{ "resourceType": "Bundle", "type": "searchset", "timestamp": "2026-07-24T20:45:12.289+00:00", "meta": { "lastUpdated": "2026-07-24T20:45:12.289+00:00", "versionId": "2df1cfa8-8921-4779-b292-1656061a14c8" }, "entry": [ { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-allergyIntolerance-patientchart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-allergyIntolerance-patientchart", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.405+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-allergyIntolerance", "name": "AllergyIntolerance", "title": "Allergy Intolerence Patient Chart", "status": "draft", "date": "2022-01-17T19:14:20.2817728+00:00", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" } ], "kind": "resource", "abstract": false, "type": "AllergyIntolerance", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/AllergyIntolerance", "derivation": "constraint", "differential": { "element": [ { "id": "AllergyIntolerance", "path": "AllergyIntolerance", "comment": "Usage Note: The allergy record is the most current state; the reactions captured may include all past reactions or only the most current, depending on the use case.\r\n\r\nConformance Rule: If NullFlavor is used then the following elements SHOULD NOT be populated:\r\n\r\nAllergyIntolerance.clinicalStatus\r\nAllergyIntolerance.verificationStatus\r\nAllergyIntolerance.type\r\nAllergyIntolerance.category\r\nAllergyIntolerance.criticality\r\nand other allergy related elements.\r\n\r\nSubstances include, but are not limited to: a therapeutic substance administered correctly at an appropriate dosage for the individual; food; material derived from plants or animals; or venom from insect stings.", "mustSupport": true }, { "id": "AllergyIntolerance.id", "path": "AllergyIntolerance.id", "comment": "Usage Note: This will usually be a GUID that is assigned by the sending application.\r\n\r\nThe only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "mustSupport": true }, { "id": "AllergyIntolerance.meta", "path": "AllergyIntolerance.meta", "comment": "**Confirm usage of last updated", "mustSupport": true }, { "id": "AllergyIntolerance.meta.lastUpdated", "path": "AllergyIntolerance.meta.lastUpdated", "mustSupport": true }, { "id": "AllergyIntolerance.meta.source", "path": "AllergyIntolerance.meta.source", "mustSupport": true }, { "id": "AllergyIntolerance.meta.profile", "path": "AllergyIntolerance.meta.profile", "comment": "Usage: May be used for validatiing a message instance against this profile. This will be determined by each implementation.\r\n\r\nIt 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.", "max": "1", "fixedCanonical": "http://telus.com/fhir/StructureDefinition/profile-allergyIntolerance-patientchart", "mustSupport": true }, { "id": "AllergyIntolerance.text", "path": "AllergyIntolerance.text", "comment": "Conformance Rule: This must be formatted, as closely as possible what was presented to the user in the originating system and must include all clinical data. \r\n\r\nCA Core - not supported\r\n\r\nContained 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.", "mustSupport": true }, { "id": "AllergyIntolerance.identifier", "path": "AllergyIntolerance.identifier", "definition": "Business identifiers assigned to this AllergyIntolerance by the performer or other systems which remain constant as the resource is updated and propagates from server to server" }, { "id": "AllergyIntolerance.clinicalStatus", "path": "AllergyIntolerance.clinicalStatus", "definition": "The most current clinical status of the allergy or intolerance.", "comment": "Conformance Rule: Sending systems must minimally support both active and inactive and resolved (specialization of inactive) where possible. Conformance Rule: Receiving systems must consume all values and map to the best of their ability to their current model.\r\nConformance Rule: Sending systems must send local codings when mapping has occurred.\r\nConformance Rule: The clinical status must be empty when the verification status is \"entered-in-error\"\r\nTBD Conformance Rule: 11/24 - If the sending EMR \"treats\" the allergy as active, this should be populated. \r\n \r\nEMRAPI: API supports current (active) allergies and \"inactive\" \r\nCHR : supports active and inactive (also have verificaiton status confirmed, unconfirmed, resolved, refuted)\r\nMA: MA doesn't support the concept of active or inactive. eg The concept of refute is present; if not refuted it is assumed to be active\r\nPSS: If listed in CPP it is active and should show up in CurrentAllergies in API. \r\nNote: Refuted is a subset of Inactive but cannot be represented here. \r\nPSS - another issue - can be on the patient list, but patient no longer has a reaction. Is this resolved? Is this active? Leave as active with severity = no reaction?\r\nChallenge: Clinical status and verificationStatus are bundled differently than in FHIR. Ensure mappings are safe/make sense. Clinical input may be required to determine the safe mappings.\r\n\r\nPS-CA - must support \r\nPS - ON - not supported - Jim - If not present, the receiving system may have to make a decision - eg assume active\r\n\r\n\r\nRefer to [discussion](extensibility.html#Special-Case) if clincalStatus is missing data.\nThe data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.", "mustSupport": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AllergyIntoleranceClinicalStatus" } ], "strength": "required", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/allergyintolerancestatuscode" } }, { "id": "AllergyIntolerance.clinicalStatus.coding", "path": "AllergyIntolerance.clinicalStatus.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "AllergyIntolerance.clinicalStatus.coding.system", "path": "AllergyIntolerance.clinicalStatus.coding.system", "min": 1, "fixedUri": "http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1", "mustSupport": true }, { "id": "AllergyIntolerance.clinicalStatus.coding.code", "path": "AllergyIntolerance.clinicalStatus.coding.code", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.clinicalStatus.coding.userSelected", "path": "AllergyIntolerance.clinicalStatus.coding.userSelected", "comment": "Conformance Rule: When encoding any coded value in FHIR, set user selectted field = true IF the code system that is being sent is the same as the code system that is being used internally. This may be a local code or a standard code such as ICD-9.\r\n\r\nAmongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.", "mustSupport": true }, { "id": "AllergyIntolerance.clinicalStatus.text", "path": "AllergyIntolerance.clinicalStatus.text", "comment": "Conformance Rule: This must be sent if the user could see this value in the soruce system. \r\n\r\nVery often the text is the same as a displayName of one of the codings.", "mustSupport": true }, { "id": "AllergyIntolerance.verificationStatus", "path": "AllergyIntolerance.verificationStatus", "comment": "EMRAPI: verificationStatus: system, code, display, text, descriptor\r\nDW - successfully mapped into these codes. \r\n\r\nConformance Rule: If verification status is entered in error, the clinical status must not be populated.\r\n\r\nPS-CA - not supported\r\nPS-ON - not supported\r\n\r\nThe data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.", "mustSupport": true }, { "id": "AllergyIntolerance.verificationStatus.coding", "path": "AllergyIntolerance.verificationStatus.coding", "mustSupport": true, "binding": { "strength": "preferred", "description": "StatusCode", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/allergyintolerancestatuscode" } }, { "id": "AllergyIntolerance.verificationStatus.coding.system", "path": "AllergyIntolerance.verificationStatus.coding.system", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.verificationStatus.coding.code", "path": "AllergyIntolerance.verificationStatus.coding.code", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.verificationStatus.text", "path": "AllergyIntolerance.verificationStatus.text", "comment": "Core-CA - 0..1\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.type", "path": "AllergyIntolerance.type", "comment": "Conformance Rule: Unless this is very clear, omit this element as it is often very difficult to distinguish\r\n\r\nFHIR>MA \r\nAllergy-> drug allergy, non-drug allergy \r\nIntollerance-> drug intollerance, non-drug intollerance\r\n\r\nFHIR->PSS do not add an intolerence value as this is too vague. Default is allergy. \r\nallergy->allergy\r\nintollerance->side-effect, exagerated effect, other.\r\n\r\nEMRAPI: ReactionType (codeable concept; system,code,display,text,descriptor)\r\n\r\nFHIR-> CHR\r\nallergy -> allergy\r\nintolerance - intolerance\r\n\r\nFHIR->MS\r\nReactionType not supported, look in reaction for text\r\n\r\nAllergic (typically immune-mediated) reactions have been traditionally regarded as an indicator for potential escalation to significant future risk. Contemporary knowledge suggests that some reactions previously thought to be immune-mediated are, in fact, non-immune, but in some cases can still pose a life threatening risk. It is acknowledged that many clinicians might not be in a position to distinguish the mechanism of a particular reaction. Often the term \"allergy\" is used rather generically and may overlap with the use of \"intolerance\" - in practice the boundaries between these two concepts might not be well-defined or understood. This data element is included nevertheless, because many legacy systems have captured this attribute. Immunologic testing may provide supporting evidence for the basis of the reaction and the causative substance, but no tests are 100% sensitive or specific for sensitivity to a particular substance. If, as is commonly the case, it is unclear whether the reaction is due to an allergy or an intolerance, then the type element should be omitted from the resource.", "mustSupport": true }, { "id": "AllergyIntolerance.category", "path": "AllergyIntolerance.category", "comment": "Conformance Rule: This must always be present for \"medication\" allergies. If non-medication, this must be populated when value is known\r\nConformance Rule: The only supported use case for more than one category is \"medication\" and \"biologic\". Other combinations are disallowed. \r\n\r\nEMRAPI: Codeable concept (system, code, display, text, descriptor)\r\nThis data element has been included because it is currently being captured in some clinical systems. This data can be derived from the substance where coding systems are used, and is effectively redundant in that situation. When searching on category, consider the implications of AllergyIntolerance resources without a category. For example, when searching on category = medication, medication allergies that don't have a category valued will not be returned. Refer to [search](search.html) for more information on how to search category with a :missing modifier to get allergies that don't have a category. Additionally, category should be used with caution because category can be subjective based on the sender.", "max": "2", "mustSupport": true }, { "id": "AllergyIntolerance.criticality", "path": "AllergyIntolerance.criticality", "comment": "Usage Note: This conveys the current state. Criticality can change over time, eg bee stings.\r\n\r\nConformance Rule: FDG - Sending systems are not expected to support this as this is often recorded in the source system in Reaction.severity event. If sending systems support criticality separately than reaction.severity, this will be sent. \r\n\r\nConformance Rule: If a value of \"high\" can be determined via logic (eg recorded as life-threatening or severe) this must be populated for patient safety purposes. \r\n\r\nConformance Rule: As this data is crucial for patient safety this should be mapped into the receiving system such that this data is visible to the user when looking at the allergy record. \r\n\r\nThe default criticality value for any propensity to an adverse reaction should be 'Low Risk', indicating at the very least a relative contraindication to deliberate or voluntary exposure to the substance. 'High Risk' is flagged if the clinician has identified a propensity for a more serious or potentially life-threatening reaction, such as anaphylaxis, and implies an absolute contraindication to deliberate or voluntary exposure to the substance. If this element is missing, the criticality is unknown (though it may be known elsewhere). Systems that capture a severity at the condition level are actually representing the concept of criticality whereas the severity documented at the reaction level is representing the true reaction severity. Existing systems that are capturing both condition criticality and reaction severity may use the term \"severity\" to represent both. Criticality is the worst it could be in the future (i.e. situation-agnostic) whereas severity is situation-dependent.", "mustSupport": true }, { "id": "AllergyIntolerance.code", "path": "AllergyIntolerance.code", "comment": "Usage Notes: This could be used at a higher level to record allergies at the medication class, eg \"penicillin\" where a substance might be amoxicillin. Another example: Allergy code = codeine (offending agent) and the Reaction.substance may be Tylenol 3.\r\nUsage Note: If the same alllergy code is documented several times the the POS, it must be sent multiple times.\r\n\r\nInfoway code set - https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode\r\n\r\nUsage Note: SNOMED codes - can be included where known but required for PS-ON and PS-CA. This must be provided where possible. EMRs are expected to map from the local code into this codeset. As at July 2022 it is DRAFT\r\n\r\nConformance Rule: The local code must always be sent for codified values. Useful when the target system understands the code, eg in the migration use case. \r\n\r\nAlignment - PS-ON - https://tgateway.infoway-inforoute.ca/singlesubset.html?id=2.16.840.1.113883.2.20.3.483&versionid=20220228\r\nAlignment - PS-CA - https://tgateway.infoway-inforoute.ca/singlesubset.html?id=2.16.840.1.113883.2.20.3.483&versionid=20220228\r\nAlignment - Core-CA - example binding\r\nAlignment - Ontario eReferral - AllergyIntoleranceSubstanceConditionUvIps (required) - 10/2022 - comment submitted re medication coding\r\n\r\nUsage Note: IPS-UV allows the supply of coding, text, or both. Use of the IPS-UV ValueSet is currently preferred, work is underway to determine the pan-Canadian terminology that will be preferred and/or socialized for this element. Until then, only the existing slices are put forward. They are considered optional, meaning an implementer can still be conformant if they use another subset of codes from SNOMED CT, SNOMED CT CA or another Code System.\r\n\r\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content.\r\n\r\n\r\n\r\nEMRAPI: SubstanceCode (system,code,display are all required)\r\nPS-CA: - AllergyintolerancesubstanceconditionGPS (required)\r\nPS-ON: https://fhir.infoway-inforoute.ca/ValueSet/AllergicCondition (required)\r\n\r\nIt is strongly recommended that this element be populated using a terminology, where possible. For example, some terminologies used include RxNorm, SNOMED CT, DM+D, NDFRT, ICD-9, IDC-10, UNII, and ATC. Plain text should only be used if there is no appropriate terminology available. Additional details can be specified in the text.\r\rWhen a substance or product code is specified for the 'code' element, the \"default\" semantic context is that this is a positive statement of an allergy or intolerance (depending on the value of the 'type' element, if present) condition to the specified substance/product. In the corresponding SNOMED CT allergy model, the specified substance/product is the target (destination) of the \"Causative agent\" relationship.\r\rThe 'substanceExposureRisk' extension is available as a structured and more flexible alternative to the 'code' element for making positive or negative allergy or intolerance statements. This extension provides the capability to make \"no known allergy\" (or \"no risk of adverse reaction\") statements regarding any coded substance/product (including cases when a pre-coordinated \"no allergy to x\" concept for that substance/product does not exist). If the 'substanceExposureRisk' extension is present, the AllergyIntolerance.code element SHALL be omitted.", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.code.coding", "path": "AllergyIntolerance.code.coding", "slicing": { "discriminator": [ { "type": "value", "path": "system" } ], "rules": "open" }, "comment": "EMRAPI: substance code\r\n\r\nMA: urn:telus:emr:ma:*:codetable:allergy-substance\r\nPSS: urn:telus:emr:pss:*:codetable:allergy-code\r\nMS: Vigilance -- they identify DIN's and General codes (GEN)\r\n\r\nConformance Rule: For Medication allergies, a CCDD code must be used if possible. \r\nConformance Rule: The local code must always be sent when available in addition to the CCDD code. \r\nJIM - CCDD is missing drug class - do we use a knowledge base code set? \r\nAnne - is there a standardized set for drug class? Infoway...\r\nJim/Travis: Representative DIN - allergies CAN be recorded in some systems, they are encoded. Can't tell the difference between an actual DIN and DIN coded because that was the best that can be done.\r\n\r\nCodes 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.", "mustSupport": true }, { "id": "AllergyIntolerance.code.coding.system", "path": "AllergyIntolerance.code.coding.system", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.code.coding.code", "path": "AllergyIntolerance.code.coding.code", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.code.coding:Medication", "path": "AllergyIntolerance.code.coding", "sliceName": "Medication", "comment": "Alignment: Not identified specifically in Core-CA, PS-ON or PS-CA or Ontario eReferral. Included as it is coded in the EMRs using CCDD/DINS rather than SNOMED\r\n\r\nCodes 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.", "max": "1", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct" } }, { "id": "AllergyIntolerance.code.coding:Medication.system", "path": "AllergyIntolerance.code.coding.system", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.code.coding:Medication.code", "path": "AllergyIntolerance.code.coding.code", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.code.coding:Medication.display", "path": "AllergyIntolerance.code.coding.display", "comment": "Usage Note: This is not necessary when sending CCDD codes for medication allergies", "mustSupport": true }, { "id": "AllergyIntolerance.code.coding:LocalCode", "path": "AllergyIntolerance.code.coding", "sliceName": "LocalCode", "comment": "Usage Note: The local code should always be sent where known as it may be helpful to receiving EMRs who may understand the code. This will not be used for every use case but could be helpful for some, eg migration, moving patients from one clinic to another who both use the same application.\r\n\r\nAlignment: This is not identified in Core-CA, PS-ON or PS-CA or Ontario eReferral\r\n\r\nCodes 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.", "max": "1", "mustSupport": true }, { "id": "AllergyIntolerance.code.coding:LocalCode.system", "path": "AllergyIntolerance.code.coding.system", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.code.coding:LocalCode.code", "path": "AllergyIntolerance.code.coding.code", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.code.coding:LocalCode.userSelected", "path": "AllergyIntolerance.code.coding.userSelected", "mustSupport": true }, { "id": "AllergyIntolerance.code.coding:AbsentOrUnknownAllergyIntolerance", "path": "AllergyIntolerance.code.coding", "sliceName": "AbsentOrUnknownAllergyIntolerance", "comment": "Alignment: PS-CA, PS-ON and Core-CA all support \r\n\r\nCodes 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.", "max": "1", "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-allergies-uv-ips" } }, { "id": "AllergyIntolerance.code.coding:AbsentOrUnknownAllergyIntolerance.system", "path": "AllergyIntolerance.code.coding.system", "min": 1, "fixedUri": "http://hl7.org/fhir/uv/ips/CodeSystem/absent-unknown-uv-ips", "mustSupport": true }, { "id": "AllergyIntolerance.code.coding:AbsentOrUnknownAllergyIntolerance.code", "path": "AllergyIntolerance.code.coding.code", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.code.text", "path": "AllergyIntolerance.code.text", "comment": "Usage: This must be displayed to the user\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.patient", "path": "AllergyIntolerance.patient", "mustSupport": true }, { "id": "AllergyIntolerance.patient.reference", "path": "AllergyIntolerance.patient.reference", "mustSupport": true }, { "id": "AllergyIntolerance.patient.display", "path": "AllergyIntolerance.patient.display", "mustSupport": true }, { "id": "AllergyIntolerance.encounter", "path": "AllergyIntolerance.encounter", "comment": "Usage Note: If data is definitively tied to an encounter in the EMR, this reference should be sent. If there is no definitive reference, this should not be derived using date or other data points.\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": false }, { "id": "AllergyIntolerance.onset[x]", "path": "AllergyIntolerance.onset[x]", "comment": "Usage Note: This should only be sent when there is a clear mapping to this date.\r\nAlignment: Not supported in Core-CA, PS-ON or PS-CA\r\n\r\nEMRAPI: Date or DateFD. String is not supported in the API, Requested by OMD CDSS as Lifestage; EMRs in Ontario have to support this (codified value). **May need to extend to a code.\r\n\r\nNOTE: There is only one date in the API and one date in MA. Which is the best date to support? \r\nMA: Patient Chart --> Allg --> add new --> pick type--> Date of Reaction", "mustSupport": true }, { "id": "AllergyIntolerance.recordedDate", "path": "AllergyIntolerance.recordedDate", "comment": "Usage Note: This date is the original date from the from the originating system. This is the clinically relevant date.\r\n\r\nEMRAPI: not supported\r\nMA: Allergen-->Date of Reported, MS: CreateDate - FDG to follow up", "mustSupport": true }, { "id": "AllergyIntolerance.recorder", "path": "AllergyIntolerance.recorder", "comment": "DISCUSSION: FDG - DO WE NEED THIS DATA? Role is important, reference a practitoiner? non-clinician practitioner, Name, Billing ID? Licence\r\nEMR API: not supported\r\nMA: Patient Chart --> Allg --> add new --> pick type--> Likey not Recorded by, choose physician, patient, pharmacist, etc\r\n\r\nAlignment: not supported in PS-ON or PS-CA\r\n\r\nPSS: who entered into chart, user initials - \r\n\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "AllergyIntolerance.recorder.reference", "path": "AllergyIntolerance.recorder.reference", "mustSupport": true }, { "id": "AllergyIntolerance.recorder.display", "path": "AllergyIntolerance.recorder.display", "comment": "Usage Note: This is a user-friendly textual representation of the reference that should be used in the narrative. This will be the name of the recorder.\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "AllergyIntolerance.asserter", "path": "AllergyIntolerance.asserter", "comment": "Usage Rule: If practitioner role is specified, only a role code is mandatory \r\nUsage Rule: Currently, there is no support for RelatedPerson in some EMRs\r\nPS-ON: This is must support in Ontario Patient Summary; not supported in Core-CA\r\n\r\nThe recorder takes responsibility for the content, but can reference the source from where they got it.\r\nMA (current user, patient, provider values) \r\nMA: Physician (role only), patient, pharmacist (role only), DPIC values - on issue list\r\nMS: \r\nCHR: Patient, related person, practitioner (reported by) - select box but no option to provide further information\r\nPSS: Allergy.reportedby - values current user, patient, provider (not on main screen; more info, dropdown). Select box - can enter further information on provider only\r\n\r\nEMRAPI: not supported", "mustSupport": true }, { "id": "AllergyIntolerance.asserter.reference", "path": "AllergyIntolerance.asserter.reference", "mustSupport": true }, { "id": "AllergyIntolerance.asserter.display", "path": "AllergyIntolerance.asserter.display", "comment": "Usage Note: This is a textual representation of the reference that should be used in the narrative\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "AllergyIntolerance.lastOccurrence", "path": "AllergyIntolerance.lastOccurrence", "comment": "Usage Note: This may be sent when there is a clear mapping from the sending EMR\r\nEMRAPI: not supported\r\nMapping exists for PSS; absent for the other EMRs\r\nPS-ON and Core CA: not supported\r\n\r\nThis date may be replicated by one of the Onset of Reaction dates. Where a textual representation of the date of last occurrence is required e.g. 'In Childhood, '10 years ago' the Comment element should be used.", "mustSupport": true }, { "id": "AllergyIntolerance.note", "path": "AllergyIntolerance.note", "comment": "Usage Note: These notes represent the latest state of the allergy that in an EMR is displayed in a CPP. Reaction events/episodic notes can be sent in addition to this information and will be captured in reaction section.\r\n\r\nEMRAPI: Notes - Descriptor (string) -- TBC - what is the definition for this?\r\nMA: note section in the allergy task\r\nCHR: single comment for documented allergy, rather than a specific occurrence\r\nPSS: short details + long details; each captured as a separate note. \r\nPS-ON and Core-CA: not supported \r\n\r\nFor example: including reason for flagging a seriousness of 'High Risk'; and instructions related to future exposure or administration of the substance, such as administration within an Intensive Care Unit or under corticosteroid cover. The notes should be related to an allergy or intolerance as a condition in general and not related to any particular episode of it. For episode notes and descriptions, use AllergyIntolerance.event.description and AllergyIntolerance.event.notes.", "mustSupport": true }, { "id": "AllergyIntolerance.note.author[x]", "path": "AllergyIntolerance.note.author[x]", "mustSupport": true }, { "id": "AllergyIntolerance.note.time", "path": "AllergyIntolerance.note.time", "mustSupport": true }, { "id": "AllergyIntolerance.note.text", "path": "AllergyIntolerance.note.text", "mustSupport": true }, { "id": "AllergyIntolerance.reaction", "path": "AllergyIntolerance.reaction", "comment": "Usage Note: Some of the EMRs edit an allergy state which results in an updated record with a single reaction. Other EMRs (eg PSS) can have multiple allergy events; these are summarized for the display in the CPP.\r\nUsage Note: There could be multiple reactions in a record; receiving systems must look at the most current reaction (based on onset date) to see the latest reaction notes. The allergy.notes will capture what is displayed in the CPP \r\nUsage Note: If the EMR enters a value of \"no reaction\", eg where a person used to react and no longer does. (eg penicillin allergy as a child and this has resolved in adulthood a reaction section is not necessary and the clinical status on this record is \"resolved\". Other than this use case, severity is captured at the reaction level and a reaction section will always be present. \r\nUsage Note: When sending the IPS, or for most referrals only the latest reaction will be included. If referring to an allergist, or for full patient chart extracts, all reactions will be sent.\r\nUsage Rule: If there is no manifestation recorded in the EMR and there is no severity recorded, reaction is not included. Example: Sulfa or Penicillin will often not have a recorded reaction/manifestation.", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.substance", "path": "AllergyIntolerance.reaction.substance", "comment": "The IPS-UV does not consider this element Must Support, however some Canadian systems may capture allergen substances separately from allergyIntolerance.code. Further investigation is required to determine what approaches are in use by participating jurisdictions.\r\n\r\nCoding of the specific substance (or pharmaceutical product) with a terminology capable of triggering decision support should be used wherever possible. The 'code' element allows for the use of a specific substance or pharmaceutical product, or a group or class of substances. In the case of an allergy or intolerance to a class of substances, (for example, \"penicillins\"), the 'reaction.substance' element could be used to code the specific substance that was identified as having caused the reaction (for example, \"amoxycillin\"). Duplication of the value in the 'code' and 'reaction.substance' elements is acceptable when a specific substance has been recorded in 'code'.", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.substance.coding", "path": "AllergyIntolerance.reaction.substance.coding", "slicing": { "discriminator": [ { "type": "value", "path": "system" } ], "rules": "open" }, "max": "1", "binding": { "strength": "required", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/nondrugallergencode" } }, { "id": "AllergyIntolerance.reaction.substance.coding.system", "path": "AllergyIntolerance.reaction.substance.coding.system", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.substance.coding.code", "path": "AllergyIntolerance.reaction.substance.coding.code", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.substance.text", "path": "AllergyIntolerance.reaction.substance.text", "comment": "Usage Noe: This may be the same as the allergy.code. \r\n\r\nVery often the text is the same as a displayName of one of the codings.", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation", "path": "AllergyIntolerance.reaction.manifestation", "slicing": { "discriminator": [ { "type": "value", "path": "coding.code" } ], "rules": "open" }, "comment": "Usage Note: Text is mandatory; if not specified in the sending system, this may be populated with the display value that was displayed to the user. Text may contain supplemental data, by example, the display may be \"Contact dermatitis (disorder)\" and the text may be \"on left finger\". Exporting systems must always send the display name when available.\r\n\r\nUsage: DW team has mapped to https://fhir.infoway-inforoute.ca/CodeSystem/snomedctcaextension\r\nAlignment: Ontario eReferral - SNOMEDCTClinicalFindings (example)\r\n\r\n\r\nMA: HL7\r\nPSS: urn:telus:emr:pss:*:codetable:allergy-reaction-type\r\nMS: N/A\r\nEMRAPI: ReactionType\r\n\r\nPS-CA - must support the same two value sets as identiied in PS-ON\r\nPS-ON - two slices 1) AllergyReactionGpsUvIps (required) - not supported 2) ManifestationSCTCA https://fhir.infoway-inforoute.ca/ValueSet/ClinicalFinding (required) - not supported - SNOMED\r\n\r\nManifestation can be expressed as a single word, phrase or brief description. For example: nausea, rash or no reaction. It is preferable that manifestation should be coded with a terminology, where possible. The values entered here may be used to display on an application screen as part of a list of adverse reactions, as recommended in the UK NHS CUI guidelines. Terminologies commonly used include, but are not limited to, SNOMED CT or ICD10.", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation.coding", "path": "AllergyIntolerance.reaction.manifestation.coding", "comment": "***Anne - update differentiator in slice; both are SNOMED\r\nUsage: A local code will be converted where possible into a SNOMED code. If the EMR has not stored a code, text must be present. If the text is an exact match to a code descriptor, then coding must be sent. Example: anaphylaxis \r\n\r\nCodes 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.", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation.coding.system", "path": "AllergyIntolerance.reaction.manifestation.coding.system", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation.coding.code", "path": "AllergyIntolerance.reaction.manifestation.coding.code", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation.coding.display", "path": "AllergyIntolerance.reaction.manifestation.coding.display", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation.text", "path": "AllergyIntolerance.reaction.manifestation.text", "comment": "Usage Note: This is populated by EMRs who capture notes on a per reaction basis. \r\nConformance Rule: this must be populated if the EMR has a textual value in addition to a code\r\nExample: EMRs may support a code of \"other\" and this allows them to convey meaningful information.\r\n\r\nPSS: Maps to radio button desciption +short description text. If the severity description is not mild, moderate, severe, concatenate the radio button description and the severity description\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation:ReactionManifestationGPS", "path": "AllergyIntolerance.reaction.manifestation", "sliceName": "ReactionManifestationGPS", "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Manifestation" } ], "strength": "required", "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/allergy-reaction-gps-uv-ips" } }, { "id": "AllergyIntolerance.reaction.manifestation:ReactionManifestationGPS.coding", "path": "AllergyIntolerance.reaction.manifestation.coding", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation:ReactionManifestationGPS.coding.system", "path": "AllergyIntolerance.reaction.manifestation.coding.system", "min": 1, "fixedUri": "http://snomed.info/sct", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation:ReactionManifestationGPS.coding.code", "path": "AllergyIntolerance.reaction.manifestation.coding.code", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation:ReactionManifestationGPS.coding.display", "path": "AllergyIntolerance.reaction.manifestation.coding.display", "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/allergy-reaction-gps-uv-ips" } }, { "id": "AllergyIntolerance.reaction.manifestation:ReactionManifestationGPS.text", "path": "AllergyIntolerance.reaction.manifestation.text", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation:manifestationSCTCA", "path": "AllergyIntolerance.reaction.manifestation", "sliceName": "manifestationSCTCA", "comment": "Usage Note: This aligns with PS-ON. \r\nUsage Note: MA and PSS are able to map to this value set \r\n\r\nManifestation can be expressed as a single word, phrase or brief description. For example: nausea, rash or no reaction. It is preferable that manifestation should be coded with a terminology, where possible. The values entered here may be used to display on an application screen as part of a list of adverse reactions, as recommended in the UK NHS CUI guidelines. Terminologies commonly used include, but are not limited to, SNOMED CT or ICD10.", "mustSupport": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Manifestation" } ], "strength": "required", "valueSet": "https://tgateway.infoway-inforoute.ca/ValueSet/ClinicalFinding" } }, { "id": "AllergyIntolerance.reaction.manifestation:manifestationSCTCA.coding", "path": "AllergyIntolerance.reaction.manifestation.coding", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation:manifestationSCTCA.coding.system", "path": "AllergyIntolerance.reaction.manifestation.coding.system", "min": 1, "fixedUri": "http://snomed.info/sct", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation:manifestationSCTCA.coding.code", "path": "AllergyIntolerance.reaction.manifestation.coding.code", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation:manifestationSCTCA.coding.display", "path": "AllergyIntolerance.reaction.manifestation.coding.display", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.manifestation:manifestationSCTCA.text", "path": "AllergyIntolerance.reaction.manifestation.text", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.reaction.description", "path": "AllergyIntolerance.reaction.description", "comment": "Alignment: This is supported by Ontario eReferral. DW not using this field\r\n\r\nUse the description to provide any details of a particular event of the occurred reaction such as circumstances, reaction specifics, what happened before/after. Information, related to the event, but not describing a particular care should be captured in the comment field. For example: at the age of four, the patient was given penicillin for strep throat and subsequently developed severe hives.", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.onset", "path": "AllergyIntolerance.reaction.onset", "comment": "Usage: Note: If the EMR is able to send this, they should include this data. It is recognized that this may be challenging and therefore some allowance may be given during conformance and will not be point of failure for conformance testing.\r\n\r\nEMRAPI: There is only one date in the EMR API; which is the allergy date, NOT The reaction date \r\nMA: Patient Chart --> Allg --> add new --> pick type--> Date of Reaction\r\nPSS: Date of first reaction and date of latest change \r\nCHR: Date of first reaction\r\n\r\n\r\nCore-CA: not supported; this suggests that it can be ignored if received.?\r\nPS-CA - not supported\r\nPS-ON - not supported", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.severity", "path": "AllergyIntolerance.reaction.severity", "comment": "Usage Note: For \"unknown\" severity or \"no reaction\", this can be entered in text. In both cases there is no severity code included. When mapping, if the wording is different it is recommended that the text that the doctor saw (eg life threatening) is included as AllergyIntolerence.reaction.note\r\n\r\nEMRAPI: not supported\r\nPS-ON - mustSupport (Nov 24)\r\nPS-CA - not supported (Nov 24)\r\n\r\nRefer to EMR-FHIR mappings; require clinical input - there are not exact mappings out of the EMRs, as per example below. \r\nFHIR-->PSS\r\nmild --> minor \r\nmoderate --> major \r\nsevere --> life threatening\r\nin addition, \"no reaction\" code is supported in PSS. You cannot enter an allergy without a reaction; you can enter it as another reaction and later downgrade it to \"no reaction\". \r\n\r\n \r\nCHR: severe, moderate, mild - in addition, they have \"unknown\" and \"no reaction\"\r\n\r\n\r\nIt is acknowledged that this assessment is very subjective. There may be some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions.", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.exposureRoute", "path": "AllergyIntolerance.reaction.exposureRoute", "comment": "Conformance Rule: This will not be supported as the source systems do not capture it in a reliable/safe manner\r\nEMRAPI: Not Supported\r\nCore-CA: not supported\r\n\r\n\r\nCoding of the route of exposure with a terminology should be used wherever possible.", "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RouteOfAdministration" } ], "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/routeofadministration" } }, { "id": "AllergyIntolerance.reaction.note", "path": "AllergyIntolerance.reaction.note", "comment": "Usage Note: EMRs are mapping additional notes pertaining only to the reaction into this data element.\r\n\r\nAlignment: ON-PS does not include this as MustSupport. PS-ON is aligned with the IPS and PS-CA \r\nAllergyIntolerance profiles, neither of which have AllergyIntolerance.note as MustSupport. In addition, neither US-Core \r\nnor CA-Baseline have AllergyIntolerance.note as MustSupport.\r\n\r\nUse this field to record information indirectly related to a particular event and not captured in the description. For example: Clinical records are no longer available, recorded based on information provided to the patient by her mother and her mother is deceased.", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.note.author[x]", "path": "AllergyIntolerance.reaction.note.author[x]", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.note.time", "path": "AllergyIntolerance.reaction.note.time", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.note.text", "path": "AllergyIntolerance.reaction.note.text", "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-bundle-collection-patientChart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-bundle-collection-patientChart", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.406+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-bundle-collection", "name": "BundlePatientChart", "title": "Bundle-PatientChart", "status": "draft", "date": "2021-03-01T20:08:28.7858355+00:00", "fhirVersion": "4.0.1", "mapping": [ { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "cda", "uri": "http://hl7.org/v3/cda", "name": "CDA (R2)" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" } ], "kind": "resource", "abstract": false, "type": "Bundle", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Bundle", "derivation": "constraint", "differential": { "element": [ { "id": "Bundle", "path": "Bundle", "mustSupport": true }, { "id": "Bundle.id", "path": "Bundle.id", "mustSupport": true }, { "id": "Bundle.meta", "path": "Bundle.meta", "min": 1, "mustSupport": true }, { "id": "Bundle.meta.source", "path": "Bundle.meta.source", "min": 1 }, { "id": "Bundle.meta.profile", "path": "Bundle.meta.profile", "min": 1, "max": "1", "fixedCanonical": "http://telus.com/fhir/StructureDefinition/profile-bundle-patient-chart", "mustSupport": true }, { "id": "Bundle.meta.tag", "path": "Bundle.meta.tag", "slicing": { "discriminator": [ { "type": "type", "path": "$this" } ], "rules": "open" }, "min": 1, "mustSupport": true }, { "id": "Bundle.meta.tag:Version", "path": "Bundle.meta.tag", "sliceName": "Version", "min": 1, "max": "1", "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "http://telus.com/fhir/ValueSet/telus-version" } }, { "id": "Bundle.meta.tag:Version.system", "path": "Bundle.meta.tag.system", "min": 1, "fixedUri": "http://telus.com/fhir/CodeSystem/telus-version", "mustSupport": true }, { "id": "Bundle.meta.tag:Version.code", "path": "Bundle.meta.tag.code", "min": 1, "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "http://telus.com/fhir/ValueSet/telus-version" } }, { "id": "Bundle.identifier", "path": "Bundle.identifier", "min": 1, "mustSupport": true }, { "id": "Bundle.type", "path": "Bundle.type", "comment": "Usage Note: This will vary based on the use case. \r\nAlignment: PS-ON has a fixed value of document.\r\n\r\nIt's possible to use a bundle for other purposes (e.g. a document can be accepted as a transaction). This is primarily defined so that there can be specific rules for some of the bundle types.", "mustSupport": true }, { "id": "Bundle.timestamp", "path": "Bundle.timestamp", "min": 1, "mustSupport": true }, { "id": "Bundle.entry", "path": "Bundle.entry", "comment": "Conformance Rule: In the context of sharing a Patient Chart, this bundle will be a collection of resources such as AllergyIntolerence, MedicationStatment, Immunizations, etc. The bundle may also contain DocumentReference as a reference to human readable attachments such as a PDF or text or a Bundle of type Document, where a document such as a Discharge Summary may be specified.", "min": 1, "mustSupport": true }, { "id": "Bundle.entry.link", "path": "Bundle.entry.link", "contentReference": "http://hl7.org/fhir/StructureDefinition/Bundle#Bundle.link" }, { "id": "Bundle.entry.fullUrl", "path": "Bundle.entry.fullUrl", "mustSupport": true }, { "id": "Bundle.entry.resource", "path": "Bundle.entry.resource", "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/4db20d3d-d7b4-4420-bbef-af2c12af2bc0", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-my-care-plan", "name": "CarePlan", "status": "draft", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "CarePlan", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/CarePlan", "derivation": "constraint", "differential": { "element": [ { "id": "CarePlan", "path": "CarePlan", "comment": "Usage: DW is only implementing when care plan is documented in MA" }, { "id": "CarePlan.id", "path": "CarePlan.id", "mustSupport": true }, { "id": "CarePlan.meta", "path": "CarePlan.meta", "mustSupport": true }, { "id": "CarePlan.meta.lastUpdated", "path": "CarePlan.meta.lastUpdated", "mustSupport": true }, { "id": "CarePlan.meta.source", "path": "CarePlan.meta.source", "mustSupport": true }, { "id": "CarePlan.meta.profile", "path": "CarePlan.meta.profile", "mustSupport": true }, { "id": "CarePlan.text", "path": "CarePlan.text", "comment": "Usage Note: The visual representation, eg PDF can be included here. \r\n\r\nContained 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.", "mustSupport": true }, { "id": "CarePlan.status", "path": "CarePlan.status", "mustSupport": true }, { "id": "CarePlan.intent", "path": "CarePlan.intent", "comment": "Usage Note: Typically a value of plan will be used by the EMRs. A draft plan that is returned from decision support, or a recommendation will be a proposal. Order and option are rarely used.\r\n\r\nThis element is labeled as a modifier because the intent alters when and how the resource is actually applicable.", "mustSupport": true }, { "id": "CarePlan.title", "path": "CarePlan.title", "mustSupport": true }, { "id": "CarePlan.subject", "path": "CarePlan.subject", "mustSupport": true }, { "id": "CarePlan.subject.reference", "path": "CarePlan.subject.reference", "mustSupport": true }, { "id": "CarePlan.subject.display", "path": "CarePlan.subject.display", "mustSupport": true }, { "id": "CarePlan.period", "path": "CarePlan.period", "mustSupport": true }, { "id": "CarePlan.period.start", "path": "CarePlan.period.start", "mustSupport": true }, { "id": "CarePlan.period.end", "path": "CarePlan.period.end", "mustSupport": true }, { "id": "CarePlan.author", "path": "CarePlan.author", "mustSupport": true }, { "id": "CarePlan.author.reference", "path": "CarePlan.author.reference", "mustSupport": true }, { "id": "CarePlan.author.display", "path": "CarePlan.author.display", "mustSupport": true }, { "id": "CarePlan.supportingInfo", "path": "CarePlan.supportingInfo", "mustSupport": true }, { "id": "CarePlan.supportingInfo.reference", "path": "CarePlan.supportingInfo.reference", "mustSupport": true }, { "id": "CarePlan.supportingInfo.display", "path": "CarePlan.supportingInfo.display", "mustSupport": true }, { "id": "CarePlan.goal", "path": "CarePlan.goal", "comment": "Usage Note: MA does support structured goals; other EMRs do not\r\n\r\nGoal can be achieving a particular change or merely maintaining a current state or even slowing a decline.", "mustSupport": true }, { "id": "CarePlan.goal.reference", "path": "CarePlan.goal.reference", "mustSupport": true }, { "id": "CarePlan.goal.display", "path": "CarePlan.goal.display", "mustSupport": true }, { "id": "CarePlan.activity", "path": "CarePlan.activity", "mustSupport": true }, { "id": "CarePlan.activity.outcomeCodeableConcept", "path": "CarePlan.activity.outcomeCodeableConcept", "comment": "Usage: Used when the planned activity is completed\r\nNote: This will be renamed in R5 to PerformedActivity\r\n\r\nNote that this should not duplicate the activity status (e.g. completed or in progress).", "mustSupport": true }, { "id": "CarePlan.activity.outcomeReference", "path": "CarePlan.activity.outcomeReference", "comment": "Usage: Used when the planned activity is completed \r\nNote: Note: This will be renamed in R5 to PerformedActivity with a codeableReference\r\n\r\nThe activity outcome is independent of the outcome of the related goal(s). For example, if the goal is to achieve a target body weight of 150 lbs and an activity is defined to diet, then the activity outcome could be calories consumed whereas the goal outcome is an observation for the actual body weight measured.", "mustSupport": true }, { "id": "CarePlan.activity.outcomeReference.reference", "path": "CarePlan.activity.outcomeReference.reference", "mustSupport": true }, { "id": "CarePlan.activity.outcomeReference.display", "path": "CarePlan.activity.outcomeReference.display", "mustSupport": true }, { "id": "CarePlan.activity.reference", "path": "CarePlan.activity.reference", "comment": "Usage Note: This is used to record a Planned Activity Reference. Alternatively, the activity.detail may be specified. Either reference or detail are specified; not both.\r\n\r\nStandard extension exists ([resource-pertainsToGoal](extension-resource-pertainstogoal.html)) that allows goals to be referenced from any of the referenced resources in CarePlan.activity.reference. \rThe goal should be visible when the resource referenced by CarePlan.activity.reference is viewed independently from the CarePlan. Requests that are pointed to by a CarePlan using this element should *not* point to this CarePlan using the \"basedOn\" element. i.e. Requests that are part of a CarePlan are not \"based on\" the CarePlan.", "mustSupport": true }, { "id": "CarePlan.activity.detail", "path": "CarePlan.activity.detail", "comment": "Usage Note: Thsi will be used for planned activities, eg kind=task, rather than a reference\r\nIn R5, this becomes CarePlan.activity.plannedActivityDetail", "mustSupport": true }, { "id": "CarePlan.activity.detail.kind", "path": "CarePlan.activity.detail.kind", "mustSupport": true }, { "id": "CarePlan.activity.detail.code", "path": "CarePlan.activity.detail.code", "mustSupport": true }, { "id": "CarePlan.activity.detail.code.text", "path": "CarePlan.activity.detail.code.text", "mustSupport": true }, { "id": "CarePlan.activity.detail.status", "path": "CarePlan.activity.detail.status", "comment": "Usage Note: entered-in-error may only be used on an update. MAIREAD - more details please\r\n\r\nSome aspects of status can be inferred based on the resources linked in actionTaken. Note that \"status\" is only as current as the plan was most recently updated. \nThe unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the activity.", "mustSupport": true }, { "id": "CarePlan.note", "path": "CarePlan.note", "mustSupport": true }, { "id": "CarePlan.note.author[x]", "path": "CarePlan.note.author[x]", "mustSupport": true }, { "id": "CarePlan.note.time", "path": "CarePlan.note.time", "mustSupport": true }, { "id": "CarePlan.note.text", "path": "CarePlan.note.text", "mustSupport": true } ] }, "id": "4db20d3d-d7b4-4420-bbef-af2c12af2bc0", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.406+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/1c5d0bb9-b207-4459-9ecc-a7be9bbe0bc3", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-CarePlan.activity.performedActivity", "name": "CarePlanPerformedActivity", "status": "draft", "fhirVersion": "4.0.1", "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "CarePlan.activity" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://hl7.org/fhir/5.0/StructureDefinition/extension-CarePlan.activity.performedActivity" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "type": [ { "code": "Reference" } ], "mustSupport": true } ] }, "id": "1c5d0bb9-b207-4459-9ecc-a7be9bbe0bc3", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.396+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/121acf1e-0413-4d6d-9b8e-c297ad0ee31b", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-CarePlan.activity.plannedActivityDetail", "name": "CarePlanPlannedActivityDetail", "status": "draft", "fhirVersion": "4.0.1", "kind": "complex-type", "abstract": false, "context": [ { "type": "fhirpath", "expression": "CarePlan.activity" }, { "type": "element", "expression": "BackboneElement" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://hl7.org/fhir/5.0/StructureDefinition/extension-CarePlan.activity.plannedActivityDetail" } ] }, "id": "121acf1e-0413-4d6d-9b8e-c297ad0ee31b", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.406+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/1cf86889-119c-4ed1-86e5-84557cd1853b", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-CarePlan.activity.plannedActivityDetail.kind", "name": "CarePlanPlannedActivityDetailKind", "status": "draft", "description": "Pre-adoption of R5 data element, under PlannedActivity", "fhirVersion": "4.0.1", "kind": "complex-type", "abstract": false, "context": [ { "type": "fhirpath", "expression": "CarePlan.activity.plannedActivityDetail" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "comment": "Pre-adoption of R5\r\nA description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest." }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://hl7.org/fhir/5.0/StructureDefinition/extension-CarePlan.activity.plannedActivityDetail.kind" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "type": [ { "code": "code" } ], "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://hl7.org/fhir/ValueSet/care-plan-activity-kind" } } ] }, "id": "1cf86889-119c-4ed1-86e5-84557cd1853b", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.396+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/a98a5203-6753-4ce2-8c5c-cdc9ac05c4f1", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-CarePlan.activity.plannedActivityDetail", "name": "CarePlanPlannedActivityReference", "status": "draft", "fhirVersion": "4.0.1", "kind": "complex-type", "abstract": false, "context": [ { "type": "fhirpath", "expression": "CarePlan.activity" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://hl7.org/fhir/5.0/StructureDefinition/extension-CarePlan.activity.plannedActivityDetail" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "type": [ { "code": "Reference" } ], "mustSupport": true }, { "id": "Extension.value[x].reference", "path": "Extension.value[x].reference", "mustSupport": true }, { "id": "Extension.value[x].display", "path": "Extension.value[x].display", "mustSupport": true } ] }, "id": "a98a5203-6753-4ce2-8c5c-cdc9ac05c4f1", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.396+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/359964fc-af03-48dd-82d3-705e8006528e", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-clinical-impression", "name": "ClinicalImpressionFuture", "status": "draft", "description": "NOT TO BE USED INITIALLY", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "ClinicalImpression", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/ClinicalImpression", "derivation": "constraint", "differential": { "element": [ { "id": "ClinicalImpression.id", "path": "ClinicalImpression.id", "mustSupport": true }, { "id": "ClinicalImpression.meta", "path": "ClinicalImpression.meta", "mustSupport": true }, { "id": "ClinicalImpression.meta.lastUpdated", "path": "ClinicalImpression.meta.lastUpdated", "mustSupport": true }, { "id": "ClinicalImpression.meta.source", "path": "ClinicalImpression.meta.source", "mustSupport": true }, { "id": "ClinicalImpression.meta.profile", "path": "ClinicalImpression.meta.profile", "max": "1", "mustSupport": true }, { "id": "ClinicalImpression.text", "path": "ClinicalImpression.text", "comment": "Conformance Rule: This must be formatted, as closely as possible what was presented to the user in the originating system and must include all clinical data. \r\n\r\nContained 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.", "mustSupport": true }, { "id": "ClinicalImpression.status", "path": "ClinicalImpression.status", "mustSupport": true }, { "id": "ClinicalImpression.subject", "path": "ClinicalImpression.subject", "mustSupport": true }, { "id": "ClinicalImpression.subject.reference", "path": "ClinicalImpression.subject.reference", "min": 1, "mustSupport": true }, { "id": "ClinicalImpression.subject.display", "path": "ClinicalImpression.subject.display", "comment": "Usage Note: This should contain the name of the Patient, which can then be used in narrative where applicable\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "ClinicalImpression.effective[x]", "path": "ClinicalImpression.effective[x]", "mustSupport": true }, { "id": "ClinicalImpression.date", "path": "ClinicalImpression.date", "min": 1, "mustSupport": true }, { "id": "ClinicalImpression.problem", "path": "ClinicalImpression.problem", "mustSupport": true }, { "id": "ClinicalImpression.problem.reference", "path": "ClinicalImpression.problem.reference", "comment": "Usage Note: This will be a reference to the condition resource\r\n\r\nUsing absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "mustSupport": true }, { "id": "ClinicalImpression.problem.display", "path": "ClinicalImpression.problem.display", "comment": "Usage Note: This is a user-friendly textual representation of the reference that should be used in the narrative\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "min": 1, "mustSupport": true }, { "id": "ClinicalImpression.investigation", "path": "ClinicalImpression.investigation", "comment": "MA - may be able to support - text only? - Subjective, Objective", "mustSupport": true }, { "id": "ClinicalImpression.investigation.code.text", "path": "ClinicalImpression.investigation.code.text", "mustSupport": true }, { "id": "ClinicalImpression.investigation.item", "path": "ClinicalImpression.investigation.item", "comment": "Usage; MA may be able to reference an observation; not great value; ; we will be exporting the results of investigation which is much more valuable\r\n\r\nMost investigations are observations of one kind or another but some other specific types of data collection resources can also be used.", "mustSupport": true }, { "id": "ClinicalImpression.investigation.item.reference", "path": "ClinicalImpression.investigation.item.reference", "mustSupport": true }, { "id": "ClinicalImpression.investigation.item.display", "path": "ClinicalImpression.investigation.item.display", "mustSupport": true }, { "id": "ClinicalImpression.summary", "path": "ClinicalImpression.summary", "min": 1, "mustSupport": true } ] }, "id": "359964fc-af03-48dd-82d3-705e8006528e", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.407+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-composition", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-composition", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.407+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-composition", "name": "Composition", "title": "Composition Patient Chart", "status": "draft", "date": "2020-11-18T16:04:17.8148173Z", "description": "Clinical document used to represent a Patient Chart. This is compliant to the International Patient Summary (IPS) data set.", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "cda", "uri": "http://hl7.org/v3/cda", "name": "CDA (R2)" }, { "identity": "fhirdocumentreference", "uri": "http://hl7.org/fhir/documentreference", "name": "FHIR DocumentReference" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" } ], "kind": "resource", "abstract": false, "type": "Composition", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Composition", "derivation": "constraint", "differential": { "element": [ { "id": "Composition", "path": "Composition", "comment": "Usage: Depending on the use case for Patient Chart, a composition may or may not be used. Example: If sent with a MedDialog message, a composition will be used as there will be an accompanying PDF and a document reference. \r\n\r\nAlignment PS-ON: When the EMR contains text only for a procedure and cannot distinguish procedure from condition, it is \r\nacceptable to include the procedure under past history of illness. *This applies to the Patient Chart as well\r\n\r\nDISCUSSION: DO WE NEED TO ADD A REFERENCE BACK TO THE DOCUMENT REFERENCE/PDF VERSION OF THIS? DO WE NEED TO ADD AN EXTENSION FOR CLINICAL DOCUMENT VERSION NUMBER (exists in clinical document profile FHIR)\r\n\r\nWhile the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical." }, { "id": "Composition.id", "path": "Composition.id", "comment": "Usage Note: This will usually be a GUID that is assigned by the sending application.\r\n\r\nThe only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "mustSupport": true }, { "id": "Composition.meta", "path": "Composition.meta", "mustSupport": true }, { "id": "Composition.meta.lastUpdated", "path": "Composition.meta.lastUpdated", "mustSupport": true }, { "id": "Composition.meta.source", "path": "Composition.meta.source", "mustSupport": true }, { "id": "Composition.meta.profile", "path": "Composition.meta.profile", "comment": "Usage: This will be determined by each implementer. This may be useful for validating message instances.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "Composition.meta.security", "path": "Composition.meta.security", "mustSupport": true }, { "id": "Composition.language", "path": "Composition.language", "comment": "BC - mandatory; support english only - conformance rule?\r\nDiscusison - is english only appropriate? mandatory\r\n\r\nLanguage 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).", "min": 1, "mustSupport": true }, { "id": "Composition.text", "path": "Composition.text", "comment": "Usage Note: Use case: Patient Chart Referral and EMR Patient Chart Transfer, External : This will be a PDF wrapped inside HTML that will convey the entire composition (all resources in the bundle) in PDF form. \r\n\r\nAlignment: PS-ON aligns with IPS and PS-CA where this data element is Must Support and optional. This does not need to be populated until Ontario provides further direction to vendors; we can propose the same approach\r\n\r\nNote: This should be treated as mandatory for use cases that ultimately result in a CDA L1.\r\n\r\nContained 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.", "mustSupport": true }, { "id": "Composition.identifier", "path": "Composition.identifier", "comment": "Usage Note: This can be genereated as a UUID; mandatory to align with ON-PS and may be generated in the same fashion as ON-PS.\r\n\r\nON-PS Usage Note: PoS systems are not expected to use the same value for all instances of a single patient summary and are not expected to preserve this identifier. It may be a generated value such as UUID.\r\r\n\r\nDISCUSSION REQUIRED\r\nSimilar to ClinicalDocument/setId in CDA. See discussion in resource definition for how these relate.", "min": 1, "mustSupport": true }, { "id": "Composition.identifier.system", "path": "Composition.identifier.system", "mustSupport": true }, { "id": "Composition.identifier.value", "path": "Composition.identifier.value", "min": 1, "mustSupport": true }, { "id": "Composition.status", "path": "Composition.status", "mustSupport": true }, { "id": "Composition.type", "path": "Composition.type", "comment": "Usage Note: In future releases, a full set of LOINC codes (including LOINC.Ontology codes) will be added to this value set. Implementers should expect that this value set will be provided outside of the specification.