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

## Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

### Behavior: Capability Statements

The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.

ADI CapabilityStatement | 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.

### Behavior: Search Parameters

These define the properties by which a RESTful server can be searched. They can also be used for sorting and including related resources.

Bundle-composition | Search by reference to a composition
Bundle-identifier | Search by business identifier
Bundle-timestamp | Search by date in time
Bundle-type | Search by type
Consent-id | Search by FHIR Resource ID
DocumentReference-authenticator | Search by who/what authenticated the document
DocumentReference-author | Search by who and/or what authored the document
DocumentReference-category | Search by categorization of document
DocumentReference-contenttype | Search by MIME type of the content, with charset etc.
DocumentReference-custodian | Search by organization which maintains the document
DocumentReference-date | Search by when this document reference was created
DocumentReference-description | Search by human-readable description
DocumentReference-encounter | Search by encounter reference
DocumentReference-event | Search by main clinical acts documented
DocumentReference-facility | Search by kind of facility where patient was seen
DocumentReference-format | Search by format code content rules for the document
DocumentReference-id | Search by FHIR Resource ID
DocumentReference-identifier | Search by business identifier of the attachment binary
DocumentReference-language | Search by human language of the content (BCP-47)
DocumentReference-location | Search by uri where the data can be found
DocumentReference-patient | Search by who/what is the subject of the document
DocumentReference-period | Search by time of service that is being documented
DocumentReference-related | Search by related identifier or resource
DocumentReference-relatesto | Search by target of the relationship
DocumentReference-relation |
Search by relation code (replaces | transforms | signs | appends)
DocumentReference-security-label | Search by document security-tags
DocumentReference-setting | Search by additional details about where the content was created (e.g. clinical specialty)
DocumentReference-status |
Search by document reference status code (current | superseded | entered-in-error)
DocumentReference-subject | Search by who/what is the subject of the document
DocumentReference-type | Search by kind of document

### Structures: Abstract Profiles

These are profiles on resources or data types that describe patterns used by other profiles, but cannot be instantiated directly. I.e. instances can conform to profiles based on these abstract profiles but do not declare conformance to the abstract profiles themselves.

ADI Composition Header | This abstract profile defines constraints that represent common administrative and demographic concepts for advance directives information used in US Realm clinical documents.
ADI Healthcare Agent Consent | This profile is used to represent a delegation of rights consent for healthcare related decision-making. The Perm Consent enables the patient to delegate the typical powers of a durable medical power of attorney to one or more healthcare agents which may be in a prioritized order (primary, secondary, tertiary) or simply may be designated as healthcare agents to act as an authorized personal representative for the patient in circumstances where the patient is not able to communicate. The ADI Healthcare Agent Consent Deny Profile may be used in conjunction to constrain the powers granted through the permit. The authorized personal representative appointed as healthcare agents are referenced from the Consent Resource via the actor.reference where the actor.code indicates the healthcare agent role
ADI PMO ServiceRequest | This profile is used to represent both a patient authored care plan (PACP) and a practitioner authored portable medical order (PMO).

### Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

ADI Autopsy Observation | This profile is used to represent the author's thoughts about autopsy.
ADI Bundle | The ADI Bundle profile is used to represent a collection of resources that are related to advance directives information.
ADI Decisional Capacity | This profile is used to represent a patient's decisional capacity for medical decision-making.
ADI Document Reference | This profile defines constraints that represent the information needed to register an advance directive information document on a FHIR server.
ADI Documentation Observation | 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.
ADI Facilitator | This profile represents a clinician who assists the patient in advance care planning services.
ADI Healthcare Agent Consent Deny | The ADI Healthcare Agent Consent Deny profile is used to constrain the powers permitted for the healthcare agent appointment through the ADI Healthcare Agent Consent Permit profile.
ADI Healthcare Agent Consent Permit | This profile is used to represent permit consents for an advance directive participant such as a healthcare agent or advisor and power or limitation granted to such persons.
ADI Healthcare Agent Participant | A person represented using the ADI Healthcare Agent Profile and referenced from the ADI Healthcare Agent Consent Permit profile is appointed by the patient as an Authorized Personal Representative permitted the typical or jurisdictionally recognized powers granted to the role of healthcare agent. The person’s specific healthcare agent role, i.e. healthcare agent, primary healthcare agent, secondary healthcare agent, tertiary healthcare agent are specific within the ADI Healthcare Agent Consent Permit profile, and may be constrained through a nested ADI Healthcare Agent Consent Deny profile.
ADI Jurisdiction | The ADI Jurisdiction Observation profile includes information about the state jurisdiction of the source advance healthcare directive document. The observation.value (codeableConcept) holds the two letter abbreviation of the relevant state which accepts this form. A valueString can be used to hold the name of a form that may be accepted in multiple states such as the 'National POLST Form', 'American Bar Association Power of Attorney Form'.
ADI Minimal Source Form | This profile represents the essential information from an ADI source form, designed for new implementers without database data processing capabilities.
ADI Notary | This profile represents a person participating as a notary for a person's advance directives.
ADI Organ Donation | This profile is used to represent the author's thoughts about organ donation.
ADI PMO Additional orders or instructions ServiceRequest | This profile is used to represent a practitioner authored portable medical order additional orders or instructions.
ADI PMO Cardiopulmonary Resuscitation ServiceRequest | This profile is used to represent a practitioner authored portable medical order for cardiopulmonary resuscitation.
ADI PMO Care Plan | The Portable Medical Order Care Plan.
ADI PMO Composition | This profile encompasses information that makes up a practitioner's portable medical order.
ADI PMO Hospice Observation | This profile is used to represent a finding that the individual is under hospice care.
ADI PMO Initial Treatment ServiceRequest | This profile is used to represent a practitioner authored portable medical order for initial treatment.
ADI PMO Medically Assisted Hydration Service Request | This profile is used to represent a practitioner authored portable medical order for medically assisted hydration.
ADI PMO Medically Assisted Nutrition Service Request | This profile is used to represent a practitioner authored portable medical order for medically assisted nutrition.
ADI PMO Participant Observation | This profile is used to represent the portable medical orders participant observation.
ADI PMO Procedure | This profile is used to represent both a practitioner authored portable medical order (PMO) procedure. This supports a POLST indication that there was another healthcare facilitator that was an intermediary.
ADI PMO Review Observation | This profile is used to represent the review status of the portable medical order.
ADI Personal Goal | This profile is a statement that presents the author's personal health and treatment goals that are pertinent when planning their care.
ADI Personal Priorities Organizer | Personal Priorities Organizer is used to represent a set of personal goals, preferences or care experiences in a preferred ranked order.
ADI Provenance | Information-sharing provenance for use in 2 scenarios: 1) finding out who retrieved the ADI information when captured and 2) who fetched and sent the provenance information associated with advance directive interoperability data.
ADI PtAuthored Care Experience Preference | 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.
ADI PtAuthored Care Plan | 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.
ADI PtAuthored Composition | This profile encompasses information that makes up the author’s advance care information plan.
ADI PtAuthored Personal Intervention Preference | This profile is used to represent a personal preference for a type of medical intervention (treatment) request under certain conditions.
ADI Upon Death Preferences | This profile is used to represent the author's thoughts about preferences upon death.
ADI Witness | This profile represents a person participating as a witness for a person's advance directives.

### Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide.

ADI Care Plan Condition Codes | Indicates hypothetical conditions that indicate when a CarePlan should be considered and not be confused with conditions a patient has, has had, is suspected of having or is at any sort of risk of having.
ADI Expiration Date | The Advance Directive document expiration date. The start date is represented by the Composition.date element.
Clause | A clause or set of clauses relevant to the resource or element being extended
Data Enterer | 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.
Document Location | The Advance Directive document location. This location is the endpoint URL that points to the ADI document or resource that exists or a string.
Enclosed Precondition | 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.
Goal Order by Descending Priority | Indicates if the goals are ordered in descending priority (Y) or no specific order (N).
Informant | 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 | Jurisdiction for which content is applicable. Represent state jurisdictions as a codeableConcept using the 2-letter state value set, and organization jurisdictions as a string value.
Notary Information | The Notary Information Extension allows for the capture of information relevant to the notary.
Participant | 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).
Performer | 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.
Revoke Status | The Advance Directive document revoke status.
Version Number | Advance Directive Information VersionNumber Extension represents a string using the dateTime of the document to version successive replacement documents.

### Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

ADI Composition Status | a document status backported from the FHIR R5 Composition status.
ADI Document Reference Status | a document status backported from the FHIR R5 Document Reference Status.
ADI Document Revoke Status | a document status backported from the FHIR R5 Composition status version which supports the revoked document use case.
Attester Role | Codes indicating a role of an attester.
Documentation Types | Types of Documents
Healthcare Agent Decisions | Codes indicating decisions a healthcare agent may or may not make on behalf of an individual.
Initial Treatment Portable Medical Order Options | Initial Treatment Portable Medical Order Options.
Intervention Preferences - Ordinal | 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 | LOINC POLST CPR Answer List (LL6263-9)
LOINC POLST Initial Tx Answer List | LOINC POLST Initial Tx Answer List (LL6264-7)
LOINC POLST Med assist nutr Answer List | LOINC POLST Med assist nutr Answer List (LL6267-0)
LOINC POLST discuss part List | LOINC POLST discuss part Answer List (LL6266-2)
LOINC POLST review Answer List | LOINC POLST review Answer List (LL6265-4)
Medically Assisted Hydration Order | Medically Assisted Hydration Order.
Medically Assisted Hydration Order Grouping | Medically Assisted Hydration Order Grouping.
No Healthcare Agent Included Reason | Includes data absent reason concepts to express why a Healthcare Agent is not included.
Personal And Legal Relationship Role Type | 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.
Portable Medical Order Categories | Codes indicating Categories of Portable Medical Orders.

### Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

ADI Goal Category Code System | Advance Directive Preference Category
ADI Revoke Status Code System | Advance Directive Revoke Status
ADI Temporary Code System | Codes to be used as placeholders until they have a formal assigned code from a recognized terminology steward
Healthcare Agent Decision Codes | Codes indicating decisions a healthcare agent may or may not make on behalf of an individual.

### Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

ADI-Facilitator-MSW-MargaretReynolds | Margaret A. Reynolds' Facilitator Role
Care Plan for Cerebrovascular accident | Example Patient Smith-Johnson PMO Care Plan 1
Care Plan for Permanent, severe brain damage | Example Patient Smith-Johnson Preference Care Plan 2
Care Plan for Terminal illness, lack of meaningful interaction | Example Patient Smith-Johnson Preference Care Plan 3
Care Plan for Unconscious, vegetative state, coma for Smith-Johnson | Example Patient Smith-Johnson Preference Care Plan 1
Example-Kyle-Anydoc-Practitioner | Example of Practitioner for PMO Composition Example 1
Example-Kyle-Anydoc-PractitionerRole1 | Example of PractitionerRole for PMO Composition Example 1
Example-Smith-Johnson-ADIJurisdiction1 | Example Patient Smith-Johnson Jurisdiction Example
Example-Smith-Johnson-ADINotary2 | Example Patient Smith-Johnson ADI Notary (Nancy Smith)
Example-Smith-Johnson-ADIPMOParticipantObservation1 | Example Patient Smith-Johnson PMO Participant Observation
Example-Smith-Johnson-ADIPMOProcedure1 | Example Patient Smith-Johnson PMO Procedure
Example-Smith-Johnson-ADIPMOReviewObservation1 | Example Patient Smith-Johnson PMO Review Observation
Example-Smith-Johnson-ADIWitness1 | Example Patient Smith-Johnson ADI Witness (Debra Johnson)
Example-Smith-Johnson-AutopsyObservation1 | Example Patient Smith-Johnson Autopsy Observation (Thoughts Regarding Autopsy)
Example-Smith-Johnson-CPR-ServiceRequest1 | Example of ADI PMO ServiceRequest
Example-Smith-Johnson-CareExperiencePreference1 | Example Patient Smith-Johnson Care Experience Preference (Role of Religion)
Example-Smith-Johnson-CareExperiencePreference2 | Example Patient Smith-Johnson Care Experience Preference (My Likes and Joys)
Example-Smith-Johnson-CareExperiencePreference3 | Example Patient Smith-Johnson Care Experience Preference (My Dislikes and Fears)
Example-Smith-Johnson-CareExperiencePreference4 | Example Patient Smith-Johnson Care Experience Preference (How to Care for Me)
Example-Smith-Johnson-CareExperiencePreference5 | Example Patient Smith-Johnson Care Experience Preference (My Religion)
Example-Smith-Johnson-CareExperiencePreference6 | Example Patient Smith-Johnson Care Experience Preference (Religious Contact)
Example-Smith-Johnson-CareExperiencePreference7 | Example Patient Smith-Johnson Care Experience Preference (Religious Contact)
Example-Smith-Johnson-CareExperiencePreference8 | Example Patient Smith-Johnson Care Experience Preference (Religious Contact)
Example-Smith-Johnson-DecisionalCapacity1 | Example Patient Smith-Johnson Decisional Capacity Observation
Example-Smith-Johnson-DocRef-Bundle | Example Patient Smith-Johnson DocumentReference Bundle
Example-Smith-Johnson-DocRef-Device1 | Example Patient Smith-Johnson DocumentReference Device
Example-Smith-Johnson-DocRef-DocumentReference | Example Patient Smith-Johnson DocumentReference
Example-Smith-Johnson-DocumentationObservation1 | Example Patient Smith-Johnson PMOLST Documentation Observation
Example-Smith-Johnson-DocumentationObservation2 | Example Patient Smith-Johnson PMOLST Documentation Observation
Example-Smith-Johnson-Endpoint1 | Betsy Smith-Johnson MHAD Endpoint Example
Example-Smith-Johnson-Endpoint2 | Betsy Smith-Johnson MHAD Composition Example
Example-Smith-Johnson-HealthcareAgent1 | Example Patient Smith-Johnson Healthcare Agent (Charles Johnson)
Example-Smith-Johnson-HealthcareAgent2 | Example Patient Smith-Johnson Healthcare Agent (Debra Johnson)
