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Patient Administration Work GroupMaturity Level: 5 Normative Compartments: Patient, Practitioner, RelatedPerson

Detailed Descriptions for the elements in the Patient resource.

Patient
Definition

Demographics and other administrative information about an individual or animal receiving care or other health-related services.

Control1..1
Requirements

Tracking patient is the center of the healthcare process.

Alternate NamesSubjectOfCare Client Resident
Patient.identifier
Definition

An identifier for this patient.

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

Patients are almost always assigned specific numerical identifiers.

Summarytrue
Patient.active
Definition

Whether this patient record is in active use.

Control0..1
Typeboolean
Is Modifiertrue (Reason: This element is labelled as a modifier because it is a status element that can indicate that a record should not be treated as valid)
Default Valuetrue
Requirements

Need to be able to mark a patient record as not to be used because it was created in error.

Summarytrue
Comments

Default is true. If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient This element is labeled as a modifier because when the patient record is marked as not active it is not expected to be used/referenced without being changed back to active.

Patient.name
Definition

A name associated with the individual.

Control0..*
TypeHumanName
Requirements

Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

Summarytrue
Comments

A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

Patient.telecom
Definition

A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

Control0..*
TypeContactPoint
Requirements

People have (primary) ways to contact them in some way such as phone, email.

Summarytrue
Comments

A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

Patient.gender
Definition

Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.

Control0..1
Terminology BindingAdministrativeGender (Required)
Typecode
Requirements

Needed for identification of the individual, in combination with (at least) name and birth date. Gender of individual drives many clinical processes.

Summarytrue
Comments

The gender might not match the biological sex as determined by genetics, or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than M and F, though the vast majority of systems and contexts only support M and F. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific gender aspect of interest (anatomical, chromosonal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosonal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overrideable error, not a "hard" error.

Patient.birthDate
Definition

The date of birth for the individual.

Control0..1
Typedate
Requirements

Age of the individual drives many clinical processes.

Summarytrue
Comments

At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternaty/infant care systems).

LOINC Code21112-8
Patient.deceased[x]
Definition

Indicates if the individual is deceased or not.

Control0..1
Typeboolean|dateTime
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifiertrue (Reason: Not known why this is labelled a modifier)
Requirements

The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

Summarytrue
Comments

If there's no value in the instance it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive. This element is labeled as a modifier because once a patient is marked as deceased, the actions that are appropriate to perform on the patient may be significantly different.

Patient.address
Definition

An address for the individual.

Control0..*
TypeAddress
Requirements

May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

Summarytrue
Comments

Patient may have multiple addresses with different uses or applicable periods.

Patient.maritalStatus
Definition

This field contains a patient's most recent marital (civil) status.

Control0..1
Terminology BindingMarital Status Codes (Extensible)
TypeCodeableConcept
Requirements

Most, if not all systems capture it.

Patient.multipleBirth[x]
Definition

Indicates whether the patient is part of a multiple (bool) or indicates the actual birth order (integer).

Control0..1
Typeboolean|integer
[x] NoteSee Choice of Data Types for further information about how to use [x]
Requirements

For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

Comments

Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a bool value was provided for this triplets example, then all 3 patient records would have valueBool=true (the ordering is not indicated).

Patient.photo
Definition

Image of the patient.

Control0..*
TypeAttachment
Requirements

Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.

Comments

Guidelines:

  • Use id photos, not clinical photos.
  • Limit dimensions to thumbnail.
  • Keep byte count low to ease resource updates.
Patient.contact
Definition

A contact party (e.g. guardian, partner, friend) for the patient.

Control0..*
Requirements

Need to track people you can contact about the patient.

Comments

Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

InvariantsDefined on this element
pat-1: SHALL at least contain a contact's details or a reference to an organization (expression : name.exists() or telecom.exists() or address.exists() or organization.exists(), xpath: exists(f:name) or exists(f:telecom) or exists(f:address) or exists(f:organization))
Patient.contact.relationship
Definition

The nature of the relationship between the patient and the contact person.

Control0..*
Terminology Bindingv2 Contact Role (Extensible)
TypeCodeableConcept
Requirements

Used to determine which contact person is the most relevant to approach, depending on circumstances.

Patient.contact.name
Definition

A name associated with the contact person.

Control0..1
TypeHumanName
Requirements

Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.

Patient.contact.telecom
Definition

A contact detail for the person, e.g. a telephone number or an email address.

Control0..*
TypeContactPoint
Requirements

People have (primary) ways to contact them in some way such as phone, email.

Comments

Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.

