MyHealtheVet PHR FHIR API
0.3.9-current - ci-build United States of America flag

MyHealtheVet PHR FHIR API, published by VA Digital Services. This guide is not an authorized publication; it is the continuous build for version 0.3.9-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/department-of-veterans-affairs/mhv-fhir-phr-mapping/ and changes regularly. See the Directory of published versions

Resource Profile: VA MHV PHR Notes

Official URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/VA.MHV.PHR.note Version: 0.3.9-current
Standards status: Trial-use Maturity Level: 4 Computable Name: MHVnote

A profile on the DocumentReference resource for MHV PHR exposing Notes (NoteTO) using FHIR API.

For API details see:

  • DocumentReference shows all uses of DocumentReference. Including Consultation Notes, Progress Notes, and Discharge Summary.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from MHVdocumentReference

NameFlagsCard.TypeDescription & Constraintsdoco
.. DocumentReference 0..* MHVdocumentReference A reference to a document
... Slices for identifier 0..* Identifier Other identifiers for the document
Slice: Unordered, Open by pattern:use
.... identifier:TOid 0..1 Identifier Other identifiers for the document
..... use 1..1 code usual | official | temp | secondary | old (If known)
Required Pattern: usual
..... system C 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
..... value 0..1 string `NoteTO` | `.` | {NoteTO.id}
... status 1..1 code May indicate entered-in-error
... type
.... coding 1..* Coding Code defined by a terminology system
.... Slices for coding Content/Rules for all slices
..... coding:LO 1..1 Coding Code defined by a terminology system
Binding: Known Note types (required)
.... text 0..1 string Plain text representation of the concept
... category 1..* CodeableConcept Categorization of document
... subject 1..1 Reference(US Core Patient Profile) Who/what is the subject of the document
... date 0..1 instant When this document reference was created
... author 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) {c} Who and/or what authored the document
... authenticator 0..1 Reference(VA MHV PHR Practitioner | Practitioner) {c} Who/what authenticated the document
.... Slices for extension Content/Rules for all slices
..... extension:when 0..1 NoteAuthenticatedWhen When the authentication happened
... content
.... attachment
..... contentType 0..1 code Mime type of the content, with charset etc.
..... data 0..1 base64Binary Data inline, base64ed
..... title 0..1 string Label to display in place of the data
..... creation 0..1 dateTime Date attachment was first created
... context
.... encounter 0..0
.... period
..... start 0..1 dateTime Starting time with inclusive boundary
..... end 0..1 dateTime End time with inclusive boundary, if not ongoing
.... related 0..* Reference(VA MHV PHR Location | Location) {c} Related identifiers or resources

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
DocumentReference.type.coding:LOrequiredNoteTypeVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/NoteTypeVS
from this IG

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorDocumentReference.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')
NameFlagsCard.TypeDescription & Constraintsdoco
.. DocumentReference 0..* MHVdocumentReference A reference to a document
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier SΣ 0..* Identifier Other identifiers for the document
Slice: Unordered, Open by pattern:use
.... identifier:TOid SΣ 0..1 Identifier Other identifiers for the document
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `NoteTO` | `.` | {NoteTO.id}
Example General: 123456
... status ?!SΣ 1..1 code May indicate entered-in-error
Binding: DocumentReferenceStatus (required)
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'

Additional BindingsPurpose
US Core Clinical Note Type Min Binding
.... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:system
..... coding:LO Σ 1..1 Coding Code defined by a terminology system
Binding: Known Note types (required)
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://loinc.org
.... text Σ 0..1 string Plain text representation of the concept
... Slices for category SΣ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by pattern:$this
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.


.... category:us-core SΣ 0..* CodeableConcept Categorization of document
Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a 'starter set' of categories supported for fetching and storing clinical notes.