Example-Smith-Johnson-HealthcareAgent3 | Example Patient Smith-Johnson Healthcare Agent (Charles Johnson)
Example-Smith-Johnson-HealthcareAgentConsent | Example Patient Smith-Johnson Healthcare Agent Consent
Example-Smith-Johnson-HealthcareAgentConsent-Deny | Example of ADI Healthcare Agent Deny
Example-Smith-Johnson-HealthcareAgentConsent-Permit | Example of ADI Healthcare Agent Permit
Example-Smith-Johnson-HealthcareAgentConsent2 | Example Patient Smith-Johnson Healthcare Agent Consent
Example-Smith-Johnson-Notary1 | Example Patient Smith-Johnson Notary
Example-Smith-Johnson-Notary2 | Example Patient Smith-Johnson Notary
Example-Smith-Johnson-OrganDonationObservation1 | Example Patient Smith-Johnson Organ Donation Observation 1
Example-Smith-Johnson-OrganizationAssembler1 | Example Patient Smith-Johnson Assembler Organization
Example-Smith-Johnson-OrganizationCustodian1 | Example Patient Smith-Johnson Custodian Organization
Example-Smith-Johnson-PACP-Bundle1 | Example Patient Smith-Johnson ADI Document Bundle Smith-Johnson 1
Example-Smith-Johnson-PMOAdditionalOrdersServiceRequest1 | Example Patient Smith-Johnson PMO Additional Orders Service Request
Example-Smith-Johnson-PMOHospiceObservation1 | Example Patient Smith-Johnson PMO Hospice Observation
Example-Smith-Johnson-PMOHydrationServiceRequest1 | Example Patient Smith-Johnson PMO Medically Assisted Hydration Service Request
Example-Smith-Johnson-PMOInitialTreatmentServiceRequest1 | Example Patient Smith-Johnson PMO Initial Treatment Service Request
Example-Smith-Johnson-PMONutritionServiceRequest1 | Example Patient Smith-Johnson PMO Medically Assisted Nutrition Service Request
Example-Smith-Johnson-PMOProvenance1 | Example Patient Smith-Johnson Provenance
Example-Smith-Johnson-Patient1 | Example Patient Smith-Johnson Patient Example 1
Example-Smith-Johnson-PersonalGoal1 | Example Patient Smith-Johnson Personal Goal 1
Example-Smith-Johnson-PersonalGoal2 | Example Patient Smith-Johnson Personal Goal 2
Example-Smith-Johnson-PersonalGoal3 | Example Patient Smith-Johnson Personal Goal 3
Example-Smith-Johnson-PersonalInterventionPreference1 | Example Patient Smith-Johnson ADI PtAuthored Personal Intervention Preference (Significant Pain or Suffering)
Example-Smith-Johnson-PersonalInterventionPreference2 | Example Patient Smith-Johnson ADI PtAuthored Personal Intervention Preference (Specific Circumstance)
Example-Smith-Johnson-PersonalInterventionPreference3 | Example Patient Smith-Johnson ADI PtAuthored Personal Intervention Preference (Mental Illness Deterioration)
Example-Smith-Johnson-PersonalInterventionPreference4 | Example Patient Smith-Johnson ADI PtAuthored Personal Intervention Preference (Severe Irreversible Brain Injury or Illness)
Example-Smith-Johnson-PersonalInterventionPreference5 | Example Patient Smith-Johnson ADI PtAuthored Personal Intervention Preference (Final Days Location)
Example-Smith-Johnson-PersonalInterventionPreference6 | Example Patient Smith-Johnson ADI PtAuthored Personal Intervention Preference (Death Arrangements)
Example-Smith-Johnson-UponDeathPreference1 | Example Patient Smith-Johnson Upon Death Preference
Example-organization-good-health-clinic | Example Organization - Good Health Clinic
MHAD-Example-Smith-Johnson-Binary | Betsy Smith-Johnson MHAD Binary Example
MHAD-Example-Smith-Johnson-Bundle3 | Betsy Smith-Johnson MHAD Bundle Example
Mental Health Directive (Maryland) | Betsy Smith-Johnson MHAD Composition Example
PMO-Example-Smith-Johnson-Bundle2 | Example Patient Smith-Johnson PMO ADI Document Bundle Smith-Johnson 2
Personal Advance Care Plan | Example Patient Smith-Johnson Personal Advance Care Plan Composition Example 1
Portable Medical Order | Example Patient Smith-Johnson Personal Advance Care Plan Composition Example 1
Practitioner-MargaretReynolds | Margaret Q. Reynolds's practitioner record.
Priorities for Goals and Preferences | Example Patient Smith-Johnson Personal Priorities Organizer