Generated Narrative: StructureDefinition ACP-TreatmentDirective Name Flags Card. Type Description & Constraints Consent 0..* NlcoreTreatmentDirective2 TreatmentDirective #xD; Slices for extension Content/Rules for all slices #xD; extension:comment O 0..1 ExtComment Optional Extensions Element Obligations Actor SHALL:populate-if-known ACP Actor Provider SHALL:no-error ACP Actor Consulter #xD; extension:additionalAdvanceDirective O 0..* ExtTreatmentDirective2AdvanceDirective Optional Extensions Element Obligations Actor SHALL:populate-if-known ACP Actor Provider SHALL:no-error ACP Actor Consulter #xD; value[x] 0..1 Reference(nl core AdvanceDirective) AdvanceDirective #xD; Slices for modifierExtension Content/Rules for all slices #xD; modifierExtension:specificationOther O 0..1 ExtTreatmentDirective2SpecificationOther Optional Extensions Element Obligations Actor SHALL:populate-if-known ACP Actor Provider SHALL:no-error ACP Actor Consulter #xD; value[x] 0..1 string SpecificationOther #xD; patient O 0..1 Reference(ACP Patient(1.0.0-rc2)) Who the consent applies to Obligations Actor SHALL:populate-if-known ACP Actor Provider SHALL:no-error ACP Actor Consulter #xD; dateTime O 0..1 dateTime MostRecentReviewDate Obligations Actor SHALL:populate-if-known ACP Actor Provider SHALL:no-error ACP Actor Consulter #xD; Slices for source[x] Content/Rules for all slices #xD; source[x]:sourceReference O 0..1 Reference(ACP AdvanceDirective(1.0.0-rc2)) AdvanceDirective Obligations Actor SHALL:populate-if-known ACP Actor Provider SHALL:no-error ACP Actor Consulter #xD; provision #xD; Slices for extension Content/Rules for all slices #xD; extension:reasonForEnding O 0..1 ExtTreatmentDirective2ReasonForEnding Optional Extensions Element Obligations Actor SHALL:populate-if-known ACP Actor Provider SHALL:no-error ACP Actor Consulter #xD; type O 0..1 code TreatmentDecision Obligations Actor SHALL:populate-if-known ACP Actor Provider SHALL:no-error ACP Actor Consulter #xD; period #xD; end O 0..1 dateTime DateExpired Obligations Actor SHALL:populate-if-known ACP Actor Provider SHALL:no-error ACP Actor Consulter #xD; Slices for actor Content/Rules for all slices #xD; actor:agreementParty O 0..* BackboneElement AgreementParty Obligations Actor SHALL:populate-if-known ACP Actor Provider SHALL:no-error ACP Actor Consulter #xD; reference 1..1 Reference(ACP Patient(1.0.0-rc2) | ACP HealthProfessional PractitionerRole(1.0.0-rc2) | ACP ContactPerson(1.0.0-rc2)) Patient / Representative / HealthProfessional #xD; code O 0..1 CodeableConcept Treatment Obligations Actor SHALL:populate-if-known ACP Actor Provider SHALL:no-error ACP Actor Consulter #xD; text O 0..1 string Plain text representation of the concept Obligations Actor SHALL:populate-if-known ACP Actor Provider SHALL:no-error ACP Actor Consulter #xD; Documentation for this format
A joint decision between a health professional (for example a general practitioner) and a patient or his representative(s) about the desirability of performing a certain treatment, such as resuscitation, before this treatment becomes (acute) necessary. Based on nl-core-TreatmentDirective2 and HCIM TreatmentDirective2.
Copyright and related rights waived via CC0, https://creativecommons.org/publicdomain/zero/1.0/. This does not apply to information from third parties, for example a medical terminology system. The implementer alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize third party IP in connection with the specification or otherwise.
A record of a healthcare consumer’s choices, which permits or denies identified recipient(s) or recipient role(s) to perform one or more actions within a given policy context, for specific purposes and periods of time.