\r\n\r\n*Work to reconcile these codes to align with CDA, eg CDX partner - refer to terminology work.\r\n\r\nPS-ON and PS-CA- Pattern: system\": \"http://loinc.org\", \"code\": \"60591-5\" (Patient Summary Document)\r\n\r\n\r\nConformance Rule: This must be specified when known. Set type to the best, most precise LOINC code corresponding to the concept of the document in the source system.\r\n\r\nConformance Rule: If available, a local code must be supplied as well (code, system, mandatory text, userSelected).\r\n\r\nConformance Rule: ??? confirm there is always a code; else what?\r\n\r\n\r\n\r\n\r\nFHIR: For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.", "mustSupport": true, "binding": { "strength": "extensible" } }, { "id": "Composition.type.coding", "path": "Composition.type.coding", "mustSupport": true }, { "id": "Composition.type.coding.system", "path": "Composition.type.coding.system", "fixedUri": "http://loinc.org", "mustSupport": true }, { "id": "Composition.type.coding.code", "path": "Composition.type.coding.code", "comment": "Usage Rule: The code value must be 60591-5 for the patient chart (patient summary). This aligns with the IPS. Other codes may be relevant, such as Patient Chart, or DW Extract.\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Composition.type.coding.display", "path": "Composition.type.coding.display", "mustSupport": true }, { "id": "Composition.type.coding.userSelected", "path": "Composition.type.coding.userSelected", "mustSupport": true }, { "id": "Composition.type.text", "path": "Composition.type.text", "min": 1, "mustSupport": true }, { "id": "Composition.category", "path": "Composition.category", "comment": "Conformance Rule: Populate category with the best, most precise LOINC code corresponding to each category code in the source system. Multiple categories may be specified in some cases. Example: A document could be categorized as both a Discharge Summary and a Post-Operative Report.\r\n\r\nUsage Rule: The POS must send a local code and the LOINC code.\r\n\r\nUsage Note: In future releases a full set of LOINC codes (including LOINC.Ontology codes) will be added to this value set. Implementers should expect that this value set will be provided outside of the specification. \r\n\r\nAlignment: Not supported in PS-ON or PS-CA\r\n\r\nNo map to CDA\r\n\r\nFHIR: This is a metadata field from [XDS/MHD](http://wiki.ihe.net/index.php?title=Mobile_access_to_Health_Documents_(MHD)).", "mustSupport": true, "binding": { "strength": "extensible" } }, { "id": "Composition.category.coding", "path": "Composition.category.coding", "mustSupport": true }, { "id": "Composition.category.coding.system", "path": "Composition.category.coding.system", "min": 1, "mustSupport": true }, { "id": "Composition.category.coding.code", "path": "Composition.category.coding.code", "min": 1, "mustSupport": true }, { "id": "Composition.category.coding.display", "path": "Composition.category.coding.display", "mustSupport": true }, { "id": "Composition.category.coding.userSelected", "path": "Composition.category.coding.userSelected", "mustSupport": true }, { "id": "Composition.category.text", "path": "Composition.category.text", "min": 1, "mustSupport": true }, { "id": "Composition.subject", "path": "Composition.subject", "min": 1, "type": [ { "code": "Reference", "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Composition.subject.reference", "path": "Composition.subject.reference", "min": 1, "mustSupport": true }, { "id": "Composition.subject.display", "path": "Composition.subject.display", "comment": "Usage Note: This should contain the name of the Patient, which can then be used in narrative\r\n\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "min": 1, "mustSupport": true }, { "id": "Composition.date", "path": "Composition.date", "mustSupport": true }, { "id": "Composition.author", "path": "Composition.author", "comment": "DISCUSS REQUIRED TO CONSTRAIN\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Device", "http://hl7.org/fhir/StructureDefinition/Organization" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Composition.author.reference", "path": "Composition.author.reference", "mustSupport": true }, { "id": "Composition.author.display", "path": "Composition.author.display", "mustSupport": true }, { "id": "Composition.title", "path": "Composition.title", "mustSupport": true }, { "id": "Composition.confidentiality", "path": "Composition.confidentiality", "comment": "BC - this is mandatory - determine if this is always available in the EMR's and whether we can make it mandatory\r\nPS-ON: supported\r\n\r\nThe exact use of this element, and enforcement and issues related to highly sensitive documents are out of scope for the base specification, and delegated to implementation profiles (see security section). This element is labeled as a modifier because highly confidential documents must not be treated as if they are not.", "mustSupport": true }, { "id": "Composition.attester", "path": "Composition.attester", "comment": "**We are not aligned; PS-ON has this as a mandatory element\r\n\r\nOnly list each attester once." }, { "id": "Composition.custodian", "path": "Composition.custodian", "comment": "Discussion: we may wish to include the Organization as this shoud be treated separately; not sending org in the 301\r\n\r\nThis is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However, it is important that this information be known when working with a derived document, so providing a custodian is encouraged.", "mustSupport": true }, { "id": "Composition.custodian.reference", "path": "Composition.custodian.reference", "mustSupport": true }, { "id": "Composition.custodian.display", "path": "Composition.custodian.display", "mustSupport": true }, { "id": "Composition.relatesTo", "path": "Composition.relatesTo", "comment": "Usage Note: Not required for Patient Chart; this is in scope for PS_ON and others.\r\n\r\nA document is a version specific composition.", "mustSupport": true }, { "id": "Composition.event", "path": "Composition.event", "comment": "Usage Rule: Not required in the patient chart; if it is to be populated, this should range from the date of the earliest entry in the chart to the most recent entry in the chart.\r\n\r\nAlignment: PS-ON There is no overall clinical event required. PS-ON has adopted guidance from IPS (included in the Composition profile) stating that \"For example if the PS is generated by a GP based on information recorded in his/her EHR-S, then the start value should represent the date when the treatment relationship between the patient and the GP started; and the end value the date of the latest care event.\"\r\r\n\r\nBC - The IHE XD-LAB technical framework defines an extension to CDA to enable sharing\r\nof non-final lab result reports; it adds an optional sub element of statusCode in\r\ndocumentationOf/serviceEvent. \r\n\r\nThe event needs to be consistent with the type element, though can provide further information if desired.", "mustSupport": true }, { "id": "Composition.event.period", "path": "Composition.event.period", "comment": "BC - \r\n\r\nA Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\").\n\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration).", "mustSupport": true }, { "id": "Composition.section", "path": "Composition.section", "slicing": { "discriminator": [ { "type": "pattern", "path": "code" } ], "rules": "open" }, "comment": "Alignment: In both PS-ON and PS-CA the Medication, Allergy and Problem sections are mandatory.", "min": 1, "mustSupport": true }, { "id": "Composition.section.title", "path": "Composition.section.title", "comment": "CDX - Title is mandatory\r\n\r\nThe title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.", "mustSupport": true }, { "id": "Composition.section.code", "path": "Composition.section.code", "mustSupport": true }, { "id": "Composition.section.text", "path": "Composition.section.text", "comment": "Usage Note: This is a rolled up version of all resources in this section. eg if a patient has 5 allergies (5 resources), this can provide a summary view of everything, eg 5 allergies; A, B, C, D, E. Ths may also be used for sections that do not have any entries/resources. \r\n\r\nUsage Note: For Patient Chart, this should contain the PDF rendering of the entire Patient Chart.\r\n\r\nAlignment PS-ON: PS-ON aligns with IPS and PS-CA where this data element is Must Support and optional.\r\n\r\nCDX - mandatory\r\n\r\nDocument profiles may define what content should be represented in the narrative to ensure clinical safety.", "mustSupport": true }, { "id": "Composition.section.entry", "path": "Composition.section.entry", "mustSupport": true }, { "id": "Composition.section.entry.reference", "path": "Composition.section.entry.reference", "mustSupport": true }, { "id": "Composition.section.section", "path": "Composition.section.section", "comment": "Usage: There is no use case identified; potential future use\r\nNested sections are primarily used to help human readers navigate to particular portions of the document.", "contentReference": "http://hl7.org/fhir/StructureDefinition/Composition#Composition.section" }, { "id": "Composition.section.section.title", "path": "Composition.section.section.title", "mustSupport": true }, { "id": "Composition.section.section.code", "path": "Composition.section.section.code", "mustSupport": true }, { "id": "Composition.section.section.text", "path": "Composition.section.section.text", "min": 1, "mustSupport": true }, { "id": "Composition.section.section.orderedBy", "path": "Composition.section.section.orderedBy", "mustSupport": true }, { "id": "Composition.section.section.entry", "path": "Composition.section.section.entry", "min": 1, "max": "1", "type": [ { "code": "Reference", "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Composition.section.section.entry.reference", "path": "Composition.section.section.entry.reference", "mustSupport": true }, { "id": "Composition.section.section.section", "path": "Composition.section.section.section", "contentReference": "http://hl7.org/fhir/StructureDefinition/Composition#Composition.section" }, { "id": "Composition.section:Medications", "path": "Composition.section", "sliceName": "Medications", "comment": "Conformance rule: If the EMR has recorded \"No known medications\" this should be sent where possible. If there is nothing recorded in the EMR this should be mandatory where possible to record the data absent reason.", "max": "1", "mustSupport": true }, { "id": "Composition.section:Medications.title", "path": "Composition.section.title", "mustSupport": true }, { "id": "Composition.section:Medications.code", "path": "Composition.section.code", "comment": "Note: LOINC 10160-0 = History of Medication use Narrative\r\n\r\nThe code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document. \n\nIf the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.", "min": 1, "fixedCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "10160-0" } ] }, "mustSupport": true }, { "id": "Composition.section:Medications.text", "path": "Composition.section.text", "comment": "PS-ON and PS-CA; Mandatory\r\n\r\nDocument profiles may define what content should be represented in the narrative to ensure clinical safety.", "min": 1, "mustSupport": true }, { "id": "Composition.section:Medications.entry", "path": "Composition.section.entry", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource", "http://telus.com/fhir/patientChart/StructureDefinition/profile-medication-order", "http://telus.com/fhir/patientChart/StructureDefinition/profile-medication-plan", "http://telus.com/fhir/patientChart/StructureDefinition/profile-medication-statement", "http://telus.com/fhir/patientChart/StructureDefinition/profile-medication-administration" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Composition.section:Medications.emptyReason", "path": "Composition.section.emptyReason", "max": "0" }, { "id": "Composition.section:Medications.section", "path": "Composition.section.section", "max": "0", "contentReference": "http://hl7.org/fhir/StructureDefinition/Composition#Composition.section" }, { "id": "Composition.section:Allergies", "path": "Composition.section", "sliceName": "Allergies", "comment": "Conformance rule: If the EMR has recorded \"No known allergies\" this should be sent where possible. If there is nothing recorded in the EMR this should be mandatory where possible to record the data absent reason.", "max": "1", "mustSupport": true }, { "id": "Composition.section:Allergies.title", "path": "Composition.section.title", "min": 1, "mustSupport": true }, { "id": "Composition.section:Allergies.code", "path": "Composition.section.code", "min": 1, "mustSupport": true }, { "id": "Composition.section:Allergies.code.coding", "path": "Composition.section.code.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Composition.section:Allergies.code.coding.system", "path": "Composition.section.code.coding.system", "min": 1, "fixedUri": "http://loinc.org", "mustSupport": true }, { "id": "Composition.section:Allergies.code.coding.code", "path": "Composition.section.code.coding.code", "min": 1, "fixedCode": "48765-2", "mustSupport": true }, { "id": "Composition.section:Allergies.text", "path": "Composition.section.text", "mustSupport": true }, { "id": "Composition.section:Allergies.entry", "path": "Composition.section.entry", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "http://telus.com/fhir/patientChart/StructureDefinition/profile-allergyIntolerance" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Composition.section:Allergies.entry.reference", "path": "Composition.section.entry.reference", "min": 1, "fixedString": "http://telus.com/fhir/patientChart/StructureDefinition/profile-allergyIntolerance-patientchart", "mustSupport": true }, { "id": "Composition.section:Allergies.emptyReason", "path": "Composition.section.emptyReason", "max": "0" }, { "id": "Composition.section:Allergies.section", "path": "Composition.section.section", "max": "0", "contentReference": "http://hl7.org/fhir/StructureDefinition/Composition#Composition.section" }, { "id": "Composition.section:Problems", "path": "Composition.section", "sliceName": "Problems", "comment": "Conformance rule: If there is nothing recorded in the EMR this should be mandatory where possible to record the data absent reason.", "max": "1", "mustSupport": true }, { "id": "Composition.section:Problems.title", "path": "Composition.section.title", "min": 1, "mustSupport": true }, { "id": "Composition.section:Problems.code", "path": "Composition.section.code", "min": 1, "mustSupport": true }, { "id": "Composition.section:Problems.code.coding", "path": "Composition.section.code.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Composition.section:Problems.code.coding.system", "path": "Composition.section.code.coding.system", "min": 1, "fixedUri": "http://loinc.org", "mustSupport": true }, { "id": "Composition.section:Problems.code.coding.code", "path": "Composition.section.code.coding.code", "min": 1, "fixedCode": "11450-4", "mustSupport": true }, { "id": "Composition.section:Problems.text", "path": "Composition.section.text", "min": 1, "mustSupport": true }, { "id": "Composition.section:Problems.entry", "path": "Composition.section.entry", "min": 1, "max": "1", "type": [ { "code": "Reference", "targetProfile": [ "http://telus.com/fhir/patientChart/StructureDefinition/profile-condition" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Composition.section:Problems.emptyReason", "path": "Composition.section.emptyReason", "max": "0" }, { "id": "Composition.section:Problems.section", "path": "Composition.section.section", "max": "0", "contentReference": "http://hl7.org/fhir/StructureDefinition/Composition#Composition.section" }, { "id": "Composition.section:ProceduresHx", "path": "Composition.section", "sliceName": "ProceduresHx", "max": "1", "mustSupport": true }, { "id": "Composition.section:ProceduresHx.code", "path": "Composition.section.code", "min": 1, "mustSupport": true }, { "id": "Composition.section:ProceduresHx.code.coding", "path": "Composition.section.code.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Composition.section:ProceduresHx.code.coding.system", "path": "Composition.section.code.coding.system", "min": 1, "fixedUri": "http://loinc.org", "mustSupport": true }, { "id": "Composition.section:ProceduresHx.code.coding.code", "path": "Composition.section.code.coding.code", "min": 1, "fixedCode": "47519-4", "mustSupport": true }, { "id": "Composition.section:ProceduresHx.text", "path": "Composition.section.text", "mustSupport": true }, { "id": "Composition.section:ProceduresHx.entry", "path": "Composition.section.entry", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "http://telus.com/fhir/patientChart/StructureDefinition/profile-procedure" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Composition.section:ProceduresHx.emptyReason", "path": "Composition.section.emptyReason", "max": "0" }, { "id": "Composition.section:ProceduresHx.section", "path": "Composition.section.section", "max": "0", "contentReference": "http://hl7.org/fhir/StructureDefinition/Composition#Composition.section" }, { "id": "Composition.section:Immunizations", "path": "Composition.section", "sliceName": "Immunizations", "max": "1", "mustSupport": true }, { "id": "Composition.section:Immunizations.title", "path": "Composition.section.title", "min": 1, "mustSupport": true }, { "id": "Composition.section:Immunizations.code", "path": "Composition.section.code", "min": 1, "mustSupport": true }, { "id": "Composition.section:Immunizations.code.coding", "path": "Composition.section.code.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Composition.section:Immunizations.code.coding.system", "path": "Composition.section.code.coding.system", "min": 1, "fixedUri": "http://loinc.org", "mustSupport": true }, { "id": "Composition.section:Immunizations.code.coding.code", "path": "Composition.section.code.coding.code", "min": 1, "fixedCode": "11369-6", "mustSupport": true }, { "id": "Composition.section:Immunizations.text", "path": "Composition.section.text", "min": 1, "mustSupport": true }, { "id": "Composition.section:Immunizations.entry", "path": "Composition.section.entry", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "http://telus.com/fhir/patientChart/StructureDefinition/profile-immunization" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Composition.section:Immunizations.emptyReason", "path": "Composition.section.emptyReason", "max": "0" }, { "id": "Composition.section:Immunizations.section", "path": "Composition.section.section", "max": "0", "contentReference": "http://hl7.org/fhir/StructureDefinition/Composition#Composition.section" }, { "id": "Composition.section:VitalSigns", "path": "Composition.section", "sliceName": "VitalSigns", "max": "1", "mustSupport": true }, { "id": "Composition.section:VitalSigns.title", "path": "Composition.section.title", "min": 1, "mustSupport": true }, { "id": "Composition.section:VitalSigns.code", "path": "Composition.section.code", "comment": "Usage: 8716-3 Vital signs LOINC\r\n\r\nThe code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document. \n\nIf the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.", "min": 1, "mustSupport": true }, { "id": "Composition.section:VitalSigns.code.coding", "path": "Composition.section.code.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Composition.section:VitalSigns.code.coding.system", "path": "Composition.section.code.coding.system", "min": 1, "fixedUri": "http://loinc.org", "mustSupport": true }, { "id": "Composition.section:VitalSigns.code.coding.code", "path": "Composition.section.code.coding.code", "min": 1, "fixedCode": "8716-3", "mustSupport": true }, { "id": "Composition.section:VitalSigns.text", "path": "Composition.section.text", "min": 1, "mustSupport": true }, { "id": "Composition.section:VitalSigns.entry", "path": "Composition.section.entry", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-vitals" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Composition.section:VitalSigns.entry.reference", "path": "Composition.section.entry.reference", "min": 1 }, { "id": "Composition.section:VitalSigns.emptyReason", "path": "Composition.section.emptyReason", "max": "0" }, { "id": "Composition.section:VitalSigns.section", "path": "Composition.section.section", "max": "0", "contentReference": "http://hl7.org/fhir/StructureDefinition/Composition#Composition.section" }, { "id": "Composition.section:Results", "path": "Composition.section", "sliceName": "Results", "comment": "Usage Note: This section will convey labs which can be a Diagnostic Report with Observations, or individual observations. The human readable form (eg PDF) assocaited with each lab report will be an attachment (Presented Form) in the Diagnostic Report.", "max": "1", "mustSupport": true }, { "id": "Composition.section:Results.title", "path": "Composition.section.title", "min": 1, "mustSupport": true }, { "id": "Composition.section:Results.code", "path": "Composition.section.code", "comment": "Usage Note: This code reflects the nature of the Diagnostic Report section; code aligns with PS-CA\r\n\r\n\r\nThe code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document. \n\nIf the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.", "mustSupport": true }, { "id": "Composition.section:Results.code.coding", "path": "Composition.section.code.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Composition.section:Results.code.coding.system", "path": "Composition.section.code.coding.system", "min": 1, "mustSupport": true }, { "id": "Composition.section:Results.code.coding.code", "path": "Composition.section.code.coding.code", "min": 1, "fixedCode": "30954-2", "mustSupport": true }, { "id": "Composition.section:Results.code.coding.display", "path": "Composition.section.code.coding.display", "comment": "Value = Relevant diagnostic tests &or laboratory data\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size" }, { "id": "Composition.section:Results.text", "path": "Composition.section.text", "min": 1, "mustSupport": true }, { "id": "Composition.section:Results.entry", "path": "Composition.section.entry", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-lab", "http://telus.com/fhir/patientChart/StructureDefinition/profile-diagnostic-report" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Composition.section:Results.entry.reference", "path": "Composition.section.entry.reference", "min": 1, "mustSupport": true }, { "id": "Composition.section:Results.emptyReason", "path": "Composition.section.emptyReason", "max": "0" }, { "id": "Composition.section:Results.section", "path": "Composition.section.section", "max": "0", "contentReference": "http://hl7.org/fhir/StructureDefinition/Composition#Composition.section" }, { "id": "Composition.section:SocialHistory", "path": "Composition.section", "sliceName": "SocialHistory", "mustSupport": true }, { "id": "Composition.section:SocialHistory.title", "path": "Composition.section.title", "comment": "Usage Note: Suggested title = \"Social History\" if this section covers multiple observations.\r\n\r\nThe title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.", "mustSupport": true }, { "id": "Composition.section:SocialHistory.code", "path": "Composition.section.code", "min": 1, "mustSupport": true }, { "id": "Composition.section:SocialHistory.code.coding", "path": "Composition.section.code.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Composition.section:SocialHistory.code.coding.system", "path": "Composition.section.code.coding.system", "min": 1, "fixedUri": "http://loinc.org", "mustSupport": true }, { "id": "Composition.section:SocialHistory.code.coding.code", "path": "Composition.section.code.coding.code", "min": 1, "fixedCode": "29762-2", "mustSupport": true }, { "id": "Composition.section:SocialHistory.entry", "path": "Composition.section.entry", "type": [ { "code": "Reference", "profile": [ "http://telus.com/fhir/patientChartStructureDefinition/profile-ObservationAlcoholUse", "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-tobacco-use", "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-social-history" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Composition.section:SocialHistory.entry.reference", "path": "Composition.section.entry.reference", "min": 1, "mustSupport": true }, { "id": "Composition.section:SocialHistory.entry.display", "path": "Composition.section.entry.display", "mustSupport": true }, { "id": "Composition.section:SocialHistory.section", "path": "Composition.section.section", "contentReference": "http://hl7.org/fhir/StructureDefinition/Composition#Composition.section" }, { "id": "Composition.section:FamilyHistory", "path": "Composition.section", "sliceName": "FamilyHistory" }, { "id": "Composition.section:FamilyHistory.title", "path": "Composition.section.title", "min": 1, "mustSupport": true }, { "id": "Composition.section:FamilyHistory.code", "path": "Composition.section.code", "mustSupport": true }, { "id": "Composition.section:FamilyHistory.text", "path": "Composition.section.text", "min": 1, "mustSupport": true }, { "id": "Composition.section:FamilyHistory.entry", "path": "Composition.section.entry", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "https://telus.com/fhir/patientChart/StructureDefinition/profile-family-member-history" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Composition.section:FamilyHistory.emptyReason", "path": "Composition.section.emptyReason", "max": "0" }, { "id": "Composition.section:FamilyHistory.section", "path": "Composition.section.section", "max": "0", "contentReference": "http://hl7.org/fhir/StructureDefinition/Composition#Composition.section" }, { "id": "Composition.section:PregnancyHx", "path": "Composition.section", "sliceName": "PregnancyHx" }, { "id": "Composition.section:PregnancyHx.title", "path": "Composition.section.title", "mustSupport": true }, { "id": "Composition.section:PregnancyHx.code", "path": "Composition.section.code", "mustSupport": true }, { "id": "Composition.section:PregnancyHx.code.text", "path": "Composition.section.code.text", "mustSupport": true }, { "id": "Composition.section:PregnancyHx.text", "path": "Composition.section.text", "mustSupport": true }, { "id": "Composition.section:PregnancyHx.entry", "path": "Composition.section.entry", "mustSupport": true }, { "id": "Composition.section:PregnancyHx.emptyReason", "path": "Composition.section.emptyReason", "max": "0" }, { "id": "Composition.section:PregnancyHx.section", "path": "Composition.section.section", "max": "0", "contentReference": "http://hl7.org/fhir/StructureDefinition/Composition#Composition.section" } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-condition-patientchart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-condition-patientchart", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.407+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-condition", "name": "Condition", "title": "Condition Patient Chart", "status": "draft", "date": "2022-03-30T17:59:35.70094+00:00", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Condition", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Condition", "derivation": "constraint", "differential": { "element": [ { "id": "Condition.id", "path": "Condition.id", "comment": "Usage Note: This will usually be a GUID that is assigned by the sending application.\r\n\r\nThe only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "mustSupport": true }, { "id": "Condition.meta", "path": "Condition.meta", "mustSupport": true }, { "id": "Condition.meta.lastUpdated", "path": "Condition.meta.lastUpdated", "mustSupport": true }, { "id": "Condition.meta.source", "path": "Condition.meta.source", "mustSupport": true }, { "id": "Condition.meta.profile", "path": "Condition.meta.profile", "comment": "Usage: This will be determined by each impelmenttion. This may be useful for validation of message instances against this profile, http://telus.com/fhir/patientChart/StructureDefinition/profile-condition.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "Condition.text", "path": "Condition.text", "comment": "Conformance Rule: This must be formatted, as closely as possible what was presented to the user in the originating system and must include all clinical data. \r\n\r\nContained 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.", "mustSupport": true }, { "id": "Condition.clinicalStatus", "path": "Condition.clinicalStatus", "comment": "Usage: Problem List items are active; past health events/problems are inactive. When conditions are added to an encounter, this could be active in or inactive/resolved, etc. though a state is not usually captured discretely in the EMR. This may be captured as text which is not accessible.\r\nUsage Note: For problem list items, this should be treated as mandatory; these will be active unless user has chosen a different statuss. For past health events, this should be mandatory and inactive. \r\nUsage Note: For encounter-diagnosis, this is optional and only specified when EMR's discretely capture this data.\r\n\r\nAlignment: Ths is mandatory in R5; known issue: the EMR does not always have an encounter diagnosis. A value of \"unknown\" may be added\r\nAlignment: Mandatory in PS-ON and PS-CA. This is not mandatory in the Patient Chart as the status is not always known in the context of an encounter-diagnosis as this may not be captured discretely.\r\n \r\nMA: urn:telus:emr:ma:*:codetable:problem-clinical-status\r\nPSS:urn:telus:emr:pss:*:codetable:problem-clinicalstatus\r\nMS: N/A\r\nEMRAPI = clinicalStatus\r\n\r\nThe data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.", "mustSupport": true }, { "id": "Condition.clinicalStatus.coding", "path": "Condition.clinicalStatus.coding", "max": "1", "mustSupport": true }, { "id": "Condition.clinicalStatus.coding.system", "path": "Condition.clinicalStatus.coding.system", "min": 1, "mustSupport": true }, { "id": "Condition.clinicalStatus.coding.code", "path": "Condition.clinicalStatus.coding.code", "min": 1, "mustSupport": true }, { "id": "Condition.clinicalStatus.text", "path": "Condition.clinicalStatus.text", "mustSupport": true }, { "id": "Condition.verificationStatus", "path": "Condition.verificationStatus", "comment": "EMRAPI = ConfirmationStatus\r\nMA: urn:telus:emr:ma:*:codetable:problem-clinical-status\r\nPSS:urn:telus:emr:pss:*:codetable:problem-clinicalstatus\r\nMS: N/A\r\nUsage Noe: verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. \r\n\r\nThe data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.", "mustSupport": true }, { "id": "Condition.verificationStatus.coding", "path": "Condition.verificationStatus.coding", "max": "1", "mustSupport": true }, { "id": "Condition.verificationStatus.coding.system", "path": "Condition.verificationStatus.coding.system", "min": 1, "mustSupport": true }, { "id": "Condition.verificationStatus.coding.code", "path": "Condition.verificationStatus.coding.code", "min": 1, "mustSupport": true }, { "id": "Condition.verificationStatus.text", "path": "Condition.verificationStatus.text", "mustSupport": true }, { "id": "Condition.category", "path": "Condition.category", "comment": "Usage: this should always be set to \"problem-list-item\" when exporting the problem list, eg in Ontario Patient Summary.\r\n\r\nFDG - do we want this element? Maybe we just always use problem-list or go with what the EMRs return?\r\nEMRAPI = category\r\nMA: urn:telus:emr:ma:*:codetable:problem-category\r\nPSS: N/A\r\nMS: Not able to distinguish between an encounter diagnosis and a problem. Therefore NA\r\nCHR: ?\r\n\r\nThe categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.", "mustSupport": true }, { "id": "Condition.category.coding", "path": "Condition.category.coding", "max": "1", "mustSupport": true }, { "id": "Condition.category.coding.system", "path": "Condition.category.coding.system", "min": 1, "mustSupport": true }, { "id": "Condition.category.coding.code", "path": "Condition.category.coding.code", "min": 1, "mustSupport": true }, { "id": "Condition.category.coding.display", "path": "Condition.category.coding.display", "mustSupport": true }, { "id": "Condition.category.text", "path": "Condition.category.text", "min": 1, "mustSupport": true }, { "id": "Condition.severity", "path": "Condition.severity", "comment": "EMRAPI: severity\r\nMA: urn:telus:emr:ma:*:codetable:problem-severity\r\nPSS: N/A\r\nMS: N/A\r\nCHR: severity not attached to a diagnosis\r\n\r\nMA: Not supported for: surgical hx, obstetric, lifestyle, social hx, \r\nFHIR-->MA \r\nsevere--> severe/alert\r\nmoderate-->moderate\r\nmild-->mild\r\nnew code-->unknown\r\nN/A-->blank\r\n\r\nFDG - do we want a code for unknown, or just leave blank?Coding of the severity with a terminology is preferred, where possible.", "mustSupport": true }, { "id": "Condition.severity.coding", "path": "Condition.severity.coding", "max": "1", "mustSupport": true }, { "id": "Condition.severity.coding.system", "path": "Condition.severity.coding.system", "min": 1, "mustSupport": true }, { "id": "Condition.severity.coding.code", "path": "Condition.severity.coding.code", "min": 1, "mustSupport": true }, { "id": "Condition.severity.coding.display", "path": "Condition.severity.coding.display", "mustSupport": true }, { "id": "Condition.severity.text", "path": "Condition.severity.text", "mustSupport": true }, { "id": "Condition.code", "path": "Condition.code", "comment": "Conformance Rule: The local code must always be specified where present. If a SNOMED. Encode, ICD-9 or ICD-10 code is present, this must also be sent.\r\n\r\nAlignment PS-ON: Must support SNOMED coding; this is very often not in the EMR; EMRs will send if there is an exact match on the code or if the EMR supports SNOMED\r\n\r\nAlignment PS-ON: n situations where the EMR cannot distinguish between no-known and no information about patient procedures, then the code for no information should be used. In the instance where a patient is KNOWN to have no procedures, the no-known code should be used.\r\n\r\nEMRAPI = code\r\n\r\nMA: ICD9-BILL, ICD9, free text, snomed, PIN (AB) code sets are too many and too large for mapping at the moment. Requires clinic input and maybe a health informatics specialist as well.\r\nPSS: http://hl7.org/fhir/sid/icd-9,10, also supports SNOMED. \r\nMS: ICD 10 or free text\r\n\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 1, "mustSupport": true }, { "id": "Condition.code.coding", "path": "Condition.code.coding", "mustSupport": true }, { "id": "Condition.code.coding.system", "path": "Condition.code.coding.system", "min": 1, "mustSupport": true }, { "id": "Condition.code.coding.code", "path": "Condition.code.coding.code", "min": 1, "mustSupport": true }, { "id": "Condition.code.coding.display", "path": "Condition.code.coding.display", "mustSupport": true }, { "id": "Condition.code.text", "path": "Condition.code.text", "comment": "Usage Note: Text must always be sent to ensure there is no loss of data. Often there is additional text recorded in the EMR\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "Condition.bodySite", "path": "Condition.bodySite", "comment": "Conformance Rule: This is not currently supported; may be in future\r\n\r\nEMRAPI = BodySites\r\nMA: N/A\r\nPSS: N/A\r\nMS: N/A\r\n\r\nOnly used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.", "mustSupport": true }, { "id": "Condition.bodySite.coding", "path": "Condition.bodySite.coding", "max": "1", "mustSupport": true }, { "id": "Condition.bodySite.coding.system", "path": "Condition.bodySite.coding.system", "min": 1, "mustSupport": true }, { "id": "Condition.bodySite.coding.code", "path": "Condition.bodySite.coding.code", "min": 1, "mustSupport": true }, { "id": "Condition.bodySite.text", "path": "Condition.bodySite.text", "mustSupport": true }, { "id": "Condition.subject", "path": "Condition.subject", "type": [ { "code": "Reference", "targetProfile": [ "http://telus.com/fhir/StructureDefinition/profile-patient-patientchart" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Condition.subject.reference", "path": "Condition.subject.reference", "min": 1, "mustSupport": true }, { "id": "Condition.subject.display", "path": "Condition.subject.display", "mustSupport": true }, { "id": "Condition.encounter", "path": "Condition.encounter", "comment": "Usage Note: If data is definitively tied to an encounter in the EMR, this reference should be sent. If there is no definitive reference, this should not be derived using date or other data points.\r\n\r\nThis will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a \"new\" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first \"known\".", "mustSupport": true }, { "id": "Condition.onset[x]", "path": "Condition.onset[x]", "comment": "EMRAPI: dateOfOnsetFD\r\n\r\nMA & CHR - only capture a date format and lifestage (eg adolescence) \r\nPSS: captures age, string\r\n\r\nAge is generally used when the patient reports an age at which the Condition began to occur.", "mustSupport": true }, { "id": "Condition.abatement[x]", "path": "Condition.abatement[x]", "comment": "EMRAPI: dateOfAbatement\r\nPSS: Supports date, age and life stage\r\nMA & CHR - only capture a date format, \r\n\r\nThere is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.", "mustSupport": true }, { "id": "Condition.recordedDate", "path": "Condition.recordedDate", "comment": "EMRAPI: dateFD\r\nPSS: Note date from database", "mustSupport": true }, { "id": "Condition.recorder", "path": "Condition.recorder", "comment": "EMRAPI: not supported\r\n\r\nMA - Whoever created the profile via the task history\r\nPSS - NA\r\nMS - Active problem-> createdBy\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "Condition.recorder.reference", "path": "Condition.recorder.reference", "mustSupport": true }, { "id": "Condition.recorder.display", "path": "Condition.recorder.display", "mustSupport": true }, { "id": "Condition.asserter", "path": "Condition.asserter", "comment": "Usage Note: Not required for Patient Chart\r\n\r\nAlignment-PS-ON: If the asserter is known to be someone other than Composition.author, that information should be conveyed using this element. Otherwise, it may be left empty\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." }, { "id": "Condition.asserter.reference", "path": "Condition.asserter.reference", "mustSupport": true }, { "id": "Condition.asserter.display", "path": "Condition.asserter.display", "mustSupport": true }, { "id": "Condition.stage", "path": "Condition.stage", "comment": "EMRAPI: disease stage\r\n\r\nDISCUSSION: NO EMR'S ARE SUPPORTED THIS TODAY. DO WE REMOVE THIS? FDG", "mustSupport": false }, { "id": "Condition.note", "path": "Condition.note", "comment": "EMRAPI: notes\r\nThis is description for the PHR project. \r\nDISCUSSION REQUIRED - determine whether this should map to code.text as opposed to here AS THE definition for this is \"additional information\". Do we need a limit? Are the EMR's supporting this concept?\r\n\r\n\r\nNote: OMD would like this to be just additional details, not the description.For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. *Annotations SHOULD NOT* be used to communicate \"modifying\" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).", "mustSupport": true }, { "id": "Condition.note.author[x]", "path": "Condition.note.author[x]", "mustSupport": true }, { "id": "Condition.note.time", "path": "Condition.note.time", "min": 1, "mustSupport": true }, { "id": "Condition.note.text", "path": "Condition.note.text", "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/c4c90334-f7c3-4983-8e71-ae52add9b914", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-diagnostic-report", "name": "DiagnosticReport", "title": "Diagnostic Report Patient Chart", "status": "draft", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "DiagnosticReport", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DiagnosticReport", "derivation": "constraint", "differential": { "element": [ { "id": "DiagnosticReport", "path": "DiagnosticReport", "mustSupport": true }, { "id": "DiagnosticReport.id", "path": "DiagnosticReport.id", "mustSupport": true }, { "id": "DiagnosticReport.meta", "path": "DiagnosticReport.meta", "mustSupport": true }, { "id": "DiagnosticReport.meta.lastUpdated", "path": "DiagnosticReport.meta.lastUpdated", "mustSupport": true }, { "id": "DiagnosticReport.meta.source", "path": "DiagnosticReport.meta.source", "mustSupport": true }, { "id": "DiagnosticReport.meta.profile", "path": "DiagnosticReport.meta.profile", "comment": "Usage: Will be determined by each implementation. May be useful for validating message instnaces against this profile.\r\n\r\nIt 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.", "max": "1", "mustSupport": true }, { "id": "DiagnosticReport.text", "path": "DiagnosticReport.text", "comment": "Conformance Rule: This must be formatted, as closely as possible what was presented to the user in the originating system and must include all clinical data. \r\n\r\nContained 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.", "mustSupport": true }, { "id": "DiagnosticReport.extension", "path": "DiagnosticReport.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "DiagnosticReport.extension:DiagnosticReportNote", "path": "DiagnosticReport.extension", "sliceName": "DiagnosticReportNote", "definition": "Comments about the Diagnostic Report", "comment": "This is a pre-adoption of an R5 data element\r\n\r\nMay include general statements about the diagnostic report, or statements about significant, unexpected or unreliable results values contained within the diagnostic report, or information about its source when relevant to its interpretation.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.note" ] } ], "isModifier": false }, { "id": "DiagnosticReport.identifier", "path": "DiagnosticReport.identifier", "comment": "Usage Note: This is mandatory for OLIS. If known this should be populated\r\n\r\nUsually assigned by the Information System of the diagnostic service provider (filler id)." }, { "id": "DiagnosticReport.basedOn", "path": "DiagnosticReport.basedOn", "comment": "Usage Note: This is supported for OLIS\r\n\r\nNote: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports." }, { "id": "DiagnosticReport.status", "path": "DiagnosticReport.status", "comment": "Usage Note: EMRs will always use a state of \"final\" for the Patient Chart.\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "DiagnosticReport.category", "path": "DiagnosticReport.category", "comment": "Usage Note: Text may be used when a code is not available.\r\n\r\nMultiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.", "min": 1, "mustSupport": true }, { "id": "DiagnosticReport.category.coding", "path": "DiagnosticReport.category.coding", "mustSupport": true }, { "id": "DiagnosticReport.category.coding.system", "path": "DiagnosticReport.category.coding.system", "min": 1, "mustSupport": true }, { "id": "DiagnosticReport.category.coding.code", "path": "DiagnosticReport.category.coding.code", "min": 1, "mustSupport": true }, { "id": "DiagnosticReport.category.text", "path": "DiagnosticReport.category.text", "mustSupport": true }, { "id": "DiagnosticReport.code", "path": "DiagnosticReport.code", "mustSupport": true }, { "id": "DiagnosticReport.code.coding", "path": "DiagnosticReport.code.coding", "mustSupport": true }, { "id": "DiagnosticReport.code.coding.system", "path": "DiagnosticReport.code.coding.system", "mustSupport": true }, { "id": "DiagnosticReport.code.coding.code", "path": "DiagnosticReport.code.coding.code", "mustSupport": true }, { "id": "DiagnosticReport.code.coding.display", "path": "DiagnosticReport.code.coding.display", "mustSupport": true }, { "id": "DiagnosticReport.code.text", "path": "DiagnosticReport.code.text", "mustSupport": true }, { "id": "DiagnosticReport.subject", "path": "DiagnosticReport.subject", "min": 1, "mustSupport": true }, { "id": "DiagnosticReport.subject.reference", "path": "DiagnosticReport.subject.reference", "min": 1, "mustSupport": true }, { "id": "DiagnosticReport.subject.display", "path": "DiagnosticReport.subject.display", "comment": "TUsage Note: This should contain the name of the Patient, which can then be used in narrative\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "DiagnosticReport.encounter", "path": "DiagnosticReport.encounter", "comment": "Usage Note: If data is definitively tied to an encounter in the EMR, this reference should be sent. If there is no definitive reference, this should not be derived using date or other data points.\r\n\r\nThis will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).", "mustSupport": true }, { "id": "DiagnosticReport.effective[x]", "path": "DiagnosticReport.effective[x]", "comment": "Usage Note: This should be populated if known. Note: this is not supported by OLIS\r\n\r\nIf the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.", "mustSupport": true }, { "id": "DiagnosticReport.issued", "path": "DiagnosticReport.issued", "comment": "Usage Note: This is the date that the EMR received the report.\r\n\r\nMay be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.", "mustSupport": true }, { "id": "DiagnosticReport.performer", "path": "DiagnosticReport.performer", "comment": "Usage Note: This must be present when known.\r\nUsage Note: This is supported by OLIS.\r\n\r\nThis is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.", "mustSupport": true }, { "id": "DiagnosticReport.performer.reference", "path": "DiagnosticReport.performer.reference", "comment": "Usage: This is typically used for internal only; for external the use of display is acceptable.\r\n\r\nUsing absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "mustSupport": true }, { "id": "DiagnosticReport.performer.display", "path": "DiagnosticReport.performer.display", "mustSupport": true }, { "id": "DiagnosticReport.specimen", "path": "DiagnosticReport.specimen", "comment": "Usage Note: This is supported by OLIS; not supported in the EMRs today\r\n\r\nIf the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group." }, { "id": "DiagnosticReport.result", "path": "DiagnosticReport.result", "comment": "Usage note: In some cases there is only a PDF and/or note\r\n\r\nObservations can contain observations.", "mustSupport": true }, { "id": "DiagnosticReport.result.reference", "path": "DiagnosticReport.result.reference", "min": 1, "mustSupport": true }, { "id": "DiagnosticReport.result.display", "path": "DiagnosticReport.result.display", "comment": "Usage Note: This is a user-friendly textual representation of the result that should be used in the narrative for this resource\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "min": 1, "mustSupport": true }, { "id": "DiagnosticReport.media", "path": "DiagnosticReport.media", "comment": "Usage Note: This is supported in order to maintain alignment with Core-CA; however there are no Patient Chart use cases where EMR's will send this data as it is not kept locally. \r\n\r\nAlignment: Core-CA - supported, 0..*", "mustSupport": true }, { "id": "DiagnosticReport.conclusion", "path": "DiagnosticReport.conclusion", "comment": "Usage Note: Future Use. This is very often not discretely stored in the EMR; it is often part of text.\r\nUsage Note: This is supported by OLIS\r\n \r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size" }, { "id": "DiagnosticReport.presentedForm", "path": "DiagnosticReport.presentedForm", "mustSupport": true }, { "id": "DiagnosticReport.presentedForm.contentType", "path": "DiagnosticReport.presentedForm.contentType", "min": 1, "mustSupport": true }, { "id": "DiagnosticReport.presentedForm.language", "path": "DiagnosticReport.presentedForm.language", "mustSupport": true }, { "id": "DiagnosticReport.presentedForm.data", "path": "DiagnosticReport.presentedForm.data", "mustSupport": true }, { "id": "DiagnosticReport.presentedForm.url", "path": "DiagnosticReport.presentedForm.url", "mustSupport": true }, { "id": "DiagnosticReport.presentedForm.size", "path": "DiagnosticReport.presentedForm.size", "mustSupport": true }, { "id": "DiagnosticReport.presentedForm.hash", "path": "DiagnosticReport.presentedForm.hash", "mustSupport": true }, { "id": "DiagnosticReport.presentedForm.title", "path": "DiagnosticReport.presentedForm.title", "mustSupport": true }, { "id": "DiagnosticReport.presentedForm.creation", "path": "DiagnosticReport.presentedForm.creation", "mustSupport": true } ] }, "id": "c4c90334-f7c3-4983-8e71-ae52add9b914", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.408+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/bea3a60e-63ad-4d64-a71b-ede736089256", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-diagnostic-report-note", "name": "DiagnosticReportNote", "status": "draft", "fhirVersion": "4.0.1", "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "DiagnosticReport" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/profile-diagnostic-report-note" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "min": 1, "type": [ { "code": "Annotation" } ], "mustSupport": true } ] }, "id": "bea3a60e-63ad-4d64-a71b-ede736089256", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.397+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/ext-request-dispenser-instructions", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "ext-request-dispenser-instructions", "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-request-dispenser-instructions", "name": "DispenserInstructions", "title": "Ext-Dispenser Instructions", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "MedicationRequest" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "mustSupport": true }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/ext-request-dispenser-instructions" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "min": 1, "type": [ { "code": "string" } ], "mustSupport": true } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.397+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/ext-medicationorder-dispense-trial", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "ext-medicationorder-dispense-trial", "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-dispense-trial", "name": "DispenseTrial", "title": "Ext-DispenseTrial", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "MedicationRequest.dispenseRequest" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "mustSupport": true }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-dispense-trial" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "type": [ { "code": "boolean" } ], "mustSupport": true } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.397+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-bundle-document", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-bundle-document", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.405+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-bundle-document", "name": "DocumentBundle", "title": "Document Bundle For Patient Chart", "status": "draft", "date": "2021-03-01T20:08:51.0359467+00:00", "description": "This profile is used for bundles of type document", "fhirVersion": "4.0.1", "mapping": [ { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "cda", "uri": "http://hl7.org/v3/cda", "name": "CDA (R2)" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" } ], "kind": "resource", "abstract": false, "type": "Bundle", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Bundle", "derivation": "constraint", "differential": { "element": [ { "id": "Bundle", "path": "Bundle", "mustSupport": true }, { "id": "Bundle.id", "path": "Bundle.id", "mustSupport": true }, { "id": "Bundle.meta", "path": "Bundle.meta", "comment": "***\r\nadd extension for original version and reference", "min": 1, "mustSupport": true }, { "id": "Bundle.meta.source", "path": "Bundle.meta.source", "comment": "Conformance Rule: This must be supplied when known which is the vast majority of times\r\n\r\nIn the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. \n\nThis 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.", "mustSupport": true }, { "id": "Bundle.meta.profile", "path": "Bundle.meta.profile", "min": 1, "max": "1", "fixedCanonical": "http://telus.com/fhir/patientChart/StructureDefinition/profile-bundle-document", "mustSupport": true }, { "id": "Bundle.meta.tag", "path": "Bundle.meta.tag", "slicing": { "discriminator": [ { "type": "type", "path": "$this" } ], "rules": "open" }, "max": "1", "mustSupport": true }, { "id": "Bundle.meta.tag:Version", "path": "Bundle.meta.tag", "sliceName": "Version", "min": 1, "max": "1", "binding": { "strength": "example", "valueSet": "http://telus.com/fhir/ValueSet/telus-version" } }, { "id": "Bundle.meta.tag:Version.system", "path": "Bundle.meta.tag.system", "min": 1, "mustSupport": true }, { "id": "Bundle.meta.tag:Version.code", "path": "Bundle.meta.tag.code", "min": 1, "mustSupport": true }, { "id": "Bundle.identifier", "path": "Bundle.identifier", "mustSupport": true }, { "id": "Bundle.type", "path": "Bundle.type", "comment": "Usage Rule: This profile is only used for documents, where the first entry must be a composition\r\nREVIEW - MAY COLLAPSE INTO A SINGLE BUNDLE PROFILE\r\n\r\nIt's possible to use a bundle for other purposes (e.g. a document can be accepted as a transaction). This is primarily defined so that there can be specific rules for some of the bundle types.", "fixedCode": "document", "mustSupport": true }, { "id": "Bundle.entry", "path": "Bundle.entry", "min": 1, "mustSupport": true }, { "id": "Bundle.entry.link", "path": "Bundle.entry.link", "contentReference": "http://hl7.org/fhir/StructureDefinition/Bundle#Bundle.link" }, { "id": "Bundle.entry.fullUrl", "path": "Bundle.entry.fullUrl", "mustSupport": true }, { "id": "Bundle.entry.resource", "path": "Bundle.entry.resource", "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-documentReference", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-documentReference", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.408+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-clinical-note-documentReference", "name": "DocumentReference", "title": "DocumentReference", "status": "draft", "date": "2021-03-01T20:09:56.9691901+00:00", "description": "Used to capture Clinical Notes", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "fhircomposition", "uri": "http://hl7.org/fhir/composition", "name": "FHIR Composition" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "cda", "uri": "http://hl7.org/v3/cda", "name": "CDA (R2)" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "xds", "uri": "http://ihe.net/xds", "name": "XDS metadata equivalent" } ], "kind": "resource", "abstract": false, "type": "DocumentReference", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DocumentReference", "derivation": "constraint", "differential": { "element": [ { "id": "DocumentReference", "path": "DocumentReference", "comment": "Usage Notes: Clinical notes that are captured as free text in the EMR map nicely into this resource. If notes are captured in a more structured manner using templates, the questionnaire response is likely more appropriate. \r\n\r\nUsually, this is used for documents other than those defined by FHIR.", "mustSupport": true }, { "id": "DocumentReference.id", "path": "DocumentReference.id", "comment": "Usage Note: This will usually be a GUID that is assigned by the sending application. \r\n\r\nThe only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "mustSupport": true }, { "id": "DocumentReference.meta", "path": "DocumentReference.meta", "mustSupport": true }, { "id": "DocumentReference.meta.lastUpdated", "path": "DocumentReference.meta.lastUpdated", "mustSupport": true }, { "id": "DocumentReference.meta.source", "path": "DocumentReference.meta.source", "mustSupport": true }, { "id": "DocumentReference.meta.profile", "path": "DocumentReference.meta.profile", "comment": "Usage: This will be determined by each implementation. This may be useful in validating message instances against this profile.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "DocumentReference.text", "path": "DocumentReference.text", "comment": "Conformance Rule: This must be formatted, as closely as possible what was presented to the user in the originating system and must include all clinical data. \r\n\r\nContained 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.", "mustSupport": true }, { "id": "DocumentReference.text.status", "path": "DocumentReference.text.status", "mustSupport": true }, { "id": "DocumentReference.text.div", "path": "DocumentReference.text.div", "mustSupport": true }, { "id": "DocumentReference.identifier", "path": "DocumentReference.identifier", "comment": "Conformance Rule: This will be populated with the business identifier; for example, DI Requisition Identifier assocaited with the attachment or Bundle when known.", "max": "1", "mustSupport": true }, { "id": "DocumentReference.identifier.system", "path": "DocumentReference.identifier.system", "mustSupport": true }, { "id": "DocumentReference.identifier.value", "path": "DocumentReference.identifier.value", "mustSupport": true }, { "id": "DocumentReference.status", "path": "DocumentReference.status", "definition": "The status of this document reference", "fixedCode": "current", "mustSupport": true }, { "id": "DocumentReference.docStatus", "path": "DocumentReference.docStatus", "comment": "Usage: Draft and unfinished notes would be preliminary; Final is often used. Amended and entered-in-error would likely not be used\r\nUsage: If EMRs are able to provide it, this must be populated\r\n\r\nThe document that is pointed to might be in various lifecycle states.", "mustSupport": true }, { "id": "DocumentReference.type", "path": "DocumentReference.type", "comment": "Usage Note: Category should be specified when known. Typical categories are things like: Internal/EMR - physicals, general assessment, Admission history nd physical, Diabetic visit note, Follow-up Opiod addiction visit ** LOOK FOR LOINC CODES FOR THESE -- https://loinc.org/LG38741-1/\r\nUsage Note: This is used to identify the type of note/structure of the document, eg consultation, progress note, discharge summary etc. This may not identifiy the specialty (eg cardiology), however, if this is known (eg cardinalogy discharge summary) it should be included here. Note: The same code may be replicated in category. Example codes: https://fhir.loinc.org/ValueSet/?url=http://loinc.org/vs/LG39083-7\r\n\r\nConformance Rule: This must be specified when known. Set type to the best, most precise LOINC code corresponding to the concept of the document in the source system.\r\nConformance Rule: If available, a local code must be supplied as well (code, system, mandatory text, userSelected).\r\nExamples (US Core) - TELUS WILL NEED TO PUBLISH OUR OWN VALUE SET\r\n\r\nConsultation Note (11488-4)\r\nDischarge Summary (18842-5)\r\nHistory & Physical Note (34117-2)\r\nProcedures Note (28570-0)\r\nProgress Note (11506-3)\r\nNote (34109-9)\r\n\r\n\r\nUsage Note: In future releases, a full set of LOINC codes (including LOINC.Ontology codes) will be added to this value set. Implementers should expect that this value set will be provided outside of the specification. This will not be populated on messages that originate from sending systems on an earlier May 2016 version.", "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "http://telus.com/fhir/ValueSet/telus-documentreference-type-category" } }, { "id": "DocumentReference.type.coding", "path": "DocumentReference.type.coding", "max": "5", "mustSupport": true }, { "id": "DocumentReference.type.coding.system", "path": "DocumentReference.type.coding.system", "min": 1, "mustSupport": true }, { "id": "DocumentReference.type.coding.code", "path": "DocumentReference.type.coding.code", "min": 1, "mustSupport": true }, { "id": "DocumentReference.type.coding.display", "path": "DocumentReference.type.coding.display", "mustSupport": true }, { "id": "DocumentReference.type.coding.userSelected", "path": "DocumentReference.type.coding.userSelected", "mustSupport": true }, { "id": "DocumentReference.type.text", "path": "DocumentReference.type.text", "min": 1, "mustSupport": true }, { "id": "DocumentReference.type.text.extension", "path": "DocumentReference.type.text.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "DocumentReference.type.text.extension:TypeTextTranslation", "path": "DocumentReference.type.text.extension", "sliceName": "TypeTextTranslation", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/translation" ] } ], "mustSupport": true }, { "id": "DocumentReference.category", "path": "DocumentReference.category", "comment": "Conformance Rule: Populate category with the best, most precise LOINC code corresponding to each category code in the source system. Multiple categories may be specified in some cases. Example: A document could be categorized as both a Discharge Summary and a Post-Operative Report.\r\n\r\nUsage note: A category will typically pertain to the specialty, eg Chemotherapy, Cardiology. This could be a repetition of the type, if the type is not a combination code of type/specialty, eg diabetes prorgess note. The type could be \"progress note\", or \"diabetes progress note\". If the document is a template/custom form/observational template, the name of the template would be captured as \"text\", eg \"CDM diabetes visit\". \r\n\r\nUsage Rule: The POS must send a local code and the LOINC code.\r\n\r\nUsage Note: In future releases a full set of LOINC codes (including LOINC.Ontology codes) will be added to this value set. Implementers should expect that this value set will be provided outside of the specification. This will not be populated on messages that originate from sending systems on an earlier May 2016 version.", "max": "10", "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "http://telus.com/fhir/ValueSet/telus-documentreference-type-category" } }, { "id": "DocumentReference.category.coding", "path": "DocumentReference.category.coding", "max": "5", "mustSupport": true }, { "id": "DocumentReference.category.coding.system", "path": "DocumentReference.category.coding.system", "min": 1, "mustSupport": true }, { "id": "DocumentReference.category.coding.code", "path": "DocumentReference.category.coding.code", "min": 1, "mustSupport": true }, { "id": "DocumentReference.category.coding.display", "path": "DocumentReference.category.coding.display", "mustSupport": true }, { "id": "DocumentReference.category.coding.userSelected", "path": "DocumentReference.category.coding.userSelected", "mustSupport": true }, { "id": "DocumentReference.category.text", "path": "DocumentReference.category.text", "min": 1, "mustSupport": true }, { "id": "DocumentReference.category.text.extension", "path": "DocumentReference.category.text.