PACIO Advance Healthcare Directive Interoperability Implementation Guide
2.0.0-ballot - STU 2 – Ballot

PACIO Advance Healthcare Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/pacio-adi/ and changes regularly. See the Directory of published versions

## Change Log

Page standards status: Informative

### STU2 Ballot Release Notes

The following changes occurred since the PACIO ADI STU1 publication in January 2024

Support for new AD document types

- Provider-authored advance directives
  - Portable Medical Orders (PMO)
- Guidance on Mental Health Advance Directives (MHAD)
- Minimally Structured Document (MSD)

Changes to STU1 based profiles

- Closer Alignment with US Core
  - ADI Care Plan
- Specifying Jurisdictions and Healthcare Facilitators
- Specifying attester and facilitator signatures

Integrative use cases

- Integrative use cases and examples to demonstrate clearer use of the ADI profiles.

#### JIRA Fixes

##### Compatible, substantive Changes

- FHIR-34472: Add example of Binary encoded document bundle and digital signature
- FHIR-34473: Add Binary profile
- FHIR-35568: Defining URL should be anchored in THO not hl7.org/fhir. Only those with required binding to a 'code' data type should be anchored in hl7.fhir.org.8
- FHIR-35574: Defining URL should be anchored in THO not hl7.org/fhir.1
- FHIR-36168: Add requirement that servers support CapabilityStatement.instantiates pointing to the included CapabilityStatement
- FHIR-40285: Add Preference Observations for handling of body after death
- FHIR-40374: Add "If you have it send it" requirement to Conformance Requirements
- FHIR-40375: Add ability to express CodeableConcept in Preference CarePlan.addresses
- FHIR-40376: Add a means to provide a location to additional documentation
- FHIR-40561: Replace PADIConsentTypeVS with VSAC value set
- FHIR-42104: Remove ADI Preference Care Plan reference from the GPP Upon Death section
- FHIR-43143: Extensions are defined with context that is too broad
- FHIR-44912: Change Personal Intervention Preference code to directly link to VSAC URL
- FHIR-46062: versionNumber in ADI Composition and in DocumentReference should be a string
- FHIR-46149: Update Category Coding and Type coding
- FHIR-46151: Fix DocumentReference.date and DocumentReference.content.attachment.creation to hold the correct date information
- FHIR-46153: Add docRevokeStatus extension to support document revocation use cases
- FHIR-46154: Create an IG-based codeSystem for temp codes not yet granted by codeSystem Stewards
- FHIR-46312: Add Temporary Codes CodeSystem to the IG
- FHIR-46446: Add constraints on Attester for Person-Authored Composition Profile
- FHIR-46475: Add constraints on Attester for Provider-Authored Composition Profile
- FHIR-46609: PMO Composition event needs further constraints for facilitators
- FHIR-46771: Tighten constraint on ServiceRequest.intent in Profiles for entries in the Medical Orders Section
- FHIR-46912: Add support for expressing a Goal associated with an Initial Treatment Order
- FHIR-46913: Need for Temporary Codes and Temporary Value Sets
- FHIR-48856: HCA Appointment Consent needs to be grounded to LOINC 81377-4
- FHIR-48858: Clarify Guidance on how to represent an ADI facilitator
- FHIR-48898: ADI Composition Header relatesTo incorrectly references Composition. Should be DocumentReference
- FHIR-48899: ADI PMO CarePlan should be removed
- FHIR-48900: ADI Consent needs guidance for permit and deny
- FHIR-48928: Create an ADI minimally structured document
- FHIR-49808: Constrains need to be added to the Composition Profiles to make the attester element a Key element
- FHIR-49914: Update Portable Medical Order Categories
- FHIR-49981: PMO attester signature needs tighter specification and guidance
- FHIR-50122: PMO Composition should include an ADI Decisional Capacity entry under the Administration Information section
- FHIR-50126: ADI Personal Goal category type and description need further constraints
- FHIR-50896: Bundle needs a profile to constrain ADI-specific profiles and elements
- FHIR-51102: ADI Composition Header needs to specify expiration dates

##### Non-substantive Changes

- FHIR-34471: Add example of Document Bundle with internal identifiers of UUID
- FHIR-34806: it's really hard to understand the intended exchange patterns
- FHIR-36659: Add better description as to the use of Contextual Value Extension
- FHIR-40345: Consent Category binding should be on a slice
- FHIR-40377: Add guidance on document status
- FHIR-40378: Add more guidance on when to write vs update a document
- FHIR-40380: Change order of sections identified in PACP Composition
- FHIR-41491: Change reference of "Portable Medical Order for Life Sustaining Treatment" to "Portable Medical Order"
- FHIR-41493: Support search for various known ADI document by adding details
- FHIR-41638: Missing guidance on metadata for specifying CDA document attachments
- FHIR-41779: Add where the advance directive came from
- FHIR-42718: Better describe how to implement the five use cases
- FHIR-43185: Add behavioral healthcare agent as an additional human actor
- FHIR-43315: Include 'behavioral healthcare agents' as an additional 'Healthcare Agent'
- FHIR-44103: Typo: The second sentence in the second paragraph should read Content Type 1 instead of Content Type I.
- FHIR-46150: 2. VersionNumber extension will be populated with a timestamp created when document is created in the system
- FHIR-46158: Organize the Profiles in a more logical order for the reader
- FHIR-46480: Capability $match missing from the RESTful Capabilities by Profile table
- FHIR-46590: Example for DocumentReference with "DocumentReference.docStatus" = final
- FHIR-50124: Remove all must-support sections (except for Medical Orders) from PMO Composition
- FHIR-50125: Pt-Authored Composition Healthcare Agent Appointment section should be required

##### Non-compatible Changes

- FHIR-36712: Remove inheritance of US Core DocumentReference from ADI Profile of DocumentReference
- FHIR-36962: Missing guidance on DocumentReference instances
- FHIR-37987: Make changes to ADI Participant Consent profile
- FHIR-40283: Remove Jurisdiction extension for Composition and pre-adopt R5 Composition.relatesTo RelatedArtifact
- FHIR-40373: Change Advance Directive Category VS and add to Document Reference
- FHIR-40379: Correct codes in DocumentationTypeValueSet and Documentation Observation
- FHIR-48545: Modify "ADI Participant Consent" and "ADI Participant" profile names to make the purpose of the profiles more clear