A straightforward and accurate mapping of zib TreatmentDirective2 to FHIR is not possible. The main consideration is to choose between the Consent and CarePlan resource. Unfortunately, the Consent resource does not have full support for treatment directives yet as its main focus is to model Patient's privacy consents. Regardless, it seems to be the best match to represent the intention of the zib, as both the resource and the zib cover a mutual agreement about treatments and not per se the resulting actions or policy for treatments, which would better be handled using the CarePlan resource. Future migration to a later version of FHIR or the zib will result in the reevaluation of the mapping.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
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
exists(f:policy) or exists(f:policyRule)
IF Scope=privacy, there must be a patient
patient.exists() or scope.coding.where(system='something' and code='patient-privacy').exists().not()
exists(f:patient) or not(exists(f:scope/f:coding[f:system/@value='something' and f:code/@value='patient-privacy'])))
IF Scope=research, there must be a patient
patient.exists() or scope.coding.where(system='something' and code='research').exists().not()
exists(f:patient) or not(exists(f:scope/f:coding[f:system/@value='something' and f:code/@value='research'])))
patient.exists() or scope.coding.where(system='something' and code='adr').exists().not()
exists(f:patient) or not(exists(f:scope/f:coding[f:system/@value='something' and f:code/@value='adr'])))
IF Scope=treatment, there must be a patient
patient.exists() or scope.coding.where(system='something' and code='treatment').exists().not()
exists(f:patient) or not(exists(f:scope/f:coding[f:system/@value='something' and f:code/@value='treatment'])))
`extension.additionalAdvanceDirective` may only be used for AdvanceDirective references in addition to first reference in `.source[x]`.
extension.where(url = 'http://nictiz.nl/fhir/StructureDefinition/ext-TreatmentDirective2.AdvanceDirective').empty() or source.exists()
If the specificationOther extension is used, `.provision.type` MUST be absent and vice versa
(extension.where(url = 'http://nictiz.nl/fhir/StructureDefinition/ext-TreatmentDirective2.SpecificitionOther').exists() and provision.type.exists()).not()
Afspraak uitzetten ICD (BehandelAanwijzing)
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
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())
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 it's 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 it's 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 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, and nor can they have their own independent transaction scope.
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.
Additional content defined by implementations
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.
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
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Optional Extension Element - found in all resources.
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
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
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.
Source of the definition for the extension code - a logical name or a URL.
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
The comment may include further information such as the reason why a treatment directive has been drawn up, persons who assisted the patient in agreeing the treatment directive but who are not otherwise involved in the agreement as a representative, etc.
A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter.
`Consent.source:sourceReference` is the primary target for referencing zib AdvanceDirective (zib concept NL-CM:2.2.8). However, the cardinality of `Consent.source[x]` is restricted to `0..1`. If more than one AdvanceDirective needs to be referenced, the _additional_ references can be communicated using this extension. If this extension is used, `Consent.source:sourceReference` SHALL be populated and it SHALL not contain the same reference as this extension.
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).
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/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
This extension extends the options of _deny_ and _permit_ of `Consent.provision.type` with the opportunity to provide free text. The `Consent.provision` cannot be safely interpreted if the free text in this extension is omitted, hence the reason for labeling this extension as a modifier.
Afspraak uitzetten ICD (BehandelBesluit)
Specification of the treatment decision when the decision is 'Other'.
In addition to the default zib/nl-core guidance, this extension is used to communicate further details about agreements concerning ICD.
Identifier for this record (external references)
Unique identifier for this copy of the Consent Statement.
This identifier identifies this copy of the consent. Where this identifier is also used elsewhere as the identifier for a consent record (e.g. a CDA consent document) then the consent details are expected to be the same.
draft | proposed | active | rejected | inactive | entered-in-error
Indicates the current state of this consent.
This element is implicitly mapped to the zib concepts NL-CM:2.2.5 (MostRecentReviewDate) and NL-CM:2.2.6 (DateExpired). Unless the status is explicitly recorded, the following guidance applies: * When MostRecentReviewDate is in the past and DateExpired is absent or in the future, `.status` will usually be set to _active_. * When DateExpired is in the past, `.status` will usually be set to _inactive_. * When MostRecentReviewDate is absent or in the future, which is not possible following the zib, `.status` will usually be set to _draft_.
