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.

This profile defines the base requirements for all ADI Goals.

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 he or she feels is relevant to his or her care experience and may be pertinent when planning his or her 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 is used to represent the author’s thoughts about organ donation.

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

This profile represents a person participating in a persons 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 is a statement that presents the author’s personal health and treatment goals that are pertinent when planning his or her care.

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

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

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.

The Attestation Information Extension allows for the capture of information relevant to the attestation.

The Advance Directive Information Authorization Extension contains the ADI Consent profile which represents information about a patient’s consents.

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

The Contextual Value Extension represents one or more values with a singular context.

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.

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.

The Information Recipient Extension records the intended recipient of the advance directive information at the time the document was created.

Jurisdiction for which content is applicable.

The Advance Directive Information Order Extension represents orders that are fulfilled by this document such as a radiologists report of an x-ray.

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.

Kinds of Advance Directives

This ValueSet is managed at the US National Library of Medicine (NLM) Value Set Authority Center (VSAC): https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.11.20.9.69.4/expansion

Codes indicating a role of an attester.

This value set includes concepts representing an individual’s care experience preferences at end of life 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 care experience preferences that may be relevant and could be considered by clinicians when making a treatment/care plan for the person.

This ValueSet is managed at the US National Library of Medicine (NLM) Value Set Authority Center (VSAC): https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1115.11/expansion

Type of clause

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 goals at end of life 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 goals that may be relevant and could be considered by clinicians when making a treatment/care plan for the person.),(Inclusion Criteria: Include member value sets for Health Goals at end of life for LOINC and SNOMED CT.),(Exclusion Criteria: None.

This ValueSet is managed at the US National Library of Medicine (NLM) Value Set Authority Center (VSAC): https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1115.7/expansion

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.)

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.)

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.)

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

Codes indicating information is regarding powers or limitations of a healthcare agent.

This value set identifies the relationship an advance directive participant has with the person the advance directive is about.

This value set identifies the role the advance directive participant has, which could include: healthcare agent, proxy, or advisor roles that individuals commonly designate to empower surrogates to make medical treatment and care decisions when the individual is unable to effectively communicate with medical personnel or requires assistance with decision making.

This ValueSet is managed at the US National Library of Medicine (NLM) Value Set Authority Center (VSAC): https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1046.35/expansion

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 specifying whether the presence of something exists or is unknown to exist.

This value set includes concepts representing an individual’s preferences of treatment.

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

Extended Advance Directive Participant Roles

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 Personal Advance Care Plan Composition Example 1

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 McBee Personal Priorities Organizer

Example Patient McBee Preference Care Plan 1

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 Binary Data Attachment

Example Patient Smith-Johnson DocumentReference Bundle

Example Patient Smith-Johnson DocumentReference Device

Example Patient Smith-Johnson DocumentReference 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 Organ Donation Observation 1

Example Patient Smith-Johnson Assembler Organization

Example Patient Smith-Johnson Custodian Organization

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

Example Patient Smith-Johnson Provenance

Example Patient Smith-Johnson Patient Example 1

Example Patient Smith-Johnson Personal Goal 1

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 Smith-Johnson Preference Care Plan 1

Example Patient Smith-Johnson Preference Care Plan 2

Example Patient Smith-Johnson Preference Care Plan 3