QI-Core Implementation Guide: STU 4 (v4.0.0 for FHIR 4.0.0)

QI-Core Implementation Guide, Clinical Quality Improvement WG - CI build for vesion 4.0.0). This version is based on the current content of https://github.com/cqframework/qi-core/ and changes regularly. See the Directory of published versions

D.4.1.4 StructureDefinition: - Detailed Descriptions

Definitions for the StructureDefinition-qicore-communication Profile.

1. Communication
Definition

An occurrence of information being transmitted; e.g. an alert that was sent to a responsible provider, a public health agency that was notified about a reportable condition.

Control0..*
InvariantsDefined on this element
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (: text.div.exists())
2. Communication.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typeid
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

3. Communication.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Control0..1
TypeMeta
4. Communication.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Control0..1
Typeuri
Is Modifiertrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

5. Communication.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language.
The codes SHOULD be taken from CommonLanguages
Max Binding: AllLanguages
Typecode
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

6. Communication.text
Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

7. Communication.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

8. Communication.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

9. Communication.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

10. Communication.identifier
Definition

Business identifiers assigned to this communication by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Requirements

Allows identification of the communication as it is known by various participating systems and in a way that remains consistent across servers.

Comments

This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

11. Communication.instantiatesCanonical
Definition

The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication.

Control0..*
Typecanonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire)
12. Communication.instantiatesUri
Definition

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication.

Control0..*
Typeuri
Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

13. Communication.basedOn
Definition

An order, proposal or plan fulfilled in whole or in part by this Communication.

Control0..*
TypeReference(Resource)
Alternate Namesfulfills
Comments

This must point to some sort of a 'Request' resource, such as CarePlan, CommunicationRequest, ServiceRequest, MedicationRequest, etc.

14. Communication.partOf
Definition

Part of this action.

Control0..*
TypeReference(Resource)
Alternate Namescontainer
15. Communication.inResponseTo
Definition

Prior communication that this communication is in response to.

Control0..*
TypeReference(Communication)
16. Communication.status
Definition

The status of the transmission.

Control1..1
BindingThe status of the communication.
The codes SHALL be taken from EventStatus
Typecode
Is Modifiertrue
Must Supporttrue
Comments

This element is labeled as a modifier because the status contains the codes aborted and entered-in-error that mark the communication as not currently valid.

17. Communication.statusReason
Definition

Captures the reason for the current state of the Communication.

Control0..1
BindingCodes for the reason why a communication did not happen.
For example codes, see CommunicationNotDoneReason
TypeCodeableConcept
Must Supporttrue
Alternate NamesSuspended Reason, Cancelled Reason
Comments

This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.

18. Communication.category
Definition

The type of message conveyed such as alert, notification, reminder, instruction, etc.

Control0..*
BindingCodes for general categories of communications such as alerts, instructions, etc.
For example codes, see CommunicationCategory
TypeCodeableConcept
Must Supporttrue
Comments

There may be multiple axes of categorization and one communication may serve multiple purposes.

19. Communication.priority
Definition

Characterizes how quickly the planned or in progress communication must be addressed. Includes concepts such as stat, urgent, routine.

Control0..1
BindingCodes indicating the relative importance of a communication.
The codes SHALL be taken from RequestPriority
Typecode
Comments

Used to prioritize workflow (such as which communication to read first) when the communication is planned or in progress.

Meaning if MissingIf missing, this communication should be treated with normal priority
20. Communication.medium
Definition

A channel that was used for this communication (e.g. email, fax).

Control0..*
BindingCodes for communication mediums such as phone, fax, email, in person, etc.
For example codes, see v3 Code System ParticipationMode
TypeCodeableConcept
Must Supporttrue
21. Communication.subject
Definition

The patient or group that was the focus of this communication.

Control0..1
TypeReference(QICorePatient | Group)
Must Supporttrue
Alternate Namespatient
22. Communication.topic
Definition

Description of the purpose/content, similar to a subject line in an email.

Control0..1
BindingCodes describing the purpose or content of the communication.
For example codes, see CommunicationTopic
TypeCodeableConcept
Comments

Communication.topic.text can be used without any codings.

23. Communication.about
Definition

Other resources that pertain to this communication and to which this communication should be associated.

Control0..*
TypeReference(Resource)
Comments

Don't use Communication.about element when a more specific element exists, such as basedOn or reasonReference.

24. Communication.encounter
Definition

The Encounter during which this Communication was created or to which the creation of this record is tightly associated.

Control0..1
TypeReference(QICoreEncounter)
Must Supporttrue
Comments

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

25. Communication.sent
Definition

The time when this communication was sent.

Control0..1
TypedateTime
Must Supporttrue
26. Communication.received
Definition

The time when this communication arrived at the destination.

Control0..1
TypedateTime
Must Supporttrue
27. Communication.recipient
Definition

The entity (e.g. person, organization, clinical information system, care team or device) which was the target of the communication. If receipts need to be tracked by an individual, a separate resource instance will need to be created for each recipient. Multiple recipient communications are intended where either receipts are not tracked (e.g. a mass mail-out) or a receipt is captured in aggregate (all emails confirmed received by a particular time).

Control0..*
TypeReference(QICoreDevice | QICoreOrganization | QICorePatient | QICorePractitioner | QICoreRelatedPerson | Group)
Must Supporttrue
28. Communication.sender
Definition

The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication.

Control0..1
TypeReference(QICoreDevice | QICoreOrganization | QICorePatient | QICorePractitioner | QICoreRelatedPerson)
Must Supporttrue
29. Communication.reasonCode
Definition

The reason or justification for the communication.

Control0..*
BindingCodes for describing reasons for the occurrence of a communication.
For example codes, see SNOMEDCTClinicalFindings
TypeCodeableConcept
Must Supporttrue
Comments

Textual reasons can be captured using reasonCode.text.

30. Communication.reasonReference
Definition

Indicates another resource whose existence justifies this communication.

Control0..*
TypeReference(Condition | Observation | DiagnosticReport | DocumentReference)
31. Communication.payload
Definition

Text, attachment(s), or resource(s) that was communicated to the recipient.

Control0..*
TypeBackboneElement
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
32. Communication.payload.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
33. Communication.payload.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

34. Communication.payload.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

35. Communication.payload.content[x]
Definition

A communicated content (or for multi-part communications, one portion of the communication).

Control1..1
TypeChoice of: string, Attachment, Reference(Resource)
[x] NoteSee Choice of Data Types for further information about how to use [x]
36. Communication.note
Definition

Additional notes or commentary about the communication by the sender, receiver or other interested parties.

Control0..*
TypeAnnotation