Generated Narrative: StructureDefinition IHE.MHD.Minimal.Folder Name Flags Card. Type Description & Constraints List 0..* MhdList A list is a curated collection of resources #xD; meta #xD; profile 0..* canonical(StructureDefinition) Profiles this resource claims to conform to #xD; Slices for extension Content/Rules for all slices #xD; extension:designationType S 0..* DesignationType Clinical code of the List #xD; Slices for identifier 0..* Identifier Business identifier Slice: Unordered, Open by value:type #xD; identifier:uniqueId S 0..1 UniqueIdIdentifier Folder.uniqueId #xD; identifier:entryUUID S 0..1 EntryUUIDIdentifier Folder.entryUUID #xD; status 1..1 code current | retired | entered-in-error #xD; mode 1..1 code working | snapshot | changes Required Pattern: working #xD; title 0..1 string Descriptive name for the list #xD; code 1..1 CodeableConcept What the purpose of this list is Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: https://profiles.ihe.net/ITI/MHD/CodeSystem/MHDlistTypes #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: folder #xD; subject S 0..1 Reference(Patient) If all resources have the same subject(s) #xD; encounter 0..0 Context in which list created #xD; date 0..1 dateTime When the list was prepared #xD; source 0..0 Who and/or what defined the list contents (aka Author) #xD; orderedBy 0..0 What order the list has #xD; note 0..1 Annotation Comments about the list #xD; entry #xD; flag 0..0 Status/Workflow information about this item #xD; deleted 0..0 If this item is actually marked as deleted #xD; date 0..0 When item added to list #xD; item 1..1 Reference(DocumentReference) Actual entry #xD; emptyReason 0..0 Why list is empty #xD; Documentation for this format
IHE IT Infrastructure Technical Committee
A profile on the List resource for MHD use as a Folder with minimal metadata constraints. - MHD is based on the [IHE Document Sharing](https://profiles.ihe.net/ITI/HIE-Whitepaper/index.html) model, - the [3:4.1 Abstract Metadata Model](https://profiles.ihe.net/ITI/TF/Volume3/ch-4.1.html#4.1), and - the use defined here is FHIR List for use as a Folder implementation of the - ebRIM implementation at [3:4.2.3.4 Folder Attributes](https://profiles.ihe.net/ITI/TF/Volume3/ch-4.2.html#4.2.3.4). - with use-cases and constraints found in [3:4.3 Additional Document Sharing Requirements](https://profiles.ihe.net/ITI/TF/Volume3/ch-4.3.html#4.3)
A list is a curated collection of resources
A List is a curated collection of resources, for things such as problem lists, allergy lists, facility list, organization list, etc.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
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()
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
A list can only have an emptyReason if it is empty
XDS Folder: Used in the context of the IHE MHD ImplementationGuide
Entity, Role, or Act,Act[classCode<ORG,moodCode=EVN]
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.
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.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
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 managable, 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.
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.
Must have either extensions or value[x], not both
The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
When the resource last changed - e.g. when the version changed.
This element is generally omitted in instances submitted in a PUT or POST. Instead, it is populated in the response instance and when retrieving information using a GET. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http://hl7.org/fhir/R5/http.html#read) interaction.
Identifies where the resource comes from
A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R5/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
The exact use of the source (and the possible implied Provenance.entity.role and agent.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. The source may correspond to Provenance.entity.what[x] or Provenance.agent.who[x], though it may be a more general or abstract reference. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
Profiles this resource claims to conform to
A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R5/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R5/structuredefinition-definitions.html#StructureDefinition.url).
It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
Security Labels applied to this resource
Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
Security Labels from the Healthcare Privacy and Security Classification System.
Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
A set of rules under which this content was created
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.
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 its narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
The base language in which the resource is written.
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).
Text summary of the resource, for human interpretation
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.
Contained resources do not have a 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.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
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.
Expresses contentType of submissionSet or the codeList of a Folder. Usually expressed in LOINC or SNOMED.
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifier for the List assigned for business purposes outside the context of FHIR.
SubmissionSet.uniqueId, SubmissionSet.entryUUID
The XDS UniqueId for the Folder. Globally unique identifier for the Folder.