The Consent Directive that is pointed to might be in various lifecycle states, e.g., a revoked Consent Directive.
This element is labelled 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
MostRecentReviewDate (implicit, main mapping is on `Consent.dateTime`)
DateExpired (implicit, main mapping is on `Consent.provision.period.end`)
Which of the four areas this resource covers (extensible)
A selector of the type of consent being presented: ADR, Privacy, Treatment, Research. This list is now extensible.
Allows changes to codes based on scope selection
The four anticipated uses for the Consent Resource.
Classification of the consent statement - for indexing/retrieval
A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.
A classification of the type of consents found in a consent statement.
The patient/healthcare consumer to whom this consent applies.
Commonly, the patient the consent pertains to is the author, but for young and old people, it may be some other person.
The date on which the treatment directive has been agreed with the patient and / or his representative (s). This can be the first time that the treatment directive have been discussed, but an existing treatment directive may also have been discussed again. The content of the treatment directive may have changed or remained the same.
This is not the time of the original consent, but the time that this statement was made or derived.
Either the Grantor, which is the entity responsible for granting the rights listed in a Consent Directive or the Grantee, which is the entity responsible for complying with the Consent Directive, including any obligations or limitations on authorizations and enforcement of prohibitions.
Commonly, the patient the consent pertains to is the consentor, but particularly for young and old people, it may be some other person - e.g. a legal guardian.
The organization that manages the consent, and the framework within which it is executed.
The source on which this consent statement is based. The source might be a scanned original paper form, or a reference to a consent that links back to such a source, a reference to a document repository (e.g. XDS) that stores the original consent document.
The source can be contained inline (Attachment), referenced directly (Consent), referenced in a consent repository (DocumentReference), or simply by an identifier (Identifier), e.g. a CDA document id.
Field 19 Informational Material Supplied Indicator
The cardinality of this `Consent.source[x]` element is restricted to `0..1`, which is narrower than the AdvanceDirective concept (NL-CM:2.2.8) specified in the HCIM TreatmentDirective2. If additional AdvanceDirective references are needed, the additionalAdvanceDirective extension can be used _in addition to_ this element. If the additionalAdvanceDirective extension is used, this element SHALL be populated and it SHALL not contain a reference that is also present in the extension.
The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.
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 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).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Entity or Organization having regulatory jurisdiction or accountability for enforcing policies pertaining to Consent Directives.
Either `.policy` or `.policyRule` should exist following core constraint ppc-1. If no explicit value is recorded, a fallback is to populate `.policy.uri` with <https://wetten.overheid.nl/> if the treatment directive is recorded following Dutch law and regulations.
A reference to the specific base computable regulation or policy.
If the policyRule is absent, computable consent would need to be constructed from the elements of the Consent resource.
Might be a unique identifier of a policy set in XACML, or other rules engine.
Whether a treatment instruction (e.g. artificial respiration yes or no) was verified with the patient, his/her family or another authorized person.
Who verified the instruction (Patient, Relative or other Authorized Person).
Constraints to the base Consent.policyRule
An exception to the base policy of this consent. An exception can be an addition or removal of access permissions.
The joint decision taken with regard to the desirability of performing the indicated treatment. If the agreement is 'Other', 'Specification Other' shall contain the instructions for whether or not to carry out the treatment. Implementers SHALL support the specificationOther modifier extension for this.
Additional terminology mapping guidance, in addition to the default zib/nl-core guidance: - BehandelBesluit (dataset id 603) values: - _Wel uitvoeren_ -> _permit_ - _Niet uitvoeren_ -> _deny_ - _Anders_ or _Onbekend_ -> do not set a value. Instead, communicate this via the `modifierExtension[specificationOther].valueString` element. - Afspraak uitzetten ICD (dataset id 638) values: - _Wel uitvoeren_ -> _permit_ - No value is mapped to _deny_ - _Nee, nog geen besluit genomen_ or _Niet besproken_ -> do not set a value. Instead, communicate this via the `modifierExtension[specificationOther].valueString` element.
Use ConceptMap TreatmentDecisionCodelist-to-ConsentProvisionType to translate terminology from the functional model to profile terminology in ValueSet ConsentProvisionType.