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "DocumentReference.category.text.extension:CategoryTextTranslation", "path": "DocumentReference.category.text.extension", "sliceName": "CategoryTextTranslation", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/translation" ] } ], "mustSupport": true }, { "id": "DocumentReference.subject", "path": "DocumentReference.subject", "min": 1, "mustSupport": true }, { "id": "DocumentReference.subject.reference", "path": "DocumentReference.subject.reference", "min": 1, "mustSupport": true }, { "id": "DocumentReference.subject.display", "path": "DocumentReference.subject.display", "comment": "Usage Note: This should contain the name of the Patient, which can then be used in narrative where applicable\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "DocumentReference.date", "path": "DocumentReference.date", "comment": "Usage Note: This is the date of the clinical note.\r\n\r\nReferencing/indexing time is used for tracking, organizing versions and searching.", "mustSupport": true }, { "id": "DocumentReference.author", "path": "DocumentReference.author", "mustSupport": true }, { "id": "DocumentReference.content", "path": "DocumentReference.content", "comment": "Conformance Rule: This is used to convey eServices discrete data bundles and/or attachments. If a discrete bundle is present, the related PDF must also be referenced below.\r\nUsage: Often used to capture clinical notes from the EMR that are pertinent to the Patient Chart data being sent", "max": "1", "mustSupport": true }, { "id": "DocumentReference.content.attachment", "path": "DocumentReference.content.attachment", "comment": "Conformance Rule: When including an eServices bundle (DocumentReference.extension:RelatedBundle), there must be a PDF attachment relating to this for consuming applications who cannot process the discrete data in the bundle.\r\n\r\nWhen providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as \"Signed Procedure Consent\".", "mustSupport": true }, { "id": "DocumentReference.content.attachment.contentType", "path": "DocumentReference.content.attachment.contentType", "min": 1, "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://telus.com/fhir/ValueSet/telus-attachment-type" } }, { "id": "DocumentReference.content.attachment.language", "path": "DocumentReference.content.attachment.language", "mustSupport": true }, { "id": "DocumentReference.content.attachment.data", "path": "DocumentReference.content.attachment.data", "comment": "Usage Note: In most cases, data is expected to convey the clinical notes.\r\n\r\nThe base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.", "mustSupport": true }, { "id": "DocumentReference.content.attachment.url", "path": "DocumentReference.content.attachment.url", "comment": "Usage: The EMR's may have a URL from an external source. eg - Repository to diagnostic images", "mustSupport": true }, { "id": "DocumentReference.content.attachment.size", "path": "DocumentReference.content.attachment.size", "comment": "Usage: Size is useful if there is a URL as it indicates the size prior to downloading\r\n\r\nThe number of bytes is redundant if the data is provided as a base64binary, but is useful if the data is provided as a URL reference.", "mustSupport": true }, { "id": "DocumentReference.content.attachment.hash", "path": "DocumentReference.content.attachment.hash", "mustSupport": true }, { "id": "DocumentReference.content.attachment.title", "path": "DocumentReference.content.attachment.title", "comment": "Usage Note: This could be populated with a template name, or if passing on an external note, the title of the attachment may be useful.\r\nUsage Note: This should be populated with the title, eg \"Dec 27, 2015, A: Gout, Left Foot\". This could be created from the Table of Contents in an EMR or a Summary from the Visit Tab. \r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "DocumentReference.content.attachment.creation", "path": "DocumentReference.content.attachment.creation", "mustSupport": true }, { "id": "DocumentReference.content.format", "path": "DocumentReference.content.format", "comment": "Usage Note: Intended to convey the set of template rules that this content adheres to. Particularly useful for CDA documents. eg Discharge summary following pattern A; \r\n\r\nNote that while IHE mostly issues URNs for format types, not all documents can be identified by a URI." }, { "id": "DocumentReference.context", "path": "DocumentReference.context", "mustSupport": true }, { "id": "DocumentReference.context.encounter", "path": "DocumentReference.context.encounter", "comment": "Usage: Encounter will be used to capture the diagnosis and other visit data\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "DocumentReference.context.encounter.reference", "path": "DocumentReference.context.encounter.reference", "mustSupport": true }, { "id": "DocumentReference.context.encounter.display", "path": "DocumentReference.context.encounter.display", "mustSupport": true }, { "id": "DocumentReference.context.period", "path": "DocumentReference.context.period", "comment": "Usage: This will be populated with the date that is pertinent to the clinical note. eg the date of surgery that the note pertains to. This is distinct from the DocumentRefernece.date which captures the date that the note was authored. \r\n\r\nA Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\").\n\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration)." }, { "id": "DocumentReference.context.period.start", "path": "DocumentReference.context.period.start", "mustSupport": true }, { "id": "DocumentReference.context.period.end", "path": "DocumentReference.context.period.end", "min": 1, "mustSupport": true }, { "id": "DocumentReference.context.sourcePatientInfo", "path": "DocumentReference.context.sourcePatientInfo", "comment": "Usage Note: This must be populated unless it is not tied to a patient.\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "min": 1, "mustSupport": true }, { "id": "DocumentReference.context.sourcePatientInfo.reference", "path": "DocumentReference.context.sourcePatientInfo.reference", "min": 1, "mustSupport": true }, { "id": "DocumentReference.context.sourcePatientInfo.display", "path": "DocumentReference.context.sourcePatientInfo.display", "comment": "Usage Note: This should contain the name of the Patient, which can then be used in narrative where applicable\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "DocumentReference.context.related", "path": "DocumentReference.context.related", "comment": "Usage Note: This can be linked to a service request for referrals.\r\nAlignment: Ontario eReferral supports this\r\n\r\nMay be identifiers or resources that caused the DocumentReference or referenced Document to be created.", "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/ext-documentreference-related-bundle", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "ext-documentreference-related-bundle", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.398+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-documentreference-related-bundle", "name": "DocumentReferenceRelatedBundle", "title": "Ext-Document Reference Related Bundle", "status": "draft", "date": "2021-03-01T20:02:05.4749926+00:00", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "DocumentReference" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/ext-documentreference-related-bundle" }, { "id": "Extension.value[x]", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "Extension.value[x]", "min": 1, "type": [ { "code": "Reference", "aggregation": [ "bundled" ] } ], "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/ext-documentreference-subtype", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "ext-documentreference-subtype", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.398+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-documentreference-subtype", "name": "DocumentReferenceSubType", "title": "Ext-Document Reference Subtype", "status": "draft", "date": "2021-03-01T20:02:28.0439961+00:00", "description": "String identifying the subtype of document that is attached", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "DocumentReference" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "definition": "This is a description of the subtype of document that is attached.", "comment": "Conformance Rule: This must not be populated by the source sending system.\r\n\r\nUsage Note: This will be used only for a small set of use cases." }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/ext-documentreference-subtype" }, { "id": "Extension.value[x]", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "Extension.value[x]", "min": 1, "type": [ { "code": "string" } ], "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/e02278cf-e9d9-452e-9d76-885ef6c5fdc2", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-encounter", "name": "Encounter", "status": "draft", "date": "2022-06-16T19:15:04.6499186+00:00", "description": "This profile is closely aligned with the TELUS DW profile", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "Encounter", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Encounter", "derivation": "constraint", "differential": { "element": [ { "id": "Encounter.id", "path": "Encounter.id", "mustSupport": true }, { "id": "Encounter.meta", "path": "Encounter.meta", "mustSupport": true }, { "id": "Encounter.meta.lastUpdated", "path": "Encounter.meta.lastUpdated", "min": 1, "mustSupport": true }, { "id": "Encounter.meta.source", "path": "Encounter.meta.source", "min": 1, "mustSupport": true }, { "id": "Encounter.meta.profile", "path": "Encounter.meta.profile", "comment": "Usage: This will be determined by each implementation project. This may be useful for validating a message instance against this profile.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "Encounter.text", "path": "Encounter.text", "mustSupport": true }, { "id": "Encounter.text.status", "path": "Encounter.text.status", "mustSupport": true }, { "id": "Encounter.text.div", "path": "Encounter.text.div", "mustSupport": true }, { "id": "Encounter.identifier", "path": "Encounter.identifier", "comment": "Usage Note: This must be sent where available; Most EMRs have a mapping to a business identifier\r\n\r\nMA: Mapping - chainID", "max": "1", "mustSupport": true }, { "id": "Encounter.identifier.system", "path": "Encounter.identifier.system", "comment": "urn:telus:emr:::encounter\r\n\r\nIdentifier.system is always case sensitive.", "min": 1, "mustSupport": true }, { "id": "Encounter.identifier.value", "path": "Encounter.identifier.value", "comment": "Usage note: Internal primary id for this table \r\n\r\nIf the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.", "min": 1, "mustSupport": true }, { "id": "Encounter.status", "path": "Encounter.status", "mustSupport": true }, { "id": "Encounter.class", "path": "Encounter.class", "comment": "Usage note: If sending applicaitons are able to find it use the mapping below. If NOT then default to AMB\r\n\r\nEMR ---> FHIR \r\nClinic Visit ----> AMB\r\nVirtual Visit -----> VR\r\nHome visit/Nursing Home---> HH\r\nMobile clinics--->FLD\r\n\r\nCodes 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.", "mustSupport": true }, { "id": "Encounter.class.system", "path": "Encounter.class.system", "mustSupport": true }, { "id": "Encounter.class.code", "path": "Encounter.class.code", "min": 1, "mustSupport": true }, { "id": "Encounter.type", "path": "Encounter.type", "comment": "Usage note: MA - N/A\r\nPSS - Note category\r\n\r\nSince there are many ways to further classify encounters, this element is 0..*.", "mustSupport": true }, { "id": "Encounter.type.text", "path": "Encounter.type.text", "mustSupport": true }, { "id": "Encounter.subject", "path": "Encounter.subject", "min": 1, "mustSupport": true }, { "id": "Encounter.subject.reference", "path": "Encounter.subject.reference", "mustSupport": true }, { "id": "Encounter.subject.display", "path": "Encounter.subject.display", "mustSupport": true }, { "id": "Encounter.participant", "path": "Encounter.participant", "comment": "Usage Note: At a minimum, the primary participant should be indicated. There is no current use identified for related person.\r\nUsage Note: This is limited to specific use cases and may not be relevant to some, eg referrals", "mustSupport": true }, { "id": "Encounter.participant.individual", "path": "Encounter.participant.individual", "mustSupport": true }, { "id": "Encounter.participant.individual.reference", "path": "Encounter.participant.individual.reference", "mustSupport": true }, { "id": "Encounter.appointment", "path": "Encounter.appointment", "comment": "Usage note - Where applicable provide the reference to the appointment\r\nUsage Note: This is limited to specific use cases and may not be relevant to some, eg referrals\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "Encounter.appointment.reference", "path": "Encounter.appointment.reference", "mustSupport": true }, { "id": "Encounter.appointment.display", "path": "Encounter.appointment.display", "mustSupport": true }, { "id": "Encounter.period", "path": "Encounter.period", "mustSupport": true }, { "id": "Encounter.period.start", "path": "Encounter.period.start", "mustSupport": true }, { "id": "Encounter.period.end", "path": "Encounter.period.end", "mustSupport": true }, { "id": "Encounter.reasonCode", "path": "Encounter.reasonCode", "comment": "Useage note: \r\nMA - provide the reason for the visit provide by the patient i.e task concern on the left\r\nPSS - N/A\r\n\r\nFor systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).", "mustSupport": true }, { "id": "Encounter.reasonCode.coding", "path": "Encounter.reasonCode.coding", "mustSupport": true }, { "id": "Encounter.reasonCode.coding.system", "path": "Encounter.reasonCode.coding.system", "mustSupport": true }, { "id": "Encounter.reasonCode.coding.code", "path": "Encounter.reasonCode.coding.code", "mustSupport": true }, { "id": "Encounter.reasonCode.text", "path": "Encounter.reasonCode.text", "mustSupport": true }, { "id": "Encounter.diagnosis", "path": "Encounter.diagnosis", "comment": "Usage note: Provide the diagnosis for the encounter if documented. \r\nNote: Submitted a change request to allow either a reference->condition OR a codeable concept, as often this is all that the EMR will have.", "mustSupport": true }, { "id": "Encounter.diagnosis.condition", "path": "Encounter.diagnosis.condition", "mustSupport": true }, { "id": "Encounter.diagnosis.condition.reference", "path": "Encounter.diagnosis.condition.reference", "mustSupport": true }, { "id": "Encounter.diagnosis.condition.display", "path": "Encounter.diagnosis.condition.display", "mustSupport": true }, { "id": "Encounter.serviceProvider", "path": "Encounter.serviceProvider", "comment": "Usage note: Reference to the organization resource that corresponds with the sub-organization where this service occured. Note: In the EMR, a single application can support 1..* partitioned patient groups, referred to by EMRs as locations, groups or sub-organizations.\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "Encounter.serviceProvider.reference", "path": "Encounter.serviceProvider.reference", "mustSupport": true }, { "id": "Encounter.serviceProvider.display", "path": "Encounter.serviceProvider.display", "mustSupport": true } ] }, "id": "e02278cf-e9d9-452e-9d76-885ef6c5fdc2", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.409+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/a230ecb4-8c2f-4e6c-8b98-3463f9cda73b", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-export-provenance", "name": "ExportProvenance", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w3c.prov", "uri": "http://www.w3.org/ns/prov", "name": "W3C PROV" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "fhirauditevent", "uri": "http://hl7.org/fhir/auditevent", "name": "FHIR AuditEvent Mapping" } ], "kind": "resource", "abstract": false, "type": "Provenance", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Provenance", "derivation": "constraint", "differential": { "element": [ { "id": "Provenance", "path": "Provenance", "mustSupport": true }, { "id": "Provenance.id", "path": "Provenance.id", "comment": "Usage Note: This will usually be a GUID that is assigned by the sending application.\r\n\r\nThe only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "mustSupport": true }, { "id": "Provenance.meta", "path": "Provenance.meta", "mustSupport": true }, { "id": "Provenance.meta.lastUpdated", "path": "Provenance.meta.lastUpdated", "mustSupport": true }, { "id": "Provenance.meta.source", "path": "Provenance.meta.source", "mustSupport": true }, { "id": "Provenance.meta.profile", "path": "Provenance.meta.profile", "mustSupport": true }, { "id": "Provenance.text", "path": "Provenance.text", "mustSupport": true }, { "id": "Provenance.target", "path": "Provenance.target", "comment": "Conformance Rule: This will reference the bundle\r\n\r\nTarget references are usually version specific, but might not be, if a version has not been assigned or if the provenance information is part of the set of resources being maintained (i.e. a document). When using the RESTful API, the identity of the resource might not be known (especially not the version specific one); the client may either submit the resource first, and then the provenance, or it may submit both using a single transaction. See the notes on transaction for further discussion.", "mustSupport": true }, { "id": "Provenance.target.reference", "path": "Provenance.target.reference", "min": 1, "mustSupport": true }, { "id": "Provenance.target.display", "path": "Provenance.target.display", "mustSupport": true }, { "id": "Provenance.occurred[x]", "path": "Provenance.occurred[x]", "comment": "Usage Note: This is often the same as the recorded date in the case of an Export.\r\n\r\nThe period can be a little arbitrary; where possible, the time should correspond to human assessment of the activity time.", "mustSupport": true }, { "id": "Provenance.recorded", "path": "Provenance.recorded", "mustSupport": true }, { "id": "Provenance.reason", "path": "Provenance.reason", "max": "1", "mustSupport": true }, { "id": "Provenance.reason.coding", "path": "Provenance.reason.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Provenance.reason.coding.system", "path": "Provenance.reason.coding.system", "min": 1, "mustSupport": true }, { "id": "Provenance.reason.coding.code", "path": "Provenance.reason.coding.code", "min": 1, "mustSupport": true }, { "id": "Provenance.activity", "path": "Provenance.activity", "comment": "***This will likely be a fixed value of \"EXPORT\"\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 1, "mustSupport": true }, { "id": "Provenance.activity.coding", "path": "Provenance.activity.coding", "mustSupport": true }, { "id": "Provenance.activity.coding.system", "path": "Provenance.activity.coding.system", "min": 1, "mustSupport": true }, { "id": "Provenance.activity.coding.code", "path": "Provenance.activity.coding.code", "min": 1, "fixedCode": "EXPORT", "mustSupport": true }, { "id": "Provenance.activity.text", "path": "Provenance.activity.text", "min": 1, "mustSupport": true }, { "id": "Provenance.agent", "path": "Provenance.agent", "comment": "Conformance Rule: There will be two agents specified in WHO. The first is a reference to exporting device, where the EMR application instance identifier must be specified (PSS1234, MA6777, etc). Example: urn:telus:emr:pss:1234. The name of the EMR software (PSSuite, MedAccess, etc) will also be specified in device. The second agent is a reference to the practitioner who carried out the action; this must be included if known\r\n\r\nConformance Rule: The name of the organization (eg Clinic ABC) will be conveyed in the onBehalfOf.display when the agent.who is the device.\r\n\r\nConformance Rule: The onBehalfOf may be present when the agent.who is the User (clinical or non-clinical) who is acting on behalf of another Practitioner (note: FHIR uses either Practitioner or Practitioner Role resource). Example: A student who is acting in a clinical role will be acting on behalf of a responsible practitioner. Example 2: An MOA will be acting on behalf of the responsible physician.\r\n\r\nSeveral agents may be associated (i.e. has some responsibility for an activity) with an activity and vice-versa.", "mustSupport": true }, { "id": "Provenance.agent.role", "path": "Provenance.agent.role", "max": "1", "mustSupport": true }, { "id": "Provenance.agent.role.coding", "path": "Provenance.agent.role.coding", "mustSupport": true }, { "id": "Provenance.agent.role.coding.system", "path": "Provenance.agent.role.coding.system", "min": 1, "mustSupport": true }, { "id": "Provenance.agent.role.coding.code", "path": "Provenance.agent.role.coding.code", "min": 1, "mustSupport": true }, { "id": "Provenance.agent.role.text", "path": "Provenance.agent.role.text", "mustSupport": true }, { "id": "Provenance.agent.who", "path": "Provenance.agent.who", "comment": "Conformance Rule: A reference to device must be specified and a reference to either Practitioner (Profile choice of Practitioner or MOA/User) must be specified\r\n\r\nwhoIdentity should be used when the agent is not a Resource type.", "type": [ { "code": "Reference", "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Provenance.agent.who.reference", "path": "Provenance.agent.who.reference", "comment": "Conformance Rule: A reference must be specified for device\r\n\r\nUsing absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "min": 1, "mustSupport": true }, { "id": "Provenance.agent.who.display", "path": "Provenance.agent.who.display", "mustSupport": true }, { "id": "Provenance.agent.onBehalfOf", "path": "Provenance.agent.onBehalfOf", "comment": "Conformance Rule: This is specified when the agent/user is acting on behalf of Practitioner\r\n\r\nConformance Rule: The PractitonerRole must always be used as this is the means for specifying the role and specialty of the practitioner. If the practitioner role is not known, the Practitioner resource may be used. \r\n\r\nonBehalfOfIdentity should be used when the agent is not a Resource type.", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/PractitionerRole" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Provenance.agent.onBehalfOf.reference", "path": "Provenance.agent.onBehalfOf.reference", "comment": "Conformance Rule: This will be a reference to the practitioner role or practitioner \r\n\r\nUsing absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "min": 1, "mustSupport": true }, { "id": "Provenance.agent.onBehalfOf.display", "path": "Provenance.agent.onBehalfOf.display", "comment": "Conformance Rule: This will be the name of the practitioner or organization who is exporting the data.\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true } ] }, "id": "a230ecb4-8c2f-4e6c-8b98-3463f9cda73b", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.409+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/e5dc6c8d-6493-48a2-9d18-3615108a8f90", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "https://telus.com/fhir/patientChart/StructureDefinition/ext-adherence-code", "name": "ExtAdherenceCode", "title": "Ext-Adherence.code", "status": "draft", "purpose": "This is a pre-adoption of MedicationUsage.adherence.code", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "primitive-type", "abstract": false, "context": [ { "type": "element", "expression": "MedicationStatement" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "mustSupport": true }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "https://telus.com/fhir/patientChart/StructureDefinition/ext-adherence-code" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "type": [ { "code": "CodeableConcept" } ], "mustSupport": true } ] }, "id": "e5dc6c8d-6493-48a2-9d18-3615108a8f90", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.395+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/ext-bundle-original-version", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "ext-bundle-original-version", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.395+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-bundle-original-version", "name": "ExtBundleOriginalVersion", "title": "Ext-Bundle Original Version", "status": "draft", "date": "2020-11-11T20:52:23.5887348+00:00", "description": "String identifying the original version of the sending software application that was most recently subjected to conformance testing", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "Bundle.meta" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "definition": "This conveys the version of the original message.", "comment": "Conformance Rule: This must not be populated by sending applications.\r\nUsage: This will be populated by the THX Central Service or other intermediaries whenthe message is transformed between the sending and receiving systems to accommodate different bundle versions." }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/ext-bundle-original-version" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "min": 1, "type": [ { "code": "string" } ], "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/ext-dateestimated", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "ext-dateestimated", "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-date-estimated", "name": "ExtDateEstimatedFlag", "title": "Ext-DateEstimatedFlag", "status": "draft", "description": "CA Core - extension - identifcal", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "Immunization.occurrence[x]" } ], "type": "Extension", "baseDefinition": 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"MedicationRequest.dispenseRequest" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "mustSupport": true }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-total-days-supply" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "type": [ { "code": "Duration" } ], "mustSupport": true } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.404+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/ext-medicationorder-total-quantity", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "ext-medicationorder-total-quantity", "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-total-quantity", "name": "ExtTotalPrescribedQuantity", "title": "Ext-Total Prescribed Quantity", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "MedicationRequest.dispenseRequest" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-total-quantity" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "type": [ { "code": "Quantity" } ], "mustSupport": true }, { "id": "Extension.value[x].value", "path": "Extension.value[x].value", "mustSupport": true }, { "id": "Extension.value[x].unit", "path": "Extension.value[x].unit", "mustSupport": true }, { "id": "Extension.value[x].system", "path": "Extension.value[x].system", "mustSupport": true }, { "id": "Extension.value[x].code", "path": "Extension.value[x].code", "comment": "Conformance Rule: A Code must be supplied if one is available from the PrescribedQuantityUnit subset. If the user picks a prescribed quantity unit that does not have a code in the PrescribedQuantityUnit subset, only then can unit be supplied without a code. If a receiving system receives a code that it doesn't recognize, the system must just display the unit.\r\n\r\nThe preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescribedquantityunit" } } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.405+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/d86be037-8b7d-426d-9405-0046f26b01e8", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "d86be037-8b7d-426d-9405-0046f26b01e8", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.409+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-family-member-history", "name": "FamilyMemberHistory", "title": "Family Member History Patient Chart", "status": "draft", "date": "2022-04-26T16:03:59.2029703+00:00", "description": "This is closely synchronized with the Family Member History Profile created by the TELUS DW Team", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "FamilyMemberHistory", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/FamilyMemberHistory", "derivation": "constraint", "differential": { "element": [ { "id": "FamilyMemberHistory", "path": "FamilyMemberHistory", "comment": "Note: This is closely synchronized with the Family Member History Profile created by the TELUS DW Team" }, { "id": "FamilyMemberHistory.id", "path": "FamilyMemberHistory.id", "comment": "Unique identifier from the EMR \r\n\r\nThe only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "mustSupport": true }, { "id": "FamilyMemberHistory.meta", "path": "FamilyMemberHistory.meta", "mustSupport": true }, { "id": "FamilyMemberHistory.meta.lastUpdated", "path": "FamilyMemberHistory.meta.lastUpdated", "mustSupport": true }, { "id": "FamilyMemberHistory.meta.source", "path": "FamilyMemberHistory.meta.source", "mustSupport": true }, { "id": "FamilyMemberHistory.meta.profile", "path": "FamilyMemberHistory.meta.profile", "comment": "Usage: Each impelmentation project will determine support for this data element. It may be useful for validating a message instance against this profile.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "FamilyMemberHistory.text", "path": "FamilyMemberHistory.text", "mustSupport": true }, { "id": "FamilyMemberHistory.status", "path": "FamilyMemberHistory.status", "comment": "EMR --> FHIR\r\nNeeds Review --> partial\r\ndocumented without any flag for needs review or unfinished --> completed\r\ndeleted --> entered in error \r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "mustSupport": true }, { "id": "FamilyMemberHistory.patient", "path": "FamilyMemberHistory.patient", "mustSupport": true }, { "id": "FamilyMemberHistory.patient.reference", "path": "FamilyMemberHistory.patient.reference", "mustSupport": true }, { "id": "FamilyMemberHistory.date", "path": "FamilyMemberHistory.date", "mustSupport": true }, { "id": "FamilyMemberHistory.relationship", "path": "FamilyMemberHistory.relationship", "comment": "Usage Note: Must be codified when mapping is possible.\r\n\r\nPS Suite: May be present as discrete data, but is commonly part of a string. Will be provided when available.\r\nMedAccess: May be present as discrete data. Will be provided when available.\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true }, { "id": "FamilyMemberHistory.relationship.coding", "path": "FamilyMemberHistory.relationship.coding", "mustSupport": true }, { "id": "FamilyMemberHistory.relationship.coding.system", "path": "FamilyMemberHistory.relationship.coding.system", "code": [ { "system": "http://terminology.hl7.org/ValueSet/v3-FamilyMember" } ], "fixedUri": "https://tgateway.infoway-inforoute.ca/vs/familymemberrelationshipcode", "mustSupport": true }, { "id": "FamilyMemberHistory.relationship.coding.code", "path": "FamilyMemberHistory.relationship.coding.code", "code": [ { "system": "https://fhir.infoway-inforoute.ca/ValueSet/familymemberrelationshipcode", "version": "2.0.0" } ], "mustSupport": true }, { "id": "FamilyMemberHistory.relationship.text", "path": "FamilyMemberHistory.relationship.text", "comment": "Usage note \r\nMA - Concatnate Relation and maternal/paternal fields together\r\nPSS - Family member field if documented in structured formate. Otherwise provide full short description \r\n\r\nVery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "FamilyMemberHistory.deceased[x]", "path": "FamilyMemberHistory.deceased[x]", "comment": "PS Suite: Available when entered as structured data Depending on documentation could be sent as deceasedBoolean or deceasedstring\r\nMed Access: N/A", "mustSupport": true }, { "id": "FamilyMemberHistory.note", "path": "FamilyMemberHistory.note", "comment": "PS Suite: When data not enterted in a structured format text string will be provided \r\nMed Access: Notes will be provided where available\r\n\r\nFor systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. *Annotations SHOULD NOT* be used to communicate \"modifying\" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).", "mustSupport": true }, { "id": "FamilyMemberHistory.condition", "path": "FamilyMemberHistory.condition", "comment": "PS Suite: Available when when family history is coded but will likely not be available for most patients\r\nMed Access: Provide when available", "mustSupport": true }, { "id": "FamilyMemberHistory.condition.code", "path": "FamilyMemberHistory.condition.code", "comment": "Usage Note: This may be codified using ICD-9, ICD-10, SNOMED, ENCODE (Ontario area) or any other available coding system. \r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true }, { "id": "FamilyMemberHistory.condition.code.coding", "path": "FamilyMemberHistory.condition.code.coding", "code": [ { "system": "http://hl7.org/fhir/sid/icd9" }, { "system": "http://snomed.info/sct" } ], "mustSupport": true }, { "id": "FamilyMemberHistory.condition.code.coding.system", "path": "FamilyMemberHistory.condition.code.coding.system", "mustSupport": true }, { "id": "FamilyMemberHistory.condition.code.coding.code", "path": "FamilyMemberHistory.condition.code.coding.code", "mustSupport": true }, { "id": "FamilyMemberHistory.condition.code.text", "path": "FamilyMemberHistory.condition.code.text", "min": 1, "mustSupport": true }, { "id": "FamilyMemberHistory.condition.outcome", "path": "FamilyMemberHistory.condition.outcome", "comment": "PS Suite: Available when entered as structured data\r\nMed Access: Available when documented \r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true }, { "id": "FamilyMemberHistory.condition.outcome.text", "path": "FamilyMemberHistory.condition.outcome.text", "mustSupport": true }, { "id": "FamilyMemberHistory.condition.onset[x]", "path": "FamilyMemberHistory.condition.onset[x]", "comment": "PS Suite: Include start date document as date, age or string\r\nMed Access: Include onset date as datetime \r\n\r\nThe context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "mustSupport": true }, { "id": "FamilyMemberHistory.condition.note", "path": "FamilyMemberHistory.condition.note", "mustSupport": true }, { "id": "FamilyMemberHistory.condition.note.text", "path": "FamilyMemberHistory.condition.note.text", "comment": "PSS - Long details \r\nMA - Note on the task panel related to condition\r\n\r\nSystems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/" } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/individual-genderIdentity", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "individual-genderIdentity", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode": "pa" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger": 1 } ], "url": "http://hl7.org/fhir/StructureDefinition/individual-genderIdentity", "version": "4.0.1", "name": "GenderIdentity", "title": "genderIdentity", "status": "draft", "experimental": false, "date": "2020-12-28T16:55:11+11:00", "publisher": "HL7", "description": "An individual's personal sense of being a man, woman, boy, girl, nonbinary, or something else. This represents an individual’s identity, ascertained by asking them what that identity is.", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "Patient" }, { "type": "element", "expression": "RelatedPerson" }, { "type": "element", "expression": "Person" }, { "type": "element", "expression": "Practitioner" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "short": "The individual's gender identity", "definition": "An individual's personal sense of being a man, woman, boy, girl, nonbinary, or something else.", "comment": "This represents an individual’s identity, ascertained by asking them what that identity is." }, { "id": "Extension.extension", "path": "Extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 1 }, { "id": "Extension.extension:value", "path": "Extension.extension", "sliceName": "value", "short": "The individual's gender identity", "definition": "An individual's personal sense of being a man, woman, boy, girl, nonbinary, or something else.", "comment": "This represents an individual’s identity, ascertained by asking them what that identity is.", "min": 1, "max": "1", "mustSupport": true }, { "id": "Extension.extension:value.url", "path": "Extension.extension.url", "type": [ { "code": "uri" } ], "fixedUri": "value" }, { "id": "Extension.extension:value.value[x]", "path": "Extension.extension.value[x]", "min": 1, "type": [ { "code": "CodeableConcept" } ], "mustSupport": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "GenderIdentity" } ], "strength": "preferred", "valueSet": "http://terminology.hl7.org/ValueSet/gender-identity" } }, { "id": "Extension.extension:value.value[x].coding", "path": "Extension.extension.value[x].coding", "mustSupport": true }, { "id": "Extension.extension:value.value[x].coding.system", "path": "Extension.extension.value[x].coding.system", "min": 1, "mustSupport": true }, { "id": "Extension.extension:value.value[x].coding.code", "path": "Extension.extension.value[x].coding.code", "min": 1, "mustSupport": true }, { "id": "Extension.extension:value.value[x].text", "path": "Extension.extension.value[x].text", "mustSupport": true }, { "id": "Extension.extension:period", "path": "Extension.extension", "sliceName": "period", "short": "The time period during which the gender identity applies to the individual", "definition": "The time period during which the gender identity applies to the individual", "comment": "Usage Note: This is not expected to be used but should be included if EMRs are capable of including.\r\n\r\nThere 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.", "min": 0, "max": "1" }, { "id": "Extension.extension:period.url", "path": "Extension.extension.url", "type": [ { "code": "uri" } ], "fixedUri": "period" }, { "id": "Extension.extension:period.value[x]", "path": "Extension.extension.value[x]", "min": 1, "type": [ { "code": "Period" } ] }, { "id": "Extension.extension:comment", "path": "Extension.extension", "sliceName": "comment", "short": "Text to further explain the use of the specified gender identity", "definition": "Text to further explain the use of the specified gender identity", "min": 0, "max": "1", "mustSupport": true }, { "id": "Extension.extension:comment.url", "path": "Extension.extension.url", "type": [ { "code": "uri" } ], "fixedUri": "comment" }, { "id": "Extension.extension:comment.value[x]", "path": "Extension.extension.value[x]", "min": 1, "type": [ { "code": "string" } ], "mustSupport": true }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://hl7.org/fhir/StructureDefinition/individual-genderIdentity" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "max": "0" } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.398+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-immunization-patientchart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-immunization-patientchart", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.410+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-immunization", "name": "Immunization", "status": "draft", "date": "2021-03-01T20:10:58.0169287+00:00", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "cda", "uri": "http://hl7.org/v3/cda", "name": "CDA (R2)" } ], "kind": "resource", "abstract": false, "type": "Immunization", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Immunization", "derivation": "constraint", "differential": { "element": [ { "id": "Immunization", "path": "Immunization", "mustSupport": true }, { "id": "Immunization.id", "path": "Immunization.id", "comment": "Usage Note: This will usually be a GUID that is assigned by the sending application.\r\n\r\nThe only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "mustSupport": true }, { "id": "Immunization.meta", "path": "Immunization.meta", "mustSupport": true }, { "id": "Immunization.meta.lastUpdated", "path": "Immunization.meta.lastUpdated", "mustSupport": true }, { "id": "Immunization.meta.source", "path": "Immunization.meta.source", "mustSupport": true }, { "id": "Immunization.meta.profile", "path": "Immunization.meta.profile", "comment": "Usage note: added this to align with PS-ON - \r\n\r\nIt 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.", "max": "1", "mustSupport": true }, { "id": "Immunization.meta.security", "path": "Immunization.meta.security" }, { "id": "Immunization.meta.security.system", "path": "Immunization.meta.security.system", "mustSupport": true }, { "id": "Immunization.meta.security.code", "path": "Immunization.meta.security.code", "mustSupport": true }, { "id": "Immunization.text", "path": "Immunization.text", "comment": "Conformance Rule: This must be formatted, as closely as possible what was presented to the user in the originating system and must include all clinical data. \r\n\r\nContained 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.", "mustSupport": true }, { "id": "Immunization.text.status", "path": "Immunization.text.status", "mustSupport": true }, { "id": "Immunization.text.div", "path": "Immunization.text.div", "mustSupport": true }, { "id": "Immunization.identifier.system", "path": "Immunization.identifier.system", "min": 1, "mustSupport": true }, { "id": "Immunization.identifier.value", "path": "Immunization.identifier.value", "min": 1, "mustSupport": true }, { "id": "Immunization.status", "path": "Immunization.status", "comment": "Conformance Rules: EMRs will use the status of not-done should be included in the export\r\nConformance Rules: All status's should be supported though this may be filtered based on use case. Example: Entered-in-error - \r\nFor patients, entered-in-error may not be returned in queries. \r\nFor EMR API, all status's are exposed as they do not know the requestor. \r\n In the context of a patient chart, entered in error would not be shared. Other implementations such as DHIR will have their own business rules to adhere to. \r\n\r\nNotes - \r\nMA - active status on the task (future) - eg first dose out of 3 and the others are to be scheduled. Cancel status maps to not-done. \r\nPSS - do not have entered-in-error, in PSS, refusal - if not-done this will map to refuse and a reason of \"PAJOBJ\" - patient objection.\r\nMS - all three can be supported\r\nDHIR - Status is fixed to completed\r\nCA Core - supported\r\n\r\n\r\nWill generally be set to show that the immunization has been completed or not done. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "mustSupport": true }, { "id": "Immunization.statusReason", "path": "Immunization.statusReason", "comment": "Usage: If EMRs are able to capture they should send this as either code or text.\r\nExample use cases: Patient already has immunity - common, ruebella; medical condition, indicates they should not get the immunization.\r\nExample 2 - \"Patient refused\" text, will have an PATOBJ code and an Immunization.status of \"not done\"\r\n\r\nMapping Notes: \r\nPSS does not handle all reasons, but does handle patient refusal - see MA below as PSS will do the same\r\nMA has a cancel reason that would need to be mapped into a code. \" Patient Declined\" and will map to \"PATOBJ\"\r\nMS -- text field with reason for refusal, but not codified - text only. \r\nCA-Core - supported \r\n\r\n\r\nThis is generally only used for the status of \"not-done\". The reason for performing the immunization event is captured in reasonCode, not here.", "mustSupport": true, "binding": { "strength": "extensible" } }, { "id": "Immunization.statusReason.coding", "path": "Immunization.statusReason.coding", "comment": "Usage Note: Local codes must always be sent when codes exist in addition to the code system \r\n\r\nCodes 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.", "mustSupport": true }, { "id": "Immunization.statusReason.coding.system", "path": "Immunization.statusReason.coding.system", "mustSupport": true }, { "id": "Immunization.statusReason.coding.code", "path": "Immunization.statusReason.coding.code", "mustSupport": true }, { "id": "Immunization.statusReason.coding.display", "path": "Immunization.statusReason.coding.display", "mustSupport": true }, { "id": "Immunization.statusReason.text", "path": "Immunization.statusReason.text", "min": 1, "mustSupport": true }, { "id": "Immunization.vaccineCode", "path": "Immunization.vaccineCode", "comment": "Usage Note: This will be use case dependent; DHIR uses CVC codes and other implementations may use other codes. CVC codes are SNOMED codes and seem to align with DHDR and Core \r\nConformance Rule: Local codes/original codes (eg HICL, DIN) should not be sent\r\n\r\nMapping Notes :\r\nCanadian Core has a preferred code set, for Generic and TradeName (2 slices). \r\nPanorama ???\r\nPSS: Maps into Ontario MD Standard - shortform (Column C - eg PSS: Maps into Ontario MD Standard - shortform Canadian Vaccine Catalogue\r\nMA - Patient Chart--> Imm. --> Task Category: \"Immunization\" --> Type\r\nMS - original code would be a DIN (source code for mapping)\r\nDHIR: binding to CVC TradeName, subset of SNOMED\r\n\r\n*Jim advises that CVC includes some codes on this list that are not immunizations, immunglobulins. BCG could be a diagnostic/test agent rather than a vaccine, but agent used to be used in vaccines\r\n\r\n**Binding should be to SNOMED (code system) , and CVC (value set)\r\n\r\nexample: \"vaccineCode\": { \"coding\": {\r\n \"system\": \"http://snomed.info/sct\",\r\n \"version\": \"http://snomed.info/sct/20611000087101\",\r\n \"code\": \"61153008\",\r\n \"display\": \"MMR\" \r\n\r\nPSS: Maps into Ontario MD Standard - shortform (column C) - Canadian Vaccine Catalogue\r\nMA : - TRAVIS TO CONFIRM - JN - looks like we expose local codes ONLY; but maybe in background they map into CVC codes for Ontario MD\r\nMS: DINS - text only; CVCatelogue provides a mapping into DIN\r\n\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true }, { "id": "Immunization.vaccineCode.coding", "path": "Immunization.vaccineCode.coding", "slicing": { "discriminator": [ { "type": "type", "path": "$this" } ], "rules": "open" }, "comment": "??? how many codings do we support?\r\n\r\nMappings:\r\nCA-Core: 1:* supported\r\nPSS: Maps into Ontario MD Standard - shortform (Column C - eg PSS: Maps into Ontario MD Standard - shortform Canadian Vaccine Catalogue\r\nMA: Patient Chart--> Imm. --> Task Category: \"Immunization\" --> Type\r\nMS: ??\r\n\r\n\r\nDiscussion: Are local codes permitted?\r\n\r\nCodes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 \r\nCore 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.", "min": 1, "mustSupport": true }, { "id": "Immunization.vaccineCode.coding.system", "path": "Immunization.vaccineCode.coding.system", "comment": "**** to be confirmed \r\n\r\nThe URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.", "min": 1, "fixedUri": "http://snomed.info/sct", "mustSupport": true }, { "id": "Immunization.vaccineCode.coding.code", "path": "Immunization.vaccineCode.coding.code", "min": 1, "mustSupport": true }, { "id": "Immunization.vaccineCode.coding:CVCGeneric", "path": "Immunization.vaccineCode.coding", "sliceName": "CVCGeneric", "comment": "Usage: Aligns with CA-Core:\r\n\r\nCodes 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.", "max": "1", "mustSupport": false, "binding": { "strength": "preferred", "valueSet": "https://cvc.canimmunize.ca/v3/ValueSet/Generic" } }, { "id": "Immunization.vaccineCode.coding:CVCGeneric.system", "path": "Immunization.vaccineCode.coding.system", "min": 1, "fixedUri": "http://snomed.info/sct", "mustSupport": true }, { "id": "Immunization.vaccineCode.coding:CVCGeneric.code", "path": "Immunization.vaccineCode.coding.code", "min": 1, "mustSupport": true }, { "id": "Immunization.vaccineCode.coding:CVCTradeName", "path": "Immunization.vaccineCode.coding", "sliceName": "CVCTradeName", "comment": "Usage: Aligns with CA-Core\r\n\r\nCodes 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.", "max": "1", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://cvc.canimmunize.ca/v3/ValueSet/Tradename" } }, { "id": "Immunization.vaccineCode.coding:CVCTradeName.system", "path": "Immunization.vaccineCode.coding.system", "min": 1, "fixedUri": "http://snomed.info/sct", "mustSupport": true }, { "id": "Immunization.vaccineCode.coding:CVCTradeName.code", "path": "Immunization.vaccineCode.coding.code", "min": 1, "mustSupport": true }, { "id": "Immunization.vaccineCode.coding:DIN", "path": "Immunization.vaccineCode.coding", "sliceName": "DIN", "comment": "Usage Note: The CVCGeneric or CVCTradename must be used where known. In some cases, there is not a 1:1 mapping to SNOMED and therefore DIN may be specified instead. eg Flumist comes out with a new DIN each year; this is not specified at this level in SNOMED as there is a single code. DIN should also be used when there is no CVC code. When mapping has occured from a local DIN to CVC codes, it is good practice to include the DIN in addition to the CVC code.\r\n\r\nCodes 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." }, { "id": "Immunization.vaccineCode.coding:DIN.system", "path": "Immunization.vaccineCode.coding.system", "min": 1 }, { "id": "Immunization.vaccineCode.coding:DIN.code", "path": "Immunization.vaccineCode.coding.code", "min": 1 }, { "id": "Immunization.vaccineCode.text", "path": "Immunization.vaccineCode.text", "min": 1, "mustSupport": true }, { "id": "Immunization.patient", "path": "Immunization.patient", "mustSupport": true }, { "id": "Immunization.patient.reference", "path": "Immunization.patient.reference", "comment": "Usage Note: This should contain the name of the Patient, which can then be used in narrative\r\n\r\nUsing absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "min": 1, "mustSupport": true }, { "id": "Immunization.patient.display", "path": "Immunization.patient.display", "mustSupport": true }, { "id": "Immunization.encounter", "path": "Immunization.encounter", "comment": "Core-CA - not supported\r\nDHIR - not supported\r\nCHR - may be able to support - consider for future\r\n\r\nImport - Jim - this has little value - this would not be added into the patient chart\r\nDW - often encounter centric so perhaps in future\r\nMS - does not support\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." }, { "id": "Immunization.occurrence[x]", "path": "Immunization.occurrence[x]", "comment": "Mappings: Canadian core is not mandatory however, the core FHIR profile is 1..1\r\n\r\nUsage Notes: DHIR makes this mandatory. They added an extension for estimated date (boolean).\r\n\r\nUsage Note: Dukoral prescription may be taken by the patient. The occurrence date may be set to the prescription date as the exact date/time of the occurrence is unknown.\r\n\r\nMapping: \r\nPSS - no issues\r\nMA - No issues \r\nMS - No way to determine if date is estimated or not - this is a GAP Date is mandatory when vaccine has been administered; estimated value = false. If no date, the records would not be shared \r\n\r\nWhen immunizations are given a specific date and time should always be known. When immunizations are patient reported, a specific date might not be known. Although partial dates are allowed, an adult patient might not be able to recall the year a childhood immunization was given. An exact date is always preferable, but the use of the String data type is acceptable when an exact date is not known. A small number of vaccines (e.g. live oral typhoid vaccine) are given as a series of patient self-administered dose over a span of time. In cases like this, often, only the first dose (typically a provider supervised dose) is recorded with the occurrence indicating the date/time of the first dose.", "mustSupport": true }, { "id": "Immunization.recorded", "path": "Immunization.recorded", "comment": "Mappings:\r\nCA-Core: not supported\r\nDHIR: \r\nMA: Patient Chart--> Imm. --> Task Category: \"Immunization\" --> Observation --> Date and Time\r\nPSS: TBD\r\nMS: TBD", "mustSupport": true }, { "id": "Immunization.primarySource", "path": "Immunization.primarySource", "comment": "Mapping Notes:\r\nCore-CA - this is mandatory in these profiles and therefore mandatory here\r\n************ revisit and see what Core-CA does - they will likely downgrade\r\n\r\n** This is a low impact field that is only of concern to DHIR. \r\nDHIR - Conformance Rule: true if the immunizaiton was administered by the submitting clinical \"OFFICE\"; otherwise this is false. On query result, there is an additional conformance rule: This will be true if the immunization was administered by the IMMPHU - Public health unit\r\n\r\nExample:1 An immunization may be recorded without an event, eg when records are imported from a paper chart. It is an external event but it is challenging to determine that it is external as there is no event recorded in the EMR, or the user did not flag as internal or external when it was recorded. \r\nExample 2: Imported the patient from another EMR; immunization is recorded as a primary immunization (not external); upon import it is external, but the record stays as internal when it is now really external. Unless further logic is applied (eg compare users with historical users in the clinic) this will read falsely. \r\n\r\nTELUS can conform to the DHIR rules\r\n\r\nPSS - there is an optional external flag to indicate someone else administered; decision on older records. If date is older then this is likely not the primary source. When vaccine record includes the clinician who administered, this should be set to true. This is more complicated as this may not always be there with older records, though this is a rare case \r\n\r\nCHR - are able to add a record without indicating who performed this; though rare, prefer this is not mandatory\r\n\r\nMA - TRAVIS - ??\r\nMS - Not stored as is but may be derived from dates, and the fact that it was administered by the provider at the clinic. Similar to PSS\r\n\r\nReflects the “reliability” of the content.", "min": 1, "mustSupport": true }, { "id": "Immunization.reportOrigin", "path": "Immunization.reportOrigin", "comment": "DHIR: Conformance Rule: Required if the primary source is false. Note: When reporting immunizations this value would not be required as the EMR is always the primary source. This is never returned in query results from DHIR. \r\n\r\nPatient Chart Conformance Rule: When sharing immunization records, EMRs should include this data if known. PSS, MA and MS do not have a \"code\" today but it will be supported for future use. Text may be populated.\r\n\r\nCA-Core: 1:1 Supported - value set binding with no further constraints on codeable concept\r\nPSS: Captures text string - map to text\r\nMS: not cpatured\r\nMA\" TRAVIS\r\n\r\nExample from DHIR follows. Value set is CVC - SNOMED codes\r\n\r\nValueSet: [basecvc]/ValueSet/RepSource - for DHIR this will be the binding but this is not national\r\nSupported codes are \r\n223366009 Healthcare professional (occupation)\r\n116154003 Patient (person)\r\n423374008 Review of systems section (record artifact) - eg Immunization records (third party app to a repository)\r\n\r\n\r\n\r\n \"system\": \"http://snomed.info/sct\",\r\n \"version\": \"http://snomed.info/sct/20611000087101\",\r\n \"code\": \"223366009\",\r\n \"display\": \"Health care provider\" \r\n\r\nShould not be populated if primarySource = True, not required even if primarySource = False.", "mustSupport": true, "binding": { "strength": "example", "valueSet": "https://cvc.canimmunize.ca/v3/ValueSet/RepSource" } }, { "id": "Immunization.reportOrigin.coding", "path": "Immunization.reportOrigin.coding", "mustSupport": true }, { "id": "Immunization.reportOrigin.text", "path": "Immunization.reportOrigin.text", "mustSupport": true }, { "id": "Immunization.location", "path": "Immunization.location", "comment": "CA - Core: not supported\r\nDHIR: not supported\r\nPatient Chart: This aligns with Canadian and DHIR and will be not supported \r\n\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." }, { "id": "Immunization.manufacturer", "path": "Immunization.manufacturer", "comment": "Canadian Core - not supported\r\nDHIR - not supported on create or query. \r\nPatient Chart - not supported; if the vaccine code is a brand name the manufacturer will be known. Conformance Rule: If EMR has captured \"text\", this can be mapped to display.\r\n\r\n\r\nPSS - captured as a text field (OMD requirement) - may be populated in display\r\nMA - captured as a text field (OMD requirement) - may be populated in display\r\nCHR - captured as a text field (OMD requirement) - may be populated in display\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." }, { "id": "Immunization.manufacturer.display", "path": "Immunization.manufacturer.display", "mustSupport": true }, { "id": "Immunization.lotNumber", "path": "Immunization.lotNumber", "comment": "Core-CA: Not supported\r\nPS-CA and PS-ON\r\nDHIR: Optional on create; Optional on query response; Support a query by lot number \r\nConformance Rule: Must be populated when known. Rationale: If there is a recall this is relevant if sending to another EMR as it is relevant to the primary physician. \r\nNote: It is not in the Patient Summary as it is irrelvent in this context.\r\n\r\nPSS - captured as a text field (OMD requirement) - may be populated in display\r\nMA - captured as a text field (OMD requirement) - may be populated in display\r\nMS - - captured as a text field \r\nCHR - captured as text\r\n\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Immunization.expirationDate", "path": "Immunization.expirationDate", "comment": "Core-CA: Not supported\r\nDHIR: Optional on create; Optional on query response; Support a query by lot number (extension on medication returned by CVC); and also returns the expiration date returned\r\n\r\nPatient Chart: Not supported. This is captured by text, not date in some EMRs. Additionally, this can be queried or discovered by other means if necessary and is therefore redundant. \r\n\r\nPSS - captured as a text field (OMD requirement) - potential issue - as a date field (month/year) is expected\r\nMA - captured as a text field (OMD requirement) - \r\nMS - - not recorded\r\nCHR - Marc - if capturing as a date, then we shoud support this" }, { "id": "Immunization.site", "path": "Immunization.site", "comment": "CA-PS - http://hl7.org/fhir/uv/ips/ValueSet/target-site-uv-ips (preferred, SNOMED) - must support = false\r\nON-PS - https://cvc.canimmunize.ca/v3/ValueSet/AnatomicalSite (preferred, SNOMED?) - must support = true, coding must be supported (ISSUE)\r\nCA-Core - supported, optional using SNOMED (preferred) Value set is CVC, text is acceptable and added here\r\nDHIR - Supported, optional , using SNOMED, no value set is specified. MUST BE CODED VALUE therefore cannot be sent and text is optional. \r\n\r\n\r\n***EMRs DO NOT SUPPORT A CODED VALUE TODAY; THEREFORE THIS CAN ONLY BE SENT AS TEXT \r\nPatient Chart - Use https://cvc.canimmunize.ca/v3/ValueSet/AnatomicalSite (preferred). \r\nConformance Rule: Must be populated when known. \r\n\r\nPSS - text only\r\nMA - Text is easiest; captured in configurable observation template - manageable list/dropdown but customization is allowed- Mapping could be tricky due to customization option. \r\nMS - text only\r\nCHR - - there is a dropdown list, potential for mapping and also a value of \"other\" without any associated text \r\n\r\nCA-Core below\r\n https://cvc.canimmunize.ca/v3/ValueSet/AnatomicalSite (preferred)\r\n\r\n368208006 Left upper arm structure (body structure)\r\n368209003 Right upper arm structure (body structure)\r\n16217701000119102 Structure of left deltoid muscle (body structure)\r\n16217661000119109 Structure of right deltoid muscle (body structure)\r\n66480008 Structure of left forearm (body structure)\r\n64262003 Structure of right forearm (body structure)\r\n123851003 Mouth region structure (body structure)\r\n244506005 Both anterior nares (body structure)\r\n723608007 Structure of left anterior naris (body structu\r\n\r\n\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://cvc.canimmunize.ca/v3/ValueSet/AnatomicalSite" } }, { "id": "Immunization.site.coding", "path": "Immunization.site.coding", "comment": "Usage Rule: Not expected to be used initially as current EMRs are supporting text only\r\n\r\nCodes 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.", "mustSupport": true }, { "id": "Immunization.site.coding.system", "path": "Immunization.site.coding.system", "fixedUri": "http://snomed.info/sct", "mustSupport": true }, { "id": "Immunization.site.coding.code", "path": "Immunization.site.coding.code", "mustSupport": true }, { "id": "Immunization.site.text", "path": "Immunization.site.text", "mustSupport": true }, { "id": "Immunization.route", "path": "Immunization.route", "comment": "Usage Note: As this is supported by IPS, CA and ON, vendors must be able to derive and populate this data element where available.\r\n\r\nMapping: \r\nCanadian Core - Value set is Canadian Core\r\nDHIR - route is optional but must be coded if present; text is not supported. binding to CVC\r\nPS-ON- https://cvc.canimmunize.ca/v3/ValueSet/RouteOfAdmin (preferred), must support, coding+text\r\nPS-CA - RouteOfAdminUvIps (preferred), must support, text only (Nov '21)\r\n\r\nMS - not captured, not even text - cannot be sent\r\nPSS - data is available if vaccine was recorded as FDB IDC code. (conforamnce example)\r\nMA - potential mapping to method - text - supported in Ontario\r\nCHR - drop down list that likely maps easily[; not required field; can set up a default \r\n\r\nUsage Ntoe: This is determined by the name/code of the immunization \r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://cvc.canimmunize.ca/v3/ValueSet/RouteOfAdmin" } }, { "id": "Immunization.route.coding", "path": "Immunization.route.coding", "comment": "DHIR - code is mandatory; text is not supported - we cannot support this so will send text only\r\nUsage: in future this could be used\r\n\r\nCodes 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.", "mustSupport": true }, { "id": "Immunization.route.coding.system", "path": "Immunization.route.coding.system", "fixedUri": "http://snomed.info/sct", "mustSupport": true }, { "id": "Immunization.route.coding.code", "path": "Immunization.route.coding.code", "mustSupport": true }, { "id": "Immunization.route.coding.userSelected", "path": "Immunization.route.coding.userSelected", "mustSupport": true }, { "id": "Immunization.route.text", "path": "Immunization.route.text", "mustSupport": true }, { "id": "Immunization.doseQuantity", "path": "Immunization.doseQuantity", "comment": "Mapping:\r\nCA-PS and CA-ON- not supported\r\nDHIR - supported as optional, value and unit (as a string) fields are required when populated\r\nPSS - dose field, if populated - unit required; almost always ML\r\nMA - no mapping\r\nMS - text only - may be able to parse the number?