This Section describes the expected capabilities of the PACIO Advance Directive Interoperability (ADI) Server actor which is responsible for providing responses to the queries submitted by the ADI Requestors.

There are two primary vehicles in which Advance Directive Information can be conveyed: DocumentReference and Bundle. Through a DocumentReference, the ADI may be encoded inside directly as content data or referred to through a content reference (pointing to the ADI included in a resource like Binary) or reference a Bundle with the type=document for FHIR encoded data. The resources referred to by the Composition in the document bundle include Patient, Observation,Goal, ServiceRequest, Organization, RelatedPerson, Consent, List, and Provenance.

Search by reference to a composition

Search by business identifier

Search by date in time

Search by type

Search by FHIR Resource ID

Search by who/what authenticated the document

Search by who and/or what authored the document

Search by categorization of document

Search by MIME type of the content, with charset etc.

Search by organization which maintains the document

Search by when this document reference was created

Search by human-readable description

Search by encounter reference

Search by main clinical acts documented

Search by kind of facility where patient was seen

Search by format code content rules for the document

Search by FHIR Resource ID

Search by business identifier of the attachment binary

Search by human language of the content (BCP-47)

Search by uri where the data can be found

Search by who/what is the subject of the document

Search by time of service that is being documented

Search by related identifier or resource

Search by target of the relationship

Search by document security-tags

Search by additional details about where the content was created (e.g. clinical specialty)

Search by who/what is the subject of the document

Search by kind of document

This abstract profile defines constraints that represent common administrative and demographic concepts for advance directives information used in US Realm clinical documents.

This profile is used to represent the author’s thoughts about autopsy.

Care Experience Preference is a clinical statement that presents the author’s personal thoughts about something a person feels is relevant to their care experience and may be pertinent when planning their care.

This profile defines constraints that represent the information needed to register an advance directive information document on a FHIR server.

This profile is used to indicate if additional advance directive documents, such as physician order for life sustaining treatment (MOLST or POLST) or Do Not Resuscitate Order (DNR) exist and a reference to the document.

This profile represents a person participating as a notary for a person’s advance directives.

This profile is used to represent the author’s thoughts about organ donation.

This profile is used to represent a practitioner authored portable medical order additional requests or instructions.

This profile is used to represent a practitioner authored portable medical order for cardiopulmonary resuscitation.

This profile is used to represent a practitioner authored portable medical order for initial treatment.

This profile is used to represent a practitioner authored portable medical order for medically assisted nutrition.

This profile is used to represent that there are no other portable medical order additional requests or instructions.

This profile is used to represent the portable medical orders participant observation.

This profile is used to represent the review status of the portable medical order.

This profile represents a person participating in a person’s advance directives in some capacity such as healthcare agent or healthcare agent advisor.

This profile is used to represent a consent for an advance directive participant such as a healthcare agent or advisor and power or limitation granted to such persons.

This profile encompasses information that makes up the author’s advance care information plan.

This profile is a statement that presents the author’s personal health and treatment goals that are pertinent when planning their care.

Personal Priorities Organizer is used to represent a set of personal goals, preferences or care experiences in a preferred ranked order.

The Portable Medical Order Care Plan.

This profile encompasses information that makes up a practitioner’s portable medical order.

This profile is used to represent a finding that the individual is under hospice care.

The Preference Care Plan is a means for an individual to express their goals and preferences under certain circumstances that may be pertinent when planning his or her care.

Advance Directive Interoperability Provenance based on US Core to capture, search and fetch provenance information associated with advance directive interoperability data.

This profile is used to represent both a patient authored care plan (PACP) and a practitioner authored portable medical order (PMO).

This profile represents a person participating as a witness for a person’s advance directives.

This profile is used to represent a personal preference for a type of medical intervention (treatment) request under certain conditions.