The XDS entryUUID for the Folder. A globally unique identifier used to identify the XDS Folder entry in ebRIM.
Indicates the current state of this list.
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
How this list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted.
This element is labeled as a modifier because a change list must not be misunderstood as a complete list.
Lists are used in various ways, and it must be known in what way it is safe to use them.
If set to "changes", the list is considered incomplete, while the other two codes indicate the list is complete, which changes the understanding of the elements listed
The processing mode that applies to this list.
A label for the list assigned by the author.
Allows customization beyond just the code identifying the kind of list.
This code defines the purpose of the list - why it was created.
If there is no code, the purpose of the list is implied where it is used, such as in a document section using Document.section.code.
Lists often contain subsets of resources rather than an exhaustive list. The code identifies what type of subset is included.
If all resources have the same subject(s)
The common subject(s) (or patient(s)) of the resources that are in the list if there is one (or a set of subjects).
Some purely arbitrary lists do not have a common subject, so this is optional. Lists having multiple subjects may raise challenges for systems that base access control or other security considerations on linkages to 'subject'. E.g. if a List is associated with multiple Patient subjects, then it would be nominally part of multiple patient compartments, which might drive access rights.
The primary purpose of listing the subject explicitly is to help with finding the right list.
.participation[typeCode<SUB].role (and sometimes .player)
The encounter that is the context in which this list was created.
inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
Date list was last reviewed/revised and determined to be 'current'.
The actual important date is the date of currency of the resources that were summarized, but it is usually assumed that these are current when the preparation occurs.
Identifies how current the list is which affects relevance.
Who and/or what defined the list contents (aka Author)
The entity responsible for deciding what the contents of the list were. Where the list was created by a human, this is the same as the author of the list.
The primary source is the entity that made the decisions what items are in the list. This may be software or user.
.participation[typeCode<AUT].role[classCode=REL].player[classCode=PSN,determinerCode=INST] or .participation[typeCode<AUT].role[classCode=REL].player[classCode=DEV,determinerCode=INST]
What order applies to the items in the list.
Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.
Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries.
What order applies to the items in a list.
.outboundRelationship[typeCode=COMP].sequenceNumber > 1
Comments that apply to the overall list.
If there are no entries in the list, an emptyReason SHOULD be provided.
Order has no meaning unless specifically asserted by List.orderedBy, in which case the List SHALL be interpreted as being ordered as specified by List.orderedBy.
.outboundRelationship[typeCode=COMP] or .participation[typeCode=SBJ]
Extensions that cannot be ignored even if unrecognized
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 managable, 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).
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](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Status/Workflow information about this item
The flag allows the system constructing the list to indicate the role and significance of the item in the list.
The flag can only be understood in the context of the List.code. If the flag means that the entry has actually been deleted from the list, the deleted element SHALL be true
This field is present to support various clinical uses of lists, such as a discharge summary medication list, where flags specify whether the medication was added, modified, or deleted from the list.
Codes that provide further information about the reason and meaning of the item in the list.
If this item is actually marked as deleted
True if this item is marked as deleted in the list.
If the flag means that the entry has actually been deleted from the list, the deleted element SHALL be true. A deleted entry should be displayed in narrative as deleted. This element is labeled as a modifier because it indicates that an item is (to be) no longer in the list.
The flag element may contain codes that an application processing the list does not understand. However there can be no ambiguity if a list item is actually marked as "deleted".
List items are generally only treated as deleted when this element explicitly carries a value of true. Systems SHOULD always populate this value when mode is 'changes'
If deleted is true, then the item included in the list isn't actually part of the list anymore
added: .updateMode=("A","AR") retained: .updateMode="NC" updated: .updateMode="R" deleted: .updateMode="D"
The date may be significant for understanding the meaning of items in a working list.
A reference to the actual resource from which data was derived.
If the list is empty, why the list is empty.
The various reasons for an empty list make a significant interpretation to its interpretation. Note that this code is for use when the entire list has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.
Allows capturing things like "none exist" or "not asked" which can be important for most lists.