\r\nCHR - dropdown units (ML, MG, G, Capsule, Vial)\r\n\r\n\r\nThe context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "mustSupport": true }, { "id": "Immunization.doseQuantity.value", "path": "Immunization.doseQuantity.value", "min": 1, "mustSupport": true }, { "id": "Immunization.doseQuantity.unit", "path": "Immunization.doseQuantity.unit", "mustSupport": true }, { "id": "Immunization.performer", "path": "Immunization.performer", "comment": "Mapping: \r\nDHIR - On the create supported as optional; with function and actor mandatory when provided. Function fixed value as AP (Adminstering Provider)\r\nDHIR - On the query response, this is just a name\r\nCanadian Core - support as optional; with function and actor mandatory when provided\r\nPS-CA and PS-ON do not support\r\nPatient Chart - For create profiles to align with Core and DHIR, we will incldue all data (Identifier, names, telecom, etc)\r\nPatient Chart - appropriate info such as licence number, name. NOT billing number, NOT phone number\r\n\r\nCHR - Injected by", "mustSupport": true }, { "id": "Immunization.performer.function", "path": "Immunization.performer.function", "comment": "Conformance Rule: DHIR -mandatory when performer is provided. Function fixed value as AP (Adminstering Provider) \r\nPatient Chart Rule: This should not be limited to AP\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 1, "mustSupport": true }, { "id": "Immunization.performer.function.coding", "path": "Immunization.performer.function.coding", "mustSupport": true }, { "id": "Immunization.performer.function.coding.system", "path": "Immunization.performer.function.coding.system", "min": 1, "fixedUri": "http://terminology.hl7.org/CodeSystem/v2-0443", "mustSupport": true }, { "id": "Immunization.performer.function.coding.code", "path": "Immunization.performer.function.coding.code", "min": 1, "mustSupport": true }, { "id": "Immunization.performer.function.coding.userSelected", "path": "Immunization.performer.function.coding.userSelected", "mustSupport": true }, { "id": "Immunization.performer.function.text", "path": "Immunization.performer.function.text", "mustSupport": true }, { "id": "Immunization.performer.actor", "path": "Immunization.performer.actor", "comment": "Canadian Core - has restricted to http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner\r\nDHIR - defined a practitioner profile - ca-on-immunizations-profile-submission-clinician-Practitioner-submitter (identifier OneID, name, phone + email)\r\nPatient Chart - Will use a TELUS profile for Practitioner, PractitionerRole and Organization (eg pharmacy) that aligns with both of the above. \r\n**Potential issues with PractitionerRole because Organization is mandatory and EMR may not always know the organization/clinic where the immunization occurred. In the case where there is a single EMR instance supporting multiple location/orgs, the exact org where the immunization occurred may not be known. Data model does not capture always. \r\n** New PractitonerRole Profile is requried HERE with an optional Organization\r\n\r\nCHR --> how do they capture this? \r\n\r\n***May wish to create a scaled down profile for this purpose, eg PractitionerPerformer and also one for PractitonerRole\r\n***** For patient chart, the provider roles may need to be extended for Nurse, Nurse Practitioner, pharmacists, etc\r\nPSS, MA, MS - all systems are capable of sending provider data\r\n*** Role code may be useful so we may wish to point to PractitionerRole\r\n \r\n\r\nWhen the individual practitioner who performed the action is known, it is best to send.", "type": [ { "code": "Reference", "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Immunization.note", "path": "Immunization.note", "comment": "Usage Note: This is supported by Patient Chart; is not supported by CA, PS_ON and PS-CA - if this is available, this should always be sent in all cases. \r\n\r\nMappings:\r\nCA-Core - not supported\r\nPS-ON and PS-CA - not supporting\r\nDHIR - not supported\r\nPSS - instructions field\r\nMA - Task Instructions, Nursing Notes and Doctor notes. MA - has a boolean to indicate that patient received education which could be mapped here\r\nMS - Comment field \r\nCHR - comment field\r\n\r\nFor systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. *Annotations SHOULD NOT* be used to communicate \"modifying\" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).", "mustSupport": true }, { "id": "Immunization.note.text", "path": "Immunization.note.text", "mustSupport": true }, { "id": "Immunization.reasonCode", "path": "Immunization.reasonCode", "comment": "TBD\r\n\r\nMapping: \r\nCanadian Core - supports a reference to condition, diagnosis, etc\r\nDHIR - not supported\r\nPSS - Not supported at the Immunization \"adminstered\" level. \r\nMA - TRAVIS - JN sees a reason field at the task level\r\nMS - not supported\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." }, { "id": "Immunization.reasonReference", "path": "Immunization.reasonReference", "comment": "Mapping Notes:\r\nCA-Core - supported\r\nDHIR - not supported\r\nPSS, MA, MS - not supported\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." }, { "id": "Immunization.isSubpotent", "path": "Immunization.isSubpotent", "comment": "Mapping:\r\nCA- core: not supported\r\nDHIR: not supported\r\nPSS, MA, MS - not supported\r\n\r\nTypically, the recognition of the dose being sub-potent is retrospective, after the administration (ex. notification of a manufacturer recall after administration). However, in the case of a partial administration (the patient moves unexpectedly and only some of the dose is actually administered), subpotency may be recognized immediately, but it is still important to record the event." }, { "id": "Immunization.subpotentReason", "path": "Immunization.subpotentReason", "comment": "Mapping:\r\nCA- core: not supported\r\nDHIR: not supported\r\nPSS, MA, MS - not supported\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." }, { "id": "Immunization.education", "path": "Immunization.education", "comment": "Mapping:\r\nCA- core: not supported\r\nDHIR: not supported\r\nPSS, \r\nMA - has a boolean to indicate that patient received education\r\nMS" }, { "id": "Immunization.programEligibility", "path": "Immunization.programEligibility", "comment": "Mapping:\r\nCA- core: not supported\r\nDHIR: not supported\r\nPSS, MA, MS - not supported\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." }, { "id": "Immunization.fundingSource", "path": "Immunization.fundingSource", "comment": "Mapping:\r\nCA- core: not supported\r\nDHIR: not supported\r\nPSS, MA, MS - not supported\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." }, { "id": "Immunization.reaction", "path": "Immunization.reaction", "comment": "Mapping:\r\nUsage: FHIR - expects an allergy record to be recorded; in Allergy, the Reaction.substance.code would be the medication/immunization\r\nCA- core: supported, reference to an observation\r\nDHIR: not supported\r\n\r\nPSS: may record this and can be tied to immunization record - connected allergy record\r\nMA - TRAVIS - is this a coded observation? \r\nMS - not supported; may be recorded separately \r\n\r\nA reaction may be an indication of an allergy or intolerance and, if this is determined to be the case, it should be recorded as a new AllergyIntolerance resource instance as most systems will not query against past Immunization.reaction elements." }, { "id": "Immunization.protocolApplied", "path": "Immunization.protocolApplied", "comment": "Mapping:\r\nCA- core: not supported\r\nDHIR: not supported\r\nPSS, MA, MS - not supported\r\n\r\nThis may be recorded as notes in the EMR" } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/ext-information-source", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "ext-information-source", "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-information-source", "name": "InformationSource", "title": "Ext-Information Source", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "MedicationRequest" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "mustSupport": true }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/ext-information-source" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "type": [ { "code": "Reference" } ], "mustSupport": true } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.399+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-interaction-bundle-patientchart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-interaction-bundle-patientchart", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.410+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-interaction-bundle", "name": "InteractionBundlePatientChart", "title": "Interaction Bundle Patient Chart", "status": "draft", "date": "2021-03-01T20:11:25.7831223+00:00", "fhirVersion": "4.0.1", "mapping": [ { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "cda", "uri": "http://hl7.org/v3/cda", "name": "CDA (R2)" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" } ], "kind": "resource", "abstract": false, "type": "Bundle", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Bundle", "derivation": "constraint", "differential": { "element": [ { "id": "Bundle", "path": "Bundle", "mustSupport": true }, { "id": "Bundle.id", "path": "Bundle.id", "comment": "Usage Note: It should be omitted when creating a new message and will be assigned by the THX for each destination.\r\n\r\nThe only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "mustSupport": true }, { "id": "Bundle.meta", "path": "Bundle.meta", "min": 1, "mustSupport": true }, { "id": "Bundle.meta.lastUpdated", "path": "Bundle.meta.lastUpdated", "mustSupport": true }, { "id": "Bundle.meta.source", "path": "Bundle.meta.source", "mustSupport": true }, { "id": "Bundle.meta.profile", "path": "Bundle.meta.profile", "comment": "Usage Rule: This will be used by the TELUS Central Switch capability tracking service to confirm that the sender has passed conformance to this profile.\r\n\r\nIt 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.\r\n\r\nUsage Note: This is used by the validator to determine the version drives the IG pack to be used. Example: |2.0 is necessary to determine the version.", "min": 1, "max": "1", "fixedCanonical": "http://telus.com/fhir/StructureDefinition/profile-interaction-bundle-patientchart|3.0", "mustSupport": true }, { "id": "Bundle.meta.tag", "path": "Bundle.meta.tag", "min": 1, "max": "1", "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://telus.com/fhir/ValueSet/telus-version" } }, { "id": "Bundle.meta.tag.system", "path": "Bundle.meta.tag.system", "min": 1, "mustSupport": true }, { "id": "Bundle.meta.tag.code", "path": "Bundle.meta.tag.code", "comment": "Conformance Rule: Vendors must ignore this value. The version may be a more current version of the message standard and This must be accepted in order to be backwards compatible.", "min": 1, "fixedCode": "eServices3.0", "mustSupport": true }, { "id": "Bundle.meta.extension", "path": "Bundle.meta.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" } }, { "id": "Bundle.meta.extension:OriginalBundleVersion", "path": "Bundle.meta.extension", "sliceName": "OriginalBundleVersion", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-bundle-original-version" ] } ], "isModifier": false }, { "id": "Bundle.type", "path": "Bundle.type", "fixedCode": "document", "mustSupport": true }, { "id": "Bundle.timestamp", "path": "Bundle.timestamp", "comment": "For many bundles, the timestamp is equal to meta.lastUpdated, because they are not stored (e.g. search results). When a bundle is placed in a persistent store, .meta.lastUpdated will be usually be changed by the server. When the bundle is a message, a middleware agent altering the message (even if not stored) SHOULD update .meta.lastUpdated. .timestamp is used to track the original time of the Bundle, and SHOULD be populated.\n\nUsage Note:\n\n* document : the date the document was created. Note: the composition may predate the document, or be associated with multiple documents. The date of the composition - the authoring time - may be earlier than the document assembly time\n* message : the date that the content of the message was assembled. This date is not changed by middleware engines unless they add additional data that changes the meaning of the time of the message\n* history : the date that the history was assembled. This time would be used as the _since time to ask for subsequent updates\n* searchset : the time that the search set was assembled. Note that different pages MAY have different timestamps but need not. Having different timestamps does not imply that subsequent pages will represent or include changes made since the initial query\n* transaction | transaction-response | batch | batch-response | collection : no particular assigned meaning\n\nThe timestamp value should be greater than the lastUpdated and other timestamps in the resources in the bundle, and it should be equal or earlier than the .meta.lastUpdated on the Bundle itself.", "min": 1, "mustSupport": true }, { "id": "Bundle.entry", "path": "Bundle.entry", "comment": "???? Add an invariant, --> first must be a \"http://telus.com/fhir/StructureDefinition/profile-composition\" profile on composition. Important for validaiton otherwise we will not enforce the root composition.", "min": 4, "condition": [ "bdl-5", "bdl-1", "bdl-2", "bdl-3", "bdl-4", "bdl-7" ], "mustSupport": true }, { "id": "Bundle.entry.link", "path": "Bundle.entry.link", "contentReference": "http://hl7.org/fhir/StructureDefinition/Bundle#Bundle.link" }, { "id": "Bundle.entry.fullUrl", "path": "Bundle.entry.fullUrl", "min": 1, "mustSupport": true }, { "id": "Bundle.entry.resource", "path": "Bundle.entry.resource", "min": 1, "mustSupport": true }, { "id": "Bundle.entry.search", "path": "Bundle.entry.search", "max": "0" }, { "id": "Bundle.entry.request", "path": "Bundle.entry.request", "max": "0" }, { "id": "Bundle.entry.response", "path": "Bundle.entry.response", "max": "0" } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-observation-lab-patientchart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-observation-lab-patientchart", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-lab", "name": "LabObservation", "title": "Lab Observation", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation", "path": "Observation", "comment": "Alignment: There is a profile for Core-CA; no lab observation profile defined in PS-CA o PS-ON (as at July 2022)\r\n\r\nUsed for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc." }, { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "requirements": "DISCUSSION REQUIRED TO CONFIRM", "mustSupport": true }, { "id": "Observation.identifier", "path": "Observation.identifier", "comment": "Usage Note: This should be populated if known. This is supported by OLIS" }, { "id": "Observation.basedOn", "path": "Observation.basedOn", "comment": "Usage Note: This should be populated if known. This is mandatory in the OLIS specification\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." }, { "id": "Observation.partOf", "path": "Observation.partOf", "requirements": "Usage Note: For now, this is out of scope. This could be a lab result that is tied to a procedure, however it is very uncommon to have this linkage within the EMR. eg specimen, observation after the fact is NOT a part of; surgery observations. \r\n\r\nMA: C3 says yes it is available; Can access it via Task.ID or Problem.ID or Allergy.ID etc. BUT, if done at task level, other non-relavent observations could be captured along with that. (ex: height for diabeties). ie: data is being captured but it could very likely be 'noisy'." }, { "id": "Observation.partOf.reference", "path": "Observation.partOf.reference", "mustSupport": true }, { "id": "Observation.partOf.display", "path": "Observation.partOf.display", "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "min": 1, "max": "1", "fixedCodeableConcept": { "text": "laboratory" }, "mustSupport": true }, { "id": "Observation.category.coding", "path": "Observation.category.coding", "mustSupport": true }, { "id": "Observation.category.coding.system", "path": "Observation.category.coding.system", "min": 1, "mustSupport": true }, { "id": "Observation.category.coding.code", "path": "Observation.category.coding.code", "min": 1, "mustSupport": true }, { "id": "Observation.category.coding.display", "path": "Observation.category.coding.display", "mustSupport": true }, { "id": "Observation.category.text", "path": "Observation.category.text", "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "comment": "Usage Note: The sending systems will always send text and where possible will also send a codified value. These are not always available. Local codes shoudl be converted to LOINC where possible. \r\n\r\nEMR API:\r\nLOINC (example)\r\nhttp://hl7.org/fhir/ValueSet/observation-codes >1000 codes\r\nMA: loinc (most common), ICD-9, snomed,type code, atc class, workload, and no codes as well\r\nPSS:\r\nMS: PCLOCD, ICD-10\r\n\r\n*All* code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.", "mustSupport": true, "binding": { "strength": "preferred" } }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "mustSupport": true }, { "id": "Observation.code.coding.system", "path": "Observation.code.coding.system", "min": 1, "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "min": 1, "mustSupport": true }, { "id": "Observation.code.coding.display", "path": "Observation.code.coding.display", "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "comment": "Usage Note: If the lab result is just an OBX, with NTE's, there is no specific code; this must be populated as \"lab note\".\r\n\r\nPSS: Observation Name (text) \r\n\r\nery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "min": 1, "mustSupport": true }, { "id": "Observation.subject.reference", "path": "Observation.subject.reference", "mustSupport": true }, { "id": "Observation.subject.display", "path": "Observation.subject.display", "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "comment": "Usage Note: In some cases the lab observation can be linked to the encoutner in the EMR. Example: Prenatal urinalysis results are often linked to an encounter. \r\nUsage Note DW: Use of this element may vary by implementation/clent agreements\r\nUsage Note: This is not in scope for OLIS\r\n\r\nThis will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).", "mustSupport": true }, { "id": "Observation.encounter.reference", "path": "Observation.encounter.reference", "mustSupport": true }, { "id": "Observation.encounter.display", "path": "Observation.encounter.display", "comment": "Usage Note: Use of this data element will vary by implementation.\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "comment": "Usage Note: Manual lab entries always have a date which is the date used; may not distinguish between collection date and observation date\r\n**** Add data absent reason extension as per core\r\n\r\n At least a date should be present unless this observation is a historical report. For recording imprecise or \"fuzzy\" times (For example, a blood glucose measurement taken \"after breakfast\") use the [Timing](datatypes.html#timing) datatype which allow the measurement to be tied to regular life events.", "min": 1, "mustSupport": true }, { "id": "Observation.performer", "path": "Observation.performer", "comment": "Usage Note: If the name of the performer (eg Lifelabs or Dr. Smith) is known this should be sent.\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "Observation.performer.display", "path": "Observation.performer.display", "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage Rule: This must be sent where known; it is possible that there are component values but no top level values and therefore this is not mandatory.\r\nUsage Note: These values must be represented exactly as they are from the source. eg Labs may send a string such as \"pending\". \r\nUsage Note: If labs have sent notes associated with the observation, they should be sent as part of the value as a string. This may be in the OBX or the NTE assocaited with the OBX. \r\nAlignment: Core-CA only supports codeableConcept and quantity \r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "mustSupport": true }, { "id": "Observation.dataAbsentReason", "path": "Observation.dataAbsentReason", "comment": "Usage Note: A value of \"temp-unknown\" may be used for pending results in the EMR (status=registered). This could occur with a panel that has returned some final results with others that are showing as outstanding\r\n\r\nNull or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be \"detected\", \"not detected\", \"inconclusive\", or \"specimen unsatisfactory\". \n\nThe alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code \"error\" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.", "mustSupport": true }, { "id": "Observation.dataAbsentReason.text", "path": "Observation.dataAbsentReason.text", "comment": "Usage Note: This should be populated with the value from the lab as stored in the EMR, eg \"pending\" when a data absent reason of \"temp-unknown\" is used\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "mustSupport": true }, { "id": "Observation.interpretation", "path": "Observation.interpretation", "mustSupport": true }, { "id": "Observation.interpretation.coding", "path": "Observation.interpretation.coding", "mustSupport": true }, { "id": "Observation.interpretation.coding.system", "path": "Observation.interpretation.coding.system", "min": 1, "mustSupport": true }, { "id": "Observation.interpretation.coding.code", "path": "Observation.interpretation.coding.code", "min": 1, "mustSupport": true }, { "id": "Observation.interpretation.text", "path": "Observation.interpretation.text", "min": 1, "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "comment": "Usage Note: Annotations added by the clinician. Notes from the lab are conveyed as separate observations\r\n\r\nMay include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.", "mustSupport": true }, { "id": "Observation.note.author[x]", "path": "Observation.note.author[x]", "mustSupport": true }, { "id": "Observation.note.time", "path": "Observation.note.time", "mustSupport": true }, { "id": "Observation.note.text", "path": "Observation.note.text", "mustSupport": true }, { "id": "Observation.method", "path": "Observation.method", "comment": "Usage Note: If present in the lab result this will be passed on as is.\r\n\r\nOnly used if not implicit in code for Observation.code.", "mustSupport": true }, { "id": "Observation.method.coding", "path": "Observation.method.coding", "mustSupport": true }, { "id": "Observation.method.text", "path": "Observation.method.text", "mustSupport": true }, { "id": "Observation.specimen", "path": "Observation.specimen", "comment": "Usage Note: This is not supported today in the EMR's; if labs begin to send results in FHIR, this may come into scope in the future\r\n\r\nShould only be used if not implicit in code found in `Observation.code`. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report)." }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "mustSupport": true }, { "id": "Observation.referenceRange.low", "path": "Observation.referenceRange.low", "mustSupport": true }, { "id": "Observation.referenceRange.high", "path": "Observation.referenceRange.high", "mustSupport": true }, { "id": "Observation.referenceRange.appliesTo", "path": "Observation.referenceRange.appliesTo", "comment": "Usage Note: This will be present if received from the lab and if stored in the EMR\r\n\r\nThis SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.", "mustSupport": true }, { "id": "Observation.referenceRange.appliesTo.coding", "path": "Observation.referenceRange.appliesTo.coding", "mustSupport": true }, { "id": "Observation.referenceRange.appliesTo.coding.system", "path": "Observation.referenceRange.appliesTo.coding.system", "mustSupport": true }, { "id": "Observation.referenceRange.appliesTo.coding.code", "path": "Observation.referenceRange.appliesTo.coding.code", "mustSupport": true }, { "id": "Observation.referenceRange.appliesTo.coding.display", "path": "Observation.referenceRange.appliesTo.coding.display", "mustSupport": true }, { "id": "Observation.referenceRange.appliesTo.text", "path": "Observation.referenceRange.appliesTo.text", "mustSupport": true }, { "id": "Observation.referenceRange.text", "path": "Observation.referenceRange.text", "mustSupport": true }, { "id": "Observation.hasMember", "path": "Observation.hasMember", "comment": "Usage Note: This is not in scope for OLIS; this is in scope for IPS\r\nUsage: PSS: Looked at an example to see if this is used (OBX-4 relationship) and cannot determine this relationship\r\n\r\n\r\nWhen using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see [Notes](observation.html#obsgrouping) below. Note that a system may calculate results from [QuestionnaireResponse](questionnaireresponse.html) into a final score and represent the score as an Observation." }, { "id": "Observation.derivedFrom", "path": "Observation.derivedFrom", "comment": "Usage Note: This may be considered for future use as it is rare that a physician/EMR would link observations back to the original document.\r\n\r\nAll the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see [Notes](observation.html#obsgrouping) below." }, { "id": "Observation.component", "path": "Observation.component", "comment": "Discussion required: May be some linking in MedAccess. \r\nUsage Note: This is not supported by OLIS\r\n\r\nFor a discussion on the ways Observations can be assembled in groups together see [Notes](observation.html#notes) below.", "mustSupport": true }, { "id": "Observation.component.code", "path": "Observation.component.code", "comment": "Example from MA:\r\n\r\n6690-2\r\nWBC\r\n\r\n\r\n\r\n\r\n\r\n*All* code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.", "mustSupport": true }, { "id": "Observation.component.code.coding", "path": "Observation.component.code.coding", "max": "1", "mustSupport": true }, { "id": "Observation.component.code.coding.system", "path": "Observation.component.code.coding.system", "min": 1, "mustSupport": true }, { "id": "Observation.component.code.coding.code", "path": "Observation.component.code.coding.code", "min": 1, "mustSupport": true }, { "id": "Observation.component.code.coding.display", "path": "Observation.component.code.coding.display", "mustSupport": true }, { "id": "Observation.component.code.text", "path": "Observation.component.code.text", "comment": "Conformance: This must be present when known\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "mustSupport": true }, { "id": "Observation.component.interpretation", "path": "Observation.component.interpretation", "mustSupport": true }, { "id": "Observation.component.interpretation.coding", "path": "Observation.component.interpretation.coding", "mustSupport": true }, { "id": "Observation.component.interpretation.text", "path": "Observation.component.interpretation.text", "mustSupport": true }, { "id": "Observation.component.referenceRange", "path": "Observation.component.referenceRange", "comment": "MA: Display range, lower range, upper range. What is the display range? Do we share this? If YES we need an extension. Definitiion: the range that you want to set as a ideal/base reference\r\n\r\nMost observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.", "contentReference": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange", "mustSupport": true }, { "id": "Observation.component.referenceRange.low", "path": "Observation.component.referenceRange.low", "mustSupport": true }, { "id": "Observation.component.referenceRange.high", "path": "Observation.component.referenceRange.high", "mustSupport": true }, { "id": "Observation.component.referenceRange.text", "path": "Observation.component.referenceRange.text", "comment": "MA: Andrew, do we support this?\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.416+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/09737847-86a9-43e4-aefd-ec7639d1d07e", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-list", "name": "List", "status": "draft", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "List", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/List", "derivation": "constraint", "id": "09737847-86a9-43e4-aefd-ec7639d1d07e", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.411+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-location-patientchart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-location-patientchart", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-location", "name": "LocationPatientChart", "title": "Location eServices", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" } ], "kind": "resource", "abstract": false, "type": "Location", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Location", "derivation": "constraint", "differential": { "element": [ { "id": "Location", "path": "Location", "comment": "Usage Note: This is not currently used in MedDialog/eServices2.0 specification or returned from the TELUS Provider Registry." }, { "id": "Location.id", "path": "Location.id", "mustSupport": true }, { "id": "Location.meta", "path": "Location.meta", "mustSupport": true }, { "id": "Location.meta.lastUpdated", "path": "Location.meta.lastUpdated", "mustSupport": true }, { "id": "Location.meta.source", "path": "Location.meta.source", "mustSupport": true }, { "id": "Location.meta.profile", "path": "Location.meta.profile", "comment": "Usage: Each implementation project will determine if this will be supported. It may be useful for validating message instances against this specific profile.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "Location.identifier", "path": "Location.identifier", "mustSupport": true }, { "id": "Location.name", "path": "Location.name", "mustSupport": true }, { "id": "Location.type", "path": "Location.type", "mustSupport": true }, { "id": "Location.type.coding", "path": "Location.type.coding", "mustSupport": true }, { "id": "Location.type.coding.system", "path": "Location.type.coding.system", "mustSupport": true }, { "id": "Location.type.coding.code", "path": "Location.type.coding.code", "mustSupport": true }, { "id": "Location.type.text", "path": "Location.type.text", "mustSupport": true }, { "id": "Location.telecom", "path": "Location.telecom", "mustSupport": true }, { "id": "Location.telecom.system", "path": "Location.telecom.system", "mustSupport": true }, { "id": "Location.telecom.value", "path": "Location.telecom.value", "mustSupport": true }, { "id": "Location.address", "path": "Location.address", "mustSupport": true }, { "id": "Location.address.use", "path": "Location.address.use", "mustSupport": true }, { "id": "Location.address.type", "path": "Location.address.type", "mustSupport": true }, { "id": "Location.address.line", "path": "Location.address.line", "mustSupport": true }, { "id": "Location.address.city", "path": "Location.address.city", "mustSupport": true }, { "id": "Location.address.state", "path": "Location.address.state", "mustSupport": true }, { "id": "Location.address.postalCode", "path": "Location.address.postalCode", "mustSupport": true }, { "id": "Location.address.country", "path": "Location.address.country", "mustSupport": true }, { "id": "Location.managingOrganization", "path": "Location.managingOrganization", "mustSupport": true }, { "id": "Location.managingOrganization.reference", "path": "Location.managingOrganization.reference", "min": 1, "mustSupport": true }, { "id": "Location.managingOrganization.display", "path": "Location.managingOrganization.display", "mustSupport": true } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.411+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/3dea79c7-a2be-46f7-98b8-d539da3bf1f3", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-detected-issue", "name": "ManagedDetectedIssue", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" } ], "kind": "resource", "abstract": false, "type": "DetectedIssue", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DetectedIssue", "derivation": "constraint", "differential": { "element": [ { "id": "DetectedIssue", "path": "DetectedIssue", "comment": "Usage Rule: Managed Detected issues may be recorded in the patient chart, either with or without a Prescription/Renewal/Medication Chart. \r\nUsage Rule: If the prescription does not complete (eg draft prescription that is never added to the chart)\r\nUsage Rule: If there is no prescription associated with it, and it is associated to a medication record, it should be exported as part of the patient chart." }, { "id": "DetectedIssue.meta", "path": "DetectedIssue.meta", "mustSupport": true }, { "id": "DetectedIssue.meta.lastUpdated", "path": "DetectedIssue.meta.lastUpdated", "mustSupport": true }, { "id": "DetectedIssue.meta.source", "path": "DetectedIssue.meta.source", "mustSupport": true }, { "id": "DetectedIssue.meta.profile", "path": "DetectedIssue.meta.profile", "mustSupport": true }, { "id": "DetectedIssue.status", "path": "DetectedIssue.status", "fixedCode": "final", "mustSupport": true }, { "id": "DetectedIssue.code", "path": "DetectedIssue.code", "comment": "Usage Rule: There are two codes; the first being the http://hl7.org/fhir/ValueSet/detectedissue-category; the second will be the drug database code (system = FBD, code = ABC)\r\n\r\n***Anne to add slice\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true }, { "id": "DetectedIssue.code.coding", "path": "DetectedIssue.code.coding", "slicing": { "discriminator": [ { "type": "value", "path": "system" } ], "rules": "open" }, "comment": "Conformance Rule: FDB / drug database code will be populated here as a second code; eg Drug-Drug Interaction (code 1) + FBDCode (code 2)\r\n\r\nFDB / drug database description will be here.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.", "min": 1, "max": "2", "mustSupport": true }, { "id": "DetectedIssue.code.coding.system", "path": "DetectedIssue.code.coding.system", "comment": "Usage: This will identify FDB, Cerner Multim, Vigillance or any other system that will identify issues.\r\n\r\nThe URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.", "mustSupport": true }, { "id": "DetectedIssue.code.coding.code", "path": "DetectedIssue.code.coding.code", "mustSupport": true }, { "id": "DetectedIssue.code.coding:Category", "path": "DetectedIssue.code.coding", "sliceName": "Category", "min": 1, "max": "1", "mustSupport": true }, { "id": "DetectedIssue.code.coding:Category.system", "path": "DetectedIssue.code.coding.system", "min": 1, "fixedUri": "http://hl7.org/fhir/ValueSet/detectedissue-category", "mustSupport": true }, { "id": "DetectedIssue.code.coding:Category.code", "path": "DetectedIssue.code.coding.code", "min": 1, "mustSupport": true }, { "id": "DetectedIssue.code.coding:DrugDatabaseCode", "path": "DetectedIssue.code.coding", "sliceName": "DrugDatabaseCode", "comment": "Conformance Rule: If availalable, this local code from the EMR's drug database must be supplied as it is useful for recipients using the same system\r\n\r\nCodes 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." }, { "id": "DetectedIssue.code.coding:DrugDatabaseCode.system", "path": "DetectedIssue.code.coding.system", "min": 1, "mustSupport": true }, { "id": "DetectedIssue.code.coding:DrugDatabaseCode.code", "path": "DetectedIssue.code.coding.code", "min": 1, "mustSupport": true }, { "id": "DetectedIssue.code.text", "path": "DetectedIssue.code.text", "comment": "Usage Note: This is the description associated with the issue that is returned/displayed to the user from the drug database. \r\nExample: Beta Blocker to Asthma \r\n\r\nVery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "DetectedIssue.severity", "path": "DetectedIssue.severity", "mustSupport": true }, { "id": "DetectedIssue.identified[x]", "path": "DetectedIssue.identified[x]", "type": [ { "code": "dateTime" } ], "mustSupport": true }, { "id": "DetectedIssue.author", "path": "DetectedIssue.author", "comment": "Usage Note: If data is returned from the drug database (interaction checker), eg FDB, Vigilance it may be populated here. This is useful for systems who share the same drug database.\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "DetectedIssue.author.reference", "path": "DetectedIssue.author.reference", "mustSupport": true }, { "id": "DetectedIssue.author.display", "path": "DetectedIssue.author.display", "mustSupport": true }, { "id": "DetectedIssue.implicated", "path": "DetectedIssue.implicated", "comment": "Usage: This will be a reference to one or more Medication Statement, Medication Order or Medication Plan, Allergy, Observation, Condition, depending on where/when the issue was managed. In some cases, this is part of the patient chart but there is no specific reference; this could occur if the management is created and the prescription is never completed.\r\n\r\nExample Usage: Drug interaction between asthma and a medication. This will reference the medication order(s); which is an active or a draft or cancelled order when this exists in the chart and depending on whether the doctor chooses to prescribe. If there is no prescription (eg a prescription was started but cancelled without a record in the EMR), there may be no reference.\r\n\r\nThere's an implicit constraint on the number of implicated resources based on DetectedIssue.type; e.g. For drug-drug, there would be more than one. For timing, there would typically only be one.", "mustSupport": true }, { "id": "DetectedIssue.implicated.reference", "path": "DetectedIssue.implicated.reference", "mustSupport": true }, { "id": "DetectedIssue.implicated.display", "path": "DetectedIssue.implicated.display", "mustSupport": true }, { "id": "DetectedIssue.detail", "path": "DetectedIssue.detail", "comment": "Usage Note: This is the monograph (reaction, evidence, etc) and is therefore not supported for this implementation.\r\n\r\nShould focus on information not covered elsewhere as discrete data - no need to duplicate the narrative." }, { "id": "DetectedIssue.mitigation", "path": "DetectedIssue.mitigation", "comment": "Usage: Mitigation can be tied to a prescription or a plan for Med A and Med B; Can be added to an EMR record with or without a prescription.", "mustSupport": true }, { "id": "DetectedIssue.mitigation.extension", "path": "DetectedIssue.mitigation.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "DetectedIssue.mitigation.extension:myExtension", "path": "DetectedIssue.mitigation.extension", "sliceName": "myExtension", "comment": "Conformance Rule:: This must reflect the effective date, rather than the recorded date and must be present when known", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-mitigation-effective-date" ] } ], "mustSupport": true, "isModifier": false }, { "id": "DetectedIssue.mitigation.action", "path": "DetectedIssue.mitigation.action", "mustSupport": true }, { "id": "DetectedIssue.mitigation.action.coding", "path": "DetectedIssue.mitigation.action.coding", "mustSupport": true }, { "id": "DetectedIssue.mitigation.action.coding.system", "path": "DetectedIssue.mitigation.action.coding.system", "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/detectedissuemitigationaction" } }, { "id": "DetectedIssue.mitigation.action.coding.code", "path": "DetectedIssue.mitigation.action.coding.code", "mustSupport": true }, { "id": "DetectedIssue.mitigation.action.text", "path": "DetectedIssue.mitigation.action.text", "min": 1, "mustSupport": true }, { "id": "DetectedIssue.mitigation.date", "path": "DetectedIssue.mitigation.date", "mustSupport": true }, { "id": "DetectedIssue.mitigation.author", "path": "DetectedIssue.mitigation.author", "comment": "Usage Note: the Practitioner must be specified where known; else the role may be used.\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "min": 1, "mustSupport": true }, { "id": "DetectedIssue.mitigation.author.reference", "path": "DetectedIssue.mitigation.author.reference", "mustSupport": true }, { "id": "DetectedIssue.mitigation.author.display", "path": "DetectedIssue.mitigation.author.display", "mustSupport": true } ] }, "id": "3dea79c7-a2be-46f7-98b8-d539da3bf1f3", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.411+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/ext-medicationorder-max-dispense", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "ext-medicationorder-max-dispense", "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-max-dispense", "name": "MaxDispense", "title": "Ext-Max Dispense", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "MedicationRequest.dispenseRequest" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "mustSupport": true }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-max-dispense" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "type": [ { "code": "Quantity" } ], "mustSupport": true }, { "id": "Extension.value[x].value", "path": "Extension.value[x].value", "mustSupport": true }, { "id": "Extension.value[x].unit", "path": "Extension.value[x].unit", "mustSupport": true }, { "id": "Extension.value[x].system", "path": "Extension.value[x].system", "mustSupport": true }, { "id": "Extension.value[x].code", "path": "Extension.value[x].code", "mustSupport": true } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.399+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-medication-patientChart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-medication-patientChart", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.412+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/medication", "name": "Medication", "status": "draft", "date": "2021-03-22T16:04:55.1965892+00:00", "description": "This is scoped for usage within the Patient Chart", "fhirVersion": "4.0.1", "mapping": [ { "identity": "script10.6", "uri": "http://ncpdp.org/SCRIPT10_6", "name": "Mapping to NCPDP SCRIPT 10.6" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" } ], "kind": "resource", "abstract": false, "type": "Medication", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Medication", "derivation": "constraint", "differential": { "element": [ { "id": "Medication", "path": "Medication", "comment": "Review complete - June 18", "mustSupport": true }, { "id": "Medication.meta", "path": "Medication.meta", "mustSupport": true }, { "id": "Medication.meta.lastUpdated", "path": "Medication.meta.lastUpdated", "mustSupport": true }, { "id": "Medication.meta.source", "path": "Medication.meta.source", "mustSupport": true }, { "id": "Medication.meta.profile", "path": "Medication.meta.profile", "mustSupport": true }, { "id": "Medication.meta.security", "path": "Medication.meta.security", "mustSupport": true }, { "id": "Medication.meta.security.system", "path": "Medication.meta.security.system", "min": 1, "mustSupport": true }, { "id": "Medication.meta.security.code", "path": "Medication.meta.security.code", "min": 1, "mustSupport": true }, { "id": "Medication.text", "path": "Medication.text", "comment": "??? May need to support for partner solutiion, eg mapping into a CDA document. For eServices, there wil always be an accompanying PDF and therefore this is not required.\r\n\r\nContained 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.", "min": 1, "mustSupport": true }, { "id": "Medication.code", "path": "Medication.code", "comment": "Conformance Rule: Supported Code systems that are acceptable in the message are: \r\n CCDD - https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset \r\n DIN - http://hl7.org/fhir/NamingSystem/ca-hc-din\r\n NPN - http://hl7.org/fhir/NamingSystem/ca-hc-npn\r\n\r\n\r\nConformance Rule: If a medication is recorded using a local code system, such as a HICL or GCN/FDB, this must be converted where possible to a CCDD, DIN or NPN. If conversion is not possible (eg if a DIN no longer exists), the local code may be sent with text. Example: Local code systems can be used, such as http://terminology.hl7.org/CodeSystem/FDDC - First DataBank Drug Codes along with a textual description. \r\n\r\nConformance Rule: Compounds will be conveyed as text only. Where possible, an ingredient list shoudl be included. Example: HC1% Canesten Cream\r\n\r\nConformance Rule: either text or code must be present\r\n\r\n\r\nBackground Discussion: DW - currently supports \"generic ingredient\", eg amoxicilin even for brand names. MA - populates ATC and AHFS class (categorization) and sent out as part of DW extract\r\n\r\n??? there are multiple codings OR it may be more appropriate to support this via extension. The receiving system should be able to consult a drug database to obtain further details, rather than providing this level coding to them.\r\n\r\nLocal codes (eg FDB, Viglliance) will be converted to CCDD. - existing functionality supported \r\nText is used for compounds, new/trial medications that do not have a CCDD code, non-medicinal products, eg test strips, \r\n\r\nMappings:\r\nMA: DIN or text plus local code, eg FBD?\r\nPSS: DINs and Representative DINs. Unlikely that we send CCDD as it was done for PrescribeIT which doesn't use the API\r\nMS: N/A in UI but DIN is available in DB - does not support CCDD, Vigillance DB. \r\nEMRAPI: code\r\nCore-CA: supported, https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct - same as PrescribeIT\r\nPrescribeIT: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct\r\nDHDR: Have sliced this by DIN, Generic, DrugClass, DrugSubClass\r\n\r\n??? Confirm we do NOT NEED TO SUPPORT REPRESENTATIVE DIN? If there is a prescription (active or future), the prescription may not be DIN based but CCDD should cover it.\r\n\r\n\r\nPrescribeIT Conformance Rule: This element is used to represent the medication ordered or dispensed. A 'code' (Canadian Clinical Drug Data Set, or DIN or NPN) must be accompanied by 'text' when presribing. For compounds, a code is not used and the description will be sent as 'text'. A DIN, representative DIN or an NPN may also be used if a CCDD code is not available. This has an extensible binding meaning that the CCDD code system should be used but if a code is not available, vendors may also submit a code from the DIN or NPN code system. (Eventually CCDD will encompass all DINs and NPNs.)\r\n\r\nCode systems that are acceptable in the message are: CCDD - https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset DIN - http://hl7.org/fhir/NamingSystem/ca-hc-din NPN - http://hl7.org/fhir/NamingSystem/ca-hc-npn\r\n\r\nEMRs and PMSs must support sending and receiving all levels of drug terminology defined in the Canadian Clinical Drug Data (CCDD) Set including: Therapeutic Moiety (TM), Non-proprietary Therapeutic Product (NTP), Manufactured Product (MP) as well as Device NTP for devices. In cases where an appropriate Canadian Clinical Drug Data Set value is not yet available within the point-of-service system, the system can send a DIN or Natural Product Number (NPN) or a DIN with the (isRepresentative) value set to 'true'.\r\n\r\nIf no drug code (TM, NTP, MP, or DIN) is available in the point of service system, only then should the system send the drug name as text without a code. The pharmacy system must always display the textual name of the medication or non-medication provided in the message to the user when displaying the prescription. This represents the name of the medication or non-medication (e.g. device) as seen by the prescriber at the time of prescribing.\r\n\r\nDHDR - 4 slices - DIN/PIN (1..1), generic(0..1), class (0..1) and sub-class (0..1) - all support system, code, display\r\n\r\n\r\nDepending on the context of use, the code that was actually selected by the user (prescriber, dispenser, etc.) will have the coding.userSelected set to true. As described in the coding datatype: \"A coding may be marked as a \"userSelected\" if a user selected the particular coded value in a user interface (e.g. the user selects an item in a pick-list). If a user selected coding exists, it is the preferred choice for performing translations etc. Other codes can only be literal translations to alternative code systems, or codes at a lower level of granularity (e.g. a generic code for a vendor-specific primary one).", "min": 1, "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct" } }, { "id": "Medication.code.coding", "path": "Medication.code.coding", "slicing": { "discriminator": [ { "type": "value", "path": "system" } ], "rules": "open" }, "comment": "Core-CA: supported 0..1\r\n\r\nConformance Rule: must be included in the message when known\r\n\r\n\r\nCodes 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.", "mustSupport": true }, { "id": "Medication.code.coding.system", "path": "Medication.code.coding.system", "comment": "Core-CA: supported\r\n\r\nThe URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.", "min": 1, "mustSupport": true }, { "id": "Medication.code.coding.code", "path": "Medication.code.coding.code", "comment": "Core-CA: supported\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "min": 1, "mustSupport": true }, { "id": "Medication.code.coding.display", "path": "Medication.code.coding.display", "comment": "Usage Rule: If text and display are identical, the display does not need to be sent.\r\nUsage Note: This must be present for local code systems such as HICL. \r\nUsage Rule: This may be used to convey the name associated with the code and is important in the case where the display name is english, and the text (that which the physican saw) is french.\r\n\r\nMappings:\r\nCore-CA: not supported\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Medication.code.coding:CCDD", "path": "Medication.code.coding", "sliceName": "CCDD", "max": "1" }, { "id": "Medication.code.coding:CCDD.system", "path": "Medication.code.coding.system", "min": 1, "fixedUri": "https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset", "mustSupport": true }, { "id": "Medication.code.coding:CCDD.code", "path": "Medication.code.coding.code", "min": 1, "mustSupport": true }, { "id": "Medication.code.coding:CCDD.display", "path": "Medication.code.coding.display", "mustSupport": true }, { "id": "Medication.code.coding:NPN", "path": "Medication.code.coding", "sliceName": "NPN", "max": "1" }, { "id": "Medication.code.coding:NPN.system", "path": "Medication.code.coding.system", "min": 1, "fixedUri": "http://hl7.org/fhir/NamingSystem/ca-hc-npn", "mustSupport": true }, { "id": "Medication.code.coding:NPN.code", "path": "Medication.code.coding.code", "min": 1, "mustSupport": true }, { "id": "Medication.code.coding:DIN", "path": "Medication.code.coding", "sliceName": "DIN", "max": "1" }, { "id": "Medication.code.coding:DIN.system", "path": "Medication.code.coding.system", "min": 1, "fixedUri": "http://hl7.org/fhir/NamingSystem/ca-hc-din", "mustSupport": true }, { "id": "Medication.code.coding:DIN.code", "path": "Medication.code.coding.code", "min": 1, "mustSupport": true }, { "id": "Medication.code.coding:VaccineCodeGeneric", "path": "Medication.code.coding", "sliceName": "VaccineCodeGeneric", "comment": "Usage Note: When conveying the medication list, prescribed vaccines may be specified here in the context of a prescription. \r\n\r\nCodes 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." }, { "id": "Medication.code.coding:VaccineCodeTradename", "path": "Medication.code.coding", "sliceName": "VaccineCodeTradename" }, { "id": "Medication.code.text", "path": "Medication.code.text", "comment": "Usage Rule: Text is mandatory as it may be different than the display, Example: in some cases the text may include the strength and the display may not. \r\nUsage Note: This is used for compounds or custom administrations such as allergy shots, IUDs \r\n\r\nMappings:\r\nCore-CA: supported 0..1 \r\n\r\nPatient Chart Conformance Rule: Mandatory. Official name recorded in the source system. This MUST be the name of the medication or non-medication. This may be the generic ingredient(s) or CCDD/DIN name or compound description or product name.\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "Medication.manufacturer", "path": "Medication.manufacturer", "mustSupport": true }, { "id": "Medication.manufacturer.display", "path": "Medication.manufacturer.display", "mustSupport": true }, { "id": "Medication.form", "path": "Medication.form", "comment": "Conformance Rule: This is only used if this is not already included in the code and then only if this is known. This could occur if the CCDD code was in the 8xxxxxx series which indicates only an ingredient and where the physician specified the form but not the strength\r\n\r\nMappings:\r\nDHDR: is supported, - [code-system-local-base]/ca-on-drug-subclass-ahfs; this is a read only system and EMRs can display\r\nPrescribeIT: https://fhir.infoway-inforoute.ca/ValueSet/dispensabledrugform\r\nCA-Core: Not supported, Same as PrescribeIT (preferred)\r\n\r\nEMRAPI: Form\r\n*EMRs who support PrescribeIT can support the same value set\r\nMA: Patient chart --> Meds --> Add new --> Drug name --> field beside Dose\r\nPSS: ending CCDD to PrescribeIT but it doesn't use the API.\r\nMS: Quantity per dose DDL -> codified form; mapping exercise\r\n\r\nPrescribeIT Usage Notes: The prescription drug form is optional to send to PrescribeIT™ but is required in some provinces in order to meet the prescribing standards set out by the College of Physicians and Surgeons. As a result the EMR must support allowing the prescriber to send a prescription drug form when the drug form is not specified by the drug identifier (e.g. for compounds, drugs prescribed using a Therapeutic Moiety or Representative DIN).\r\n\r\nConformance Rule: A Code must be supplied if one is available from the PrescriptionDrugForm subset. If the user picks a prescription drug form that does not have a code in the PrescriptionDrugForm subset, only then can text be supplied without a code.\r\n\r\nWhen Medication is referenced from MedicationRequest, this is the ordered form. When Medication is referenced within MedicationDispense, this is the dispensed form. When Medication is referenced within MedicationAdministration, this is administered form.", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/dispensabledrugform" } }, { "id": "Medication.form.coding", "path": "Medication.form.coding", "mustSupport": true }, { "id": "Medication.form.coding.system", "path": "Medication.form.coding.system", "comment": "Conformance Rule: If the system is known it must be populated. \r\n\r\nThe URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.", "mustSupport": true }, { "id": "Medication.form.coding.code", "path": "Medication.form.coding.code", "min": 1, "mustSupport": true }, { "id": "Medication.form.text", "path": "Medication.form.text", "comment": "Conformance Rule: This is the text used to convey the exact word that was displayed to the practitioner\r\n\r\nery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "Medication.amount", "path": "Medication.amount", "comment": "Discussion Note: Canadian issue where the DIN is the same regardless of the amount, so you need to be able to specify the amount, et 3ml versus 10ml. This may occur with injectibles. This is more relevant to the dispense. \r\n\r\nPatient Chart - not supported, this is unclear and may be complicated\r\nDW - not supported\r\nCHR & EMRs - not supported\r\n\r\nMappings:\r\nCA-Core - not supported\r\nPrescribeIT: not supported; was not in May2016\r\nEMRs - this is not in the spreadsheet - is this concept supported?\r\n\r\n\r\nThe Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to \"1\", Quantity should be used instead of Ratio." }, { "id": "Medication.ingredient", "path": "Medication.ingredient", "comment": "Conformance Rule: This is used to specify the ingredients in compounds when this has been recorded in the sending system. This may be a code (eg DIN or CCDD) or text to describe each ingredient. \r\n\r\n***Anne - add MedicaitonStrengthDescription extension here as strength is too hard to support as a ratio\r\n\r\nExample - HC1% in Canesten cream (Medication.code.text) - 1% would be in the extension, Medication Strength\r\n\r\n**** follow PrescribeIT rules\r\n\r\nMappings:\r\nCA-Core: not supported\r\nPrescribeIT: supported as future, item, isActive, amount\r\nDHDR: not supported\r\nEMRAPI: not supported\r\nEMRs: PSS does not support, MA can specify discrete ingredients\r\n\r\nThe ingredients need not be a complete list. If an ingredient is not specified, this does not indicate whether an ingredient is present or absent. If an ingredient is specified it does not mean that all ingredients are specified. It is possible to specify both inactive and active ingredients.", "mustSupport": true }, { "id": "Medication.ingredient.item[x]", "path": "Medication.ingredient.item[x]", "comment": "Conformance Rule: If there is no codified value, text should be sent\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "type": [ { "code": "CodeableConcept" } ], "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct" } }, { "id": "Medication.ingredient.item[x].coding", "path": "Medication.ingredient.item[x].coding", "mustSupport": true }, { "id": "Medication.ingredient.item[x].coding.system", "path": "Medication.ingredient.item[x].coding.system", "min": 1, "mustSupport": true }, { "id": "Medication.ingredient.item[x].coding.code", "path": "Medication.ingredient.item[x].coding.code", "min": 1, "mustSupport": true }, { "id": "Medication.ingredient.item[x].text", "path": "Medication.ingredient.item[x].text", "mustSupport": true }, { "id": "Medication.ingredient.isActive", "path": "Medication.ingredient.isActive", "mustSupport": true }, { "id": "Medication.ingredient.strength", "path": "Medication.ingredient.strength", "comment": "Usage Note: This is not supported as many sending systems only support a string representation of strength. As such, an extension for Medication Strength description will be added and used in place of this data element.\r\n\r\nThe Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to \"1\", Quantity should be used instead of Ratio.", "mustSupport": true }, { "id": "Medication.ingredient.strength.numerator", "path": "Medication.ingredient.strength.numerator", "mustSupport": true }, { "id": "Medication.ingredient.strength.numerator.value", "path": "Medication.ingredient.strength.numerator.value", "min": 1, "mustSupport": true }, { "id": "Medication.ingredient.strength.numerator.unit", "path": "Medication.ingredient.strength.numerator.unit", "mustSupport": true }, { "id": "Medication.ingredient.strength.numerator.system", "path": "Medication.ingredient.strength.numerator.system", "mustSupport": true }, { "id": "Medication.ingredient.strength.numerator.code", "path": "Medication.ingredient.strength.numerator.code", "mustSupport": true }, { "id": "Medication.ingredient.strength.denominator", "path": "Medication.ingredient.strength.denominator", "mustSupport": true }, { "id": "Medication.ingredient.strength.denominator.value", "path": "Medication.ingredient.strength.denominator.value", "min": 1, "mustSupport": true }, { "id": "Medication.ingredient.strength.denominator.unit", "path": "Medication.ingredient.strength.denominator.unit", "mustSupport": true }, { "id": "Medication.ingredient.strength.denominator.system", "path": "Medication.ingredient.strength.denominator.system", "mustSupport": true }, { "id": "Medication.ingredient.strength.denominator.code", "path": "Medication.ingredient.strength.denominator.code", "mustSupport": true }, { "id": "Medication.batch", "path": "Medication.batch", "comment": "Usage Notes: The lotNumber and expirationDate should be sent if known. This is typically used for medication admin, such as immunizations, allergy shots, etc.\r\n\r\nMappings:\r\nCA-Core: not supported\r\nPrescribeIT: not supported\r\nDHDR: not supported\r\nEMRAPI: not supported\r\nEMRs: not supported", "mustSupport": true }, { "id": "Medication.batch.lotNumber", "path": "Medication.batch.lotNumber", "mustSupport": true }, { "id": "Medication.batch.expirationDate", "path": "Medication.batch.expirationDate", "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/3a87f022-123a-4b8e-a652-d342fa15bebd", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-medication-administration", "name": "MedicationAdministration", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "w3c.prov", "uri": "http://www.w3.org/ns/prov", "name": "W3C PROV" } ], "kind": "resource", "abstract": false, "type": "MedicationAdministration", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationAdministration", "derivation": "constraint", "differential": { "element": [ { "id": "MedicationAdministration.id", "path": "MedicationAdministration.id", "mustSupport": true }, { "id": "MedicationAdministration.meta", "path": "MedicationAdministration.meta", "mustSupport": true }, { "id": "MedicationAdministration.meta.lastUpdated", "path": "MedicationAdministration.meta.lastUpdated", "mustSupport": true }, { "id": "MedicationAdministration.meta.source", "path": "MedicationAdministration.meta.source", "mustSupport": true }, { "id": "MedicationAdministration.meta.profile", "path": "MedicationAdministration.meta.profile", "comment": "Usage: May be used for validatiing a message instance against this profile. This will be determined by each implementation.