A clause or set of clauses relevant to the resource or element being extended

Data Enterer Extension represents the person who transferred the content, written or dictated, into the Advance Directive document. To clarify, an author provides the content, subject to their own interpretation; a dataEnterer adds an author’s information to the electronic system.

The Advance Directive document effective dates.

The Enclosed Precondition Extension allows for a precondition to be applied to an advance directive observation or goal. When applied to Goal instance, the stated goal only applies if the precondition is met. For example, the precondition ‘If I am so sick or seriously injured that I cannot express my own medical treatment preferences’ could be applied to the patient’s goal of ‘Avoiding prolonged dependence on machines’. When applied to an Observation instance, it is important to note that the precondition applies only to the preference expressed within the observation, not to the observation itself, since the act of recording the preference as an observation has already been done. For example, the precondition ‘If I am nearing end of life’ could be applied to the preference ‘Please attempt to notify someone from my religion at the following number…’ recorded within an observation.

Indicates if the goals are ordered in descending priority (Y) or no specific order (N).

The Advance Directive Information Informant Extension describes an information source for any content within the Advance Directive document. This informant is constrained for use when the source of information is an assigned health care provider for the patient.

Jurisdiction for which content is applicable.

The Notary Information Extension allows for the capture of information relevant to the notary.

The Advance Directive Information Participant Extension identifies supporting entities, including parents, relatives, caregivers, insurance policyholders, guarantors, and others related in some way to the patient. A supporting person or organization is an individual or an organization with a relationship to the patient. A supporting person who is playing multiple roles would be recorded in multiple participants (e.g., emergency contact and next-of-kin).

The Advance Directive Information Performer Extension represents clinicians who actually and principally carry out the clinical services being documented. In a transfer of care this represents the healthcare providers involved in the current or pertinent historical care of the patient. Preferably, the patients key healthcare care team members would be listed, particularly their primary physician and any active consulting physicians, therapists, and counselors.

Advance Directive Information VersionNumber Extension represents a numeric value used to version successive replacement documents.

Codes indicating a role of an attester.

Codes indicating type of advance directive consents.

Types of Documents

Codes indicating decisions a healthcare agent may or may not make on behalf of an individual.

Clinical Focus: This value set includes concepts representing an individual’s intervention preferences which can be expressed by the individual in his or her advance care plan.),(Data Element Scope: The intent of this value set is to identify personal intervention preferences that may be relevant and could be considered by clinicians or any person or organization that is providing care, treatment, or performing any other type of act to or on behalf of the individual.)

LOINC POLST CPR Answer List (LL6263-9)

LOINC POLST Initial Tx Answer List (LL6264-7)

LOINC POLST Med assist nutr Answer List (LL6267-0)

LOINC POLST discuss part Answer List (LL6266-2)

LOINC POLST review Answer List (LL6265-4)

Includes data absent reason concepts to express why a Healthcare Agent is not included.

Clinical Focus: A personal or legal relationship records the role of a person in relation to another person, or a person to himself or herself. This value set is to be used when recording relationships based on personal or family ties or through legal assignment of responsibility.

Codes indicating Categories of Portable Medical Orders.

Advance Directive Preference Category

Codes indicating decisions a healthcare agent may or may not make on behalf of an individual.

Example Patient Smith-Johnson Preference Care Plan 2

Example Patient Smith-Johnson Preference Care Plan 3

Example Patient McBee Preference Care Plan 1

Example Patient Smith-Johnson Preference Care Plan 1

Example Patient McBee Care ADI Notary

Example Patient McBee Care ADI Witness

Example Patient McBee Autopsy Observation (Thoughts Regarding Autopsy)

Example Patient McBee ADI Document Bundle McBee 1

Example Patient McBee Care Experience Preference (My Joys)

Example Patient McBee Care Experience Preference (How to care for me)

Example Patient McBee Care Experience Preference (Religious affiliation contact)

Example Patient McBee Care Experience Preference (My unfinished business)