... subject SΣ 1..1 Reference(US Core Patient Profile) Who/what is the subject of the document
... date SΣ 0..1 instant When this document reference was created
... author SΣ 0..* Reference(US Core Practitioner Profile) {c} Who and/or what authored the document
... authenticator S 0..1 Reference(VA MHV PHR Practitioner | Practitioner) {c} Who/what authenticated the document
.... Slices for extension Content/Rules for all slices
..... when S 0..1 dateTime When the authentication happened
URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/noteAuthenticatedWhen
... content SΣ 1..1 BackboneElement Document referenced
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣC 1..1 Attachment Where to access the document
us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
..... contentType SΣ 0..1 code Mime type of the content, with charset etc.
Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.


Example General: text/plain; charset=UTF-8, image/png
..... data SC 0..1 base64Binary Data inline, base64ed
..... title SΣ 0..1 string Label to display in place of the data
Example General: Official Corporate Logo
..... creation SΣ 0..1 dateTime Date attachment was first created
... context SΣ 0..1 BackboneElement Clinical context of document
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... period SΣ 0..1 Period Time of service that is being documented
..... start ΣC 0..1 dateTime Starting time with inclusive boundary
..... end ΣC 0..1 dateTime End time with inclusive boundary, if not ongoing
.... related S 0..* Reference(VA MHV PHR Location | Location) {c} Related identifiers or resources

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
DocumentReference.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
DocumentReference.statusrequiredDocumentReferenceStatus
http://hl7.org/fhir/ValueSet/document-reference-status
from the FHIR Standard
DocumentReference.typerequiredUSCoreDocumentReferenceType
Additional Bindings Purpose
US Core Clinical Note Type Min Binding
http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type
DocumentReference.type.coding:LOrequiredNoteTypeVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/NoteTypeVS
from this IG
DocumentReference.categoryexampleDocumentClassValueSet
http://hl7.org/fhir/ValueSet/document-classcodes
from the FHIR Standard
DocumentReference.category:us-corerequiredUSCoreDocumentReferenceCategory
http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category
DocumentReference.relatesTo.coderequiredDocumentRelationshipType
http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1
from the FHIR Standard
DocumentReference.content.attachment.contentTyperequiredMime Types (a valid code from urn:ietf:bcp:13)
http://hl7.org/fhir/ValueSet/mimetypes|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorDocumentReference.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')
NameFlagsCard.TypeDescription & Constraintsdoco
.. DocumentReference 0..* MHVdocumentReference A reference to a document
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier SΣ 0..* Identifier Other identifiers for the document
Slice: Unordered, Open by pattern:use
.... identifier:TOid SΣ 0..1 Identifier Other identifiers for the document
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `NoteTO` | `.` | {NoteTO.id}
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code May indicate entered-in-error
Binding: DocumentReferenceStatus (required)
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'

Additional BindingsPurpose
US Core Clinical Note Type Min Binding
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:system
..... coding:LO Σ 1..1 Coding Code defined by a terminology system
Binding: Known Note types (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://loinc.org
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 0..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... Slices for category SΣ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by pattern:$this
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.


.... category:us-core SΣ 0..* CodeableConcept Categorization of document
Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a 'starter set' of categories supported for fetching and storing clinical notes.


... subject SΣ 1..1 Reference(US Core Patient Profile) Who/what is the subject of the document
... date SΣ 0..1 instant When this document reference was created
... author SΣ 0..* Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) {c} Who and/or what authored the document
... authenticator S 0..1 Reference(VA MHV PHR Practitioner | Practitioner) {c} Who/what authenticated the document
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... when S 0..1 dateTime When the authentication happened
URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/noteAuthenticatedWhen
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... content SΣ 1..1 BackboneElement Document referenced
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣC 1..1 Attachment Where to access the document
us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... contentType SΣ 0..1 code Mime type of the content, with charset etc.
Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.