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "MedicationAdministration.meta.security", "path": "MedicationAdministration.meta.security", "mustSupport": true }, { "id": "MedicationAdministration.meta.security.system", "path": "MedicationAdministration.meta.security.system", "mustSupport": true }, { "id": "MedicationAdministration.meta.security.code", "path": "MedicationAdministration.meta.security.code", "mustSupport": true }, { "id": "MedicationAdministration.text", "path": "MedicationAdministration.text", "comment": "Conformance Rule: This must be formatted, as closely as possible what was presented to the user in the originating system and must include all clinical data. \r\n\r\nContained 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.", "mustSupport": true }, { "id": "MedicationAdministration.status", "path": "MedicationAdministration.status", "comment": "TERMINOLOGY: Completed, not-done (refused) are supported; other values \r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "mustSupport": true }, { "id": "MedicationAdministration.statusReason", "path": "MedicationAdministration.statusReason", "comment": "Terminology - create a value set for statusReason. Include value of \"refused\" \r\n\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true }, { "id": "MedicationAdministration.statusReason.coding", "path": "MedicationAdministration.statusReason.coding", "mustSupport": true }, { "id": "MedicationAdministration.statusReason.coding.system", "path": "MedicationAdministration.statusReason.coding.system", "mustSupport": true }, { "id": "MedicationAdministration.statusReason.coding.code", "path": "MedicationAdministration.statusReason.coding.code", "mustSupport": true }, { "id": "MedicationAdministration.statusReason.text", "path": "MedicationAdministration.statusReason.text", "mustSupport": true }, { "id": "MedicationAdministration.medication[x]", "path": "MedicationAdministration.medication[x]", "comment": "Usage Note: This reference should include a user-friendly textual representation of the reference that should be used in the narrative\r\n\r\nIf only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.", "mustSupport": true }, { "id": "MedicationAdministration.subject", "path": "MedicationAdministration.subject", "mustSupport": true }, { "id": "MedicationAdministration.subject.reference", "path": "MedicationAdministration.subject.reference", "min": 1, "mustSupport": true }, { "id": "MedicationAdministration.subject.display", "path": "MedicationAdministration.subject.display", "comment": "Usage Note: This should contain the name of the Patient, which can then be used in narrative\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "MedicationAdministration.effective[x]", "path": "MedicationAdministration.effective[x]", "comment": "Conformance Rule: The only known use case is a dateTime; no known use case for Period", "mustSupport": true }, { "id": "MedicationAdministration.performer", "path": "MedicationAdministration.performer", "mustSupport": true }, { "id": "MedicationAdministration.performer.actor", "path": "MedicationAdministration.performer.actor", "mustSupport": true }, { "id": "MedicationAdministration.performer.actor.reference", "path": "MedicationAdministration.performer.actor.reference", "mustSupport": true }, { "id": "MedicationAdministration.performer.actor.display", "path": "MedicationAdministration.performer.actor.display", "comment": "Usage Note: This is a user-friendly textual representation of the reference that should be used in the narrative\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "MedicationAdministration.reasonCode", "path": "MedicationAdministration.reasonCode", "mustSupport": true }, { "id": "MedicationAdministration.dosage", "path": "MedicationAdministration.dosage", "mustSupport": true }, { "id": "MedicationAdministration.dosage.text", "path": "MedicationAdministration.dosage.text", "comment": "Usage Note: This is a user-friendly textual representation of the reference that should be used in the narrative\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "min": 1, "mustSupport": true } ] }, "id": "3a87f022-123a-4b8e-a652-d342fa15bebd", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.412+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/b149692f-1532-4f7f-8aad-5f50f99587b4", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-medication-for-life", "name": "MedicationForLife", "title": "Ext-Medication For Life Indicator", "status": "draft", "description": "This is flag indicating that the prescription is \"for life\". This is a requirement in Quebec, Canada", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "MedicationRequest.dispenseRequest" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "mustSupport": true }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/ext-medication-for-life" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "min": 1, "type": [ { "code": "boolean" } ], "mustSupport": true } ] }, "id": "b149692f-1532-4f7f-8aad-5f50f99587b4", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.400+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-medication-request-order-patient-chart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-medication-request-order-patient-chart", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-medication-order", "name": "MedicationOrder", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "script10.6", "uri": "http://ncpdp.org/SCRIPT10_6", "name": "Mapping to NCPDP SCRIPT 10.6" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "PrescribeIT", "name": "PrescribeIT" } ], "kind": "resource", "abstract": false, "type": "MedicationRequest", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationRequest", "derivation": "constraint", "differential": { "element": [ { "id": "MedicationRequest", "path": "MedicationRequest", "comment": "START REVIEW - ON INFORMATION SOURCE Review Requestor, Dose&Rate - Datatype\r\n\r\nReview - MELVA - patient instructions\r\n**Add Dispenser Instructions as extension - see PrescribeIT\r\nExtensions - TreatmentType, Observations (height/weight/creatine), ManagedIssues (0..*) PharmacyInstructions, MonitoredDrug, NoRenewals, + dispense Trial, MaxDispense, TotalPrescribedQuantity,\r\n\r\n*Add - rendered dosage instruction ext ... 0..1 Conformance Rule: Must be present where dosage was specified. This is not mandatory as there may be orders for tests or products where dosage does not apply such as lancets or pregnancy tests.", "mustSupport": true }, { "id": "MedicationRequest.id", "path": "MedicationRequest.id", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.meta", "path": "MedicationRequest.meta", "mustSupport": true }, { "id": "MedicationRequest.meta.versionId", "path": "MedicationRequest.meta.versionId", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.meta.lastUpdated", "path": "MedicationRequest.meta.lastUpdated", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.meta.source", "path": "MedicationRequest.meta.source", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.meta.profile", "path": "MedicationRequest.meta.profile", "comment": "Usage: Each implementation project will determine if this will be supported. It may be useful for validating message instances against this specific profile.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "MedicationRequest.text", "path": "MedicationRequest.text", "mustSupport": true }, { "id": "MedicationRequest.contained", "path": "MedicationRequest.contained", "comment": "Usage Rule: The medication resource will be contained and present in most situations.\r\n\r\nThis 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.", "type": [ { "code": "Resource", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/medication" ] } ] }, { "id": "MedicationRequest.extension", "path": "MedicationRequest.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "MedicationRequest.extension:RenderedDosageInstruction", "path": "MedicationRequest.extension", "sliceName": "RenderedDosageInstruction", "comment": "Usage Note: This is intended to provide all dosage instructions in a clear human-readable format. This field may be presented to users when viewing the prescription. This must be as clear as possible and must include all instructions. \r\nAlignment: This is a pre-adoption of an R5 element; this is also present in PrescribeIT\r\n\r\nIt is recognized that very complex instructions may be conveyed as text only (not as structured data). Example: take 500 mg twice a day at breakfast and at lunch AND 250 mg once a day at bedtime - THEN (new dosage line)). If the EMR submits structured dosage instructions, this must be consistent with the textual instructions provided here. Example: the EMR may enter frequency (multiplier of the dose) in their system like this (2 qam and 3 qhs ), in the structured frequency. The textual instructions could say Take 2 tablets in the morning and 3 at bedtime.\r\n\r\nConformance Rule: The rendered dosage instruction MUST contain ALL dosage instructions. This includes ALL child elements of dosage instruction, such as dosage quantity, dosage unit, frequency, etc) in human readable form and must be able to stand on its own. This field will include all of the information contained in the structured dosage as well as patient instructions (eg take with food, starting one day before dental appointment), assembled into one field and formatted as human-readable. Coded values codes should not be used (e.g. 'days' should be used instead of 'd', the code of PO as 'oral' )\r\n\r\nConformance Rule: MUST allow all printable characters and carriage return/line feeds.\r\n\r\nAlignment - PrescribeIT - Rendered Dosage Instruction", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-rendered-dosage-instruction" ] } ], "isModifier": false }, { "id": "MedicationRequest.extension:DispenserInstructions", "path": "MedicationRequest.extension", "sliceName": "DispenserInstructions", "comment": "Alignment: MedicationOrder.extension:pharmacyInstructions\r\nUsage Note: If available, this should be included\r\n\r\nThere 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.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-request-dispenser-instructions" ] } ], "isModifier": false }, { "id": "MedicationRequest.extension:MonitoredDrug", "path": "MedicationRequest.extension", "sliceName": "MonitoredDrug", "comment": "Allows prescribers to indicate that the compound contains a 'Monitored Drug in the prescription message to the pharmacies\r\n\r\nConformance Rule: The prescriber should have the ability to set this flag (= true) when the medication is a compound and it contains a monitored medication. The absence of this extension means (i.e. value=”false”) that this compound does not contain a monitored substance OR that the EMR does not have this field available in the province.\r\n\r\nUsage Note: Provinces may require prescribers to enter this value when a compound contains a monitored substance (e.g. narcotic) to support Prescription Drug Monitoring Programs (e.g. the Alberta Triplicate Prescription Program).\r\n\r\nAlignment: PrescribeIT - MedicationOrder.extension:monitoredDrug\r\n\r\nthere 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.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-monitored-drug" ] } ], "isModifier": false }, { "id": "MedicationRequest.extension:NoRenewalsFlag", "path": "MedicationRequest.extension", "sliceName": "NoRenewalsFlag", "definition": "Indicates that the prescriber will not support renewals for this prescription", "comment": "Alignment: PrescribeIT: MedicationOrder.extension:noRenewals\r\n\r\nPSS: If the user has placed a value of \"0\" in the field, they have specified no renewals and this flag is set. If the user has left this blank, PSS puts a value of \"-1\" in the DB and in this case the flag is not set. \r\n\r\nConformance Rule: The PMS should present a warning to the dispenser if they create a renewal request for a prescription that has this flag set to indicate 'no renewals'. The PMS should allow the renewal to be submitted along with an explanation as there may be exceptional circumstances.\r\n\r\nThere 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.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-no-renewals" ] } ], "isModifier": false }, { "id": "MedicationRequest.extension:StatusChanged", "path": "MedicationRequest.extension", "sliceName": "StatusChanged", "definition": "The date that the status has changed", "comment": "This is a pre-adoption of an R5 data element, statusChanged. This may be different than lastUpdatedDate as it specifically calls out the date the status was changed.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationRequest.statusChanged" ] } ], "isModifier": false }, { "id": "MedicationRequest.identifier", "path": "MedicationRequest.identifier", "slicing": { "discriminator": [ { "type": "value", "path": "type.coding.code" } ], "rules": "open" }, "comment": "Conformance Rule: The Placer ID (identifier.type=PLAC) must be populated with the prescription identifier issued by the source system for each medication. This aligns with PrescribeIT. Note: An EMR may view a \"prescription\" as having multiple medications whereas in FHIR, a medication request represents a single medication. \r\n\r\nConformance Rule: If the provincial DIS ID is available, this should be included\r\n\r\nMapping: PrescribeIT MedicationOrder.identifier\r\n\r\nThis is a business identifier, not a resource identifier.", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.identifier.type", "path": "MedicationRequest.identifier.type", "mustSupport": true }, { "id": "MedicationRequest.identifier.system", "path": "MedicationRequest.identifier.system", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.identifier.value", "path": "MedicationRequest.identifier.value", "min": 1, "mustSupport": true, "mapping": [ { "identity": "PrescribeIT", "map": "MedicationOrder.identifier:EMR-id.value" } ] }, { "id": "MedicationRequest.identifier:Placer", "path": "MedicationRequest.identifier", "sliceName": "Placer", "max": "1" }, { "id": "MedicationRequest.identifier:Placer.type", "path": "MedicationRequest.identifier.type", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.identifier:Placer.type.coding", "path": "MedicationRequest.identifier.type.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "MedicationRequest.identifier:Placer.type.coding.code", "path": "MedicationRequest.identifier.type.coding.code", "min": 1, "fixedCode": "PLAC", "mustSupport": true }, { "id": "MedicationRequest.identifier:Placer.system", "path": "MedicationRequest.identifier.system", "comment": "Conformance Rule: Follow the same rule as PrescribeIT for consistency ********** more to come on this\r\n\r\nPrescribeIT Conformance Rule: This must be an OID of the URI form [Vendor root].[Application instance node].2 (e.g. urn:oid:1.2.3.4). The branch, “.2” is appended to create a unique namespace for the Prescription Identifer\r\n\r\n\r\nIdentifier.system is always case sensitive.", "min": 1, "fixedUri": "http://hl7.org/fhir/identifier-type", "mustSupport": true }, { "id": "MedicationRequest.identifier:Placer.value", "path": "MedicationRequest.identifier.value", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.identifier:DISID", "path": "MedicationRequest.identifier", "sliceName": "DISID", "comment": "Conformance Rule: If this is available to the sending system, this must be sent. The second instance is to support the situation where an order is sent to two provincial systems, aka border town.\r\n\r\nThis is a business identifier, not a resource identifier.", "max": "2" }, { "id": "MedicationRequest.identifier:DISID.type", "path": "MedicationRequest.identifier.type", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.identifier:DISID.type.coding", "path": "MedicationRequest.identifier.type.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "MedicationRequest.identifier:DISID.type.coding.system", "path": "MedicationRequest.identifier.type.coding.system", "min": 1, "fixedUri": "http://hl7.org/fhir/v2/0203", "mustSupport": true }, { "id": "MedicationRequest.identifier:DISID.type.coding.code", "path": "MedicationRequest.identifier.type.coding.code", "min": 1, "fixedCode": "RRI", "mustSupport": true }, { "id": "MedicationRequest.identifier:DISID.system", "path": "MedicationRequest.identifier.system", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.identifier:DISID.value", "path": "MedicationRequest.identifier.value", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.status", "path": "MedicationRequest.status", "comment": "Usage Rule: The prescription is \"active\" and will remain active as long as the patient is authorized to take the medication. The prescription authorizes both the dispense period and the period of time that the patient is expected to be taking the medication. The order will remain active until a) the prescription end date is reached, if it can be calculated based on dosage instructions b) the prescription is discontinued/stopped c) the prescription is on-hold and not resumed or discontinued d) the medication is renewed or e) the prescription has completed based on rules in the EMR such as dosage instructions, auto-discontinue, etc.\r\n\r\nNote: Some EMRs will not track the legal prescription end date/expiry date. \r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "mustSupport": true }, { "id": "MedicationRequest.statusReason", "path": "MedicationRequest.statusReason", "comment": "Usage Note: When radio buttons are used, the status reason is be captured discretely.\r\n\r\nThis is generally only used for \"exception\" statuses such as \"suspended\" or \"cancelled\". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.", "mustSupport": true }, { "id": "MedicationRequest.intent", "path": "MedicationRequest.intent", "fixedCode": "order", "mustSupport": true }, { "id": "MedicationRequest.category", "path": "MedicationRequest.category", "comment": "Conformance Rule: This should be populated if known\r\nPrescribeIT Mapping: May2016 extension \r\n\r\nThe category can be used to include where the medication is expected to be consumed or other types of requests.", "max": "1", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptiontype" }, "mapping": [ { "identity": "PrescribeIT", "map": "http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-category" } ] }, { "id": "MedicationRequest.category.coding", "path": "MedicationRequest.category.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "MedicationRequest.category.coding.system", "path": "MedicationRequest.category.coding.system", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.category.coding.code", "path": "MedicationRequest.category.coding.code", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.reported[x]", "path": "MedicationRequest.reported[x]", "comment": "Conformance Rule: The boolean is mandatory where known, the source resource must be included in the extension:InformationSource. \r\nConformance Rule: In EMR's this may be derived from the \"external\" prescription indicator consider it reported and set value = true. \r\n\r\nUsage Note: The presence of the boolean = true is set only when the exporting system can be set with certainty. By example, the value would be set to \"true\" when a record was imported or when the physician has input the prescription data into the EMR from a bottle, prescription, discharge summary or consult report. In these cases the EMR can detect that the prescription being exported was an external prescription. It is recognized that there are other more complex scenarios where this flag cannot be set with certainty and should therefore not be populated.\r\n\r\nUsage Rule: For migration from EMR-EMR, it is important to ensure that not all records are marked as reported; rather the rules in the source EMR should be respected.\r\n\r\nCore-CA - supported\r\n \r\nNote R5 - does not support a reference in this field (in R5 it is an information source) and therefore it will not be supported by extension", "type": [ { "code": "boolean" } ], "mustSupport": true }, { "id": "MedicationRequest.medication[x]", "path": "MedicationRequest.medication[x]", "mustSupport": true }, { "id": "MedicationRequest.subject", "path": "MedicationRequest.subject", "mustSupport": true }, { "id": "MedicationRequest.subject.reference", "path": "MedicationRequest.subject.reference", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.subject.display", "path": "MedicationRequest.subject.display", "comment": "Usage Note: This should contain the name of the Patient, which can then be used in narrative\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "MedicationRequest.encounter", "path": "MedicationRequest.encounter", "comment": "Usage Note: This should be included if there is a definitive link to an encounter in the EMR and when it is deemed to be important for the implmementation.\r\n\r\nThis will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.\" If there is a need to link to episodes of care they will be handled with an extension.", "mustSupport": true }, { "id": "MedicationRequest.supportingInformation", "path": "MedicationRequest.supportingInformation", "comment": "Usage Rules: This will be used to support the observations for weight, height, creatinine, eGFR. \r\nUsage Rule: Consider use of the vitals and lab profiles\r\n\r\nPrescribeIT mapping: extension, supporting information\r\n\r\n** **For MedicationOrders, create a value set that is scoped to weight, height, creatinine, eGFR (extensible) -- LOINC\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "type": [ { "code": "Reference", "aggregation": [ "bundled" ] } ], "mustSupport": true, "mapping": [ { "identity": "PrescribeIT", "map": "http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-supportinginfo" } ] }, { "id": "MedicationRequest.supportingInformation.reference", "path": "MedicationRequest.supportingInformation.reference", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.supportingInformation.display", "path": "MedicationRequest.supportingInformation.display", "mustSupport": true }, { "id": "MedicationRequest.authoredOn", "path": "MedicationRequest.authoredOn", "comment": "Alignment: PrescribeIT Mapping: DateWritten\r\nConformance Rule: In the context of \"order\" this is often the date when the prescription was originally written. If this is an external prescription the date may not be known. In some cases this date will be an estimate by the physician who entered the record. \r\n\r\nConformance Rule: Must be either a full date (i.e. yyyy-mm-dd) or a full date and time with timezone (i.e. yyyy-mm-dd-HH:mm:ss.SSS-ZZZZZ). Prescriptions sent within Alberta will support the full date time.\r\n\r\nAlignment - PS-ON - TELUS asked: Are there any rules around this? Is this always the \"initial\" prescription date or latest renewal? Eg 7 years ago, rather than the date of the latest renewal? Please update the specification with this level of detail. Answer: They will seek clinical guidance in the future and advise.\r\r\n\r\nCA-Core: supported\r\nPrescribeIT: Date written\r\nPrescribeIT Conformance Rule: Must be either equal to or earlier then the MedicationOrder.dispenseRequest.valididityPeriod.start element.", "mustSupport": true, "mapping": [ { "identity": "PrescribeIT", "map": "MedicationOrder.dateWritten" } ] }, { "id": "MedicationRequest.requester", "path": "MedicationRequest.requester", "comment": "Developer Guidance: This is not mandatory as the EMR may not always know the prescriber when creating an external prescription. If the role is known, the practitionerRole can be specified which has minimal information.\r\n\r\nCA - this element is supported\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "MedicationRequest.requester.reference", "path": "MedicationRequest.requester.reference", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.requester.display", "path": "MedicationRequest.requester.display", "mustSupport": true }, { "id": "MedicationRequest.reasonCode", "path": "MedicationRequest.reasonCode", "comment": "Conformance Rule: In the case where the prescriber wants to send an Indication for Use that is not included in the value set the prescriber must be able to send a text value without a code.\r\n\r\n\r\nThis could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionindicationforuse" }, "mapping": [ { "identity": "PrescribeIT", "map": "MedicationOrder.reasonCode" } ] }, { "id": "MedicationRequest.reasonCode.coding", "path": "MedicationRequest.reasonCode.coding", "mustSupport": true }, { "id": "MedicationRequest.reasonCode.coding.system", "path": "MedicationRequest.reasonCode.coding.system", "mustSupport": true }, { "id": "MedicationRequest.reasonCode.coding.code", "path": "MedicationRequest.reasonCode.coding.code", "mustSupport": true }, { "id": "MedicationRequest.reasonCode.text", "path": "MedicationRequest.reasonCode.text", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.basedOn", "path": "MedicationRequest.basedOn", "comment": "Conformance Rule: This must reference the MedicationRequest (Plan). This is the only supported resource at this time and is expected to be mandatory.\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "max": "1", "type": [ { "code": "Reference", "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "MedicationRequest.basedOn.reference", "path": "MedicationRequest.basedOn.reference", "mustSupport": true }, { "id": "MedicationRequest.courseOfTherapyType", "path": "MedicationRequest.courseOfTherapyType", "comment": "Usage Note: This should be included where known\r\nAlignment: PrescribeIT Mapping - Extension - TreatmentType\r\n\r\nPSS: Duration: One time, short term maps to Acute, Long term PRN maps to Chronic. If the medication is auto-discontinued, this can map to Acute. If no discontinue, this is chronic as it is not removed from the medication list\r\n\r\n\r\nThis attribute should not be confused with the protocol of the medication.", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptiontreatmentcategory" }, "mapping": [ { "identity": "PrescribeIT", "map": "http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-treatment-type" } ] }, { "id": "MedicationRequest.courseOfTherapyType.coding", "path": "MedicationRequest.courseOfTherapyType.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "MedicationRequest.courseOfTherapyType.coding.system", "path": "MedicationRequest.courseOfTherapyType.coding.system", "min": 1, "fixedUri": "http://hl7.org/fhir/v3/ActCode", "mustSupport": true }, { "id": "MedicationRequest.courseOfTherapyType.coding.code", "path": "MedicationRequest.courseOfTherapyType.coding.code", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.courseOfTherapyType.text", "path": "MedicationRequest.courseOfTherapyType.text", "mustSupport": true }, { "id": "MedicationRequest.note", "path": "MedicationRequest.note", "comment": "Usage Note: This may record the reason for the record being updated, eg dosage change, author, etc.\r\n\r\nFor systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. *Annotations SHOULD NOT* be used to communicate \"modifying\" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).", "mustSupport": true }, { "id": "MedicationRequest.note.author[x]", "path": "MedicationRequest.note.author[x]", "mustSupport": true }, { "id": "MedicationRequest.note.time", "path": "MedicationRequest.note.time", "mustSupport": true }, { "id": "MedicationRequest.note.text", "path": "MedicationRequest.note.text", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction", "path": "MedicationRequest.dosageInstruction", "comment": "Conformance Rules - if this is available in discrete form, this should be sent. This represents a single dosage line/instruction.\r\n\r\nAlignment Note: For sending systems, this will follow the same rules as PrescribeIT with one difference; the sequence data element is an extension in PrescribeIt. \r\nAlignment Note: Please refer to the SIG Table that is published in PrescribeIT for a full breakdown and guidance on populating these data elements.\r\n\r\nThere are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, \"Ondansetron 8mg orally or IV twice a day as needed for nausea\" or \"Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting\". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.sequence", "path": "MedicationRequest.dosageInstruction.sequence", "comment": "Usage Rule: This indicates the relationship between instruction line. If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. This carries the meaning of AND. If the sequence number is different, then the Dosages are intended to be sequential. and carries a meaning of \"THEN\". \r\n\r\nPrescribeIT Mapping: MedicationOrder.dosageInstruction.extension:instructionRelationship", "min": 1, "mustSupport": true, "mapping": [ { "identity": "PrescribeIT", "map": "http://prescribeit.ca/fhir/StructureDefinition/ext-medication-dosageinstruction-sequence" } ] }, { "id": "MedicationRequest.dosageInstruction.text", "path": "MedicationRequest.dosageInstruction.text", "comment": "Alignment Note: This follows the same conformance rules as PrescribeIT and represents a textual version of the discrete data.\r\nCA core - must support\r\n\r\nConformance Rule: When providing multiple dosage lines this can be expressed individually. All dosage lines (full text content) must be concatenated into MedicationOrder.extension(renderedDosageInstruction).\r\n\r\nUsage Note: This is a string composed of any available discrete MedicationOrder.dosageInstruction child elements such as timing, asNeeded[x], siteCodeableConcept, route, dose[x], rate[x], and maxDosePerPeriod for each repetition sequence line.\r\n\r\nExample: Prednisone; variable dosage instruction, or concurrent instructions (1 pill morning and 1 pill before bed) or sequential dosages (1 pill for 2 days, then 2 pills). Note that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true, "mapping": [ { "identity": "PrescribeIT", "map": "MedicationOrder.dosageInstruction.text" } ] }, { "id": "MedicationRequest.dosageInstruction.additionalInstruction", "path": "MedicationRequest.dosageInstruction.additionalInstruction", "comment": "Usage Notes: It is strongly recommended to consult with the excel spreadsheet for the SIG table for real world examples. This is published by PrescribeIT and will be available upon request. \r\nUsage Note: Some EMR fields may map better to patient instruction, rather than additional instructions. \r\n\r\nMapping: \r\nOMD requires that additional instructions are captured separately in the EMR\r\n\r\nInformation about administration or preparation of the medication (e.g. \"infuse as rapidly as possibly via intraperitoneal port\" or \"immediately following drug x\") should be populated in dosage.text.", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.additionalInstruction.coding", "path": "MedicationRequest.dosageInstruction.additionalInstruction.coding", "max": "1", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.additionalInstruction.coding.system", "path": "MedicationRequest.dosageInstruction.additionalInstruction.coding.system", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.additionalInstruction.coding.code", "path": "MedicationRequest.dosageInstruction.additionalInstruction.coding.code", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.additionalInstruction.text", "path": "MedicationRequest.dosageInstruction.additionalInstruction.text", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.patientInstruction", "path": "MedicationRequest.dosageInstruction.patientInstruction", "comment": "Usage: This will not be used by all EMRs as this is a representation of the entire dosage line in patient friendly terms and may not be mappable directly from the EMR. This does not exist in some EMRs today explicity and this mapping may be appropriate. \r\n\r\nPSS - conversion is happening on frequency, but not guaranteed for other shortforms; recipient is pharmacist. LABEL\r\nMA - has patient instruction field - this may be appropriate mapping, TBD\r\n\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing", "path": "MedicationRequest.dosageInstruction.timing", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat", "path": "MedicationRequest.dosageInstruction.timing.repeat", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.bounds[x]", "path": "MedicationRequest.dosageInstruction.timing.repeat.bounds[x]", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.count", "path": "MedicationRequest.dosageInstruction.timing.repeat.count", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.countMax", "path": "MedicationRequest.dosageInstruction.timing.repeat.countMax", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.duration", "path": "MedicationRequest.dosageInstruction.timing.repeat.duration", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.durationMax", "path": "MedicationRequest.dosageInstruction.timing.repeat.durationMax", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.durationUnit", "path": "MedicationRequest.dosageInstruction.timing.repeat.durationUnit", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.frequency", "path": "MedicationRequest.dosageInstruction.timing.repeat.frequency", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.frequencyMax", "path": "MedicationRequest.dosageInstruction.timing.repeat.frequencyMax", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.period", "path": "MedicationRequest.dosageInstruction.timing.repeat.period", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.periodMax", "path": "MedicationRequest.dosageInstruction.timing.repeat.periodMax", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.periodUnit", "path": "MedicationRequest.dosageInstruction.timing.repeat.periodUnit", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.code", "path": "MedicationRequest.dosageInstruction.timing.code", "comment": "Usage Note: EMRs who can send the frequency in a textual form may populate this. The code is not provided as this is not standardized coding.\r\n\r\nPSS: Frequency, eg QHS, is translated to \" every day at bedtime\"\r\n\r\n\r\nBID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is \"always at 7am and 6pm\". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times).", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.code.text", "path": "MedicationRequest.dosageInstruction.timing.code.text", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.asNeeded[x]", "path": "MedicationRequest.dosageInstruction.asNeeded[x]", "comment": "Usage Note: This will follow the same conformance rules as PrescribeIT:\r\nConformance Rule: This is ONLY populated when the medication is prescribed on an as needed (i.e. PRN) basis.\r\nConformance Rule: Set value = true\r\nConformance Rule: When this is specified, it is not acceptable to express the quantity exclusively as a duration/DAYS_SUPPLY. The DOSAGE_QUANTITY must be provided.\r\n\r\nConformance Rule: The CodeableConcept should not be used at this time. If it is present, treat it as though the boolean value is set to true.\r\n\r\nCan express \"as needed\" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express \"as needed\" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not \"prn\" or \"as needed\".", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.site", "path": "MedicationRequest.dosageInstruction.site", "comment": "This follows the same conformance rule as PrescribeIT:\r\n\r\nConformance Rule: When providing a structured SIG, this should be populated when appropriate. If not structured, this should be part of the SIG (RENDERED_DOSAGE_INSTRUCTION)\r\n\r\nIf the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionadministrationsitees" } }, { "id": "MedicationRequest.dosageInstruction.site.coding", "path": "MedicationRequest.dosageInstruction.site.coding", "max": "1", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.site.coding.system", "path": "MedicationRequest.dosageInstruction.site.coding.system", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.site.coding.code", "path": "MedicationRequest.dosageInstruction.site.coding.code", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.site.text", "path": "MedicationRequest.dosageInstruction.site.text", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.route", "path": "MedicationRequest.dosageInstruction.route", "comment": "Conformance Rule: Coding should be populated if a code is available. However, text is always required.\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionrouteofadministration" } }, { "id": "MedicationRequest.dosageInstruction.route.coding", "path": "MedicationRequest.dosageInstruction.route.coding", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.route.coding.system", "path": "MedicationRequest.dosageInstruction.route.coding.system", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.route.coding.code", "path": "MedicationRequest.dosageInstruction.route.coding.code", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.route.text", "path": "MedicationRequest.dosageInstruction.route.text", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate", "path": "MedicationRequest.dosageInstruction.doseAndRate", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate.dose[x]", "path": "MedicationRequest.dosageInstruction.doseAndRate.dose[x]", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate.rate[x]", "path": "MedicationRequest.dosageInstruction.doseAndRate.rate[x]", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.value", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.value", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.unit", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.unit", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.system", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.system", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.code", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator.code", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptiondosequantityunit" } }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod.denominator", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod.denominator", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.value", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.value", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.system", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.system", "fixedUri": "http://unitsofmeasure.org", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.code", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod.denominator.code", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest", "path": "MedicationRequest.dispenseRequest", "comment": "Usage Rule: This will be mandatory for internally created prescriptions (source system is the reported source). This is not expected for external prescriptions that have been manually entered into the EMR by the physician; by exmaple, from a prescription bottle or a discharge summary.", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.extension", "path": "MedicationRequest.dispenseRequest.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "MedicationRequest.dispenseRequest.extension:MaxDispensed", "path": "MedicationRequest.dispenseRequest.extension", "sliceName": "MaxDispensed", "definition": "This field is used for patient safety reasons, to convey that the phyisician wants to restrict the quantity dispensed at a given time. eg the Total Quantity might be 90 pills and the max to be dispensed at any given time might be 30. \r\n\r\nOptional Extension Element - found in all resources.", "comment": "Alignment PrescribeIT: MedicationOrder.dispenseRequest.extension:maxDispense\r\n\r\nConformance Rule: If this is supported within the EMR as a discrete data element, this must be populated.\r\n\r\nExample: A prescriber instructs a patient to take 3 Tylenol 3 tablets every day as needed for pain for 90 days. However, the prescriber does not wish the patient to have more than 30 days supply at any given time so the prescriber instructs the pharmacist that the maxDispense is 90 tablets. The pharmacist then does 3 partial fills of 90 tablets (or 30 days supply) over the 90 day period.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-max-dispense" ] } ], "isModifier": false }, { "id": "MedicationRequest.dispenseRequest.extension:TotalQuantity", "path": "MedicationRequest.dispenseRequest.extension", "sliceName": "TotalQuantity", "comment": "Usage Rule: This is used for narcotics when the total quantity for the prescription is different than the \"quantity\" for the dispense. eg the quantity for the dispense might be one per day, but the pharmacist will not create a refill each day. \r\n\r\nAlignment Note: PrescribeIT - MedicationOrder.dispenseRequest.extension:totalPrescribedQuantity\r\n\r\nConformance Rule: The Total Prescribed Quantity is not mandatory but must be supplied if the value is entered by the user or can be calculated by the system.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-total-quantity" ] } ], "isModifier": false }, { "id": "MedicationRequest.dispenseRequest.extension:TotalDaysSupplyPrescription", "path": "MedicationRequest.dispenseRequest.extension", "sliceName": "TotalDaysSupplyPrescription", "definition": "Identifies the total period of time over which the prescription is expected to last", "comment": "Usage Rule: This will not be populated for all use cases; eg for DB extracts, this may not be relevant\r\n\r\nAlignment - PrescribeIT Mapping - MedicationOrder.dispenseRequest.extension:totalDaysSupply\r\n\r\nConformance Rule: Must be populated when the Total Days Supply is entered by the user or when the Total Days Supply can be calculated by the system. Note: In Quebec this cannot be calculated; it is only provided if entered by the prescriber.\r\n\r\nConformance Rule: Code must be 'd' and system must be 'http://unitsofmeasure.org'.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-total-days-supply" ] } ], "isModifier": false }, { "id": "MedicationRequest.dispenseRequest.extension:DispenseTrial", "path": "MedicationRequest.dispenseRequest.extension", "sliceName": "DispenseTrial", "comment": "Alignment: PrescribeIT: Maps to extension MedicationOrder.dispenseRequest.extension:trialEligibility\r\nConformance Rule: If eligible for trial, this must be set to 'true' and presented to the Pharmacist.\r\nConformance Rule: This is ONLY populated if it is for trial, else it is assumed not to be eligble.\r\nNote: Prescribers may include this information in notes.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-medicationorder-dispense-trial" ] } ], "isModifier": false }, { "id": "MedicationRequest.dispenseRequest.extension:MedForLife", "path": "MedicationRequest.dispenseRequest.extension", "sliceName": "MedForLife", "definition": "Indicates that the medication dispense does not expire", "comment": "Alignment - PrescribeIT - MedicationOrder.dispenseRequest.extension:forLifeFlag\r\nConformance Rule: This is only used in Quebec\r\nConformance Rule: This must be set to \"true\" when the prescriber has indicated that the medication is authorized for the patient's lifetime (eg ephipens)\r\nConformance Rule: When flag = \"true\", there will be no end date on the validity period; there will be no total days supply or numberOfRepeats specified.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-medication-for-life" ] } ], "isModifier": false }, { "id": "MedicationRequest.dispenseRequest.initialFill", "path": "MedicationRequest.dispenseRequest.initialFill", "comment": "Mapping: PrescribeIT first fill instructions - \r\nJN ******** need to add an extension for \"date\", as per PrescribeIT\r\nConformance Rule: If entry of the first fill information is supported within the EMR as discrete information, this must be populated. For the first fill instructions to be meaningful, the first fill quantity or the first fill expected supply duration must be provided. Both can be provided if available but at minimum one of these must be provided.\r\n\r\nIf populating this element, either the quantity or the duration must be included.", "mustSupport": true, "mapping": [ { "identity": "PrescribeIT", "map": "http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-first-fill" } ] }, { "id": "MedicationRequest.dispenseRequest.initialFill.quantity", "path": "MedicationRequest.dispenseRequest.initialFill.quantity", "comment": "PrescribeIT mapping: \r\n\r\nThe context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescribedquantityunit" }, "mapping": [ { "identity": "PrescribeIT", "map": "http://prescribeit.ca/fhir/StructureDefinition/dtprofile-quantity-drug" } ] }, { "id": "MedicationRequest.dispenseRequest.initialFill.quantity.value", "path": "MedicationRequest.dispenseRequest.initialFill.quantity.value", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.initialFill.quantity.unit", "path": "MedicationRequest.dispenseRequest.initialFill.quantity.unit", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.initialFill.quantity.system", "path": "MedicationRequest.dispenseRequest.initialFill.quantity.system", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.initialFill.quantity.code", "path": "MedicationRequest.dispenseRequest.initialFill.quantity.code", "comment": "Conformance Rule: A Code must be supplied if one is available from the PrescribedQuantityUnit subset. If the user picks a prescribed quantity unit that does not have a code in the PrescribedQuantityUnit subset, only then can unit be supplied without a code. If a receiving system receives a code that it doesn't recognize, the system must just display the unit.\r\n\r\nThe preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.initialFill.duration", "path": "MedicationRequest.dispenseRequest.initialFill.duration", "comment": "Conformance Rule: The duration must be expressed as a ‘day(s)’ value and must be coded in the following way; code must be 'd' and system must be 'http://unitsofmeasure.org'.\r\n\r\nThe context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.initialFill.duration.value", "path": "MedicationRequest.dispenseRequest.initialFill.duration.value", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.initialFill.duration.system", "path": "MedicationRequest.dispenseRequest.initialFill.duration.system", "fixedUri": "http://unitsofmeasure.org", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.initialFill.duration.code", "path": "MedicationRequest.dispenseRequest.initialFill.duration.code", "fixedCode": "d", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.dispenseInterval", "path": "MedicationRequest.dispenseRequest.dispenseInterval", "comment": "Usage Rule: EMRs may wish to align with PrescribeIT, if this makes sense for the use case. For some uses cases, the raw data as stored will be used, eg if \"3 months\" is stored, then this may be sent. \r\n\r\nMapping: PrescribeIT extension\r\nPrescribeIT Conformance Rule: Only days are currently support as a measurement of dispenseInterval.\r\n\r\n\r\nThe context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "mustSupport": true, "mapping": [ { "identity": "PrescribeIT", "map": "http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dispense-interval" } ] }, { "id": "MedicationRequest.dispenseRequest.dispenseInterval.value", "path": "MedicationRequest.dispenseRequest.dispenseInterval.value", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.dispenseInterval.system", "path": "MedicationRequest.dispenseRequest.dispenseInterval.system", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.dispenseInterval.code", "path": "MedicationRequest.dispenseRequest.dispenseInterval.code", "comment": "Conformance Rule: Only days are currently support as a measurement of dispenseInterval.\r\n\r\nThe preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.validityPeriod", "path": "MedicationRequest.dispenseRequest.validityPeriod", "comment": "Usage Rule: If status = on hold//stopped - the date it was put on hold conveyed as the end date. Start Date of Med + Hold/End Date\r\nIf status = intended - convey future estimated start date\r\nIf status = not taken - single date - ??? confirm this woudl be a date/time\r\n\r\nExample: Patient on med from Jan 1-Jan31 - put on hold on Jan 31. Patient never started the med but was formally discontinued on Feb 15th. \r\n\r\nOption 1** On Hold status - effective Jan 1-Jan 31. Second Med Statement - Feb 15th - Stopped. (single date conveys that the patient was NOT on the drug during the period statement- action by Prescriber) \r\n\r\nOption 2 - 3 med statements? First: Complete: Jan 1-Jan 31, second:On Hold Jan 31, single date Third: Stopped Feb 15, single date\r\n\r\nConformance Rule: Active, Intended, On-Hold will have an effective date that reflects a period of time. ??? Example: For an active and intended med statement, this will be the same as the Prescription Period. For On-Hold, this will reflect the start date of the Prescription and the Hold date will be the end date.\r\n\r\n***NOTE; QUEBEC HAS A NOTION OF A QC VALIDITY PERIOD, EXPRESSED AS A PERIOD OF TIME (EG 30 DAYS), BUT THIS IS NOT THE TOTAL DAYS SUPPLY (MEETING 08/31)\r\n\r\nMappings for Effective Date: \r\nCore-CA - supported\r\nEMRAPI: effectiveDate\r\nPSS: Available but not supported in the API. Derived from dose, frequency and quantity. End date Is calculated if discrete fields dose, frequency, duration OR dose, frequency and quantity if captured discretely. CPP->Rx->More details->Start Date beside label instructions\r\nMA: Patient--> Meds --> new --> start date, No API support\r\nMS: start date\r\n\r\nIt reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.validityPeriod.start", "path": "MedicationRequest.dispenseRequest.validityPeriod.start", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.validityPeriod.end", "path": "MedicationRequest.dispenseRequest.validityPeriod.end", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.numberOfRepeatsAllowed", "path": "MedicationRequest.dispenseRequest.numberOfRepeatsAllowed", "comment": "Conformance Rule: This must be populated when the number of repeats is 1 or more. As this field only allows a positive integer, this is not populated if there are no refills allowed.\r\n\r\nGuidance: For narcotics, if this is incorrectly populated, the PMS could choose not to reject the message; rather they can adjust for the dispense.If displaying \"number of authorized fills\", add 1 to this number.", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.quantity", "path": "MedicationRequest.dispenseRequest.quantity", "comment": "Alignment Mapping: PrescribeIT - total quantity\r\n\r\nThe context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.quantity.value", "path": "MedicationRequest.dispenseRequest.quantity.value", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.quantity.unit", "path": "MedicationRequest.dispenseRequest.quantity.unit", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.quantity.system", "path": "MedicationRequest.dispenseRequest.quantity.system", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.quantity.code", "path": "MedicationRequest.dispenseRequest.quantity.code", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.expectedSupplyDuration", "path": "MedicationRequest.dispenseRequest.expectedSupplyDuration", "comment": "Usage Note: This is typically \"days\" (d), but could also be stored as weeks, months, years. \r\nAlignment: PrescribeIT has a fixed value of \"d\" (days). Field= ExpectedSupplyDuration\r\n\r\nPrescribeIT Conformance Rule: This maps to 'duration' in some EMR's. Must be populated when this is a discrete data element in the EMR; else this is sent as part of the textual description.\r\nPrescribeIT Conformance Rule: If Fill Quantity is NOT populated, this must be present.\r\n\r\nIn some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage). When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.expectedSupplyDuration.value", "path": "MedicationRequest.dispenseRequest.expectedSupplyDuration.value", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.expectedSupplyDuration.unit", "path": "MedicationRequest.dispenseRequest.expectedSupplyDuration.unit", "fixedString": "days", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.expectedSupplyDuration.system", "path": "MedicationRequest.dispenseRequest.expectedSupplyDuration.system", "min": 1, "fixedUri": "http://unitsofmeasure.org", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.expectedSupplyDuration.code", "path": "MedicationRequest.dispenseRequest.expectedSupplyDuration.code", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.performer", "path": "MedicationRequest.dispenseRequest.performer", "comment": "Usage Note: The pharmacy should be included when known, as either display, when minimal data or a full resource. \r\n\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.performer.reference", "path": "MedicationRequest.dispenseRequest.performer.reference", "mustSupport": true }, { "id": "MedicationRequest.dispenseRequest.performer.display", "path": "MedicationRequest.dispenseRequest.performer.display", "mustSupport": true }, { "id": "MedicationRequest.substitution", "path": "MedicationRequest.substitution", "comment": "Conformance Rule: This MUST be included when the prescriber specifies \"no substitution\" (boolean = false)\r\nConformance Rule: must be specified when available as a discrete data element in the EMR\r\n\r\nAlignment: Not supported in PrescribeIT\r\nMS: support\r\nPSS: no sub flag is present; there is no reason\r\nMA: supported\r\nCHR: no sub flag is present\r\n\r\nNote: This is not supported in PrescribeIT as a discrete data element; it is included in Pharmacist Instructions", "mustSupport": true }, { "id": "MedicationRequest.substitution.allowed[x]", "path": "MedicationRequest.substitution.allowed[x]", "mustSupport": true }, { "id": "MedicationRequest.substitution.reason", "path": "MedicationRequest.substitution.reason", "comment": "Conformance Rule: If available this must be sent. A local code may be used or if no code is available then text may be sent\r\n\r\n* Create our own value set (CT exists) \r\n\r\nMS: Reasons supported are: Allergy, Intolerence, ExactDosage, CT-ContininingTherapy, Brand Names not good enough, etc\r\nPSS: no reason\r\nMA: \r\nCHR: no reason\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true }, { "id": "MedicationRequest.substitution.reason.coding", "path": "MedicationRequest.substitution.reason.coding", "comment": "Usage Rules: Coding is not supported by all EMRs; this can be conveyed as text\r\n\r\nCodes 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.", "mustSupport": true }, { "id": "MedicationRequest.substitution.reason.coding.system", "path": "MedicationRequest.substitution.reason.coding.system", "mustSupport": true }, { "id": "MedicationRequest.substitution.reason.coding.code", "path": "MedicationRequest.substitution.reason.coding.code", "mustSupport": true }, { "id": "MedicationRequest.substitution.reason.text", "path": "MedicationRequest.substitution.reason.text", "mustSupport": true }, { "id": "MedicationRequest.priorPrescription", "path": "MedicationRequest.priorPrescription", "comment": "Usage Rule: If there is an electronic identifier of a prior prescription, this may be sent. This is not necessary for all use cases.\r\nAlignment: This is supported by OMD in the CDS specification\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "MedicationRequest.priorPrescription.identifier", "path": "MedicationRequest.priorPrescription.identifier", "mustSupport": true }, { "id": "MedicationRequest.detectedIssue", "path": "MedicationRequest.detectedIssue", "comment": "Conformance Rule: Detected Issue will be used to convey managed drug interactions. If available, this must be sent.\r\n\r\nPrescribeIT mapping - extension, detected issues\r\n\r\nThis element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.", "mustSupport": true, "mapping": [ { "identity": "PrescribeIT", "map": "http://prescribeit.ca/fhir/StructureDefinition/ext-request-detectedissue" } ] }, { "id": "MedicationRequest.detectedIssue.reference", "path": "MedicationRequest.detectedIssue.reference", "mustSupport": true }, { "id": "MedicationRequest.detectedIssue.display", "path": "MedicationRequest.detectedIssue.display", "mustSupport": true } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.412+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-medication-request-plan-patient-chart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-medication-request-plan-patient-chart", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-medication-plan", "name": "MedicationPlan", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "script10.6", "uri": "http://ncpdp.org/SCRIPT10_6", "name": "Mapping to NCPDP SCRIPT 10.6" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" } ], "kind": "resource", "abstract": false, "type": "MedicationRequest", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationRequest", "derivation": "constraint", "differential": { "element": [ { "id": "MedicationRequest", "path": "MedicationRequest", "comment": "Usage Note: EMRs may not be capable of importing plans as FHIR; instead they will import and store the key clinical data in a way that aligns with each EMR data structure. \r\n\r\nUsage Note: In general, each version of the EMR medicaiton record will align with a version of the medication plan. The physician will determine if only the current version is shared, or if a historical view of the medication is to be included in the patient chart.\r\n\r\nConformance Rule: If an EMR imports a plan, the original identfiers must be retained and included when the plan is re-exposed. The EMR must also assign its own identifier to the plan\r\n\r\n\r\nReview complete - June" }, { "id": "MedicationRequest.id", "path": "MedicationRequest.id", "comment": "Usage Notes: This must be a stable id that must be identifcal with each export, so that importing systems will recognize that they already have a plan. Systems can consider developing a hash formula that is based on the medication (CCDD) and the start date of the plan and an internal patient identifier\r\n\r\nThe only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "mustSupport": true }, { "id": "MedicationRequest.meta", "path": "MedicationRequest.meta", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.meta.versionId", "path": "MedicationRequest.meta.versionId", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.meta.lastUpdated", "path": "MedicationRequest.meta.lastUpdated", "comment": "REVIEW: DO WE WANT AN EXTENSION INSTEAD?\r\nUsage Note: Timestamp reflecting the time the system stored the information that was used to derive this version of the record (non-FHIR). Example: If a record was imported it will be stored in a db within the EMR and though the plan was created at a later date, it is the db date that is used.\r\n\r\nUsage Note: The plan could be derived from multiple records with different dates; the most appropriate date should be exposed, eg perhaps the earliest.RE\r\n\r\nThis value is always populated except when the resource is first being created. 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.html#read) interaction.", "mustSupport": true }, { "id": "MedicationRequest.meta.source", "path": "MedicationRequest.meta.source", "mustSupport": true }, { "id": "MedicationRequest.meta.profile", "path": "MedicationRequest.meta.profile", "comment": "Usage: This fixed value is present in the message to allow the FHIR validator to distinguish between Medication Orders and Medication Plans, as they both use Medication Request resources.\r\n\r\n\r\nIt 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.", "fixedCanonical": "http://telus.com/fhir/patientChart/StructureDefinition/medication-request-plan", "mustSupport": true }, { "id": "MedicationRequest.meta.security", "path": "MedicationRequest.meta.security", "comment": "Usage: Tags for masked data must be supported. The masked data can be shared with a masked flag. The owner system must ensure that the receiving system adheres to policies. \r\n\r\nThe 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.", "mustSupport": true }, { "id": "MedicationRequest.text", "path": "MedicationRequest.text", "comment": "Usage Note: Each implementation will deteremine whether this is mandatory. Should be mandatory where possible as receiving systems may not be able to understand all of the discrete data. \r\n\r\nContained 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.", "mustSupport": true }, { "id": "MedicationRequest.extension", "path": "MedicationRequest.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "MedicationRequest.extension:RenderedDosageInstruction", "path": "MedicationRequest.extension", "sliceName": "RenderedDosageInstruction", "comment": "Conformance Rule: This must be populated where applicable and when the dosageInstruction is present. \r\nAlignment: This is a pre-adoption of an R5 element; this is also prsent in PrescribeIT", "requirements": "This is the human-readable dosage instruction and therefore must be present whenever possible.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-rendered-dosage-instruction" ] } ], "isModifier": false }, { "id": "MedicationRequest.extension:PlanEffectivePeriod", "path": "MedicationRequest.extension", "sliceName": "PlanEffectivePeriod", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-medication-request-effective-period" ] } ], "isModifier": false }, { "id": "MedicationRequest.extension:StatusChanged", "path": "MedicationRequest.extension", "sliceName": "StatusChanged", "definition": "The date when the status has changed", "comment": "This is a pre-adoption of an R5 data element.\r\n https://build.fhir.org/medicationrequest-definitions.html#MedicationRequest.statusChanged", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-status-changed" ] } ], "isModifier": false }, { "id": "MedicationRequest.identifier", "path": "MedicationRequest.identifier", "comment": "Usage: Use of this data element will be determined by each implementation.\r\n\r\nThis is a business identifier, not a resource identifier." }, { "id": "MedicationRequest.status", "path": "MedicationRequest.status", "comment": "Conformance Rule: In the context of a plan, this may be active, on-hold, stopped or completed. Though a draft plan may exist in the EMR it will not be sent as there is no clinical value in doing so. There is no known use case for \"unknown\" and \"entered in error\" at this time.