Patient.contact.address
Definition

Address for the contact person.

Control0..1
TypeAddress
Requirements

Need to keep track where the contact person can be contacted per postal mail or visited.

Patient.contact.gender
Definition

Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.

Control0..1
Terminology BindingAdministrativeGender (Required)
Typecode
Requirements

Needed to address the person correctly.

Patient.contact.organization
Definition

Organization on behalf of which the contact is acting or for which the contact is working.

Control0..1
TypeReference(Organization)
Requirements

For guardians or business related contacts, the organization is relevant.

InvariantsAffect this element
pat-1: SHALL at least contain a contact's details or a reference to an organization (expression : name.exists() or telecom.exists() or address.exists() or organization.exists(), xpath: exists(f:name) or exists(f:telecom) or exists(f:address) or exists(f:organization))
Patient.contact.period
Definition

The period during which this contact person or organization is valid to be contacted relating to this patient.

Control0..1
TypePeriod
Patient.animal
Definition

This patient is known to be an animal.

Control0..1
Is Modifiertrue (Reason: Not known why this is labelled a modifier)
Requirements

Many clinical systems are extended to care for animal patients as well as human.

Summarytrue
Comments

The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject declared animal records.

The absence of the animal element does not imply that the patient is a human. If a system requires such a positive assertion that the patient is human, an extension will be required. (Do not use a species of homo-sapiens in animal species, as this would incorrectly infer that the patient is an animal).

Patient.animal.species
Definition

Identifies the high level taxonomic categorization of the kind of animal.

Control1..1
Terminology BindingAnimalSpecies (Example)
TypeCodeableConcept
Requirements

Need to know what kind of animal.

Summarytrue
Comments

If the patient is non-human, at least a species SHALL be specified. Species SHALL be a widely recognised taxonomic classification. It might or might not be Linnaean taxonomy and might or might not be at the level of species. If the level is finer than species--such as a breed code--the code system used SHALL allow inference of the species. (The common example is that the word "Hereford" does not allow inference of the species Bos taurus, because there is a Hereford pig breed, but the SNOMED CT code for "Hereford Cattle Breed" does.).

Patient.animal.breed
Definition

Identifies the detailed categorization of the kind of animal.

Control0..1
Terminology BindingAnimalBreeds (Example)
TypeCodeableConcept
Requirements

May need to know the specific kind within the species.

Summarytrue
Comments

Breed MAY be used to provide further taxonomic or non-taxonomic classification. It may involve local or proprietary designation--such as commercial strain--and/or additional information such as production type.

Patient.animal.genderStatus
Definition

Indicates the current state of the animal's reproductive organs.

Control0..1
Terminology BindingGenderStatus (Example)
TypeCodeableConcept
Requirements

Gender status can affect housing and animal behavior.

Summarytrue
Patient.communication
Definition

A language which may be used to communicate with the patient about his or her health.

Control0..*
Requirements

If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency is an important things to keep track of both for patient and other persons of interest.

Comments

If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

Patient.communication.language
Definition

The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.

Control1..1
Terminology BindingCommon Languages (Extensible but limited to ??)
TypeCodeableConcept
Requirements

Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

Comments

The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

Patient.communication.preferred
Definition

Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).

Control0..1
Typeboolean
Requirements

People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.

Comments

This language is specifically identified for communicating healthcare information.

Patient.generalPractitioner
Definition

Patient's nominated care provider.

Control0..*
TypeReference(Organization | Practitioner | PractitionerRole)
Alternate NamescareProvider
Comments

This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disablity setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.

Patient.managingOrganization
Definition

Organization that is the custodian of the patient record.

Control0..1
TypeReference(Organization)
Requirements

Need to know who recognizes this patient record, manages and updates it.

Summarytrue
Comments

There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).

Patient.link
Definition

Link to another patient resource that concerns the same actual patient.

Control0..*
Is Modifiertrue (Reason: Not known why this is labelled a modifier)
Requirements

There are multiple usecases:

  • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
  • Distribution of patient information across multiple servers.
Summarytrue
Comments

There is no assumption that linked patient records have mutual links. This element is labelled as a modifier because it might not be the main Patient resource, and the referenced patient should be used instead of this Patient record. This is when the link.type value is 'replaced-by'.

Patient.link.other
Definition

The other patient resource that the link refers to.

Control1..1
TypeReference(Patient | RelatedPerson)
Summarytrue
Comments

Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

Patient.link.type
Definition

The type of link between this patient resource and another patient resource.

Control1..1
Terminology BindingLinkType (Required)
Typecode
Summarytrue