Example General: text/plain; charset=UTF-8, image/png
..... data SC 0..1 base64Binary Data inline, base64ed
..... title SΣ 0..1 string Label to display in place of the data
Example General: Official Corporate Logo
..... creation SΣ 0..1 dateTime Date attachment was first created
... context SΣ 0..1 BackboneElement Clinical context of document
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... period SΣ 0..1 Period Time of service that is being documented
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... start ΣC 0..1 dateTime Starting time with inclusive boundary
..... end ΣC 0..1 dateTime End time with inclusive boundary, if not ongoing
.... related S 0..* Reference(VA MHV PHR Location | Location) {c} Related identifiers or resources

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
DocumentReference.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
DocumentReference.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
DocumentReference.identifier:TOid.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
DocumentReference.statusrequiredDocumentReferenceStatus
http://hl7.org/fhir/ValueSet/document-reference-status
from the FHIR Standard
DocumentReference.typerequiredUSCoreDocumentReferenceType
Additional Bindings Purpose
US Core Clinical Note Type Min Binding
http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type
DocumentReference.type.coding:LOrequiredNoteTypeVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/NoteTypeVS
from this IG
DocumentReference.categoryexampleDocumentClassValueSet
http://hl7.org/fhir/ValueSet/document-classcodes
from the FHIR Standard
DocumentReference.category:us-corerequiredUSCoreDocumentReferenceCategory
http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category
DocumentReference.authenticator.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
DocumentReference.relatesTo.coderequiredDocumentRelationshipType
http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1
from the FHIR Standard
DocumentReference.content.attachment.contentTyperequiredMime Types (a valid code from urn:ietf:bcp:13)
http://hl7.org/fhir/ValueSet/mimetypes|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorDocumentReference.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

This structure is derived from MHVdocumentReference

Summary

Mandatory: 0 element(1 nested mandatory element)
Prohibited: 1 element

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of DocumentReference.identifier

Maturity: 4

Differential View

This structure is derived from MHVdocumentReference

NameFlagsCard.TypeDescription & Constraintsdoco
.. DocumentReference 0..* MHVdocumentReference A reference to a document
... Slices for identifier 0..* Identifier Other identifiers for the document
Slice: Unordered, Open by pattern:use
.... identifier:TOid 0..1 Identifier Other identifiers for the document
..... use 1..1 code usual | official | temp | secondary | old (If known)
Required Pattern: usual
..... system C 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
..... value 0..1 string `NoteTO` | `.` | {NoteTO.id}
... status 1..1 code May indicate entered-in-error
... type
.... coding 1..* Coding Code defined by a terminology system
.... Slices for coding Content/Rules for all slices
..... coding:LO 1..1 Coding Code defined by a terminology system
Binding: Known Note types (required)
.... text 0..1 string Plain text representation of the concept
... category 1..* CodeableConcept Categorization of document
... subject 1..1 Reference(US Core Patient Profile) Who/what is the subject of the document
... date 0..1 instant When this document reference was created
... author 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) {c} Who and/or what authored the document
... authenticator 0..1 Reference(VA MHV PHR Practitioner | Practitioner) {c} Who/what authenticated the document
.... Slices for extension Content/Rules for all slices
..... extension:when 0..1 NoteAuthenticatedWhen When the authentication happened
... content
.... attachment
..... contentType 0..1 code Mime type of the content, with charset etc.
..... data 0..1 base64Binary Data inline, base64ed
..... title 0..1 string Label to display in place of the data
..... creation 0..1 dateTime Date attachment was first created
... context
.... encounter 0..0
.... period
..... start 0..1 dateTime Starting time with inclusive boundary
..... end 0..1 dateTime End time with inclusive boundary, if not ongoing
.... related 0..* Reference(VA MHV PHR Location | Location) {c} Related identifiers or resources

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
DocumentReference.type.coding:LOrequiredNoteTypeVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/NoteTypeVS
from this IG

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorDocumentReference.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. DocumentReference 0..* MHVdocumentReference A reference to a document
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier SΣ 0..* Identifier Other identifiers for the document
Slice: Unordered, Open by pattern:use
.... identifier:TOid SΣ 0..1 Identifier Other identifiers for the document
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `NoteTO` | `.` | {NoteTO.id}
Example General: 123456
... status ?!SΣ 1..1 code May indicate entered-in-error
Binding: DocumentReferenceStatus (required)
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'

Additional BindingsPurpose
US Core Clinical Note Type Min Binding
.... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:system
..... coding:LO Σ 1..1 Coding Code defined by a terminology system
Binding: Known Note types (required)
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://loinc.org
.... text Σ 0..1 string Plain text representation of the concept
... Slices for category SΣ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by pattern:$this
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.