\r\n\r\nConformance Rule: If the physician has discontinued the medication, prior to the plan naturally completing, the status will be \"stopped\" ; this is an end-state and the status is never moved to \"completed\"\r\n\r\nConformance Rule: if the plan naturally completes (when the medication end date is reached) the status will be \"completed\" and this will have a provenance.activity of \"auto-complete\". If the status is scheduled in advance, (eg by assigning an end-date), the status of \"completed\" will only be exposed after the scheduled event occurs. The end-date will trigger the status change and the provenance associated with this action will indicate an \"auto-complete\" has occurred.\r\n\r\nConformance Rule: If the patient is no longer taking the medication and the source system cannot determine concretely whether the drug was completed or stopped, set value = \"stopped\". If a medication that was not auto-completed/auto-discontinued/auto-ended is no longer being taken then the state = \"stopped\". If the patient is still taking the medicaiton, the state will be active.\r\n\r\n\r\n\r\nConformance Rule: . A short term medication that automatically completed in the past will be sent with a \"completed\" status. \r\n\r\nUsage Note: In the context of sharing medication data, we would not send plans with a status of entered in error, draft or unknown\r\n \r\nUsage Note: If a prescription was given to the patient, but never filled, and this is relevant data to be sharing, this can be recorded as discontinued whereby the discontinue date matches the order date. The accompanying text will provide context as to why the patient did not fill the order.\r\n\r\nBackground Discussion: This cannot be tied to the prescription order dates as the doctor may discontinue/stopped because the patient no longer needs the meds (eg headaches). If \"completed\" this means that youve achieved what you intended, then this becomes fuzzy in cases where there are renewals on the RX that are not fulfilled\r\n\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "mustSupport": true }, { "id": "MedicationRequest.status.extension", "path": "MedicationRequest.status.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 1 }, { "id": "MedicationRequest.status.extension:StatusDate", "path": "MedicationRequest.status.extension", "sliceName": "StatusDate", "definition": "This is the date that the status changed. By example, if the drug became active on Jan 1, and was on hold Jan 15th, this date reflects the date of the status change. Rationale: A plan may be updated for several reasons; this status date is important clinically and is therefore mandatory.", "comment": "Usage Note: This will align with the Provenance Occurence date when the status change has occurred.\r\n\r\nThere 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.", "min": 1, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/StructureDefinition/ext-status-effective-date" ] } ] }, { "id": "MedicationRequest.status.extension:StatusDate.url", "path": "MedicationRequest.status.extension.url", "fixedUri": "http://telus.com/fhir/StructureDefinition/ext-status-effective-date" }, { "id": "MedicationRequest.status.extension:StatusDate.value[x]", "path": "MedicationRequest.status.extension.value[x]", "min": 1 }, { "id": "MedicationRequest.statusReason", "path": "MedicationRequest.statusReason", "comment": "Usage Note: Status reason may be present for exception status's such as medications that are stopped/discontinued. It is not expected that this will be used for status's such as \"active\" or \"completed. Note: Provenance - extension for comments is also populated with this information\r\n\r\nCore-CA - not supported\r\nMA - capture as text and selection from dropdown with NO CONFIGURATION!!! \r\nPSS - text only if available - discontinue reason, or allergy/intolereance reason\r\nMS - no reason captured :D \r\nCHR - \r\n\r\n\r\nThis is generally only used for \"exception\" statuses such as \"suspended\" or \"cancelled\". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.", "mustSupport": true }, { "id": "MedicationRequest.statusReason.coding", "path": "MedicationRequest.statusReason.coding", "max": "1", "mustSupport": true }, { "id": "MedicationRequest.statusReason.coding.system", "path": "MedicationRequest.statusReason.coding.system", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.statusReason.coding.code", "path": "MedicationRequest.statusReason.coding.code", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.statusReason.text", "path": "MedicationRequest.statusReason.text", "mustSupport": true }, { "id": "MedicationRequest.intent", "path": "MedicationRequest.intent", "comment": "CA-Core: supported\r\nFixed value for this profile\r\n\r\nIt is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only.\r\rAn instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record.\r\rThis element is labeled as a modifier because the intent alters when and how the resource is actually applicable.", "fixedCode": "plan", "mustSupport": true }, { "id": "MedicationRequest.reported[x]", "path": "MedicationRequest.reported[x]", "comment": "Conformance Rule: The EMRs do not have a mechanism for capturing this data discretely. If the plan has been triggered by a medication statement, then the first version of the plan will be reported, value = \"true\". At this point, the physician owns the plan so all subsequent versions of the plan will be set to \"false\". If the plan was triggered by a medication start in the EMR or by a prescription/medication order, this must always be set to \"false\". \r\n\r\nMapping: supported in CA-Core", "type": [ { "code": "boolean" } ], "mustSupport": true }, { "id": "MedicationRequest.medication[x]", "path": "MedicationRequest.medication[x]", "comment": "Usage Note: Where possible, this should be a reference to the Medication resource, rather than just the code as pertinent details may be in the resource.\r\n\r\nIf only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the Medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource.", "type": [ { "code": "CodeableConcept" }, { "code": "Reference", "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "MedicationRequest.subject", "path": "MedicationRequest.subject", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "MedicationRequest.subject.reference", "path": "MedicationRequest.subject.reference", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.subject.display", "path": "MedicationRequest.subject.display", "comment": "Usage Note: This must be populated with the Patient Name. \r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "MedicationRequest.supportingInformation.reference", "path": "MedicationRequest.supportingInformation.reference", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.authoredOn", "path": "MedicationRequest.authoredOn", "comment": "Conformance Rule: In the context of \"plan\" this is often the date when the first prescription was written. If there is no prescription and there is only a plan this will be the date of the original plan. Often EMRs do not have plans so this will be based on the \"start date\" of the medication as recorded in the EMR. \r\n\r\nConformance Rule: This date will NOT change when new versions of the plan are created. \r\n\r\nCA-Core: supported\r\nPrescribeIT: Date written\r\nPrescribeIT Conformance Rule: Must be either equal to or earlier then the MedicationOrder.dispenseRequest.valididityPeriod.start element.", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.requester", "path": "MedicationRequest.requester", "comment": "Usage: This is the originator of the plan and must be populated when known. This is the prescriber (requestor) on the original medication order. For a plan initiated by a medication statement, this may be left blank.\r\n\r\nCA-Core - suppported\r\nPrescribeIT; May2016 \"Prescriber\"\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "type": [ { "code": "Reference", "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "MedicationRequest.requester.reference", "path": "MedicationRequest.requester.reference", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.requester.display", "path": "MedicationRequest.requester.display", "comment": "Usage note: This is the name of the requester. \r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "MedicationRequest.reasonCode", "path": "MedicationRequest.reasonCode", "comment": "Conformance Rule: When creating the plan version, the reason code must be populated with the latest non-empty indication code from the medication orders. Rationale: This is replicated in the plan, as the export may not include the medication orders. \r\n\r\n\r\n\r\nPrescribeIT: supported, 0..5 with binding to PrescriptionIndicationForUse (20190430)\r\nCA-Core: not supported\r\n\r\n\r\nThis could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.", "mustSupport": true }, { "id": "MedicationRequest.reasonCode.coding", "path": "MedicationRequest.reasonCode.coding", "mustSupport": true }, { "id": "MedicationRequest.reasonCode.coding.system", "path": "MedicationRequest.reasonCode.coding.system", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.reasonCode.coding.code", "path": "MedicationRequest.reasonCode.coding.code", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.reasonCode.text", "path": "MedicationRequest.reasonCode.text", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.note", "path": "MedicationRequest.note", "comment": "Usage Note: This is used to capture information about the medication plan that is not a status reason (eg discontinue reason) or notes pertaining to the dosageInstruction. Example: Doctor's notes pertainining to a dosage change reason, eg blood pressure getting too low, general note such as \"medication working well\" \r\n\r\nUsage Note: This is not specifically related to the latest activity; it is a running list of notes/time. \r\nConformance Rule:: The addition of a note will generate a new version of the plan\r\n\r\nConformance Rule: Provenance is not always shared; if provenance.reason is populated it must be replicated here.\r\n\r\nConformance Rule: If notes are being populated from multiple entities in the EMR, multiple note instances will be populated. They are exposed as a list of notes rather than concatenated.\r\n\r\nPSS: comment field to capture notes such as where dosage change reason can be recorded\r\n\r\n\r\nFor systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. *Annotations SHOULD NOT* be used to communicate \"modifying\" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).", "mustSupport": true }, { "id": "MedicationRequest.note.time", "path": "MedicationRequest.note.time", "mustSupport": true }, { "id": "MedicationRequest.note.text", "path": "MedicationRequest.note.text", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction", "path": "MedicationRequest.dosageInstruction", "comment": "Conformance Rule: The dosage must be specified where known. The dosage line is mandatory when the source system is the source. The dosage may not be known if the plan was triggered by a medication statement.\r\nUsage: If the sending applicaiton cannot produce the discrete dosage instruction, the RenderedDosageInstruction must be used.\r\n\r\nAlignment:: PrescribeIT has extensions for dosage sequence and instruction relationship; it is handled differently in Patient Chart, FHIR R4\r\n\r\nThere are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, \"Ondansetron 8mg orally or IV twice a day as needed for nausea\" or \"Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting\". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.sequence", "path": "MedicationRequest.dosageInstruction.sequence", "comment": "Usage Rule: The sequence number is used to convey the relationship between instructions. In PrescribeIT, this maps to the concepts of \"and\" or \"then\" that is used to link instructions together properly.\r\n\r\n32 bit number; for values larger than this, use decimal", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.text", "path": "MedicationRequest.dosageInstruction.text", "comment": "Usage Note: \"As directed\" is a valid dosage\r\nUsage Note: Where applicable, this follows the same conformance rules as PrescribeIT and represents a textual version of the discrete data.\r\n\r\nConformance Rule: When providing multiple dosage lines this can be expressed individually. All dosage lines (full text content) must be concatenated into MedicationOrder.extension(renderedDosageInstruction).\r\n\r\nUsage Note: This is a string composed of any available discrete MedicationOrder.dosageInstruction child elements such as timing, asNeeded[x], siteCodeableConcept, route, dose[x], rate[x], and maxDosePerPeriod for each repetition sequence line.\r\n\r\nExample: Prednisone; variable dosage instruction, or concurrent instructions (1 pill morning and 1 pill before bed) or sequential dosages (1 pill for 2 days, then 2 pills).Note that FHIR strings SHALL NOT exceed 1MB in size\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.additionalInstruction", "path": "MedicationRequest.dosageInstruction.additionalInstruction", "comment": "Mapping: CHR - OMD requires that additional instructions are captured separately in the EMR\r\nPSS - two text fields; pharmacy instrucitons and \"other\" \r\n\r\nConformance Rule: When providing an additional instruction at the dosage line level (complex), this should be populated when appropriate.\r\n\r\nUsage Note: This follows the same conformance rules as PrescribeIT as follows:- Usage Note: It may be necessary for the EMR to parse instructions such as QHS (take at bedtime), into two data elements DOSAGE_TIMING_FREQUENCY = once a day and 'at bedtime' would be placed into this field.nformation about administration or preparation of the medication (e.g. \"infuse as rapidly as possibly via intraperitoneal port\" or \"immediately following drug x\") should be populated in dosage.text.", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing", "path": "MedicationRequest.dosageInstruction.timing", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat", "path": "MedicationRequest.dosageInstruction.timing.repeat", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.bounds[x]", "path": "MedicationRequest.dosageInstruction.timing.repeat.bounds[x]", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.count", "path": "MedicationRequest.dosageInstruction.timing.repeat.count", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.countMax", "path": "MedicationRequest.dosageInstruction.timing.repeat.countMax", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.duration", "path": "MedicationRequest.dosageInstruction.timing.repeat.duration", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.durationMax", "path": "MedicationRequest.dosageInstruction.timing.repeat.durationMax", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.durationUnit", "path": "MedicationRequest.dosageInstruction.timing.repeat.durationUnit", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.frequency", "path": "MedicationRequest.dosageInstruction.timing.repeat.frequency", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.frequencyMax", "path": "MedicationRequest.dosageInstruction.timing.repeat.frequencyMax", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.period", "path": "MedicationRequest.dosageInstruction.timing.repeat.period", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.periodMax", "path": "MedicationRequest.dosageInstruction.timing.repeat.periodMax", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing.repeat.periodUnit", "path": "MedicationRequest.dosageInstruction.timing.repeat.periodUnit", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.asNeeded[x]", "path": "MedicationRequest.dosageInstruction.asNeeded[x]", "comment": "Usage Note: This will follow the same conformance rules as PrescribeIT:\r\nConformance Rule: This is ONLY populated when the medication is prescribed on an as needed (i.e. PRN) basis.\r\nConformance Rule: Set value = true\r\nConformance Rule: When this is specified, it is not acceptable to express the quantity exclusively as a duration/DAYS_SUPPLY. The DOSAGE_QUANTITY must be provided.\r\n\r\nConformance Rule: The CodeableConcept should not be used at this time. If it is present, treat it as though the boolean value is set to true.\r\n\r\nCan express \"as needed\" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express \"as needed\" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not \"prn\" or \"as needed\".", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.site", "path": "MedicationRequest.dosageInstruction.site", "comment": "IThis follows the same conformance rule as PrescribeIT:\r\n\r\nConformance Rule: When providing a structured SIG, this should be populated when appropriate. If not structured, this should be part of the SIG (RENDERED_DOSAGE_INSTRUCTION)\r\n\r\nf the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.site.coding", "path": "MedicationRequest.dosageInstruction.site.coding", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.site.coding.system", "path": "MedicationRequest.dosageInstruction.site.coding.system", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.site.coding.code", "path": "MedicationRequest.dosageInstruction.site.coding.code", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.site.text", "path": "MedicationRequest.dosageInstruction.site.text", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.route", "path": "MedicationRequest.dosageInstruction.route", "comment": "Conformance Rule: Coding should be populated if a code is available. However, text is always required.\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.route.coding", "path": "MedicationRequest.dosageInstruction.route.coding", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.route.coding.system", "path": "MedicationRequest.dosageInstruction.route.coding.system", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.route.coding.code", "path": "MedicationRequest.dosageInstruction.route.coding.code", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.route.coding.display", "path": "MedicationRequest.dosageInstruction.route.coding.display", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.route.text", "path": "MedicationRequest.dosageInstruction.route.text", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate", "path": "MedicationRequest.dosageInstruction.doseAndRate", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate.type.coding", "path": "MedicationRequest.dosageInstruction.doseAndRate.type.coding", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate.type.coding.system", "path": "MedicationRequest.dosageInstruction.doseAndRate.type.coding.system", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate.type.coding.code", "path": "MedicationRequest.dosageInstruction.doseAndRate.type.coding.code", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate.type.coding.display", "path": "MedicationRequest.dosageInstruction.doseAndRate.type.coding.display", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate.type.text", "path": "MedicationRequest.dosageInstruction.doseAndRate.type.text", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate.dose[x]", "path": "MedicationRequest.dosageInstruction.doseAndRate.dose[x]", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.doseAndRate.rate[x]", "path": "MedicationRequest.dosageInstruction.doseAndRate.rate[x]", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod.numerator", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.maxDosePerPeriod.denominator", "path": "MedicationRequest.dosageInstruction.maxDosePerPeriod.denominator", "mustSupport": true }, { "id": "MedicationRequest.substitution", "path": "MedicationRequest.substitution", "comment": "Conformance Rule: This must be populated when known\r\n\r\nPrescribeIT mapping: Does not exist in PrescribeIT as a discrete data element", "mustSupport": true }, { "id": "MedicationRequest.substitution.allowed[x]", "path": "MedicationRequest.substitution.allowed[x]", "mustSupport": true }, { "id": "MedicationRequest.substitution.reason", "path": "MedicationRequest.substitution.reason", "mustSupport": true }, { "id": "MedicationRequest.substitution.reason.coding", "path": "MedicationRequest.substitution.reason.coding", "mustSupport": true }, { "id": "MedicationRequest.substitution.reason.coding.system", "path": "MedicationRequest.substitution.reason.coding.system", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.substitution.reason.coding.code", "path": "MedicationRequest.substitution.reason.coding.code", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.substitution.reason.text", "path": "MedicationRequest.substitution.reason.text", "mustSupport": true }, { "id": "MedicationRequest.detectedIssue", "path": "MedicationRequest.detectedIssue", "comment": "Conformance Rule: The source system must send all drug interaction alerts/DUR \"managements\" that are a component of the medication record; these were not added as part of the medication orders/prescription. Most of the DUR managements will be associated with a prescription, as such this will be rarely used. \r\n\r\nConformance Rule: The managed issue is only applicable to a single version of the plan; it is not carried forward to subsequent versions.\r\n\r\nConformance Rule: If there is a medication order with detected issues, the plan must reference the same detected issue (for the plan version that was triggered by the medication order). \r\n\r\nUsage Note: This is used to convey the action the user took (eg override on a warning). This could also be a drug/allergy alert. \r\nUsage Note: EMRs commonly do not capture detected issues unless there is a mitigation attached. \r\nUsage Note: Some exporting systems are not able to capture managed issue at the plan level; rather they will capture managed issues only at time of prescribing/renewals.\r\n\r\nMapping; PrescribeIT extension\r\n\r\nConformance Rules: \r\n\r\nThis element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.", "mustSupport": true }, { "id": "MedicationRequest.detectedIssue.reference", "path": "MedicationRequest.detectedIssue.reference", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.eventHistory", "path": "MedicationRequest.eventHistory", "comment": "Usage Note: This is not used as the provenance will reference the Medication Plan, instead of using this relationship\r\n\r\nThis might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.)." } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.413+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/ext-medication-request-effective-period", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "ext-medication-request-effective-period", "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-medication-request-effective-period", "name": "MedicationPlanEffectivePeriod", "title": "Ext-Medication Plan Effective Period", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "MedicationRequest" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/ext-medication-request-effective-period" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "type": [ { "code": "Period" } ], "mustSupport": true } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.400+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-medicationStatement-patientchart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-medicationStatement-patientchart", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.413+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-medication-statement", "name": "MedicationStatement", "title": "Medication Statement Patient Chart", "status": "draft", "date": "2021-03-22T16:05:12.5060946+00:00", "description": "This profile is scoped for usage within the Patient Chart", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" } ], "kind": "resource", "abstract": false, "type": "MedicationStatement", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationStatement", "derivation": "constraint", "differential": { "element": [ { "id": "MedicationStatement", "path": "MedicationStatement", "comment": "***** Add adherence code extension\r\n\r\nConformance Rule: If the EMR is able to distinguish that the patient was the source/data enterer of the medication information (eg entered by the patient in the patient portal or into a e-questionnaire/qnaire), this must be conveyed as a Medication Statement. Example: Questionnaire may capture existing drugs. This is a potential use case where an EMR is able to distinguish that the patient is the source of the information.\r\n\r\nConformance Rule: A medication Statement will always trigger the creation of a plan; as a plan is required in order to convey changes in status, eg on-hold, stopped, etc \r\n\r\nConformance Rule: A medication statement is only to be used when EMRs can detect that the patient is the information source. It is not always possible for the EMR to distinguish the patient/related person as the information source is not alwasy recorded discretely. In this case the key data (eg patient not taking due to side effect) will be captured on the plan as a note. \r\n\r\nConformance Rule: The status of a medication statement will always be set to \"complete\"\r\n\r\n\r\nTO BE REVIEWED --- Patient Chart Usage Guidelines: \r\n1. In the context of sending a consultation request/referral it is usually not necessary to send the Prescription information along with the Medication Statement. . Prescription details may be very important when referring to an oncologist, or to share dose, interval frequency (once a day)\r\n2. There will be a medication statement for each new SIG. There will be a new medication statement for each status change (eg on hold, discontinued).\r\n\r\n3. A single med statement could include multiple prescriptions; OR multiple medication statements may reference a single prescription (eg dose change) OR a medication statement may be sent without a prescription (eg prescribed by specialist, non-prescription (eg aspirin) or prescribed medication that was reported by the patient or a mediication that was started by another doctor (aka external prescription).\r\n\r\n4. Type of Medication Statements: 1. A patient chart will cover a period of time that a patient was on the same dose of a medication. 2. Dose changes over a fixed schedule, over a period of time as specified in the presciption dosage instructions (eg warafin). If there is a new SIG, there will be a new medication statement. 3. PRN - this is a valid medication period\r\n\r\n6. Conformance Rule: If the patient follows the dose on the prescription, we would expect a single medication statement which may have multiple dosage lines. If the dose changes unexpectedly, or in a way that was not indicated on the original SIG, there will be multiple medication statements; one for each consecutive period and dosage instructions for that period.\r\n\r\nCONFIRM: NEW MED STATEMENT WHEN WE CHANGE DOSAGE\r\n\r\n\r\n\r\nDW - Use Case\r\n\r\nExample - Warafin - a patient on warafin could be represented by multiple medication statements; one for each interval of time/dosage instruction. The prescription is a \"proposed\" treatment, whereas the medication statement is a retrospective view/what the patient actually took (dosage/frequency).\r\nPSS: This is captured in treatment history, which captures the discrete dosage, time interval\r\n\r\nExample - Anti-depressant. Ramp up approach. This can be represented as 2 med statements; the first is the ramp up period and the second being the final dosage. Alternatively, this could be one med statement with two dosage lines (first this, then that). \r\n\r\n\r\nEXAMPLES: \r\nhttps://simplifier.net/onlyfortestingmedication/medicationstatement-example\r\nhttps://build.fhir.org/ig/HL7/ccda-on-fhir-r4//MedicationStatement-medication-statement.xml.html\r\nhttps://fhir.ch/ig/ch-emed/MedicationStatement-2-7-MedStatBeloczok.xml.html\r\nhttps://simplifier.net/finnishphr/medicationstatement-example-max\r\n\r\nPHARMACY WORKING GROUP FHIR - https://confluence.hl7.org/display/PHAR/May+2020+-+Virtual+Pharmacy+Meetings\r\n\r\n** THE .wasNotTaken DATA ELEMENT NO LONGER EXISTS; WAS REMOVED IN R3\r\n\r\nUse Case 1 - Sending Patient Chart to Specialist: Send \"active\" medications always and any relevant completed medications that pertain to the specific case. May wish to share \"intended\" as well. \r\nUse Case 2 - Sharing full Patient Chart (eg switching physicians). ALL history/all status's will be sent.\r\nUse Case 3 - DW - only \"active\" medications will be shared; will could be extended in the future\r\n\r\nEMR will not be aware of whether a drug is taken or not taken. PSS will know whether it was prescribed but not taken; it is then discontinued. \r\n\r\nMA - would support one medication statement, per prescription recorded in the EMR. If there is no prescription recorded (\"external prescription\"), this would be a single medication statement for each record.\r\n\r\nWe can SEND: \r\nStatus=Active = Taking (as of today's date) \r\nStatus=Completed = Taken in past (no future prescription, was a prescription in past)\rStatus=Active + NotTaken=T = Not currently taking \rStatus=Completed + NotTaken=T = Not taken in the past\rStatus=Intended = No intention of taking\rStatus=Active + NotTaken=F = Taking, but not as prescribed\rStatus=Active + NotTaken=F = Taking\rStatus=Intended +NotTaken= F = Will be taking (not started)\rStatus=Completed + NotTaken=F = Taken in past\rStatus=In Error + NotTaken=N/A = In Error.", "mustSupport": true }, { "id": "MedicationStatement.id", "path": "MedicationStatement.id", "mustSupport": true }, { "id": "MedicationStatement.meta", "path": "MedicationStatement.meta", "mustSupport": true }, { "id": "MedicationStatement.meta.lastUpdated", "path": "MedicationStatement.meta.lastUpdated", "mustSupport": true }, { "id": "MedicationStatement.meta.source", "path": "MedicationStatement.meta.source", "mustSupport": true }, { "id": "MedicationStatement.meta.profile", "path": "MedicationStatement.meta.profile", "comment": "Usage: Each implementation will determine if this will be used. It may be useful to validate a message instance against this profile.\r\n\r\nIt 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.", "max": "1", "mustSupport": true }, { "id": "MedicationStatement.text", "path": "MedicationStatement.text", "comment": "************ lots of work to be done on narrative in ALL Resources to ensure it can be summarized into a bigger picture for recipients who cannot accept discrete data\r\n\r\nCA-Core - not supported\r\nDiscussion: Important for mapping into CDA with CDX \r\n\r\nContained 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.", "mustSupport": true }, { "id": "MedicationStatement.text.status", "path": "MedicationStatement.text.status", "mustSupport": true }, { "id": "MedicationStatement.text.div", "path": "MedicationStatement.text.div", "mustSupport": true }, { "id": "MedicationStatement.extension", "path": "MedicationStatement.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "MedicationStatement.extension:RenderedDosageInstruction", "path": "MedicationStatement.extension", "sliceName": "RenderedDosageInstruction", "definition": "Concatenation of all dosage lines in a human readable form.", "comment": "Alignment: This is a pre-adoption of an R5 element; this is also prsent in PrescribeIT", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-rendered-dosage-instruction" ] } ], "isModifier": false }, { "id": "MedicationStatement.basedOn", "path": "MedicationStatement.basedOn", "comment": "Usage: The detailed prescription should be shared when known. This may be a prescription from the sending system, or a prescription that was imported from another system or recorded by the clinician (eg 'external prescription'). \r\n\r\nCA-Core - not supported but they are supporting derived from - ?\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "MedicationStatement.basedOn.reference", "path": "MedicationStatement.basedOn.reference", "mustSupport": true }, { "id": "MedicationStatement.partOf", "path": "MedicationStatement.partOf", "comment": "Alignment: This data element will be supported for DW Extract. Not supported by Core-CA\r\n\r\nPatient Chart This data element will not be used as we have scoped med statement to particular use when patient advises of a medication they are taking and there is no prescription that has been created. \r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." }, { "id": "MedicationStatement.status", "path": "MedicationStatement.status", "comment": "Conformance Rule: For Patient Chart, only \"completed\" is supported; other status's (active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown) will be conveyed in the Medication Request.status of the associated Plan. Rationale: In R5, many of these status's will no longer be supported\r\n\r\nFor Dw, this is a list of medications that the patient is currently taking, is planning to take or has taken. As such all status's are relevent.\r\n\r\nNote: The restricted code set aligns with R5, MedicationUsage. \r\n\r\nConformance Rule: Status of unknown and entered-in-error will not be sent for the Patient Chart. Rationale: EMRs do not have an indicator for unknown and entered-in-error are not clinically relevant or have been removed from the chart\r\n\r\n Medication Statement used to capture a change in medication at a given date. Example: There may be one \"active\" med statements for the same drug, with effective date \"x\" and another \"completed\" med statement with where dosage instructions have changed. \r\n\r\nFDG: what statuses would be considered as active (ex: recently active? Added to issues list\r\nConformance Rule: FDG *** confirm what status's are expected to be shared. Added to issues list\r\n\r\nMappings: \r\nEMRAPI: Status (CC)\r\nCA-Core: supported\r\n\r\nPSS - Discuss in FDG to confirm what status are appropriate. Active-> Active, completed->N/A N/A-> Inactive (won't show in CPP). entered-in-error-> N/A intended-> N/A stopped->Auto-discontinue ??--> discontinue (may or may not be codified, ask FDG for guidence), on hold-> on hold unknown-> N/A not taken-> \"not currently taking\" (compliance, not codified)\r\n\r\nMS : See value from Medication object. active -> active completed -> check stopped date in the past entered-in-error-> N/A\r\nintended -> N/A stopped -> stop (check SIG field in prescriber) on-hold -> N/A unknown -> N/A not-taken-> N/A. Looks for deactivation date. If deactivation date is null it is considered active.\r\n\r\nMA - Active - specific logic to drive active or inactive. Falls from active to inactive (dynamic/derived), based on calc based on end date and half-life of a drug (time it takes for drug to disappear 50% in patient's system). Discontinue=stopped. Hold=on-hold. Inactive=completed. Manual interventions (discontinue, renew) are also part of the logic. Example: Renewal -> instance of inactive /effective period+ instance of activ/start date _>> Two medication statements\r\n\r\nExample: RX/dose 1, then renew same RX/dose2 with overlap effectiveDate -> renewal would always replace the first one, and this would be a single med statement. \r\nCHR - if re-presecribing, replacing the original; implicitly end and start; can technically be represented either way.\r\nWarfarin - 1mg tab and 5mg tab - different med; different RX, \r\nWarafin - 1mg tab, second RX, 1mg tab - replace - single line, single med statement, start date from original\r\nEnd date is not definitive (eg if on hold, end date is bumped) - auto-calc\r\nMA - Early renewal. if you take meds with days remaining, and then renew, it defaults the start date of next RX to be the expected end date. 2 med statements in MA. To make this a single med statement, heuristic 1 med statement in PSS\r\n\r\n\r\nFor FDG: what statuses would be considered as active (ex: recently active?)\r\n\r\nCore-CA - supported\r\n\r\nFHIR: MedicationStatement is a statement at a point in time. The status is only representative at the point when it was asserted. The value set for MedicationStatement.status contains codes that assert the status of the use of the medication by the patient (for example, stopped or on hold) as well as codes that assert the status of the medication statement itself (for example, entered in error).\r\rThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "fixedCode": "completed", "mustSupport": true }, { "id": "MedicationStatement.statusReason", "path": "MedicationStatement.statusReason", "comment": "Usage Rule: This is supported as text only \r\nAlignment: This is not supported in the Core-CA; also support for DW Extract\r\n\r\nThis is generally only used for \"exception\" statuses such as \"not-taken\", \"on-hold\", \"cancelled\" or \"entered-in-error\". The reason for performing the event at all is captured in reasonCode, not here.", "mustSupport": true }, { "id": "MedicationStatement.statusReason.text", "path": "MedicationStatement.statusReason.text", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.category", "path": "MedicationStatement.category", "comment": "Mappings:\r\nCore-CA - not supported\r\nEMRAPI: N/A\r\nMA: N/A\r\nPSS: N/A \r\nMS: N/A\r\n \r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." }, { "id": "MedicationStatement.medication[x]", "path": "MedicationStatement.medication[x]", "comment": "Conformance Rule: This will be the \"prescribed\" medication, rather than the \"dispensed\" medication. The dispensed medication is assumed to be equivalent and therefore is not relevant to the medication statement. \r\n\r\nDISCUSSION\r\nIPS - has added an absent reason slice - https://build.fhir.org/ig/HL7/fhir-ips/ValueSet-absent-or-unknown-medications-uv-ips.html\r\nto convey \"no medication info\" or \"no known reasons\".\r\n\r\nADD A SLICE (codeable concept) - AS PER IPS AND MAYBE CANADIAN CORE? FOR THIS\r\n\r\nIPS value set:\r\nno-medication-info No information about medications There is no information available about the subject's medication use or administration.\r\nno-known-medications No known medications There are no medications for the subject that have to be reported in this record. This can mean either that there are none known, or that those known are not relevant for the purpose of this record.\r\n\r\n\r\nMS - does not capture explictly - could map to no-medication-info\r\nMA - ?\r\nPSS - ?\r\n \r\n\r\nJIM -- DO WE WANT TO SUPPORT THIS EXTENSION TO CONVEY NO MEDICATION INFO? alternatively we could put a null flavour on the reference from composition\r\n\r\nCore-CA - supported\r\n\r\nIf only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.", "type": [ { "code": "CodeableConcept" }, { "code": "Reference", "aggregation": [ "contained" ] } ], "mustSupport": true }, { "id": "MedicationStatement.subject", "path": "MedicationStatement.subject", "comment": "Core-CA - supported\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "MedicationStatement.subject.reference", "path": "MedicationStatement.subject.reference", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.subject.display", "path": "MedicationStatement.subject.display", "comment": "Usage Note: This should contain the name of the Patient, which can then be used in narrative\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "MedicationStatement.context", "path": "MedicationStatement.context", "comment": "EMRAPI: Not supported \r\nCore-CA; Not supported\r\nPSS - Encounters are available via stamps and custom forms.\r\nMA, MS - N/A\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." }, { "id": "MedicationStatement.effective[x]", "path": "MedicationStatement.effective[x]", "comment": "Conformance Rule: This may be a fuzzy start date where the patient does not know exactly when the medication began. \r\nUsage Note: The default rule is that the most recent effective date (Prescribed/renewed date) should be used for episodic events, eg repeated bladder infection \r\n\r\nMed Statement. effective Period\r\n*if no end date, this is ACTIVE OR ON-HOLD in the plan; med statement is a fixed status of \"completed\"\r\n*IF end date is present AND Med Statement Date is less than= end date then it is ACTIVE in the plan\r\n*If end date is present AND Med Statement date is greater than end date, then it is COMPLETED in the plan\r\n If status Start date (of active record) and date the record was marked as completed \r\n\r\nAlignment-PS-ON: Question to them: If it is an episodic drug, what is expected? Most recent \r\nepisode, or original episode dates? Example: repeated bladder infections. Please update the specification to clarify\r\nAnswer from ON: Clinical consultation will be required to provide guidance for this. Ontario Health will look for opportunities to seek clinical guidance in the future.\r\n\r\n\r\nThis attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken at the time the statement is recorded, the \"end\" date will be omitted. The date/time attribute supports a variety of dates - year, year/month and exact date. If something more than this is required, this should be conveyed as text.", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.dateAsserted", "path": "MedicationStatement.dateAsserted", "comment": "EMRAPI: N/A\r\nCore-CA - supported\r\nMA/MS: n/a\r\n\r\nPSS: One of 3 sources: a)\"Prescribed on Date\" may be used for medications that were prescribed by the doctor. b) For other recorded medications, the change date may be used. c) Date Issued may be used when treatment is entered via the Fast Profile Entry. Date when the patient told the PCP about it. \r\nFDG: Unless we really need this we can drop it.", "mustSupport": true }, { "id": "MedicationStatement.informationSource", "path": "MedicationStatement.informationSource", "comment": "Conformance Rule: If the EMR is able to distinguish that the patient was the information source of the medication information (eg entered by the patient in the patient portal or into a e-questionnaire/qnaire), then the information source must be the patient.\r\n\r\nConformance Rule: This is only expected to be populated with the patient or related person (mother, child) or an organization in the case of a nursing home when discretely recorded in the EMR. If the information source is not discretely \r\n\r\nCore-CA - supported\r\nDHDR - is this the Pharmacy?\r\n\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "type": [ { "code": "Reference", "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "MedicationStatement.informationSource.reference", "path": "MedicationStatement.informationSource.reference", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.informationSource.display", "path": "MedicationStatement.informationSource.display", "mustSupport": true }, { "id": "MedicationStatement.derivedFrom", "path": "MedicationStatement.derivedFrom", "comment": "Conformance Rule: This is supported in order to align with the CA-Core profile. To date, we do not have a specific use case for inclusion of this data. There is no expectation that this will be supported at this time for this implementation, though it may be used in other implementations in Canada.\r\n\r\nCore-CA - supported and also supported in US Core. CA- Core has scoped to support MedRequest, MedDispense, Claim, ObservationProfile (General Use)\r\n\r\nLikely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from.", "mustSupport": true }, { "id": "MedicationStatement.derivedFrom.reference", "path": "MedicationStatement.derivedFrom.reference", "mustSupport": true }, { "id": "MedicationStatement.derivedFrom.display", "path": "MedicationStatement.derivedFrom.display", "mustSupport": true }, { "id": "MedicationStatement.reasonCode", "path": "MedicationStatement.reasonCode", "comment": "Conformance Rule: A local code must be included if known. Text must also be included where known.\r\nCore-CA - not supported\r\nPSS: Local codes or for free text just send display. PSS: ICD9/10, SNOMED via FDB, encode\r\nMA: ICD9, SNOMED, free text, local code system\r\nMS: N/A\r\nDHDR: ODB reason for use code\r\n\r\nThis could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference.", "mustSupport": true }, { "id": "MedicationStatement.reasonCode.coding", "path": "MedicationStatement.reasonCode.coding", "mustSupport": true }, { "id": "MedicationStatement.reasonCode.coding.system", "path": "MedicationStatement.reasonCode.coding.system", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.reasonCode.coding.code", "path": "MedicationStatement.reasonCode.coding.code", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.reasonCode.coding.display", "path": "MedicationStatement.reasonCode.coding.display", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.reasonCode.text", "path": "MedicationStatement.reasonCode.text", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.reasonReference", "path": "MedicationStatement.reasonReference", "comment": "Core-CA - not supported\r\n\r\n\r\nThis is a reference to a condition that is the reason why the medication is being/was taken. If only a code exists, use reasonForUseCode." }, { "id": "MedicationStatement.note", "path": "MedicationStatement.note", "comment": "Usage Notes: Used to capture any information from the patient that is pertinent to the statement. Information that is specific to dosage should be captured under dosage where possible. Example: Some EMRs record whether the medication is \"successful\" or \"not successful\" and general text comments that may be captured here. \r\n\r\nEMRAPI: Notes\r\nCore-CA - not supported\r\n\r\nMA: Patient instructions go in the dosage object\r\nPSS: Any comment can be added into medication, in addition the dosage.text/SIG? \r\nMS: Patient chart-->summary-->active medication --> comment\r\n\r\n\r\nFor systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. *Annotations SHOULD NOT* be used to communicate \"modifying\" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).", "mustSupport": true }, { "id": "MedicationStatement.dosage", "path": "MedicationStatement.dosage", "comment": "Conformance Rule: This is the dosage that the patient actually took, which may differ than the dosage that is on the prescription.\r\nConformance Rule: This must always be included where known\r\n\r\n\r\nCore-CA - supported - text only is supported \r\n\r\nUsage: It is rare that a medication statement, will not have dosage (minimally text), but it may occur. \r\n\r\nUsage: This captures what the patient is actually taking. This COULD be the same as the dosage in the prescription (steady, ramp-up, ramp-down). If there is a change after the patient has started to take it, it is recorded in the EMR (not included in the prescription)\r\n\r\nUsage: Dosage instruction can be a single instance, with multiple dosage instructions/lines (eg one a night for 7 nights, then 2/day)\r\nUsage: Unexpected Dosage change - update to the dosage from the prescription. This would be recorded in the EMR and would have a different effective period. This is a trigger to send a new medication statement. \r\n*** For MS, this will be challenging; you dont' have a sense of history. eg active meds have an end date in 2017. RX for ongoing drug; renewal deactivates the previous one without changing dates on the old one or adapting on the new one (if you had the drug for years, it creates a new record)\r\n*** PSS - dosage/renewals are separate line; works well for a new med statement. \r\n\r\nConformance Rule: Where possible, each renewal could be a new/second med statement if the dosage changes.\r\nConformance Rule: Where possible, If the same drug, same dosage, many RX's, this can be rolled up and effective period would start at first RX. \r\n\r\nNotes: SIG can change multiple times for a single prescription. Doctors have the ability to change dosages and the prescription dosage is only valid at the time of writing and can be overridden at any point in the future. Prescription is a single event in the series of events that occur for that drug. including dosage instructions. Dosage instructions can be changed at any time; update/change within the system. Events: Prescription, Dosage Change, On-Hold, Discontinued, StartedAgain, etc.\r\n\r\nConformance Rule: If sending systems are capable, they should send the discrete data. This will be captured using the same mechanisms as PrescribeIT. Rationale: this may be useful for dosage checking and monitoring compliance to guidelines.\r\nUsage Note: An Excel spreadsheet published by PrescribeIT provides guidance on how to populate dosage instructions.\r\n\r\nMappings:\r\nIPS - support text, timing and route - https://build.fhir.org/ig/HL7/fhir-ips/StructureDefinition-MedicationStatement-uv-ips.html\r\n\r\n\r\nWhen the dose or rate is intended to change over the entire administration period, e.g. Tapering dose prescriptions, multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. Another common example in institutional settings is 'titration' of an IV medication dose to maintain a specific stated hemodynamic value or range e.g. drug x to be administered to maintain AM (arterial mean) greater than 65.\r\n\r\nThe dates included in the dosage on a Medication Statement reflect the dates for a given dose. For example, \"from November 1, 2016 to November 3, 2016, take one tablet daily and from November 4, 2016 to November 7, 2016, take two tablets daily.\" It is expected that this specificity may only be populated where the patient brings in their labeled container or where the Medication Statement is derived from a MedicationRequest.", "mustSupport": true }, { "id": "MedicationStatement.dosage.sequence", "path": "MedicationStatement.dosage.sequence", "comment": "Usage Note: This is mandatory as it indicates the dosage instruction sequence.\r\n\r\nMapping Note: This concept is represented in PrescribeIT as an extension on dosage. Core-CA - not supported ?\r\n \r\n 32 bit number; for values larger than this, use decimal", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.dosage.text", "path": "MedicationStatement.dosage.text", "comment": "Conformance Rule: When providing multiple dosage lines can be expressed individually. All dosage lines (full text content) must be concatenated into MedicationStatement.extension(RenderedDosageInstruction) for recipients who can support the receipt of individual lines.\r\n\r\nUsage Note: This is a string composed of any available discrete MedicationStatement.dosage child elements such as timing, asNeeded[x], siteCodeableConcept, route, dose[x], rate[x], and maxDosePerPeriod for each repetition sequence line.\r\n\r\nExample: Prednisone; variable dosage instruction, or concurrent instructions (1 pill morning and 1 pill before bed) or sequential dosages (1 pill for 2 days, then 2 pills).", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.dosage.additionalInstruction", "path": "MedicationStatement.dosage.additionalInstruction", "comment": "EMRAPI: Not supported\r\nCore-CA - not supported\r\n\r\nPrescribeIT Usage Notes below - MAY NOT BE ALL APPROPRIATE; DISCUSSION REQUIRED\r\n\r\nUsage Note:: To convey explicit instructions to the Pharmacist/dispenser related to this medication order.\r\n\r\nUsage Note: If the PMS solution is unable to display the entire instructions, then it is expected that the current solution has a fail-over process and will create a printout of the prescription.\r\n\r\nConformance Rule: When 'compliance pack' is indicated on the prescription within the EMR, populate the pharmacist instruction/dispenser instructions with 'COMPLIANCE PACK REQUESTED'\r\n\r\nUsage Note: In the case where the prescriber indicates the concept of ‘do not adapt’ (meaning that the pharmacist should not alter the prescription based on the patient's weight as an example), this direction to the pharmacist should be conveyed in human language in this field.\r\n\r\nConformance Rule: If a prescriber wishes to indicate that there is no substitution it must be included as part of the pharmacy instructions.\r\n\r\nConformance Rule: LU Codes must be clearly conveyed as part of the Pharmacists Instructions. If vendors are programmitically mapping into this field, they should use a prefix of LU Code before the identifier.\r\n\r\nInformation about administration or preparation of the medication (e.g. \"infuse as rapidly as possibly via intraperitoneal port\" or \"immediately following drug x\") should be populated in dosage.text.", "mustSupport": true }, { "id": "MedicationStatement.dosage.patientInstruction", "path": "MedicationStatement.dosage.patientInstruction", "comment": "Core-CA - not supported\r\n\r\nDiscussion required: \r\nPSS: Label Instruction. Note: this is also part of text. Note, with meals\", \"may cause drowsiness are included here but FHIR shows under additional instructions.\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing", "path": "MedicationStatement.dosage.timing", "comment": "Core-CA - not supported\r\n\r\nConformance Rule: If an EMR cannot send discrete elements in all cases for timing.repeat element, this is acceptable as long as RENDERED_DOSAGE_INSTRUCTION captures the timing.\r\n\r\nThis attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.repeat", "path": "MedicationStatement.dosage.timing.repeat", "comment": "Conformance Rule: If an EMR cannot send discrete elements in all cases for timing.repeat element, this is acceptable as long as RENDERED_DOSAGE_INSTRUCTION captures the timing.", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.repeat.bounds[x]", "path": "MedicationStatement.dosage.timing.repeat.bounds[x]", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.repeat.count", "path": "MedicationStatement.dosage.timing.repeat.count", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.repeat.countMax", "path": "MedicationStatement.dosage.timing.repeat.countMax", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.repeat.duration", "path": "MedicationStatement.dosage.timing.repeat.duration", "comment": "Example: \"5 mL Q6H for 4 day(s)\"\r\n\r\nFor some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).", "requirements": "API Mapping: *.currentMedications.dosageInstructions.duration.value\r\n\r\nSome activities are not instantaneous and need to be maintained for a period of time.", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.repeat.durationMax", "path": "MedicationStatement.dosage.timing.repeat.durationMax", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.repeat.durationUnit", "path": "MedicationStatement.dosage.timing.repeat.durationUnit", "comment": "Example: \"5 mL Q6H for 4 day(s)\"\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "requirements": "API Mapping: *.currentMedications.dosageInstructions.duration.unit.coding\r\n\r\nUnit of time (required)\r\ns/min/h/d/wk/mo/ a \r\nMA: urn:telus:emr:ma:*:codetable:medication-frequency\r\nPSS: urn:telus:emr:pss:*:codetable:dose-duration", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.repeat.frequency", "path": "MedicationStatement.dosage.timing.repeat.frequency", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.repeat.frequencyMax", "path": "MedicationStatement.dosage.timing.repeat.frequencyMax", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.repeat.period", "path": "MedicationStatement.dosage.timing.repeat.period", "requirements": "5 mL Q6H for 4 day(s)\"\r\nAPI doesn't break this out by period and period unit.\r\nAPI Mapping: *.currentMedication.doageInstructions.frequency.coding", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.repeat.periodMax", "path": "MedicationStatement.dosage.timing.repeat.periodMax", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.repeat.periodUnit", "path": "MedicationStatement.dosage.timing.repeat.periodUnit", "comment": "5 mL Q6H for 4 day(s)\"\r\n****Don't think API frequency value will work as it is a single code and doesn't break out both the amount and unit.\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "requirements": "API Mapping: *.currentMedication.doageInstructions.frequency.coding", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.code", "path": "MedicationStatement.dosage.timing.code", "comment": "EMRAPI: *.currentMedication.doageInstructions.frequency.coding\r\n\r\n??? this is NOT supported in PrescriebIT, so we need to revisit to ensure we need this. Mapping is pretty clear\r\n**Maybe API frequency element would be better used here?\r\n\r\nBID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is \"always at 7am and 6pm\". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times).", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.code.coding", "path": "MedicationStatement.dosage.timing.code.coding", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing.code.coding.code", "path": "MedicationStatement.dosage.timing.code.coding.code", "mustSupport": true }, { "id": "MedicationStatement.dosage.asNeeded[x]", "path": "MedicationStatement.dosage.asNeeded[x]", "comment": "Core-CA - not supported\r\n\r\nEMRAPI: .currentMedications.dosageInstructions.asNeeded\r\n\r\nUsage Note: \r\n\r\nFHIR: Can express \"as needed\" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express \"as needed\" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not \"prn\" or \"as needed\".", "mustSupport": true }, { "id": "MedicationStatement.dosage.site", "path": "MedicationStatement.dosage.site", "comment": "Core-CA \r\n\r\n- not supportedIf the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.", "mustSupport": true }, { "id": "MedicationStatement.dosage.site.coding", "path": "MedicationStatement.dosage.site.coding", "max": "1", "mustSupport": true }, { "id": "MedicationStatement.dosage.site.text", "path": "MedicationStatement.dosage.site.text", "min": 1 }, { "id": "MedicationStatement.dosage.route", "path": "MedicationStatement.dosage.route", "comment": "EMRAPI: *.currentMedications.route\r\nCore-CA - not supported\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true }, { "id": "MedicationStatement.dosage.route.coding", "path": "MedicationStatement.dosage.route.coding", "mustSupport": true }, { "id": "MedicationStatement.dosage.route.text", "path": "MedicationStatement.dosage.route.text", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.dosage.method", "path": "MedicationStatement.dosage.method", "comment": "Core-CA - not supported\r\n\r\nTerminologies used often pre-coordinate this term with the route and or form of administration." }, { "id": "MedicationStatement.dosage.doseAndRate", "path": "MedicationStatement.dosage.doseAndRate", "comment": "EMRAPI: *.dosageInstructions.doseRangeLow and *.doseRangeHigh\r\nCore-CA - not supported", "mustSupport": true }, { "id": "MedicationStatement.dosage.doseAndRate.dose[x]", "path": "MedicationStatement.dosage.doseAndRate.dose[x]", "requirements": "API Mapping: *.dosageInstructions.quantity\r\n*.dosageInstructions.doseRangeLow \r\n\r\nFHIR: The amount of therapeutic or other substance given at one administration event.", "mustSupport": true }, { "id": "MedicationStatement.dosage.doseAndRate.rate[x]", "path": "MedicationStatement.dosage.doseAndRate.rate[x]", "comment": "Example: \"5 mL Q6H for 4 day(s)\"\r\n\r\nPrescribeIT - always a ratio I think\r\n\r\nIt is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.\r\rIt is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.", "mustSupport": true }, { "id": "MedicationStatement.dosage.maxDosePerPeriod", "path": "MedicationStatement.dosage.maxDosePerPeriod", "comment": "Core-CA - not supported\r\n\r\nThis is intended for use as an adjunct to the dosage when there is an upper cap. For example \"2 tablets every 4 hours to a maximum of 8/day\"." }, { "id": "MedicationStatement.dosage.maxDosePerAdministration", "path": "MedicationStatement.dosage.maxDosePerAdministration", "comment": "Core-CA - not supported\r\n\r\nThis is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg." } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/820b1b89-0d50-4830-9df4-5dace2dc4536", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "820b1b89-0d50-4830-9df4-5dace2dc4536", "meta": { "lastUpdated": "2022-12-14T16:33:39.414+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChartStructureDefinition/profile-observation-alcohol-use", "name": "ObservationAlcoholUse", "title": "Observation Alcohol Use", "status": "draft", "date": "2022-05-31T20:00:20.7714514+00:00", "description": "This is closely synchronized with the Alcohol Use profile created by the TELUS DW team", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation", "path": "Observation", "comment": "Usage Note: This profile is used as a grouping observation with \"has.member\" observations to specify status, type of alcohol, drinks consumed and years of ETOH Use. \r\n\r\nNote: This is closely synchronized with the Alcohol Use profile created by the TELUS DW team\r\n\r\nUsed for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc." }, { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "comment": "Usage: When \"http://telus.com/fhir/patientChartStructureDefinition/profile-observation-alcohol-use\" is specified, a message instance may be valiidated against this profile.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted\r\nPSS -->FHIR\r\nNeeds Review, unfinished --> Final\r\nUpdated --> amended - only if delta is being send\r\ndeleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nMA --> FHIR\r\nActive --> Final\r\ndeleted --> entered-in-error - only if delta is being send\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.