The start of the period. The boundary is inclusive.
If the low element is missing, the meaning is that the low boundary is not known.
The date on which the treatment directive has been withdrawn and therefore no longer applies. An explicit decision must be taken about the 'date expired', in consultation between the responsible care provider and the patient or his representative(s).Any future termination can only be entered as a condition. Often this will be linked to 1 or more events.
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
If the end of the period is missing, it means that the period is ongoing
Who|what controlled by this rule (or group, by role)
Who or what is controlled by this rule. Use group to identify a set of actors by some property they share (e.g. 'admitting officers').
There is no specific actor associated with the exception
How the individual is involved in the resources content that is described in the exception.
How an actor is involved in the consent considerations.
Resource for the actor (or group, by role)
The resource that identifies the actor. To identify actors by type, use group to identify a set of actors by some property they share (e.g. 'admitting officers').
Patient / Representative / HealthProfessional
* Patient as the person with whom the agreement was made. * Person who represents the patient in health care matters and with whom the agreement has been made (too). * HealthProfessional who has made the agreement regarding the treatment directive.
Each occurrence of the zib HealthProfessional is normally represented by _two_ FHIR resources: a PractitionerRole resource (instance of [nl-core-HealthProfessional-PractitionerRole](http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-PractitionerRole)) and a Practitioner resource (instance of [nl-core-HealthProfessional-Practitioner](http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-Practitioner)). The Practitioner resource is referenced from the PractitionerRole instance. For this reason, sending systems should fill the reference to the PractitionerRole instance here, and not the Practitioner resource. Receiving systems can then retrieve the reference to the Practitioner resource from that PractitionerRole instance. In rare circumstances, there is only a Practitioner instance, in which case it is that instance which will be referenced here. However, since this should be the exception, the nl-core-HealthProfessional-Practitioner profile is not explicitly mentioned as a target profile.
Note that this is the direct action (not the grounds for the action covered in the purpose element). At present, the only action in the understood and tested scope of this resource is 'read'.
Security Labels that define affected resources
A security label, comprised of 0..* security label fields (Privacy tags), which define which resources are controlled by this exception.
If the consent specifies a security label of "R" then it applies to all resources that are labeled "R" or lower. E.g. for Confidentiality, it's a high water mark. For other kinds of security labels, subsumption logic applies. When the purpose of use tag is on the data, access request purpose of use shall not conflict.
Security Labels from the Healthcare Privacy and Security Classification System.
Context of activities covered by this rule
The context of the activities a user is taking - why the user is accessing the data - that are controlled by this rule.
When the purpose of use tag is on the data, access request purpose of use shall not conflict.
What purposes of use are controlled by this exception. If more than one label is specified, operations must have all the specified labels.
The class of information covered by this rule. The type can be a FHIR resource type, a profile on a type, or a CDA document, or some other type that indicates what sort of information the consent relates to.
Multiple types are or'ed together. The intention of the contentType element is that the codes refer to profiles or document types defined in a standard or an implementation guide somewhere.
The class (type) of information a consent rule covers.
The medical treatment to which the treatment instruction applies.
Typical use of this is a Document code with class = CDA.
If this code is found in an instance, then the exception applies.
A reference to a code defined by a terminology system.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
`.code.type` has a required binding. Therefore, only codes in the bound ValueSet are permitted. For concepts not present in the ValueSet, such as SNOMED CT code 400231000146108 (Uitzetten van cardioverter-defibrillator in laatste levensfase), use the `.text` field as per FHIR guidance.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Timeframe for data controlled by this rule
Clinical or Operational Relevant period of time that bounds the data controlled by this rule.
This has a different sense to the Consent.period - that is when the consent agreement holds. This is the time period of the data that is controlled by the agreement.
The resources controlled by this rule if specific resources are referenced.
instance | related | dependents | authoredby
How the resource reference is interpreted when testing consent restrictions.
How a resource reference is interpreted when testing consent restrictions.
A reference to a specific resource that defines which resources are covered by this consent.
Rules which provide exceptions to the base rule or subrules.