.",
        "comment" : "The roleStatus extension has been flagged for further implementer feedback regarding whether it should be considered a modifier extension.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-rolestatus"
            ]
          }
        ]
      },
      {
        "id" : "PractitionerRole.extension:statusReason",
        "path" : "PractitionerRole.extension",
        "sliceName" : "statusReason",
        "short" : "Role status reason extension",
        "definition" : "Represents the textual description for the possible states of the Role, as defined by the HL7v3 Role class state machine.",
        "min" : 0,
        "max" : "1",
        "type" : [
          {
            "code" : "Extension",
            "profile" : [
              "http://hl7.org/fhir/ca/baseline/StructureDefinition/ext-statusreason"
            ]
          }
        ]
      },
      {
        "id" : "PractitionerRole.identifier",
        "path" : "PractitionerRole.identifier",
        "comment" : "This element is considered SHOULD support and it is recommended to have an identifier associated with PractitionerRole to assist in searches, not every implementation (especially legacy implementations that combined both concepts of practitioner & practitionerRole) will include an identifier practioner role.",
        "type" : [
          {
            "code" : "Identifier",
            "profile" : [
              "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-identifier"
            ]
          }
        ]
      },
      {
        "id" : "PractitionerRole.practitioner",
        "path" : "PractitionerRole.practitioner",
        "short" : "Practitioner that is able to provide the defined services for the organization.",
        "min" : 1,
        "type" : [
          {
            "code" : "Reference",
            "targetProfile" : [
              "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner"
            ]
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "PractitionerRole.code",
        "path" : "PractitionerRole.code",
        "short" : "HealthcareProviderRoleType",
        "comment" : "The binding strength of this element is [Preferred](https://www.hl7.org/fhir/terminologies.html#strength), meaning that codes are encouraged to draw from the HealthcareProviderRoleType code system for interoperability purposes but are not required to do so to be considered conformant.",
        "binding" : {
          "strength" : "preferred",
          "description" : "A role type that is used to categorize an entity that delivers health care in an expected and professional manner to an entity in need of health care services. Examples: Registered Nurse, Chiropractor, Physician, Custodial Care Clinic.",
          "valueSet" : "https://fhir.infoway-inforoute.ca/ValueSet/healthcareproviderroletype"
        }
      },
      {
        "id" : "PractitionerRole.specialty",
        "path" : "PractitionerRole.specialty",
        "short" : "PractitionerSpecialty",
        "comment" : "The binding strength of this element is [Preferred](https://www.hl7.org/fhir/terminologies.html#strength), meaning that codes are encouraged to draw from the PractitionerSpecialty code system for interoperability purposes but are not required to do so to be considered conformant.",
        "mustSupport" : true,
        "binding" : {
          "strength" : "preferred",
          "description" : "Defines the clinical, medical, surgical or other healthcare-related service specialty of a practitioner who interacts, treats or provides such services to or for a patient.",
          "valueSet" : "https://fhir.infoway-inforoute.ca/ValueSet/practitionerspecialty"
        }
      },
      {
        "id" : "PractitionerRole.telecom",
        "path" : "PractitionerRole.telecom",
        "mustSupport" : true
      },
      {
        "id" : "PractitionerRole.telecom.system",
        "path" : "PractitionerRole.telecom.system",
        "min" : 1
      },
      {
        "id" : "PractitionerRole.telecom.value",
        "path" : "PractitionerRole.telecom.value",
        "min" : 1
      }
    ]
  }
}

```