\r\n\r\nConformance Rule - PSS status for active risk factors the status should be final. For updated risk factor the status should be updated to amended", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "fixedCodeableConcept": { "text": "social-history" }, "mustSupport": true }, { "id": "Observation.category.coding", "path": "Observation.category.coding", "mustSupport": true }, { "id": "Observation.category.coding.system", "path": "Observation.category.coding.system", "mustSupport": true }, { "id": "Observation.category.coding.code", "path": "Observation.category.coding.code", "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "mustSupport": true }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "min": 1, "mustSupport": true }, { "id": "Observation.code.coding.system", "path": "Observation.code.coding.system", "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "min": 1, "fixedCode": "11330-8", "mustSupport": true }, { "id": "Observation.code.coding.display", "path": "Observation.code.coding.display", "comment": "Value = History of Alcohol use Narrative\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "min": 1, "mustSupport": true }, { "id": "Observation.subject.reference", "path": "Observation.subject.reference", "min": 1, "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "comment": "Usage note - Last updated date for the risk factor \r\n\r\nAt least a date should be present unless this olast updated datebservation is a historical report. For recording imprecise or \"fuzzy\" times (For example, a blood glucose measurement taken \"after breakfast\") use the [Timing](datatypes.html#timing) datatype which allow the measurement to be tied to regular life events.", "min": 1, "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage note - PSS provide description text \r\nMA - Consumption observation + comment\r\nAlignment: Not supported in PS-CA\r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "comment": "Usage Note: PSS provide Details if documented\r\nMA: Provide note in the task (on the left)\r\n\r\nMay include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" }, { "id": "Observation.hasMember", "path": "Observation.hasMember", "type": [ { "code": "Reference", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/observation-alcohol-use-years-of-etoh-use", "http://telus.com/fhir/patientChart/StructureDefinition/observation-alcohol-use-drinks-consumed", "http://telus.com/fhir/patientChart/StructureDefinition/observation-alcohol-use-current-status", "http://telus.com/fhir/patientChart/StructureDefinition/observation-alcohol-use-alcohol-type" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Observation.hasMember.reference", "path": "Observation.hasMember.reference", "min": 1, "mustSupport": true }, { "id": "Observation.hasMember.display", "path": "Observation.hasMember.display", "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/fb2ccedb-ab20-44c4-ae0d-39292169b073", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "meta": { "lastUpdated": "2022-12-14T16:33:39.414+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-alcohol-use-alcohol-type", "name": "ObservationAlcoholUseAlcoholType", "status": "draft", "date": "2022-06-02T21:23:25.8478656+00:00", "description": "This profile is synchronized with the TELUS DW project", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "comment": "Usage: When the profile, value = http://telus.com/fhir/patientChart/StructureDefinition/observation-alcohol-use-alcohol-type is specified, the message instance can be validated against the profile. \r\n\r\nIt 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.", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "min": 1, "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted\r\nPSS -->FHIR\r\nNeeds Review, unfinished --> Final\r\nUpdated --> amended - only if delta is being send\r\ndeleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nMA --> FHIR\r\nActive --> Final\r\ndeleted --> entered-in-error - only if delta is being send\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.\r\n\r\nConformance Rule - PSS status for active risk factors the status should be final. For updated risk factor the status should be updated to amended", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "fixedCodeableConcept": { "text": "social-history" }, "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "comment": "Usage note- Label of the observation being observered from EMR UI \r\nMA - Alcohol Types\r\nPSS - Alcohol Types\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "min": 1, "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage note - value type codeable concept, system is snomed CT \r\nBeer Beer 230085005 Beer intake (observable entity) \r\nWine  Wine 230086006 Wine intake (observable entity)\r\nLiquor Whiskey 230088007 Hard liquor intake (observable entity) \r\nVodka 230088007 Hard liquor intake (observable entity) \r\nOther spirits 230088007 Hard liquor intake (observable entity)\r\n\r\n\r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" } ] }, "id": "fb2ccedb-ab20-44c4-ae0d-39292169b073" } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/aaa5f1e3-2d37-4de2-a330-fea2fb39b679", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "meta": { "lastUpdated": "2022-12-14T16:33:39.414+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-alcohol-use-current-status", "name": "ObservationAlcoholUseCurrentStatus", "status": "draft", "date": "2022-05-30T15:15:36.6384818+00:00", "description": "This profile is synchronized with the TELUS DW project", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "comment": "Usage: When the profile, value = http://telus.com/fhir/patientChart/StructureDefinition/observation-alcohol-use-current-status is specified, the message instance can be validated against the profile. \r\n\r\nIt 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.", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "min": 1, "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted\r\nPSS -->FHIR\r\nNeeds Review, unfinished --> Final\r\nUpdated --> amended - only if delta is being send\r\ndeleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nMA --> FHIR\r\nActive --> Final\r\ndeleted --> entered-in-error - only if delta is being send\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.\r\n\r\nConformance Rule - PSS status for active risk factors the status should be final. For updated risk factor the status should be updated to amended", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "fixedCodeableConcept": { "text": "social-history" }, "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "mustSupport": true }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "comment": "11331-6 - History of Alcohol use\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "min": 1, "mustSupport": true }, { "id": "Observation.code.coding.display", "path": "Observation.code.coding.display", "comment": "History of Alcohol use\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "comment": "Usage note - Last reviewed date for the risk factor \r\nPSS and MA to investigate whether we have last reviewed date. If unable to find last reviewed date populate with . \r\n\r\nAt least a date should be present unless this olast updated datebservation is a historical report. For recording imprecise or \"fuzzy\" times (For example, a blood glucose measurement taken \"after breakfast\") use the [Timing](datatypes.html#timing) datatype which allow the measurement to be tied to regular life events.", "min": 1, "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage note - value type codeable concept, system is snomed CT \r\n\r\nNon-Drinker 105542008 Current non-drinker of alcohol\r\nRare Drinker 228276006 Occasional drinker \r\nRegular Drinker 219006 Current drinker of alcohol\r\n\r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" } ] }, "id": "aaa5f1e3-2d37-4de2-a330-fea2fb39b679" } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/1886585e-3b7b-453f-bf26-b71f64ae0bd1", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "meta": { "lastUpdated": "2022-12-14T16:33:39.415+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-alcohol-use-drinks-consumed", "name": "ObservationAlcoholUseDrinksConsumed", "status": "draft", "date": "2022-05-30T15:15:36.6384818+00:00", "description": "This profile is synchronized with the TELUS DW project", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "comment": "Usage: When the profile, value =\"http://telus.com/fhir/patientChart/StructureDefinition/observation-alcohol-use-drinks-consumed\" is specified, the message instance can be validated against the profile. \r\n\r\nIt 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.", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "min": 1, "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted\r\nPSS -->FHIR\r\nNeeds Review, unfinished --> Final\r\nUpdated --> amended - only if delta is being send\r\ndeleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nMA --> FHIR\r\nActive --> Final\r\ndeleted --> entered-in-error - only if delta is being send\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.\r\n\r\nConformance Rule - PSS status for active risk factors the status should be final. For updated risk factor the status should be updated to amended", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "fixedCodeableConcept": { "text": "social-history" }, "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "mustSupport": true, "binding": { "strength": "preferred" } }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "mustSupport": true }, { "id": "Observation.code.coding.system", "path": "Observation.code.coding.system", "min": 1, "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "comment": "MA drinks per day - 74013-4\r\nPS drinks per week 44940-5 \r\n\r\nAlignment: PS-CA - 74013-4, LOINC used to specify drinks per day\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "min": 1, "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "comment": "Usage note- Label of the observation being observered from EMR UI \r\nMA - intake\r\nPSS - Drinks per Week\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "comment": "Usage note - Last reviewed date for the risk factor \r\nPSS and MA to investigate whether we have last reviewed date. If unable to find last reviewed date populate with . \r\n\r\nAt least a date should be present unless this olast updated datebservation is a historical report. For recording imprecise or \"fuzzy\" times (For example, a blood glucose measurement taken \"after breakfast\") use the [Timing](datatypes.html#timing) datatype which allow the measurement to be tied to regular life events.", "min": 1, "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage note - value type Quantity\r\nPSS units - drinks/week \r\nMA - drinks/day \r\n\r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" } ] }, "id": "1886585e-3b7b-453f-bf26-b71f64ae0bd1" } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/dd42dd51-4f9e-49b6-8f02-0101cf66b124", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "meta": { "lastUpdated": "2022-12-14T16:33:39.415+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-alcohol-use-years-of-etoh-use", "name": "ObservationAlcoholUseYearsOfETOHUse", "status": "draft", "date": "2022-05-31T14:21:00.2410096+00:00", "description": "This profile is synchronized with the TELUS DW project to convey the years of ethanol alcohol use.", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "comment": "Usage: When the profile, value =\"http://telus.com/fhir/patientChart/StructureDefinition/observation-alcohol-use-years-of-etoh-use\" is specified, the message instance can be validated against the profile. \r\n\r\nIt 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.", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "min": 1, "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted\r\nPSS -->FHIR\r\nNeeds Review, unfinished --> Final\r\nUpdated --> amended - only if delta is being send\r\ndeleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nMA --> FHIR\r\nActive --> Final\r\ndeleted --> entered-in-error - only if delta is being send\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.\r\n\r\nConformance Rule - PSS status for active risk factors the status should be final. For updated risk factor the status should be updated to amended", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "fixedCodeableConcept": { "text": "social-history" }, "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "mustSupport": true }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "comment": "74012-6 Number of years alcohol consumed\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "comment": "Usage note- Label of the observation being observered from EMR UI \r\n\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "comment": "Usage note - Last reviewed date for the risk factor \r\nPSS and MA to investigate whether we have last reviewed date. If unable to find last reviewed date populate with . \r\n\r\nAt least a date should be present unless this olast updated datebservation is a historical report. For recording imprecise or \"fuzzy\" times (For example, a blood glucose measurement taken \"after breakfast\") use the [Timing](datatypes.html#timing) datatype which allow the measurement to be tied to regular life events.", "min": 1, "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage note - value type string\r\n\r\nIf partial date is provided only provide the partial date to the precision it was documented ( ex 2020-00-00 = 2020)\r\n\r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "comment": "If onset documented as age provide \"end date, 16 years\" \r\n\r\nMay include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" } ] }, "id": "dd42dd51-4f9e-49b6-8f02-0101cf66b124" } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/bebce228-1d09-4728-b34a-aeb0c8206a22", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "meta": { "lastUpdated": "2022-12-14T16:33:39.415+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-drug-use", "name": "ObservationDrugUse", "status": "draft", "date": "2022-07-06T19:36:14.0905835+00:00", "description": "This is closely synchronized with the DW Observation Drug Use Profile", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "min": 1, "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "comment": "Usage: When \"http://telus.com/fhir/patientChart/StructureDefinition/observation-drug-use\" is specified, the message instance may be validated to align with this profile.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "min": 1, "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted PSS -->FHIR \r\nNeeds Review, unfinished --> Final \r\nUpdated --> amended - only if delta is being send \r\ndeleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nMA --> FHIR \r\nActive --> Final \r\ndeleted --> entered-in-error - only if delta is being send\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.\r\n\r\nConformance Rule - PSS status for active risk factors the status should be final. For updated risk factor the status should be updated to amended", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "mustSupport": true }, { "id": "Observation.category.coding", "path": "Observation.category.coding", "mustSupport": true }, { "id": "Observation.category.coding.system", "path": "Observation.category.coding.system", "fixedUri": "http://hl7.org/fhir/ValueSet/observation-category", "mustSupport": true }, { "id": "Observation.category.coding.code", "path": "Observation.category.coding.code", "fixedCode": "social-history", "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "mustSupport": true }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "comment": "Code - 74204-9 Drug Use\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "min": 1, "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "min": 1, "mustSupport": true }, { "id": "Observation.effective[x].extension", "path": "Observation.effective[x].extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "Observation.effective[x].extension:dataAbsentReason", "path": "Observation.effective[x].extension", "sliceName": "dataAbsentReason", "min": 0, "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/data-absent-reason" ] } ], "isModifier": false }, { "id": "Observation.issued", "path": "Observation.issued", "mustSupport": true }, { "id": "Observation.interpretation", "path": "Observation.interpretation", "max": "1" }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.method", "path": "Observation.method", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" }, { "id": "Observation.hasMember", "path": "Observation.hasMember", "type": [ { "code": "Reference", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/observation-drug-use-frequency", "http://telus.com/fhir/patientChart/StructureDefinition/observation-drug-use-drug-type" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Observation.hasMember.reference", "path": "Observation.hasMember.reference", "min": 1, "mustSupport": true }, { "id": "Observation.hasMember.display", "path": "Observation.hasMember.display", "mustSupport": true }, { "id": "Observation.derivedFrom", "path": "Observation.derivedFrom", "max": "0" } ] }, "id": "bebce228-1d09-4728-b34a-aeb0c8206a22" } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/42875a41-0189-4440-b4c1-11cde5539abb", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "meta": { "lastUpdated": "2022-12-14T16:33:39.415+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-drug-use-drug-type", "name": "ObservationDrugUseDrugtype", "status": "draft", "date": "2022-06-30T18:37:43.6867192+00:00", "description": "This aligns closely with the TELUS DW profile", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "min": 1, "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "comment": "Usage: When the profile is specified in the message instance, it may be validated against the profile.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted PSS -->FHIR \r\nNeeds Review, unfinished --> Final \r\nUpdated --> amended - only if delta is being send \r\ndeleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nMA --> FHIR \r\nActive --> Final \r\ndeleted --> entered-in-error - only if delta is being send\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.\r\n\r\nConformance Rule - PSS status for active risk factors the status should be final. For updated risk factor the status should be updated to amended", "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "mustSupport": true }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "comment": "code - 56832-9 Type of substance abused\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "comment": "Usage note: Past or current use of drug substance\r\nVery often the text is the same as a displayName of one of the codings.", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage note - use valueCodeableConcept use SNOMED CT \r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" } ] }, "id": "42875a41-0189-4440-b4c1-11cde5539abb" } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/1f8b50da-9780-4aa6-be61-d9727f275d3e", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "meta": { "lastUpdated": "2022-12-14T16:33:39.416+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-drug-use-frequency", "name": "ObservationDrugUseFrequency", "status": "draft", "date": "2022-06-30T18:37:43.6867192+00:00", "description": "This aligns closely with the TELUS DW profile", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "min": 1, "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "comment": "Usage: When the profile is specified in the message instance, it may be validated against the profile.\r\nIt 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.", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted PSS -->FHIR \r\nNeeds Review, unfinished --> Final \r\nUpdated --> amended - only if delta is being send \r\ndeleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nMA --> FHIR \r\nActive --> Final \r\ndeleted --> entered-in-error - only if delta is being send\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.\r\n\r\nConformance Rule - PSS status for active risk factors the status should be final. For updated risk factor the status should be updated to amended", "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "mustSupport": true }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "mustSupport": true }, { "id": "Observation.code.coding.system", "path": "Observation.code.coding.system", "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage note - use valueCodeableConcept\r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" } ] }, "id": "1f8b50da-9780-4aa6-be61-d9727f275d3e" } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/RPSObservationPS", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "RPSObservationPS", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.416+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-pregnancy-status", "name": "ObservationPregnancyStatus", "status": "draft", "date": "2022-05-24T18:33:49.7654611+00:00", "description": "This profile is based on the RAPIDs profile for Pregnancy Status.", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "min": 1, "mustSupport": true }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "min": 1, "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "min": 1, "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "mustSupport": true }, { "id": "Observation.contained", "path": "Observation.contained", "max": "1" }, { "id": "Observation.extension", "path": "Observation.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "Observation.extension:episodeOfCare", "path": "Observation.extension", "sliceName": "episodeOfCare", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare" ] } ], "isModifier": false }, { "id": "Observation.extension:episodeOfCare.value[x].reference", "path": "Observation.extension.value[x].reference", "mustSupport": true }, { "id": "Observation.basedOn", "path": "Observation.basedOn", "max": "1" }, { "id": "Observation.code", "path": "Observation.code", "mustSupport": true }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "min": 1 }, { "id": "Observation.code.coding.system", "path": "Observation.code.coding.system", "min": 1, "fixedUri": "http://loinc.org", "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "min": 1, "fixedCode": "82810-3", "mustSupport": true }, { "id": "Observation.code.coding.display", "path": "Observation.code.coding.display", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "mustSupport": true }, { "id": "Observation.subject.reference", "path": "Observation.subject.reference", "mustSupport": true }, { "id": "Observation.focus", "path": "Observation.focus", "max": "1" }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "type": [ { "code": "dateTime" } ], "mustSupport": true }, { "id": "Observation.performer", "path": "Observation.performer", "max": "1" }, { "id": "Observation.performer.id", "path": "Observation.performer.id", "max": "0" }, { "id": "Observation.performer.type", "path": "Observation.performer.type", "max": "0" }, { "id": "Observation.performer.identifier", "path": "Observation.performer.identifier", "max": "0" }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "type": [ { "code": "CodeableConcept" } ], "mustSupport": false }, { "id": "Observation.value[x].coding.system", "path": "Observation.value[x].coding.system", "fixedUri": "http://loinc.org" }, { "id": "Observation.value[x].coding.code", "path": "Observation.value[x].coding.code", "mustSupport": true, "binding": { "strength": "required", "description": "IPS Pregnancy Status", "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/pregnancy-status-uv-ips" } }, { "id": "Observation.value[x].coding.display", "path": "Observation.value[x].coding.display", "mustSupport": true, "binding": { "strength": "required", "description": "IPS Pregnancy Status", "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/pregnancy-status-uv-ips" } }, { "id": "Observation.value[x].text", "path": "Observation.value[x].text", "mustSupport": true }, { "id": "Observation.interpretation.id", "path": "Observation.interpretation.id", "max": "0" }, { "id": "Observation.note", "path": "Observation.note", "max": "1" }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" }, { "id": "Observation.hasMember", "path": "Observation.hasMember", "max": "0" }, { "id": "Observation.derivedFrom", "path": "Observation.derivedFrom", "max": "1" }, { "id": "Observation.component", "path": "Observation.component", "max": "0" } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/3d60daa6-9799-441e-8d52-2ada04360be2", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "3d60daa6-9799-441e-8d52-2ada04360be2", "meta": { "lastUpdated": "2022-12-14T16:33:39.417+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-social-history", "name": "ObservationSocialHistory", "status": "draft", "date": "2022-05-31T20:00:20.7714514+00:00", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation", "path": "Observation", "comment": "Usage Notes: . This profile may be used for other observations pertaining to social history excluding tobacco, alcohol and drug abuse. This will be used to record diet, exercise, personal history such as occupation, education, etc.\r\n\r\nNote: There are profiles defined specifically for vital signs (height, weight, bp, etc) tobacco use, alcohol use and drug use which should be used.\r\n\r\nUsed for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc." }, { "id": "Observation.id", "path": "Observation.id", "comment": "Usage Note: This will usually be a GUID that is assigned by the sending application.\r\n\r\nThe only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.id", "path": "Observation.meta.id", "mustSupport": true }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "min": 1, "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "min": 1, "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted\r\nPSS -->FHIR\r\nNeeds Review, unfinished --> Final\r\nUpdated --> amended - only if delta is being send\r\ndeleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nMA --> FHIR\r\nActive --> Final\r\ndeleted --> entered-in-error - only if delta is being send\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "comment": "Usage note : Lifestyle, social history and personal traits category in EMRs will map to social-history category in FHIR\r\n\r\nIn addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.", "mustSupport": true }, { "id": "Observation.category.coding", "path": "Observation.category.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Observation.category.coding.system", "path": "Observation.category.coding.system", "min": 1, "fixedUri": "http://terminology.hl7.org/CodeSystem/observation-category", "mustSupport": true }, { "id": "Observation.category.coding.code", "path": "Observation.category.coding.code", "min": 1, "fixedCode": "social-history", "mustSupport": true }, { "id": "Observation.category.coding.display", "path": "Observation.category.coding.display", "comment": "Usage: Social History Narrartive\r\nNote that FHIR strings SHALL NOT exceed 1MB in size" }, { "id": "Observation.code", "path": "Observation.code", "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "min": 1, "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Useage note: MA - TBD\r\nPSS - description (to fit in profile) text field \r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" }, { "id": "Observation.hasMember", "path": "Observation.hasMember", "mustSupport": true }, { "id": "Observation.hasMember.reference", "path": "Observation.hasMember.reference", "mustSupport": true }, { "id": "Observation.hasMember.display", "path": "Observation.hasMember.display", "mustSupport": true }, { "id": "Observation.derivedFrom", "path": "Observation.derivedFrom", "max": "0" } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/5a2b6012-9ee1-4c4d-af8c-cb89d398a17e", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "meta": { "lastUpdated": "2022-12-14T16:33:39.417+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-tobacco-use", "name": "ObservationTobaccoUse", "title": "Observation Tobacco Use", "status": "draft", "date": "2022-05-30T19:52:59.7470191+00:00", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.id", "path": "Observation.meta.id", "min": 1 }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "min": 1, "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted PSS -->FHIR Needs Review, unfinished --> Final Updated --> amended - only if delta is being send deleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "comment": "social-history\r\nIn addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.", "fixedCodeableConcept": { "text": "social-history" }, "mustSupport": true }, { "id": "Observation.category.coding", "path": "Observation.category.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Observation.category.coding.system", "path": "Observation.category.coding.system", "min": 1, "fixedUri": "http://terminology.hl7.org/CodeSystem/observation-category", "mustSupport": true }, { "id": "Observation.category.coding.code", "path": "Observation.category.coding.code", "min": 1, "fixedCode": "social-history", "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "mustSupport": true }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "mustSupport": true }, { "id": "Observation.code.coding.system", "path": "Observation.code.coding.system", "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "comment": "88028-6 Tobacco use panel\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Observation.subject.reference", "path": "Observation.subject.reference", "mustSupport": true }, { "id": "Observation.subject.display", "path": "Observation.subject.display", "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "comment": "Useage Note - Provide encounter for MA if available\r\n\r\nThis will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).", "mustSupport": true }, { "id": "Observation.encounter.reference", "path": "Observation.encounter.reference", "mustSupport": true }, { "id": "Observation.encounter.display", "path": "Observation.encounter.display", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "min": 1, "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage note - PSS provide description text MA - smoking status observation + comment\r\nAlignment: Not supported in PS-CA\r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "min": 1, "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "comment": "Usage Note: PSS provide Details if documented MA: Provide note in the task (on the left)\r\n\r\nMay include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" }, { "id": "Observation.hasMember", "path": "Observation.hasMember", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Observation", "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse", "http://telus.com/fhir/patientChart/StructureDefinition/observation-tobacco-use-cigarettes-per-day", "http://telus.com/fhir/patientChart/StructureDefinition/observation-tobacco-use-current-status", "http://telus.com/fhir/patientChart/StructureDefinition/observation-tobacco-use-pack-years", "http://telus.com/fhir/patientChart/StructureDefinition/observation-tobacco-use-tobacco-product" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Observation.derivedFrom", "path": "Observation.derivedFrom", "max": "0" } ] }, "id": "5a2b6012-9ee1-4c4d-af8c-cb89d398a17e" } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/4bc1f8e9-8ffd-41fc-a4ad-fae2eca4c8a2", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "meta": { "lastUpdated": "2022-12-14T16:33:39.417+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-tobacco-use-cigarettes-per-day", "name": "ObservationTobaccoUseCigarettesPerDay", "status": "draft", "date": "2022-07-05T20:06:30.612362+00:00", "description": "This profile aligns closely with the TELUS DW profile", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta" }, { "id": "Observation.meta.id", "path": "Observation.meta.id", "min": 1 }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "min": 1 }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "min": 1 }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted PSS -->FHIR Needs Review, unfinished --> Final Updated --> amended - only if delta is being send deleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid." }, { "id": "Observation.category", "path": "Observation.category", "comment": "social-history\r\nIn addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.", "fixedCodeableConcept": { "text": "social-history" }, "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "comment": "63640-7 How many cigarettes per day do, or did, you smoke\r\n\r\n*All* code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation." }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "comment": "8663-7 Cigarettes smoked current (pack per day) - Reported\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size" }, { "id": "Observation.code.text", "path": "Observation.code.text", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "comment": "Useage Note - Provide encounter for MA if available\r\n\r\nThis will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "mustSupport": true }, { "id": "Observation.issued", "path": "Observation.issued", "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage note - Use value String\r\n\r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" }, { "id": "Observation.derivedFrom", "path": "Observation.derivedFrom", "max": "0" } ] }, "id": "4bc1f8e9-8ffd-41fc-a4ad-fae2eca4c8a2" } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/2aaf5225-083b-415e-943b-8728d19d3a25", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "meta": { "lastUpdated": "2022-12-14T16:33:39.418+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-tobacco-use-current-status", "name": "ObservationTobaccoUseCurrentStatus", "status": "draft", "date": "2022-06-30T20:54:40.1081922+00:00", "description": "This profile aligns closely with the TELUS DW profile", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.id", "path": "Observation.meta.id", "min": 1 }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "min": 1 }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted PSS -->FHIR Needs Review, unfinished --> Final Updated --> amended - only if delta is being send deleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "comment": "social-history\r\nIn addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.", "fixedCodeableConcept": { "text": "social-history" }, "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "comment": "72166-2 Tobacco smoking status\r\n*All* code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.", "mustSupport": true }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "mustSupport": true }, { "id": "Observation.code.coding.system", "path": "Observation.code.coding.system", "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "comment": "63638-1 Tobacco smoking status\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Observation.code.coding.display", "path": "Observation.code.coding.display", "comment": "Set value = Tobacco smoking status\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "comment": "Useage Note - Provide encounter for MA if available\r\n\r\nThis will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "min": 1, "mustSupport": true }, { "id": "Observation.issued", "path": "Observation.issued", "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage note - Use valueCodeableConcept, provide smoking status + comment as text\r\n \r\n266919005 Never smoked tobacco\r\n8392000 Non-smoker\r\n281018007 Ex-cigarette smoker \r\n\r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "type": [ { "code": "CodeableConcept" }, { "code": "string" } ], "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" }, { "id": "Observation.derivedFrom", "path": "Observation.derivedFrom", "max": "0" } ] }, "id": "2aaf5225-083b-415e-943b-8728d19d3a25" } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/3e061c2e-9f76-41fa-93c8-8bbe7bf36e58", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "meta": { "lastUpdated": "2022-12-14T16:33:39.418+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-tobacco-use-pack-years", "name": "ObservationTobaccoUsePackYears", "status": "draft", "date": "2022-07-06T13:22:00.1596883+00:00", "description": "This profile aligns closely with the TELUS DW profile", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.id", "path": "Observation.meta.id", "min": 1 }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "min": 1 }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted PSS -->FHIR Needs Review, unfinished --> Final Updated --> amended - only if delta is being send deleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "comment": "social-history\r\nIn addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.", "fixedCodeableConcept": { "text": "social-history" }, "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "comment": "Snomed 401201003 Cigarette pack-years\r\n*All* code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.", "mustSupport": true }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "mustSupport": true }, { "id": "Observation.code.coding.system", "path": "Observation.code.coding.system", "fixedUri": "http://snomed.info/sct", "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "comment": "8664-5 Cigarettes smoked total (pack per year) - Reported\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Observation.code.coding.display", "path": "Observation.code.coding.display", "comment": "Set value = Cigarettes smoked total (pack per year) - Reported\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "comment": "Useage Note - Provide encounter for MA if available\r\n\r\nThis will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "mustSupport": true }, { "id": "Observation.issued", "path": "Observation.issued", "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage note - ValueQuantity\r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "type": [ { "code": "Quantity" } ], "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" }, { "id": "Observation.derivedFrom", "path": "Observation.derivedFrom", "max": "0" } ] }, "id": "3e061c2e-9f76-41fa-93c8-8bbe7bf36e58" } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/a81c3cc9-4148-4b0f-9e87-292fbaaa82ed", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "meta": { "lastUpdated": "2022-12-14T16:33:39.418+00:00", "versionId": "1" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-tobacco-use-tobacco-product", "name": "ObservationTobaccoUseTobaccoProduct", "status": "draft", "date": "2022-06-30T20:54:40.1081922+00:00", "description": "This profile aligns closely with the TELUS DW profile", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.id", "path": "Observation.meta.id", "min": 1 }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "min": 1 }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "mustSupport": true }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note - Historical load do not send the deleted entries. For delta send all updated resource including deleted PSS -->FHIR Needs Review, unfinished --> Final Updated --> amended - only if delta is being send deleted --> entered-in-error - only if delta is being send TBD question for Lloyd\r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "comment": "social-history\r\nIn addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.", "fixedCodeableConcept": { "text": "social-history" }, "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "comment": "81228-9 Tobacco product\r\n*All* code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.", "mustSupport": true }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "mustSupport": true }, { "id": "Observation.code.coding.system", "path": "Observation.code.coding.system", "mustSupport": true }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "comment": "code 81228-9 Tobacco product\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "fixedCode": "365981007", "mustSupport": true }, { "id": "Observation.code.coding.display", "path": "Observation.code.coding.display", "comment": "Set value = Tobacco product\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "mustSupport": true }, { "id": "Observation.encounter", "path": "Observation.encounter", "comment": "Useage Note - Provide encounter for MA if available\r\n\r\nThis will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).", "mustSupport": true }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "mustSupport": true }, { "id": "Observation.issued", "path": "Observation.issued", "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "Usage note - PSS provide description text MA - smoking status observation + comment\r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "type": [ { "code": "string" } ], "mustSupport": true }, { "id": "Observation.note", "path": "Observation.note", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "max": "0" }, { "id": "Observation.specimen", "path": "Observation.specimen", "max": "0" }, { "id": "Observation.device", "path": "Observation.device", "max": "0" }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "max": "0" }, { "id": "Observation.derivedFrom", "path": "Observation.derivedFrom", "max": "0" } ] }, "id": "a81c3cc9-4148-4b0f-9e87-292fbaaa82ed" } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-observation-vitals-patientchart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-observation-vitals-patientchart", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.418+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-observation-vitals", "name": "ObservationVitals", "title": "Observation Vitals Patient Chart", "status": "draft", "date": "2021-03-01T20:13:35.2658231+00:00", "description": "Observations defined for use in the TELUS Patient Chart for conveying Vital Signs", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "differential": { "element": [ { "id": "Observation", "path": "Observation", "comment": "Usage Note: For Blood Pressure, follow the structure https://build.fhir.org/bp.html, where we use the panel code https://loinc.org/85354-9/ and then specify systolic and diastolic components. We will use a data absent reason (unknown) if diastolic is not present. Mean blood pressure can be sent as a stand-alone observation or could be an additional component if calculated at the same time as BP. Examples of other components that may be recorded as part of the BP reading are: position with respect to gravity, anotomical site (left/right arm).\r\n\r\nUsed for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.", "mustSupport": true }, { "id": "Observation.id", "path": "Observation.id", "mustSupport": true }, { "id": "Observation.meta", "path": "Observation.meta", "mustSupport": true }, { "id": "Observation.meta.lastUpdated", "path": "Observation.meta.lastUpdated", "mustSupport": true }, { "id": "Observation.meta.source", "path": "Observation.meta.source", "mustSupport": true }, { "id": "Observation.meta.profile", "path": "Observation.meta.profile", "comment": "Usage Note: This might be used during testing, when implementers wish to specify a more detailed HL7 vitals profile and test using the FHIR validator\r\n\r\nIt 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.", "mustSupport": true }, { "id": "Observation.text", "path": "Observation.text", "comment": "Usage Note: This should always be sent; there is no expectation that this will be there on the response.\r\n\r\nContained 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.", "mustSupport": true }, { "id": "Observation.identifier", "path": "Observation.identifier", "comment": "Usage Note: A universal identifier (PLAC or FILL) must be present when known. By example, if the originating system was a lab and the lab results includes an identifier this must be sent..", "max": "1" }, { "id": "Observation.status", "path": "Observation.status", "comment": "Usage Note: For labs, a mapping of preliminary and final are common and can be mapped within the EMR. 99.9% of the cases, final is the correct value but in rare cases another value may be more appropriate.\r\n\r\nEMR Mapping spreadsheet\r\nPSS: 99% of time this will be set to final\r\nMA: Coding is mixed; \r\nFHIR->MA\r\nregistered-> LL - Registered means that the lab has it but waiting on a result; typiclly only used inside the lab\r\npreliminary->preliminary\r\nfinal->Final\r\namended->Corrected?\r\n->cancelled\r\n->incomplete\r\n->not done\r\n->partial\r\n->received\r\n->stored\r\n->booked\r\n->done\r\n-> pending \r\n\r\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "mustSupport": true }, { "id": "Observation.category", "path": "Observation.category", "comment": "EMR API - Category\r\nMA: TBC\r\nPSS: \r\nMS: Can be derived\r\n\r\nIn addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.", "min": 1, "max": "1", "fixedCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "vital-signs" } ] }, "mustSupport": true }, { "id": "Observation.category.coding", "path": "Observation.category.coding", "mustSupport": true }, { "id": "Observation.category.text", "path": "Observation.category.text", "mustSupport": true }, { "id": "Observation.code", "path": "Observation.code", "comment": "**Terminology: May wish to create a TELUS value set and add missing values, eg HIP measurement, Waist measurement, etc; import FHIR vitals plus the newbies\r\n\r\nUsage Rule: Additonal Codings are allowed in Observation.code- e.g. more specific LOINC Codes, SNOMED CT concepts, system specific codes. \r\nExample: For weight, the LOINC code of 29463-7 must be specified and an additional code of 8339-4, \"Birth Weight Measured\" may also be sent.\r\n\r\nConformance Rule: The local code must always be sent for codified values. \r\nTBC - Usage Note: If the same observation code is documented several times the the POS, it must be sent multiple times.\r\n\r\nUsage: LOINC (example)\r\nhttp://hl7.org/fhir/ValueSet/observation-codes >1000 codes\r\nMA: loinc (most common), ICD-9, snomed,type code, atc class, workload, and no codes as well\r\nPSS: PSS: Custom codes may not have a code and only text would be conveyed. H for standard vitals\r\nMS: PCLOCD, ICD-10\r\n\r\n*All* code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.", "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult" } }, { "id": "Observation.code.coding", "path": "Observation.code.coding", "comment": "Usage Note: There is an expectation that you must always send the high level LOINC code; a second coding should be present to represent the \"reported\" LOINC value. Example: this could occur when a value is extracted from a specialist report and sent as a \"reported\" observation rather than a measured observation.\r\n\r\nCodes 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.", "mustSupport": true }, { "id": "Observation.code.coding.system", "path": "Observation.code.coding.system", "min": 1, "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "http://loinc.org" } }, { "id": "Observation.code.coding.code", "path": "Observation.code.coding.code", "min": 1, "mustSupport": true }, { "id": "Observation.code.text", "path": "Observation.code.text", "comment": "Usage Note: Text is mandatory as it is important to convey exactly what the clinican entered or selected. Example: Weight will often have further meaning such as Pre-Pregnancy Weight, Discharge Weight, Birth weight, current weight, etc.\r\n\r\nTBC - If height is recorded as 6'2, do we want it here? or should we capture specifically with the quantity?\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "Observation.subject", "path": "Observation.subject", "min": 1, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Observation.subject.reference", "path": "Observation.subject.reference", "mustSupport": true }, { "id": "Observation.subject.display", "path": "Observation.subject.display", "comment": "Usage Note: This should contain the name of the Patient, which can then be used in narrative where applicable\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "Observation.focus", "path": "Observation.focus", "comment": "FDG/Jim - we don't think we need to support this; convey via text. System likely do not support a separate field for fetus; we would need to infer from coding?\r\n\r\nTypically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., \"Blood Glucose\") and does not need to be represented separately using this element. Use `specimen` if a reference to a specimen is required. If a code is required instead of a resource use either `bodysite` for bodysites or the standard extension [focusCode](extension-observation-focuscode.html)." }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "comment": "Usage: Mandatory when sending data and must be a dateTime. \r\n\r\nEMRAPI - effectiveDateTime\r\nEffective period, instant and timing are removed as DTs; not supported by EMRs or API\r\n\r\nAt least a date should be present unless this observation is a historical report. For recording imprecise or \"fuzzy\" times (For example, a blood glucose measurement taken \"after breakfast\") use the [Timing](datatypes.html#timing) datatype which allow the measurement to be tied to regular life events.", "type": [ { "code": "dateTime" } ], "mustSupport": true }, { "id": "Observation.performer", "path": "Observation.performer", "mustSupport": true }, { "id": "Observation.performer.reference", "path": "Observation.performer.reference", "comment": "Discussion requried - if this is important, we can maybe work this out \r\n\r\nUsing absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "mustSupport": true }, { "id": "Observation.performer.display", "path": "Observation.performer.display", "mustSupport": true }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "comment": "???????????????/ still thinking - can the text go in value as an extension? is it captured this way or should this be part of \"Note\" associated with the entire observation?\r\n\r\nANNE - add text value for weight profile to record \"6'2\" - which is then convered\r\nHeight - typically three ways to measure: eg 172cm = inches = 68 and = feet and inches - 5'8\" or 5ft 8in. This will be conveyed as quanity.text (extension).\r\nWeight - 5lb 3oz, or 5'3\" \r\n\r\nConformance Rule: If no value is present, a dataAbsentReason should be populated.\r\n\r\nEMRAPI - valueQuantity\r\nEMRAPI: valueString - PSS: BP is extracted as a value string after the colon. Syntax is BP: value or T: value\r\nEMRAPI: valueDateTime\r\nEMRAPI: valueBoolean\r\nInteger and Range are not supported in the API\r\nVitals will always be quantities - ANNE CHECK HL7 PROFILE\r\nValue string is used for Blood Pressure\r\n\r\nPSS: Unit of valueQuantity is not extracted therefor confidence is 'L'. In PSS unless otherwise specified all units are assumed to be kg.\r\nMS: \r\n\r\nDiscussion: confirm if we take anythign out of scope or leave it for future; \r\n\r\nJason/Anne - add UCUM - as mandatory\r\n\r\nAn observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "type": [ { "code": "Quantity" } ], "mustSupport": true }, { "id": "Observation.dataAbsentReason", "path": "Observation.dataAbsentReason", "comment": "Usage Note: Use a value of \"unknown\" where diastolic would normally be present but is not stored in the EMR.\r\n\r\nNull or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be \"detected\", \"not detected\", \"inconclusive\", or \"specimen unsatisfactory\". \n\nThe alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code \"error\" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.", "mustSupport": true }, { "id": "Observation.dataAbsentReason.coding", "path": "Observation.dataAbsentReason.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Observation.dataAbsentReason.coding.system", "path": "Observation.dataAbsentReason.coding.system", "min": 1 }, { "id": "Observation.dataAbsentReason.coding.code", "path": "Observation.dataAbsentReason.coding.code", "min": 1, "mustSupport": true }, { "id": "Observation.dataAbsentReason.text", "path": "Observation.dataAbsentReason.text", "comment": "Usage note: This is used in the Observation.text instead of the code.\r\n\r\nVery often the text is the same as a displayName of one of the codings." }, { "id": "Observation.interpretation", "path": "Observation.interpretation", "comment": "Usage Note: This is not supported in PSS; MA, MS for vitals as a discrete data element; this information would be buried in text. \r\nIf the EMR has this in an accessible manner, eg on custom forms such as a Chronic Disease Management forms this may be included.\r\n\r\nHistorically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result." }, { "id": "Observation.note", "path": "Observation.note", "comment": "Usage Note: This will be supported by MA as there is a single note per vital. PSS does not have a vital note and therefore cannot support this; in PSS, this is entered in context of an encounter note. MS have a single note shared across multiple vitals; may attach the note to all vitals.\r\n\r\nConformance Rule: Must be displayed to recipient.\r\n\r\nEMRAPI: notes\r\n\r\nMay include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.", "mustSupport": true }, { "id": "Observation.note.time", "path": "Observation.note.time", "mustSupport": true }, { "id": "Observation.note.text", "path": "Observation.note.text", "mustSupport": true }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "comment": "EMRAPI: not supproted\r\nPSS does have custom user created stamps but as these are customized they aren't reliable as discrete data. MA does not support this today.\r\nOnly used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. \n\nIf the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension[ bodySite](extension-bodysite.html)." }, { "id": "Observation.bodySite.text", "path": "Observation.bodySite.text", "mustSupport": true }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "comment": "Usage Note: Some EMRs (eg MA) will have the ability to specify the reference range on a vital. This is rare but will be sent if it has been specified. \r\n\r\n\r\nMost observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.", "mustSupport": true }, { "id": "Observation.referenceRange.low", "path": "Observation.referenceRange.low", "mustSupport": true }, { "id": "Observation.referenceRange.high", "path": "Observation.referenceRange.high", "mustSupport": true }, { "id": "Observation.referenceRange.text", "path": "Observation.referenceRange.text", "mustSupport": true }, { "id": "Observation.component", "path": "Observation.component", "requirements": "Usage: For BP, the panel code of https://loinc.org/85354-9 can be used; with components to specifiy systolic and diastolic components. Use a data absent reason if diastolic is not present. Alignment: This aligns with the base FHIR profile: https://build.fhir.org/bp.html\r\n\r\nMRAPI: *.component\r\nMS: Patient Summary-> Clinical Data -> vital signs->blood pressure\r\nPSS: BP comes back as a valueString but we can derive componebt by parsing the string. Systolic is numerator and diastolic is the denominator.\r\nMA: ???\r\n\r\n\r\nComponent observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.", "mustSupport": true }, { "id": "Observation.component.code", "path": "Observation.component.code", "comment": "EMRAPI: *.component.code\r\nLOINC (example)\r\nhttp://hl7.org/fhir/ValueSet/observation-codes\r\n1000+ codes\r\nMA: \r\nPSS:\r\nMS: Does not support \"mean blood pressure\". What happens when receiving this data?\r\n\r\nUsage Rule: Send th preferred code where possible; alway include a local code when available and minimally text\r\n\r\n*All* code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.", "mustSupport": true, "binding": { "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/observation-vitalsignresult" } }, { "id": "Observation.component.code.coding", "path": "Observation.component.code.coding", "mustSupport": true }, { "id": "Observation.component.code.coding.system", "path": "Observation.component.code.coding.system", "mustSupport": true }, { "id": "Observation.component.code.coding.code", "path": "Observation.component.code.coding.code", "mustSupport": true }, { "id": "Observation.component.code.coding.display", "path": "Observation.component.code.coding.display", "mustSupport": true }, { "id": "Observation.component.code.text", "path": "Observation.component.code.text", "min": 1, "mustSupport": true }, { "id": "Observation.component.value[x]", "path": "Observation.component.value[x]", "comment": "EMRAPI: *.component.valueQuantity\r\nEMRAPI: *.component.valueString\r\nEMRAPI: does not support dateTime or Integers\r\nMA: only numerics are allowed\r\n\r\nRules for receiving \r\n\r\nConformance Rule: For blood pressure - o\r\n\r\nUsed when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "mustSupport": true }, { "id": "Observation.component.dataAbsentReason", "path": "Observation.component.dataAbsentReason", "mustSupport": true }, { "id": "Observation.component.dataAbsentReason.coding", "path": "Observation.component.dataAbsentReason.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Observation.component.dataAbsentReason.coding.system", "path": "Observation.component.dataAbsentReason.coding.system", "min": 1, "fixedUri": "http://terminology.hl7.org/CodeSystem/data-absent-reason", "mustSupport": true }, { "id": "Observation.component.dataAbsentReason.coding.code", "path": "Observation.component.dataAbsentReason.coding.code", "min": 1, "mustSupport": true }, { "id": "Observation.component.interpretation", "path": "Observation.component.interpretation", "comment": "EMRAPI: Interpretation\r\nUsage Notes: This is used for lab results\r\n\r\nHistorically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result." }, { "id": "Observation.component.interpretation.coding", "path": "Observation.component.interpretation.coding", "mustSupport": true }, { "id": "Observation.component.interpretation.coding.system", "path": "Observation.component.interpretation.coding.system", "min": 1, "mustSupport": true }, { "id": "Observation.component.interpretation.coding.code", "path": "Observation.component.interpretation.coding.code", "min": 1, "mustSupport": true }, { "id": "Observation.component.interpretation.coding.display", "path": "Observation.component.interpretation.coding.display", "min": 1, "mustSupport": true }, { "id": "Observation.component.interpretation.text", "path": "Observation.component.interpretation.text", "mustSupport": true }, { "id": "Observation.component.referenceRange", "path": "Observation.component.referenceRange", "comment": "EMRAPI: referenceRangeLow, referenceRangeHigh\r\nUsage: This is supported for lab; but not often used for vitals. Some EMRs will allow for this\r\n\r\nMost observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.", "contentReference": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.referenceRange", "mustSupport": true }, { "id": "Observation.component.referenceRange.low", "path": "Observation.component.referenceRange.low", "mustSupport": true }, { "id": "Observation.component.referenceRange.high", "path": "Observation.component.referenceRange.high", "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-operationoutcome", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-operationoutcome", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.419+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-operation-outcome", "name": "OperationOutcome", "title": "Operation Outcome", "status": "draft", "date": "2021-03-01T20:14:20.3259726+00:00", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" } ], "kind": "resource", "abstract": false, "type": "OperationOutcome", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/OperationOutcome", "derivation": "constraint", "differential": { "element": [ { "id": "OperationOutcome.id", "path": "OperationOutcome.id", "min": 1, "mustSupport": true }, { "id": "OperationOutcome.meta", "path": "OperationOutcome.meta", "mustSupport": true }, { "id": "OperationOutcome.meta.lastUpdated", "path": "OperationOutcome.meta.lastUpdated", "mustSupport": true }, { "id": "OperationOutcome.meta.source", "path": "OperationOutcome.meta.source", "mustSupport": true }, { "id": "OperationOutcome.issue", "path": "OperationOutcome.issue", "mustSupport": true }, { "id": "OperationOutcome.issue.extension", "path": "OperationOutcome.issue.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "OperationOutcome.issue.extension:UserFriendlyText", "path": "OperationOutcome.issue.extension", "sliceName": "UserFriendlyText", "definition": "This captures a user friendly message that is intended to be displayed to the user", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-operationoutcome-usertext" ] } ], "mustSupport": true, "isModifier": false }, { "id": "OperationOutcome.issue.extension:ReferenceNumber", "path": "OperationOutcome.issue.extension", "sliceName": "ReferenceNumber", "definition": "This can be used to convey a reference number for the issues. This can be displayed to the user and can be relayed to customer service representatives to expedite trouble shooting should an issue arise.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-operationoutcome-referencenum" ] } ], "mustSupport": true, "isModifier": false }, { "id": "OperationOutcome.issue.severity", "path": "OperationOutcome.issue.severity", "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://telus.com/fhir/ValueSet/telus-operationoutcome-issue-severity" } }, { "id": "OperationOutcome.issue.code", "path": "OperationOutcome.issue.code", "comment": "Conformance Rule: Receiving systems must take corrective action based upon the code indicated. Retries with the same content are permissible for 'transient' errors. For 'invalid' and 'processing' errors, retries are not permitted as they are likely to result in the same error. Corrective action by the system or user must first be taken.", "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://telus.com/fhir/ValueSet/telus-operationoutcome-issue-type" } }, { "id": "OperationOutcome.issue.details", "path": "OperationOutcome.issue.details", "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "http://telus.com/fhir/ValueSet/telus-operationoutcome-details" } }, { "id": "OperationOutcome.issue.details.coding", "path": "OperationOutcome.issue.details.coding", "mustSupport": true }, { "id": "OperationOutcome.issue.details.coding.system", "path": "OperationOutcome.issue.details.coding.system", "min": 1, "mustSupport": true }, { "id": "OperationOutcome.issue.details.coding.code", "path": "OperationOutcome.issue.details.coding.code", "min": 1, "mustSupport": true }, { "id": "OperationOutcome.issue.details.text", "path": "OperationOutcome.issue.details.text", "min": 1, "maxLength": 1000, "mustSupport": true }, { "id": "OperationOutcome.issue.details.text.extension", "path": "OperationOutcome.issue.details.text.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "OperationOutcome.issue.details.text.extension:DetailsTextTranslation", "path": "OperationOutcome.issue.details.text.extension", "sliceName": "DetailsTextTranslation", "comment": "Usage Note: This is being deprecated and is not likely to be populated. POS vendors are not expected to populate this.