.... category:us-core SΣ 0..* CodeableConcept Categorization of document
Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a 'starter set' of categories supported for fetching and storing clinical notes.


... subject SΣ 1..1 Reference(US Core Patient Profile) Who/what is the subject of the document
... date SΣ 0..1 instant When this document reference was created
... author SΣ 0..* Reference(US Core Practitioner Profile) {c} Who and/or what authored the document
... authenticator S 0..1 Reference(VA MHV PHR Practitioner | Practitioner) {c} Who/what authenticated the document
.... Slices for extension Content/Rules for all slices
..... when S 0..1 dateTime When the authentication happened
URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/noteAuthenticatedWhen
... content SΣ 1..1 BackboneElement Document referenced
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣC 1..1 Attachment Where to access the document
us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
..... contentType SΣ 0..1 code Mime type of the content, with charset etc.
Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.


Example General: text/plain; charset=UTF-8, image/png
..... data SC 0..1 base64Binary Data inline, base64ed
..... title SΣ 0..1 string Label to display in place of the data
Example General: Official Corporate Logo
..... creation SΣ 0..1 dateTime Date attachment was first created
... context SΣ 0..1 BackboneElement Clinical context of document
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... period SΣ 0..1 Period Time of service that is being documented
..... start ΣC 0..1 dateTime Starting time with inclusive boundary
..... end ΣC 0..1 dateTime End time with inclusive boundary, if not ongoing
.... related S 0..* Reference(VA MHV PHR Location | Location) {c} Related identifiers or resources

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
DocumentReference.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
DocumentReference.statusrequiredDocumentReferenceStatus
http://hl7.org/fhir/ValueSet/document-reference-status
from the FHIR Standard
DocumentReference.typerequiredUSCoreDocumentReferenceType
Additional Bindings Purpose
US Core Clinical Note Type Min Binding
http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type
DocumentReference.type.coding:LOrequiredNoteTypeVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/NoteTypeVS
from this IG
DocumentReference.categoryexampleDocumentClassValueSet
http://hl7.org/fhir/ValueSet/document-classcodes
from the FHIR Standard
DocumentReference.category:us-corerequiredUSCoreDocumentReferenceCategory
http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category
DocumentReference.relatesTo.coderequiredDocumentRelationshipType
http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1
from the FHIR Standard
DocumentReference.content.attachment.contentTyperequiredMime Types (a valid code from urn:ietf:bcp:13)
http://hl7.org/fhir/ValueSet/mimetypes|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorDocumentReference.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. DocumentReference 0..* MHVdocumentReference A reference to a document
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier SΣ 0..* Identifier Other identifiers for the document
Slice: Unordered, Open by pattern:use
.... identifier:TOid SΣ 0..1 Identifier Other identifiers for the document
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `NoteTO` | `.` | {NoteTO.id}
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code May indicate entered-in-error
Binding: DocumentReferenceStatus (required)
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: US Core DocumentReference Type (required): All LOINC values whose SCALE is DOC in the LOINC database and the HL7 v3 Code System NullFlavor concept 'unknown'

Additional BindingsPurpose
US Core Clinical Note Type Min Binding
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by pattern:system
..... coding:LO Σ 1..1 Coding Code defined by a terminology system
Binding: Known Note types (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://loinc.org
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 0..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... Slices for category SΣ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by pattern:$this
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.


.... category:us-core SΣ 0..* CodeableConcept Categorization of document
Binding: US Core DocumentReference Category (required): The US Core DocumentReferences Type Value Set is a 'starter set' of categories supported for fetching and storing clinical notes.