Example Patient McBee Healthcare Agent (Sally Bobbins)

Example Patient McBee Healthcare Agent (S. Leonard Susskind)

Example Patient McBee Healthcare Agent Consent

Example Patient McBee Organ Donation Observation 1

Example Patient McBee Assembler Organization

Example Patient McBee Custodian Organization

Example Patient McBee Provenance

Example Patient McBee Patient Example 1

Example Patient McBee Personal Goal 1

Example Patient McBee Personal Goal 2

Example Patient McBee Personal Goal 3

Example Patient McBee Personal Goal 4

Example Patient McBee Personal Goal 5

Example Patient McBee Personal Goal 6

Example Patient McBee Personal Goal 7

Example Patient McBee Personal Intervention Preference (Palliative Care)

Example Patient McBee Personal Intervention Preference (Terminal Illness Health Deterioration)

Example Patient McBee Personal Intervention Preference (Artificial Nutrition and Hydration)

Example Patient McBee Personal Intervention Preference (Severe Illness or Injury)

Example Patient McBee Personal Intervention Preference (Thoughts on CPR 1)

Example Patient McBee Personal Intervention Preference (THoughts on CPR 2)

Example Patient McBee Personal Intervention Preference (Preferred Location for Last Days)

Example Patient McBee Personal Intervention Preference (Death arrangements)

Example Patient Smith-Johnson Autopsy Observation (Thoughts Regarding Autopsy)

Example Patient Smith-Johnson ADI Document Bundle Smith-Johnson 1

Example Patient Smith-Johnson Care Experience Preference (Role of Religion)

Example Patient Smith-Johnson Care Experience Preference (My Likes and Joys)

Example Patient Smith-Johnson Care Experience Preference (My Dislikes and Fears)

Example Patient Smith-Johnson Care Experience Preference (How to Care for Me)

Example Patient Smith-Johnson Care Experience Preference (My Religion)

Example Patient Smith-Johnson Care Experience Preference (Religious Contact)

Example Patient Smith-Johnson Care Experience Preference (Religious Contact)

Example Patient Smith-Johnson Care Experience Preference (Religious Contact)

Example Patient Smith-Johnson DocumentReference Bundle

Example Patient Smith-Johnson DocumentReference Device

Example Patient Smith-Johnson DocumentReference

Example Patient Smith-Johnson PMOLST Documentation Observation

Example Patient Smith-Johnson Healthcare Agent (Charles Johnson)

Example Patient Smith-Johnson Healthcare Agent (Debra Johnson)

Example Patient Smith-Johnson Healthcare Agent Consent

Example Patient Smith-Johnson Notary

Example Patient Smith-Johnson Organ Donation Observation 1

Example Patient Smith-Johnson Assembler Organization

Example Patient Smith-Johnson Custodian Organization

Example Patient Smith-Johnson Provenance

Example Patient Smith-Johnson Patient Example 1

Example Patient Smith-Johnson Personal Goal 1

Example Patient Smith-Johnson Personal Goal 2

Example Patient Smith-Johnson Personal Goal 3

Example Patient Smith-Johnson Personal Intervention Preference (Significant Pain or Suffering)

Example Patient Smith-Johnson Personal Intervention Preference (Specific Circumstance)

Example Patient Smith-Johnson Personal Intervention Preference (Mental Illness Deterioration)

Example Patient Smith-Johnson Personal Intervention Preference (Severe Irreversible Brain Injury or Illness)

Example Patient Smith-Johnson Personal Intervention Preference (Final Days Location)

Example Patient Smith-Johnson Personal Intervention Preference (Death Arrangements)

Example Patient McBee Personal Priorities Organizer

Example Patient Smith-Johnson Personal Advance Care Plan Composition Example 1

Example Patient McBee Personal Advance Care Plan Composition Example 1

Example Patient Smith-Johnson Personal Priorities Organizer

Extended example: example practitioner