... subject SΣ 1..1 Reference(US Core Patient Profile) Who/what is the subject of the document
... date SΣ 0..1 instant When this document reference was created
... author SΣ 0..* Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) {c} Who and/or what authored the document
... authenticator S 0..1 Reference(VA MHV PHR Practitioner | Practitioner) {c} Who/what authenticated the document
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... when S 0..1 dateTime When the authentication happened
URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/noteAuthenticatedWhen
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... content SΣ 1..1 BackboneElement Document referenced
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣC 1..1 Attachment Where to access the document
us-core-6: DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... contentType SΣ 0..1 code Mime type of the content, with charset etc.
Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.


Example General: text/plain; charset=UTF-8, image/png
..... data SC 0..1 base64Binary Data inline, base64ed
..... title SΣ 0..1 string Label to display in place of the data
Example General: Official Corporate Logo
..... creation SΣ 0..1 dateTime Date attachment was first created
... context SΣ 0..1 BackboneElement Clinical context of document
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... period SΣ 0..1 Period Time of service that is being documented
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... start ΣC 0..1 dateTime Starting time with inclusive boundary
..... end ΣC 0..1 dateTime End time with inclusive boundary, if not ongoing
.... related S 0..* Reference(VA MHV PHR Location | Location) {c} Related identifiers or resources

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
DocumentReference.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
DocumentReference.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
DocumentReference.identifier:TOid.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
DocumentReference.statusrequiredDocumentReferenceStatus
http://hl7.org/fhir/ValueSet/document-reference-status
from the FHIR Standard
DocumentReference.typerequiredUSCoreDocumentReferenceType
Additional Bindings Purpose
US Core Clinical Note Type Min Binding
http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-type
DocumentReference.type.coding:LOrequiredNoteTypeVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/NoteTypeVS
from this IG
DocumentReference.categoryexampleDocumentClassValueSet
http://hl7.org/fhir/ValueSet/document-classcodes
from the FHIR Standard
DocumentReference.category:us-corerequiredUSCoreDocumentReferenceCategory
http://hl7.org/fhir/us/core/ValueSet/us-core-documentreference-category
DocumentReference.authenticator.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
DocumentReference.relatesTo.coderequiredDocumentRelationshipType
http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1
from the FHIR Standard
DocumentReference.content.attachment.contentTyperequiredMime Types (a valid code from urn:ietf:bcp:13)
http://hl7.org/fhir/ValueSet/mimetypes|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorDocumentReference.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

This structure is derived from MHVdocumentReference

Summary

Mandatory: 0 element(1 nested mandatory element)
Prohibited: 1 element

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of DocumentReference.identifier

Maturity: 4

 

Other representations of profile: CSV, Excel, Schematron

Notes:

  • The mock data I have
  • maps to NoteTO schema.
  • Mapping from VIA - NoteTO
  • Examples
  • Vivian TIU Document
  • va.gov team requirements for notes
    • Note that this also asks about the usefulness of the ADT feed Discharge Summary from the DS that comes from the notes feed.
    • This also notes many additional kinds of notes. It does indicate MVP will stick to what MHV currently presents.
  • based on US-Core for Clinical Notes
  • should have meta.profile set to https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/VA.MHV.PHR.note to indicate the intent to be compliant with this profile
  • status will be current for those we receive from VIA, those we no longer receive will be changed to entered-in-error
  • type (PN, DS, CR, A).
    • DS - LOINC#18842-5 "Discharge summary"
    • PN - LOINC#11506-3 "Progress note"
    • CR - LOINC#11488-4 "Consultation Note"
    • anything else is ignored
      • Note mock data has A Adverse React/Allergy
    • Vivian Document type definitions - 289 types of documents – should we support any of these?
    • FYI" KBS analysis - TIU Local and Standard Title.xlsx - for the following three document types, there are many local titles and standard titles.
      • CONSULT - 174,399 sub document types
      • PROGRESS NOTE - 2,208 sub document types
      • DISCHARGE SUMMARY - 1,647 sub document types
  • Historically MHV has also extracted Discharge Summary from the ADT feed, but this feed does not include the unique identifier for that Discharge Summary, thus it would present a de-duplication problem. current plan is to not extract Discharge Summary from ADT feed for FHIR. We will extract Discharge Summary from the notes feed. Unclear what Discharge Summary would be missing, and only in the ADT feed.
    • KBS Question asked on Leaf #88
  • titles: preserve both localTitle and standardTitle. Do not try to convert to a code
  • dates: VIA gives us timestamp and procTimestamp
    • There is a third signatureTimestamp in the VIA xml schema, but this does not seem to be populated by VIA
    • timestamp will go into the DocumentReference.content.attachment.creation (not expanded, so if just a date, then it is just a date)
    • procTimestamp will go into an extension on DocumentReference.authenticator
    • if timestamp has both date and time, then it will go into the DocumentReference.date
      • else procTimestamp will go into DocumentReference.date
  • delete / entered-in-error
    • We don't see notes until they are signed (most entered-in-error will be caught prior to this signature)
    • Notes that are already signed have a workflow that can be used to delete them. First there is an annex that is added indicating the note needs to be deleted, and that is signed. Then within 24-48 hours the note is deleted.
    • We could detect this annex, but that would only work if we refreshed that patient during the 24-48 hours.
    • KBS: asking how often this happens. Is it important for the timeframe we have left with vista?
  • When a document is amended, the text body is as it was before and has additional text at the bottom
    • "You may not VIEW this UNSIGNED addendum."
    • Once the addendum is signed, then the text body also has the addendum text
  • Admitting physician. this was historically extracted out of the discharge summary text body ("ATTENDING: "). This WILL NOT be done for FHIR. The client can search the note body if this is still desirable.
  • ADT feed discharge summary do not have an id so it is not clear how we would keep from duplicating
    • discharge summary in the notes feed do have an id
    • why do we need to watch the discharge feed? What does it give us that we don't get with the notes?
    • could we just de-duplicate only based on timestamp? If so, does that do anything useful?
  • Using attachment.data. Note that Cerner uses attachment.url with a Binary.
  • some schema elements found in VIA_v4.0.7_uat.wsdl are not mapped here because I can't tell what is in them. Most of them likely have a place to go in the FHIR model, but I need to know more about them. It seems that VIA might not be populating them. serviceCategory, cosigner, hasAddendum, isAddendum, originalNoteID, hasImages, itemId, consultId, surgicalProcId, prfId, and parentId
  • VIA does not tell us about signed notes that have been deleted or marked entered-in-error.

Business Rules

  • Ignore any without a facility
  • Ignore any without an id
  • Ignore any NoteTO.status that is not completed or COMPLETED or AMENDED.
  • Ignore any NoteTO that is not signed
  • Ignore any NoteTO.type other than PN, DS, and CR
  • if the standard title contains the string C & P , then this note is held for 30 days past the signature date/time
    • Compensation and Pension
    • Many sub-titles but all have "C & P EXAMINATION CONSULT" (e.g. PODIATRY C & P EXAMINATION CONSULT)
  • all other notes, labs, and conditions are held for 36 hours past the signature date/time

Mapping Concerns

  • discharge summary may have a period. The NoteTO/dischargeTimestamp or NoteTO/admitTimestamp have not been seen in sample notes feed.
    • These values do exist in the discharge feed, but that feed does not include id values so we have no way to de-duplicate them. Further the discharge feed I have has no text body, so suspect these are not realistic.
    • The notes feed does have DS but does not populate the NoteTO/dischargeTimestamp or NoteTO/admitTimestamp, but does have well behaved TEXT elements with a DATE (no time) "DATE OF ADMISSION: {date}", and "DATE OF DISCHARGE: {date}" that could be used if the xml does not give them to us.
    • Note that there is a sample PN that has an embedded DS with the strings (id=62846416)
    • MHV-57063