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/translation" ] } ], "mustSupport": true }, { "id": "OperationOutcome.issue.diagnostics", "path": "OperationOutcome.issue.diagnostics", "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-organization-patientchart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-organization-patientchart", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.419+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-organization", "name": "Organization", "title": "TELUS Organization eServices", "status": "draft", "date": "2022-03-29T18:02:59.3384868Z", "fhirVersion": "4.0.1", "mapping": [ { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "servd", "uri": "http://www.omg.org/spec/ServD/1.0/", "name": "ServD" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" } ], "kind": "resource", "abstract": false, "type": "Organization", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Organization", "derivation": "constraint", "differential": { "element": [ { "id": "Organization", "path": "Organization", "comment": "Conformance Rule: This is the full url returned in the TPR query response. Example: https://api.telus.com/rest/v1/preconf/THP/TPRMD_vs1/r4/Organization/EMRClinic1CPRID", "mustSupport": true }, { "id": "Organization.id", "path": "Organization.id", "mustSupport": true }, { "id": "Organization.meta", "path": "Organization.meta", "mustSupport": true }, { "id": "Organization.meta.lastUpdated", "path": "Organization.meta.lastUpdated", "comment": "Conformance Rule: Where known, this must be supplied.\r\n\r\nThis value is always populated except when the resource is first being created. 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.html#read) interaction.", "mustSupport": true }, { "id": "Organization.meta.source", "path": "Organization.meta.source", "comment": "Usage: Where known this must be supplied\r\n\r\nIn the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. \n\nThis 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.", "mustSupport": true }, { "id": "Organization.meta.profile", "path": "Organization.meta.profile", "comment": "Usage Note: This should be provided in order to identify the resource profile.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "Organization.text", "path": "Organization.text", "mustSupport": true }, { "id": "Organization.text.status", "path": "Organization.text.status", "mustSupport": true }, { "id": "Organization.text.div", "path": "Organization.text.div", "mustSupport": true }, { "id": "Organization.identifier", "path": "Organization.identifier", "short": "Identifies this organization across multiple systems", "comment": "Usage Note: If a business identifier is available, this may be populated as agreed to by each implementer.\r\nUsage Note: This is the Main/Parent Location which is essentially a separate office that shares the same server. Note: In some cases the sub-location may also be used", "mustSupport": true }, { "id": "Organization.identifier.system", "path": "Organization.identifier.system", "comment": "Usage Note: urn:telus:emr:::organization\r\n\r\ndentifier.system is always case sensitive.\r\n\r\nExample: urn:telus:emr:ma::emr-organization, where value could be labtestsk1", "mustSupport": true }, { "id": "Organization.identifier.value", "path": "Organization.identifier.value", "comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.", "min": 1, "mustSupport": true }, { "id": "Organization.active", "path": "Organization.active", "mustSupport": true }, { "id": "Organization.type", "path": "Organization.type", "comment": "TBD - review and finalize codes - start with TELUS code set - look at http://telus.com/fhir/ValueSet/telus-organization-type\r\n\r\nOrganizations can be corporations, wards, sections, clinical teams, government departments, etc. Note that code is generally a classifier of the type of organization; in many applications, codes are used to identity a particular organization (say, ward) as opposed to another of the same type - these are identifiers, not codes\n\nWhen considering if multiple types are appropriate, you should evaluate if child organizations would be a more appropriate use of the concept, as different types likely are in different sub-areas of the organization. This is most likely to be used where type values have orthogonal values, such as a religious, academic and medical center.\n\nWe expect that some jurisdictions will profile this optionality to be a single cardinality.", "mustSupport": true, "binding": { "strength": "required" } }, { "id": "Organization.type.coding", "path": "Organization.type.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Organization.type.coding.system", "path": "Organization.type.coding.system", "min": 1, "mustSupport": true }, { "id": "Organization.type.coding.code", "path": "Organization.type.coding.code", "min": 1, "mustSupport": true }, { "id": "Organization.type.coding.display", "path": "Organization.type.coding.display", "mustSupport": true }, { "id": "Organization.name", "path": "Organization.name", "comment": "Conformance Rule: The may include the Clinic name as known to the Vendor. As this is a string data type, reminder to structure for readability and presentation.\r\n\r\nIf the name of an organization changes, consider putting the old name in the alias column so that it can still be located through searches.", "min": 1, "maxLength": 100, "mustSupport": true }, { "id": "Organization.telecom", "path": "Organization.telecom", "comment": "Usage Note: This is used to specify the public Clinic telephone number or fax number. This data may be considered sensitive and therefore is only supported in some cases.\r\n\r\nAlignment: This is supported for eReferral in Ontario\r\n\r\nContactPoint.use code 'home' is not to be used. Note that these contacts are not the contact details of people who are employed by or represent the organization, but official contacts for the organization itself.", "mustSupport": true }, { "id": "Organization.telecom.system", "path": "Organization.telecom.system", "min": 1, "mustSupport": true }, { "id": "Organization.telecom.value", "path": "Organization.telecom.value", "min": 1, "mustSupport": true }, { "id": "Organization.telecom.use", "path": "Organization.telecom.use", "mustSupport": true }, { "id": "Organization.telecom.period", "path": "Organization.telecom.period", "mustSupport": true }, { "id": "Organization.telecom.period.start", "path": "Organization.telecom.period.start", "min": 1, "mustSupport": true }, { "id": "Organization.telecom.period.end", "path": "Organization.telecom.period.end", "mustSupport": true }, { "id": "Organization.address", "path": "Organization.address", "mustSupport": true }, { "id": "Organization.address.text", "path": "Organization.address.text", "mustSupport": true }, { "id": "Organization.address.line", "path": "Organization.address.line", "mustSupport": true }, { "id": "Organization.address.city", "path": "Organization.address.city", "mustSupport": true }, { "id": "Organization.address.state", "path": "Organization.address.state", "mustSupport": true }, { "id": "Organization.address.postalCode", "path": "Organization.address.postalCode", "mustSupport": true }, { "id": "Organization.partOf", "path": "Organization.partOf", "comment": "Usage: The organization of which this organization forms a part, eg a sub-location will be part of the parent location/organization. An EMR security separation defined by “functional location” configuration in EMR will be identified by part of. \r\nConformance Rule: This is only populated when the organization has been assigned functional locations.\r\n\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "Organization.partOf.reference", "path": "Organization.partOf.reference", "mustSupport": true }, { "id": "Organization.partOf.display", "path": "Organization.partOf.display", "comment": "Usage Note: This is a textual representation of the reference that should be used in the narrative\r\nConformance Rule: This must be populated with the key identifier associated with teh reference**** - TBD\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "Organization.contact", "path": "Organization.contact", "comment": "Alignment: This is supported for eReferral in Ontario\r\n\r\nWhere multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use." } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-patient", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-patient", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.419+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-patient", "name": "Patient", "title": "TELUS Patient", "status": "draft", "date": "2020-11-09T22:28:57.3566147+00:00", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "cda", "uri": "http://hl7.org/v3/cda", "name": "CDA (R2)" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "loinc", "uri": "http://loinc.org", "name": "LOINC code for the element" } ], "kind": "resource", "abstract": false, "type": "Patient", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Patient", "derivation": "constraint", "differential": { "element": [ { "id": "Patient", "path": "Patient", "mustSupport": true }, { "id": "Patient.id", "path": "Patient.id", "comment": "Usage Note: This will usually be a GUID assigned by the sending application.", "mustSupport": true }, { "id": "Patient.meta", "path": "Patient.meta", "mustSupport": true }, { "id": "Patient.meta.lastUpdated", "path": "Patient.meta.lastUpdated", "mustSupport": true }, { "id": "Patient.meta.source", "path": "Patient.meta.source", "mustSupport": true }, { "id": "Patient.meta.profile", "path": "Patient.meta.profile", "mustSupport": true }, { "id": "Patient.text", "path": "Patient.text", "mustSupport": true }, { "id": "Patient.extension", "path": "Patient.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "Patient.extension:genderIdentity", "path": "Patient.extension", "sliceName": "genderIdentity", "min": 0, "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/patient-genderIdentity" ] } ], "mustSupport": true, "isModifier": false }, { "id": "Patient.extension:genderIdentity.value[x]", "path": "Patient.extension.value[x]", "slicing": { "discriminator": [ { "type": "type", "path": "$this" } ], "rules": "open" }, "mustSupport": true }, { "id": "Patient.extension:genderIdentity.value[x]:valueCodeableConcept", "path": "Patient.extension.value[x]", "sliceName": "valueCodeableConcept", "mustSupport": true }, { "id": "Patient.extension:Pronouns", "path": "Patient.extension", "sliceName": "Pronouns", "definition": "The pronouns to use when referring to an individual in verbal or written communication", "comment": "Usage Note: This is a pre-adoption of an HL7 extension, http://hl7.org/fhir/StructureDefinition/individual-pronouns in R5", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://telus.com/fhir/patientChart/StructureDefinition/ext-individual-pronouns" ] } ], "mustSupport": true, "isModifier": false }, { "id": "Patient.identifier", "path": "Patient.identifier", "slicing": { "discriminator": [ { "type": "pattern", "path": "type" } ], "rules": "open" }, "comment": "******** ADD JHN EXTENSION FOR VERSION HERE\r\nUsage Note: For all known profiles, this will be mandatory, with the exception of anonomyized data feeds such as RAPIDs.", "mustSupport": true }, { "id": "Patient.identifier.type", "path": "Patient.identifier.type", "mustSupport": true }, { "id": "Patient.identifier.system", "path": "Patient.identifier.system", "min": 1, "mustSupport": true }, { "id": "Patient.identifier.value", "path": "Patient.identifier.value", "min": 1, "mustSupport": true }, { "id": "Patient.identifier:MRN", "path": "Patient.identifier", "sliceName": "MRN", "comment": "Conformance Rule: Sender local patient identifier MAY be stored by the receiving application and used for linking.", "max": "1", "mustSupport": true }, { "id": "Patient.identifier:MRN.type", "path": "Patient.identifier.type", "min": 1, "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "MR" } ] }, "mustSupport": true }, { "id": "Patient.identifier:MRN.type.coding", "path": "Patient.identifier.type.coding", "mustSupport": true }, { "id": "Patient.identifier:MRN.type.coding.system", "path": "Patient.identifier.type.coding.system", "min": 1, "mustSupport": true }, { "id": "Patient.identifier:MRN.type.coding.code", "path": "Patient.identifier.type.coding.code", "min": 1, "fixedCode": "MR", "mustSupport": true }, { "id": "Patient.identifier:MRN.system", "path": "Patient.identifier.system", "comment": "Conformance Rule: This will generally be an OID of the form [Vendor OID].[Application Instance node].1.Suggested format: A branch “.1” is appended to create a unique namespace for the Patient ID.", "min": 1, "mustSupport": true }, { "id": "Patient.identifier:MRN.value", "path": "Patient.identifier.value", "min": 1, "mustSupport": true }, { "id": "Patient.identifier:JHN", "path": "Patient.identifier", "sliceName": "JHN", "comment": "Conformance: The TELUS Patient Jurisdictional Health Number Identifier . This must be supplied when known.\r\nUsage Note: There may be multiple active HN's; example, a baby will use the mother's JHN for a period of time before the baby obtains their own PHN. There could also be two if a person is moving from one province to another", "mustSupport": true }, { "id": "Patient.identifier:JHN.type", "path": "Patient.identifier.type", "min": 1, "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "JHN" } ] }, "mustSupport": true }, { "id": "Patient.identifier:JHN.type.coding", "path": "Patient.identifier.type.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Patient.identifier:JHN.type.coding.system", "path": "Patient.identifier.type.coding.system", "min": 1, "mustSupport": true }, { "id": "Patient.identifier:JHN.type.coding.code", "path": "Patient.identifier.type.coding.code", "min": 1, "fixedCode": "JHN", "mustSupport": true }, { "id": "Patient.identifier:JHN.system", "path": "Patient.identifier.system", "comment": "Conformance Rule: This is the OID representing the jurisdictional identifier.\r\n\r\nIf identifier.system is urn:ietf:rfc:3986, then the identifier.value must be a full URI (e.g. start with a scheme).", "min": 1, "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "http://telus.com/fhir/ValueSet/telus-identifier-system-patient-jhn" } }, { "id": "Patient.identifier:JHN.value", "path": "Patient.identifier.value", "comment": "Conformance Rule: This is the patient's jurisdictional health number\r\n\r\nIf the value is a full URI, then the system must be urn:ietf:rfc:3986.", "min": 1, "mustSupport": true }, { "id": "Patient.name", "path": "Patient.name", "slicing": { "discriminator": [ { "type": "value", "path": "use" } ], "rules": "open" }, "comment": "Usage: EMRs typically record the name from the healthcard in which case this should be the \"official\" name and should always be sent. Additionally, there is often a preferred name or \"usual\"name in the EMR that should also be sent. Old and/or maiden names can also be helpful for receiving applications who may have existing records with these names. \r\nUsage: If the EMR uses the label \"nickname\", or \"preferred\" name this should map to usual. In PSS, \"preferred\" name will map to \"usual\"; in MA, \"nickname\" will map to \"usual\"\r\n\r\nA patient may have multiple names with different uses or applicable periods. For animals, the name is a \"HumanName\" in the sense that is assigned and used by humans and has the same patterns.", "min": 1, "max": "1", "mustSupport": true }, { "id": "Patient.name.use", "path": "Patient.name.use", "comment": "Usage Note: This may be referred to as the Preferred name in some EMRs - this would map to \"usual\".\r\nUsage Note: \"Official\" use should always be present. \"Usual\" should be used for preferred when this name is populated as a separate field in the EMR.\r\n\r\nApplications can assume that a name is current unless it explicitly says that it is temporary or old.", "mustSupport": true }, { "id": "Patient.name.family", "path": "Patient.name.family", "mustSupport": true }, { "id": "Patient.name.given", "path": "Patient.name.given", "mustSupport": true }, { "id": "Patient.name.prefix", "path": "Patient.name.prefix", "mustSupport": true }, { "id": "Patient.name.suffix", "path": "Patient.name.suffix", "mustSupport": true }, { "id": "Patient.gender", "path": "Patient.gender", "comment": "Usage Note: This data is most often captured as a single data element in the EMR. This can also be considered as the Recorded Sex or Gender, that is introduced as an extension in R5. (http://hl7.org/fhir/StructureDefinition/individual-recordedSexOrGender) which will map into this data element. This extension is not used at this point in time. The gender field in the EMRs tend to represent sex at birth, or admin sex or chromosomal sex. Typically this comes from a birth certificate, OHIP/JHN passport, etc - known government identification \r\n\r\nUsage Note: When gender has a value of \"other\" or unknown\", systems may be capable of specifying the \"Sex for Clinical Use\" which an HL7 extension introduced for R5 (http://hl7.org/fhir/StructureDefinition/patient-sexForClinicalUse). This field may be recorded as part of the lab, observation or any other resource where this context is appropriate. \r\n\r\nThe gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a \"hard\" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.", "mustSupport": true }, { "id": "Patient.birthDate", "path": "Patient.birthDate", "comment": "Usage Note: At least an estimated year should be provided as a guess if the real DOB is unknown.\r\n \r\nUsage Note: There is a standard extension \"patient-birthTime\" available that should be used where Time is required (such as in maternity/infant care systems).", "mustSupport": true }, { "id": "Patient.deceased[x]", "path": "Patient.deceased[x]", "mustSupport": true }, { "id": "Patient.contact", "path": "Patient.contact", "comment": "Usage Rule: Privacy reviews are imperative prior to sharing contact infromation\r\n\r\nContact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.", "mustSupport": true }, { "id": "Patient.contact.relationship", "path": "Patient.contact.relationship", "mustSupport": true }, { "id": "Patient.contact.relationship.coding", "path": "Patient.contact.relationship.coding", "mustSupport": true }, { "id": "Patient.contact.relationship.coding.system", "path": "Patient.contact.relationship.coding.system", "mustSupport": true }, { "id": "Patient.contact.relationship.coding.code", "path": "Patient.contact.relationship.coding.code", "mustSupport": true }, { "id": "Patient.contact.relationship.coding.display", "path": "Patient.contact.relationship.coding.display", "mustSupport": true }, { "id": "Patient.contact.name", "path": "Patient.contact.name", "mustSupport": true }, { "id": "Patient.contact.name.use", "path": "Patient.contact.name.use", "mustSupport": true }, { "id": "Patient.contact.name.family", "path": "Patient.contact.name.family", "min": 1, "mustSupport": true }, { "id": "Patient.contact.name.given", "path": "Patient.contact.name.given", "mustSupport": true }, { "id": "Patient.contact.telecom", "path": "Patient.contact.telecom", "mustSupport": true }, { "id": "Patient.contact.telecom.system", "path": "Patient.contact.telecom.system", "min": 1, "mustSupport": true }, { "id": "Patient.contact.telecom.value", "path": "Patient.contact.telecom.value", "min": 1, "mustSupport": true }, { "id": "Patient.contact.telecom.use", "path": "Patient.contact.telecom.use", "mustSupport": true }, { "id": "Patient.contact.address", "path": "Patient.contact.address", "mustSupport": true }, { "id": "Patient.contact.address.use", "path": "Patient.contact.address.use", "mustSupport": true }, { "id": "Patient.contact.address.line", "path": "Patient.contact.address.line", "mustSupport": true }, { "id": "Patient.contact.address.city", "path": "Patient.contact.address.city", "mustSupport": true }, { "id": "Patient.contact.address.state", "path": "Patient.contact.address.state", "mustSupport": true }, { "id": "Patient.contact.address.postalCode", "path": "Patient.contact.address.postalCode", "mustSupport": true }, { "id": "Patient.contact.address.country", "path": "Patient.contact.address.country", "mustSupport": true }, { "id": "Patient.contact.organization", "path": "Patient.contact.organization", "comment": "Usage: Example may be family and child services\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "Patient.contact.organization.reference", "path": "Patient.contact.organization.reference", "mustSupport": true }, { "id": "Patient.contact.organization.display", "path": "Patient.contact.organization.display", "mustSupport": true }, { "id": "Patient.communication", "path": "Patient.communication", "mustSupport": true }, { "id": "Patient.communication.language", "path": "Patient.communication.language", "mustSupport": true }, { "id": "Patient.communication.language.coding", "path": "Patient.communication.language.coding", "mustSupport": true }, { "id": "Patient.communication.language.coding.system", "path": "Patient.communication.language.coding.system", "mustSupport": true }, { "id": "Patient.communication.language.coding.code", "path": "Patient.communication.language.coding.code", "mustSupport": true }, { "id": "Patient.communication.language.text", "path": "Patient.communication.language.text", "mustSupport": true }, { "id": "Patient.generalPractitioner", "path": "Patient.generalPractitioner", "comment": "Usage note: Provider reference to the organization and the practitioner resource \r\nIf a patient has not been assigned a doctor at the clinic only provide reference to the organization (parent organization)\r\n\r\nWhen a Primary MD/NP for that provider at that clinic is assigned provide reference to the organization or in some cases, the sub-organization (eg conceptual location in EMRs where two orgs exist under the same application instance) and the practitioner \r\n\r\nUsage Note: Primary and secondary providers in PSS are determined by the appointment system. ***Further discussion is required to determine how this would be conveyed in FHIR. \r\n\r\nThis may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources.\nMultiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a \"fly-in/fly-out\" worker that has the onsite GP also included with his home GP to remain aware of medical issues.\n\nJurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.", "mustSupport": true }, { "id": "Patient.generalPractitioner.reference", "path": "Patient.generalPractitioner.reference", "mustSupport": true }, { "id": "Patient.generalPractitioner.display", "path": "Patient.generalPractitioner.display", "mustSupport": true }, { "id": "Patient.managingOrganization", "path": "Patient.managingOrganization", "comment": "Usage note: This should be populated with a particular Org (parent organization with the EMR instance) that is associated with the patient. \r\n\r\nThere is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).", "mustSupport": true }, { "id": "Patient.managingOrganization.reference", "path": "Patient.managingOrganization.reference", "comment": "Usage Note: Either the identifier or reference may be used.\r\n\r\nUsing absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "min": 1, "mustSupport": true }, { "id": "Patient.managingOrganization.display", "path": "Patient.managingOrganization.display", "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-practitioner", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-practitioner", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.420+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-practitioner", "name": "Practitioner", "title": "TELUS Practitioner", "status": "draft", "date": "2020-11-10T21:07:38.2646453+00:00", "fhirVersion": "4.0.1", "mapping": [ { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "servd", "uri": "http://www.omg.org/spec/ServD/1.0/", "name": "ServD" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" } ], "kind": "resource", "abstract": false, "type": "Practitioner", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Practitioner", "derivation": "constraint", "differential": { "element": [ { "id": "Practitioner", "path": "Practitioner", "comment": "In Practitioner up to three identifiers can be provided. One for the issued TPR identifier (CPRID), a jurisdictional billing identifier may also be used under some circumstances, and a licence Number", "mustSupport": true }, { "id": "Practitioner.meta", "path": "Practitioner.meta", "mustSupport": true }, { "id": "Practitioner.meta.lastUpdated", "path": "Practitioner.meta.lastUpdated", "mustSupport": true }, { "id": "Practitioner.meta.source", "path": "Practitioner.meta.source", "min": 1, "mustSupport": true }, { "id": "Practitioner.meta.profile", "path": "Practitioner.meta.profile", "mustSupport": true }, { "id": "Practitioner.text", "path": "Practitioner.text", "mustSupport": true }, { "id": "Practitioner.text.status", "path": "Practitioner.text.status", "mustSupport": true }, { "id": "Practitioner.text.div", "path": "Practitioner.text.div", "mustSupport": true }, { "id": "Practitioner.identifier", "path": "Practitioner.identifier", "slicing": { "discriminator": [ { "type": "pattern", "path": "type" } ], "description": "Identifiers are a means to identify the person rather than their current qualifications", "rules": "open" }, "comment": "Usage Rule: This is used for both licenced clinicians and EMR Users/MOAs. For non-clinicans this may be populated with a unique user identifier issued by the EMR\r\nUsage Note: This must be supported where a licence number and/or other known business identifier is specified.\r\nAlignment: PS-ON uses identifiers to specify licence number", "mustSupport": true }, { "id": "Practitioner.identifier.use", "path": "Practitioner.identifier.use", "mustSupport": true }, { "id": "Practitioner.identifier.type", "path": "Practitioner.identifier.type", "mustSupport": true }, { "id": "Practitioner.identifier.system", "path": "Practitioner.identifier.system", "min": 1, "mustSupport": true }, { "id": "Practitioner.identifier.value", "path": "Practitioner.identifier.value", "min": 1, "mustSupport": true }, { "id": "Practitioner.identifier:EMRProviderID", "path": "Practitioner.identifier", "sliceName": "EMRProviderID", "comment": "Usage Note: An identifier that is assigned by the EMR. This links billing data and patient data. A practitioner may have multiples; one per bill book or specialty. eg Provider ID in PSS, is issued per bill book. All identifiers that are available should be sent. This may be structured as (", "mustSupport": true }, { "id": "Practitioner.identifier:EMRProviderID.type", "path": "Practitioner.identifier.type", "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRN" } ] }, "mustSupport": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "valueSet": "http://telus.com/fhir/ValueSet/telus-identifier-type" } }, { "id": "Practitioner.identifier:EMRProviderID.type.coding", "path": "Practitioner.identifier.type.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Practitioner.identifier:EMRProviderID.type.coding.system", "path": "Practitioner.identifier.type.coding.system", "min": 1, "mustSupport": true }, { "id": "Practitioner.identifier:EMRProviderID.type.coding.code", "path": "Practitioner.identifier.type.coding.code", "min": 1, "mustSupport": true }, { "id": "Practitioner.identifier:EMRProviderID.system", "path": "Practitioner.identifier.system", "comment": "Usage Note: Typically this can be constructed as follows: Vendor.ApplicationInstance.Branch to represent the EMR User ID\r\n\r\nIdentifier.system is always case sensitive.", "min": 1, "fixedUri": "http://telus.com/fhir/Identifiers/TPR", "mustSupport": true }, { "id": "Practitioner.identifier:EMRProviderID.value", "path": "Practitioner.identifier.value", "comment": "Conformance Rule: This must match the Practitioner.id value.", "min": 1, "mustSupport": true }, { "id": "Practitioner.identifier:JurisdictionalBillingNumber", "path": "Practitioner.identifier", "sliceName": "JurisdictionalBillingNumber", "comment": "Usage Note: There may be some use cases that will require this identifier. This only applies to physicians, not to nurse practitioners or other clinicians.", "max": "1", "mustSupport": true }, { "id": "Practitioner.identifier:JurisdictionalBillingNumber.type", "path": "Practitioner.identifier.type", "min": 1, "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "MCR" } ] }, "mustSupport": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "valueSet": "http://telus.com/fhir/ValueSet/telus-identifier-type" } }, { "id": "Practitioner.identifier:JurisdictionalBillingNumber.type.coding", "path": "Practitioner.identifier.type.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Practitioner.identifier:JurisdictionalBillingNumber.type.coding.system", "path": "Practitioner.identifier.type.coding.system", "mustSupport": true }, { "id": "Practitioner.identifier:JurisdictionalBillingNumber.type.coding.code", "path": "Practitioner.identifier.type.coding.code", "mustSupport": true }, { "id": "Practitioner.identifier:JurisdictionalBillingNumber.type.coding.display", "path": "Practitioner.identifier.type.coding.display", "mustSupport": true }, { "id": "Practitioner.identifier:JurisdictionalBillingNumber.system", "path": "Practitioner.identifier.system", "comment": "Conformance Rule: If known, this must be populated\r\n\r\nIf identifier.system is urn:ietf:rfc:3986, then the identifier.value must be a full URI (e.g. start with a scheme).", "mustSupport": true }, { "id": "Practitioner.identifier:JurisdictionalBillingNumber.value", "path": "Practitioner.identifier.value", "min": 1, "mustSupport": true }, { "id": "Practitioner.identifier:LicenceNumber", "path": "Practitioner.identifier", "sliceName": "LicenceNumber", "comment": "Conformance Rule: This will be populated with the licence numbers that are known to the EMR for this practitioner." }, { "id": "Practitioner.identifier:LicenceNumber.type", "path": "Practitioner.identifier.type", "min": 1, "mustSupport": true }, { "id": "Practitioner.identifier:LicenceNumber.type.coding", "path": "Practitioner.identifier.type.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Practitioner.identifier:LicenceNumber.type.coding.system", "path": "Practitioner.identifier.type.coding.system", "min": 1, "fixedUri": "http://terminology.hl7.org/CodeSystem/v2-0203", "mustSupport": true }, { "id": "Practitioner.identifier:LicenceNumber.type.coding.code", "path": "Practitioner.identifier.type.coding.code", "min": 1, "fixedCode": "LN", "mustSupport": true }, { "id": "Practitioner.identifier:LicenceNumber.system", "path": "Practitioner.identifier.system", "comment": "Usage Note: This value set contains the OIDs for the various licencing bodies across Canada.\r\n\r\nIdentifier.system is always case sensitive.", "min": 1, "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "http://telus.com/fhir/ValueSet/telus-identifier-system-practitioner-ln" } }, { "id": "Practitioner.identifier:LicenceNumber.value", "path": "Practitioner.identifier.value", "comment": "Conformance Rule: This is populated with the licence number.\r\n\r\nIf the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.", "min": 1, "mustSupport": true }, { "id": "Practitioner.identifier:LicenceNumber.assigner", "path": "Practitioner.identifier.assigner", "comment": "Usage Note: A user-friendly value may be included, eg \"Ontario College of Physicians and Surgeons\"\r\n\r\nThe Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.", "mustSupport": true }, { "id": "Practitioner.identifier:LicenceNumber.assigner.display", "path": "Practitioner.identifier.assigner.display", "mustSupport": true }, { "id": "Practitioner.identifier:EMRUserID", "path": "Practitioner.identifier", "sliceName": "EMRUserID", "comment": "Usage Note: Each practitioner has a single user id assigned by the EMR that may be used\r\nMapping: PSS - Table Key from the User Table", "max": "1" }, { "id": "Practitioner.identifier:EMRUserID.type", "path": "Practitioner.identifier.type", "mustSupport": true }, { "id": "Practitioner.identifier:EMRUserID.type.coding", "path": "Practitioner.identifier.type.coding", "mustSupport": true }, { "id": "Practitioner.identifier:EMRUserID.type.coding.system", "path": "Practitioner.identifier.type.coding.system", "fixedUri": "http://terminology.hl7.org/CodeSystem/v2-0203", "mustSupport": true }, { "id": "Practitioner.identifier:EMRUserID.type.coding.code", "path": "Practitioner.identifier.type.coding.code", "fixedCode": "USER", "mustSupport": true }, { "id": "Practitioner.identifier:EMRUserID.system", "path": "Practitioner.identifier.system", "comment": "Conformance Rule: As this must be a unique identifier, the EMR must assign an OID or URN for their User ID's. One example of how this can be constructed as follows: Vendor.ApplicationInstance.Branch to represent the EMR User ID\r\n\r\nIdentifier.system is always case sensitive.", "min": 1, "mustSupport": true }, { "id": "Practitioner.identifier:EMRUserID.value", "path": "Practitioner.identifier.value", "min": 1, "mustSupport": true }, { "id": "Practitioner.name", "path": "Practitioner.name", "comment": "Conformance Rule: The discrete values (eg family and given names) should be used when known; if not only text may be used.\r\n\r\nNote: THIS IS NOT CONFORMANT WITH THE CA-CORE PROFILES, WHO MANDATE GIVEN AND FAMILY", "min": 1, "max": "1", "mustSupport": true }, { "id": "Practitioner.name.use", "path": "Practitioner.name.use", "comment": "Conformance Rule: Legal name is mandatory.", "mustSupport": true }, { "id": "Practitioner.name.text", "path": "Practitioner.name.text", "min": 1, "mustSupport": true }, { "id": "Practitioner.name.family", "path": "Practitioner.name.family", "comment": "Conformance Rule: Family is not to include professional designations.\r\n\r\nConformance Rule: A legal name must be provided. It is not acceptable to submit all blanks/spaces.", "mustSupport": true }, { "id": "Practitioner.name.given", "path": "Practitioner.name.given", "comment": "Conformance Rule: Given name(s) is not to include profession designations\r\n\r\nIf only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to practical limitations. This element is not called \"first name\" since given names do not always come first.", "mustSupport": true }, { "id": "Practitioner.name.prefix", "path": "Practitioner.name.prefix", "comment": "Conformance Rule: Prefix must be used for Practitioner to represent the appropriate professional designation.", "max": "1", "mustSupport": true }, { "id": "Practitioner.name.suffix", "path": "Practitioner.name.suffix", "comment": "Conformance Rule: Suffix must be used for Practitioner to represent the appropriate professional designation.", "max": "1", "mustSupport": true }, { "id": "Practitioner.telecom", "path": "Practitioner.telecom", "comment": "Usage Note: Home numbers and/or confidential numbers should never be sent in the context of exporting data as part of a patient chart export (eg referral/transfer of care or providing data for insurance purposes). Often the contact information will be part of the cover letter associated with the patient chart data that is being exported.\r\n\r\nUsage Note: If this resource is used in the context of a migration, all telecom data should be considered for the particular use case. Otherwise this is not expected to be supported.\r\nAlignment: Core-CA, PS-ON not supported\r\n\r\nPerson may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.", "mustSupport": true }, { "id": "Practitioner.telecom.system", "path": "Practitioner.telecom.system", "min": 1, "mustSupport": true }, { "id": "Practitioner.telecom.value", "path": "Practitioner.telecom.value", "min": 1, "mustSupport": true }, { "id": "Practitioner.telecom.use", "path": "Practitioner.telecom.use", "mustSupport": true }, { "id": "Practitioner.qualification", "path": "Practitioner.qualification", "comment": "Alignment: This is supported for eReferral in Ontario." }, { "id": "Practitioner.communication", "path": "Practitioner.communication", "comment": "Alignment: This is supported for eReferral in Ontario\r\n\r\nThe structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems code this but instead have it as free text. Hence CodeableConcept instead of code as the data type." } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-practitionerRole-patientchart", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-practitionerRole-patientchart", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.420+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-practitionerRole", "name": "PractitionerRolePatientChart", "title": "Practitioner Role eServices", "status": "draft", "date": "2020-11-17T21:41:32.4178306+00:00", "fhirVersion": "4.0.1", "mapping": [ { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "servd", "uri": "http://www.omg.org/spec/ServD/1.0/", "name": "ServD" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" } ], "kind": "resource", "abstract": false, "type": "PractitionerRole", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "derivation": "constraint", "differential": { "element": [ { "id": "PractitionerRole", "path": "PractitionerRole", "comment": "Usage Note: This resource will be referenced in messages in the context of Communication.sender, Communication.extension:ReplyTo, and Communication.recipient.", "mustSupport": true }, { "id": "PractitionerRole.id", "path": "PractitionerRole.id", "mustSupport": true }, { "id": "PractitionerRole.meta", "path": "PractitionerRole.meta", "mustSupport": true }, { "id": "PractitionerRole.meta.lastUpdated", "path": "PractitionerRole.meta.lastUpdated", "mustSupport": true }, { "id": "PractitionerRole.meta.source", "path": "PractitionerRole.meta.source", "mustSupport": true }, { "id": "PractitionerRole.meta.profile", "path": "PractitionerRole.meta.profile", "mustSupport": true }, { "id": "PractitionerRole.text", "path": "PractitionerRole.text", "mustSupport": true }, { "id": "PractitionerRole.identifier", "path": "PractitionerRole.identifier", "comment": "Usage Note: For PS-ON - this can be populated with a UUID", "mustSupport": true }, { "id": "PractitionerRole.identifier.system", "path": "PractitionerRole.identifier.system", "mustSupport": true }, { "id": "PractitionerRole.identifier.value", "path": "PractitionerRole.identifier.value", "mustSupport": true }, { "id": "PractitionerRole.practitioner", "path": "PractitionerRole.practitioner", "comment": "Conformance Rule: This must be populated when known. There are some situations, such as receiving a report from an Emergency Physician where there are no Practitioner details.", "type": [ { "code": "Reference", "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "PractitionerRole.practitioner.reference", "path": "PractitionerRole.practitioner.reference", "min": 1, "mustSupport": true }, { "id": "PractitionerRole.practitioner.display", "path": "PractitionerRole.practitioner.display", "mustSupport": true }, { "id": "PractitionerRole.organization", "path": "PractitionerRole.organization", "comment": "Conformance Rule: This must be populated when known. May not be known when a specialist sends a report; organization/clinic data may not be provided.\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "type": [ { "code": "Reference", "targetProfile": [ "http://telus.com/fhir/StructureDefinition/profile-organization-patientchart" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "PractitionerRole.organization.reference", "path": "PractitionerRole.organization.reference", "min": 1, "mustSupport": true }, { "id": "PractitionerRole.organization.display", "path": "PractitionerRole.organization.display", "mustSupport": true }, { "id": "PractitionerRole.code", "path": "PractitionerRole.code", "comment": "Usage: If no code mapping exists, text must be sent. in its place. \r\n\r\nConformance Rule: This is the role that the practitioner was playing when this message was created. If the role code is not known, text must be used.", "min": 1, "max": "1", "mustSupport": true }, { "id": "PractitionerRole.code.coding", "path": "PractitionerRole.code.coding", "comment": "Conformance: Two codes should be sent; one from the HealthcareProviderRoleCode set (Infoway code system) and a second one that uses a SNOMED code system and supports messaging with international communities. Rationale: The Infoway code system may be replaced with SNOMED in the future though it must be supported until that time in order to align with Core-CA, PS-ON and PS-CA profiles. It is the primary subset for use in Canada.\r\n\r\nCodes 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.", "mustSupport": true }, { "id": "PractitionerRole.code.coding.system", "path": "PractitionerRole.code.coding.system", "min": 1, "mustSupport": true }, { "id": "PractitionerRole.code.coding.code", "path": "PractitionerRole.code.coding.code", "min": 1, "mustSupport": true }, { "id": "PractitionerRole.code.coding.display", "path": "PractitionerRole.code.coding.display", "mustSupport": true }, { "id": "PractitionerRole.code.coding.display.extension", "path": "PractitionerRole.code.coding.display.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "PractitionerRole.code.coding.display.extension:RoleDisplayTranslation", "path": "PractitionerRole.code.coding.display.extension", "sliceName": "RoleDisplayTranslation", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/translation" ] } ], "mustSupport": true }, { "id": "PractitionerRole.code.text", "path": "PractitionerRole.code.text", "comment": "Usage note: This should be populated when translation has occurred; the text conveys the original value from the EMR. It must be present if a local code is used\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "PractitionerRole.specialty", "path": "PractitionerRole.specialty", "comment": "*** confirm that we will use the Infoway code set - doesn't seem to be avaialbel yet on the infoway site; see PS_ON\r\n\r\nConformance Rule: This must be populated by sending systems if known. Both the preferred code and the local code should be included when known. Where no local code exist, the text should be populated. If the mapping from the local code to the preferred code set (SNOMED) is not available, only the local code is sent.", "mustSupport": true }, { "id": "PractitionerRole.specialty.coding", "path": "PractitionerRole.specialty.coding", "comment": "Usage Note: Specialty.coding will not be returned at this time; only Specialty.text will be returned in TPR Queries\r\nUsage Note: In Ontario, the two digit code used for billing can be used", "max": "1", "mustSupport": true }, { "id": "PractitionerRole.specialty.coding.system", "path": "PractitionerRole.specialty.coding.system", "min": 1, "mustSupport": true }, { "id": "PractitionerRole.specialty.coding.code", "path": "PractitionerRole.specialty.coding.code", "min": 1, "mustSupport": true }, { "id": "PractitionerRole.specialty.coding.display", "path": "PractitionerRole.specialty.coding.display", "min": 1, "mustSupport": true }, { "id": "PractitionerRole.specialty.text", "path": "PractitionerRole.specialty.text", "mustSupport": true }, { "id": "PractitionerRole.specialty.text.extension", "path": "PractitionerRole.specialty.text.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 0 }, { "id": "PractitionerRole.specialty.text.extension:SpecialtyTextTranslation", "path": "PractitionerRole.specialty.text.extension", "sliceName": "SpecialtyTextTranslation", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/translation" ] } ], "mustSupport": true } ] } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/88841fac-db39-4e54-a0c2-70ae7528b15e", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-procedure", "name": "Procedure", "status": "draft", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "Procedure", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Procedure", "derivation": "constraint", "differential": { "element": [ { "id": "Procedure.id", "path": "Procedure.id", "mustSupport": true }, { "id": "Procedure.meta", "path": "Procedure.meta", "mustSupport": true }, { "id": "Procedure.meta.lastUpdated", "path": "Procedure.meta.lastUpdated", "mustSupport": true }, { "id": "Procedure.meta.source", "path": "Procedure.meta.source", "mustSupport": true }, { "id": "Procedure.meta.profile", "path": "Procedure.meta.profile", "mustSupport": true }, { "id": "Procedure.text", "path": "Procedure.text", "mustSupport": true }, { "id": "Procedure.status", "path": "Procedure.status", "comment": "Usage Note: Most of the time, the status will be completed as they are typically recorded after the procedure has completed.\r\n\r\nThe \"unknown\" code is not to be used to convey other statuses. The \"unknown\" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.\r\n\r\n\n\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "mustSupport": true }, { "id": "Procedure.code", "path": "Procedure.code", "comment": "Conformance Rule: The local code must always be specified where present. If a SNOMED code is present, this must also be sent.\r\n\r\nAlignment PS-ON: 1..1 Must support SNOMED coding; this is very often not used by the physician. \r\nAlignment PS-ON: In situations where the EMR cannot distinguish between no-known and no information about patient procedures, then the code for no information should be used. In the instance where a patient is KNOWN to have no procedures, the no-known code should be used.\r\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true }, { "id": "Procedure.code.coding", "path": "Procedure.code.coding", "slicing": { "discriminator": [ { "type": "value", "path": "system" } ], "rules": "open" }, "mustSupport": true }, { "id": "Procedure.code.coding.system", "path": "Procedure.code.coding.system", "min": 1, "fixedUri": "http://snomed.info/sct", "mustSupport": true }, { "id": "Procedure.code.coding.code", "path": "Procedure.code.coding.code", "min": 1, "mustSupport": true }, { "id": "Procedure.code.coding.display", "path": "Procedure.code.coding.display", "mustSupport": true }, { "id": "Procedure.code.coding:SCTCA", "path": "Procedure.code.coding", "sliceName": "SCTCA", "comment": "CoreCA: While the IPS-UV specification considers this a Must Support element, some systems will not have the ability to support codings for every codeableConcept, further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance. Implementors that support codings should still send the codings for codeable concepts if they are available and receivers should not produce failures or rejections if codings are included in the patient summary in the first release (a base tenet of FHIR). Additionally vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content\r\n\r\nCodes 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.", "binding": { "strength": "required", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/procedurecode" } }, { "id": "Procedure.code.coding:SCTCA.system", "path": "Procedure.code.coding.system", "mustSupport": true }, { "id": "Procedure.code.coding:SCTCA.code", "path": "Procedure.code.coding.code", "mustSupport": true }, { "id": "Procedure.code.coding:codeICD9CM", "path": "Procedure.code.coding", "sliceName": "codeICD9CM", "definition": "This slice reflects that ICD-9 CM is used in some Canadian jurisdictions for procedures. While SNOMED-CT CA is the preferred code system for this element, implementers may encounter ICD-9 CM codes in some circumstances or jurisdictions. Note: Implementers should be cautioned that ICD-9 CM is considered a legacy terminology that is no longer maintained by the organization that developed it.", "comment": "Core-CA\r\n\r\nCodes 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.", "binding": { "strength": "required", "valueSet": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/ICD9CM" } }, { "id": "Procedure.code.coding:codeICD9CM.system", "path": "Procedure.code.coding.system", "fixedUri": "http://terminology.hl7.org/CodeSystem/icd9cm", "mustSupport": true }, { "id": "Procedure.code.coding:codeICD9CM.code", "path": "Procedure.code.coding.code", "mustSupport": true }, { "id": "Procedure.code.coding:absentOrUnknownProcedure", "path": "Procedure.code.coding", "sliceName": "absentOrUnknownProcedure", "comment": "Core-CA - While the IPS-UV specification considers this a Must Support element, some systems will not have the ability to support codings for every codeableConcept, further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance. Implementors that support codings should still send the codings for codeable concepts if they are available and receivers should not produce failures or rejections if codings are included in the patient summary in the first release (a base tenet of FHIR). Additionally vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content\r\n\r\nCodes 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.", "binding": { "strength": "required", "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-procedures-uv-ips" } }, { "id": "Procedure.code.coding:absentOrUnknownProcedure.system", "path": "Procedure.code.coding.system", "fixedUri": "http://hl7.org/fhir/uv/ips/CodeSystem/absent-unknown-uv-ips", "mustSupport": true }, { "id": "Procedure.code.coding:absentOrUnknownProcedure.code", "path": "Procedure.code.coding.code", "mustSupport": true }, { "id": "Procedure.code.text", "path": "Procedure.code.text", "min": 1, "mustSupport": true }, { "id": "Procedure.subject", "path": "Procedure.subject", "mustSupport": true }, { "id": "Procedure.subject.reference", "path": "Procedure.subject.reference", "min": 1, "mustSupport": true }, { "id": "Procedure.subject.display", "path": "Procedure.subject.display", "mustSupport": true }, { "id": "Procedure.performed[x]", "path": "Procedure.performed[x]", "comment": "Core-CA - this is mandatory in Core-CA and in order to align, it must be specified here when known.\r\n\r\nUsage Note: This may not be recorded in the EMR in some cases, eg the patient is taking CBT and has not provided specific dates. In this case, the string may be used to state \"unknown\" at time of export.\r\n\r\nAge is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.", "min": 1, "mustSupport": true } ] }, "id": "88841fac-db39-4e54-a0c2-70ae7528b15e", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.420+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/individual-pronouns", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "individual-pronouns", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode": "pa" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger": 1 } ], "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-individual-pronouns", "version": "4.0.1", "name": "Pron", "title": "pronouns", "status": "draft", "experimental": false, "date": "2020-12-28T16:55:11+11:00", "publisher": "HL7", "description": "The pronouns to use when referring to an individual in verbal or written communication.", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "fhirpath", "expression": "Patient" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "short": "The pronouns to use when communicating about an individual.", "definition": "The pronouns to use when referring to an individual in verbal or written communication." }, { "id": "Extension.extension", "path": "Extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 1 }, { "id": "Extension.extension:value", "path": "Extension.extension", "sliceName": "value", "short": "The individual's pronouns", "definition": "The pronouns to use when referring to an individual in verbal or written communication.", "min": 1, "max": "1", "mustSupport": true }, { "id": "Extension.extension:value.url", "path": "Extension.extension.url", "type": [ { "code": "uri" } ], "fixedUri": "value" }, { "id": "Extension.extension:value.value[x]", "path": "Extension.extension.value[x]", "min": 1, "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Pronouns" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/pronouns" } }, { "id": "Extension.extension:period", "path": "Extension.extension", "sliceName": "period", "short": "When the pronouns apply to the individual", "definition": "The time period during which the pronouns apply to the individual", "min": 0, "max": "1", "mustSupport": true }, { "id": "Extension.extension:period.url", "path": "Extension.extension.url", "type": [ { "code": "uri" } ], "fixedUri": "period" }, { "id": "Extension.extension:period.value[x]", "path": "Extension.extension.value[x]", "min": 1, "type": [ { "code": "Period" } ] }, { "id": "Extension.extension:comment", "path": "Extension.extension", "sliceName": "comment", "short": "Explaination about the use of the pronouns", "definition": "Text to further explain the use of the specified pronouns", "min": 0, "max": "1", "mustSupport": true }, { "id": "Extension.extension:comment.url", "path": "Extension.extension.url", "type": [ { "code": "uri" } ], "fixedUri": "comment" }, { "id": "Extension.extension:comment.value[x]", "path": "Extension.extension.value[x]", "min": 1, "type": [ { "code": "string" } ] }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/ext-individual-pronouns" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "max": "0" } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.399+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/0036855f-b9f3-431f-b95f-561b1dab53bc", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "https://telus.com/fhirpatientChart//StructureDefinition/profile-provenance", "name": "Provenance", "status": "draft", "fhirVersion": "4.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w3c.prov", "uri": "http://www.w3.org/ns/prov", "name": "W3C PROV" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "fhirauditevent", "uri": "http://hl7.org/fhir/auditevent", "name": "FHIR AuditEvent Mapping" } ], "kind": "resource", "abstract": false, "type": "Provenance", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Provenance", "derivation": "constraint", "differential": { "element": [ { "id": "Provenance", "path": "Provenance", "comment": "*** add provenance comment extension\r\n\r\nConformance Rule: Provenance IS ALWAYS present when sharing a medication “with history”. Provenance is never present when sharing a medication without history (eg the current state)\r\n\r\nSome parties may be duplicated between the target resource and its provenance. For instance, the prescriber is usually (but not always) the author of the prescription resource. This resource is defined with close consideration for W3C Provenance.", "mustSupport": true }, { "id": "Provenance.meta", "path": "Provenance.meta", "mustSupport": true }, { "id": "Provenance.meta.lastUpdated", "path": "Provenance.meta.lastUpdated", "mustSupport": true }, { "id": "Provenance.meta.source", "path": "Provenance.meta.source", "mustSupport": true }, { "id": "Provenance.meta.profile", "path": "Provenance.meta.profile", "mustSupport": true }, { "id": "Provenance.text", "path": "Provenance.text", "comment": "Usage Note: The text must include all data that is clinically relevant; this may be displayed to the user along with text from other resources such as the Medication Plan. This must include tall items that are \"must support\"he target.display, occurred, recorded, reason, activity\r\n\r\nContained 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.", "min": 1, "mustSupport": true }, { "id": "Provenance.target", "path": "Provenance.target", "mustSupport": true }, { "id": "Provenance.target.reference", "path": "Provenance.target.reference", "min": 1, "mustSupport": true }, { "id": "Provenance.target.display", "path": "Provenance.target.display", "comment": "Usage: This should contain the text \"Plan for x\", where x is the name of the medication name (eg .Medication.code.text)\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "min": 1, "mustSupport": true }, { "id": "Provenance.occurred[x]", "path": "Provenance.occurred[x]", "comment": "Usage Note: This is the actual date and time that the activity occurred. Example: The patient stopped taking the medicaiton on January 1st; this was recorded at the patient visit on January 15th. The occurred date is January 1st. \r\n \r\nExample: The occurred date may be different from the recorded date if the EMR is unavailable when the practitioner actions a change.\r\n\r\nThe period can be a little arbitrary; where possible, the time should correspond to human assessment of the activity time.", "min": 1, "type": [ { "code": "dateTime" } ], "mustSupport": true }, { "id": "Provenance.recorded", "path": "Provenance.recorded", "mustSupport": true }, { "id": "Provenance.reason", "path": "Provenance.reason", "comment": "Usage Note: The reason is optional as it may not be recorded discretely as a reason in the exporting system. This should only be used by sending systems who can discretely capture a reason for the acitvity. \r\n\r\nExample: Activity might be DISCONTINUED (state change) and the reason may be explicity captured, eg \"Patient Stopped Medication\". \r\n\r\n Example 2: If the EMR captures a medication change comment in the same dialogue as the activity (eg Medication Change), the reason may be captured here. \"on hold due to surgery\", \"current dosages too low\" \r\n\r\nUsage Note: The EMRs support coding in some circumstances, eg ON MD mandates codified values for discontinue/termination. (Gavin to validate). \r\n\r\nUsage Note: In the context of an \"export\" (activity=export), the reason may include values such as \"Complete Patient Chart with full history\", or \"Partial Patient Chart\", IPS Export, eReferral Export, Other\r\n\r\nConformance Rule: The reason must be replicated in the MedicationPlan.notes. Rationale: Provenance is not always shared.\r\n\r\nPSS: Comments field - comments captured at time of dosage change reason\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "mustSupport": true }, { "id": "Provenance.reason.coding", "path": "Provenance.reason.coding", "comment": "Usage Note: EMRs are not capturing this information discretely today.\r\n\r\nCodes 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.", "mustSupport": true }, { "id": "Provenance.reason.coding.system", "path": "Provenance.reason.coding.system", "mustSupport": true }, { "id": "Provenance.reason.coding.code", "path": "Provenance.reason.coding.code", "mustSupport": true }, { "id": "Provenance.reason.text", "path": "Provenance.reason.text", "comment": "Usage Note; \r\n\r\nVery often the text is the same as a displayName of one of the codings.", "mustSupport": true }, { "id": "Provenance.activity", "path": "Provenance.activity", "comment": "Conformance Rule: The EMR may not have a record of when the activity occurred and in this case may use the recorded date in its place. This can support a partial date if that is all that is known. \r\n\r\nConformance Rule: If the sending system recognizes that a medication will auto-complete on a certain date, a provenance should be created in order to record this, using a code of \"medication completion\". This is a system level activity versus a clinical discontinuation, which uses an activity code of \"discontinue\".\r\n\r\nConformance Rule: Period may be useful when there is a fuzzy date and the exact date is not known\r\n\r\nExample: Medication Change (eg dosage change), or \"auto-complete\" for a short-term drug plan.\r\n\r\nConformance Rule: Activity must be codified ***VALUE SET TO BE UPDATED TO A MEDICAITON-SPECIFIC VALUE SET\r\n\r\nConformance Rule: Set value = \"export patient chart\" at the bundle level, as an overall activity for the patient chart\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 1, "mustSupport": true }, { "id": "Provenance.activity.coding", "path": "Provenance.activity.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "Provenance.activity.coding.system", "path": "Provenance.activity.coding.system", "min": 1, "mustSupport": true }, { "id": "Provenance.activity.coding.code", "path": "Provenance.activity.coding.code", "min": 1, "mustSupport": true }, { "id": "Provenance.activity.text", "path": "Provenance.activity.text", "comment": "Usage Rule: Notes recorded that are assocaited with the activity. Example: If there is a Medication Update, the physicians notes associated with the transaction\r\n\r\nPSS: If a medication is changed, a transaction is added to the journal, CHANGE TO: (dose, quantity, refills, instructions. If comments or compliance or success are part of the change, they can be included. \r\nPSS: If a comment or compliance or success is added without a medication change, it is called a COMMENTS ABOUT.\r\n\r\n\r\nVery often the text is the same as a displayName of one of the codings.", "min": 1, "mustSupport": true }, { "id": "Provenance.agent", "path": "Provenance.agent", "comment": "Conformance Rule: One or more iistances of WHO may be specified; this will be a reference to the user who carried out the action. \r\n\r\nConformance Rule: If the PractitionerRole resource can be populated, this must be specified as the role is clinically important. The PractitionerRole should always reference the Practitioner resource. Organization can be referenced from PractitionerRole and becomes important when the organization is external. Lastly, if the practitioner role cannot be determined, the Practitioner resource is permitted.\r\n\r\nConformance Rule: In the case of an auto-complete, the agent specified must be the last user to prescribe or renew or start a medication.\r\n\r\nUsage Note: On an import, the agent data may be limited and EMRs should specify what they can.\r\nUsage Note: For external agents, a who.display value of \"external\" may be used.\r\nUsage Note: For the bundle level \"export\" provenance, who should always be the practitioner role, with references to practitioner and organization.\r\n\r\nMapping PSS: Uses two sets of initials; the first is the \"doctor initials\", such as physician/nurse practitioner responsible for the \"patient piece\", aka transaction/note/medication update. If the doctor is the only person who touched a record, only the first set of initials will be included.\r\nThe second set of initials is the \"user initials\". This is the last person who touched the patient piece other than doctor. If there are two sets of initials, both will be sent as two agents. The initials will be converted into a full name and populated in the practitioner resource; the associated role will be specified in PractitionerRole.\r\nSeveral agents may be associated (i.e. has some responsibility for an activity) with an activity and vice-versa.", "mustSupport": true }, { "id": "Provenance.agent.who", "path": "Provenance.agent.who", "comment": "Conformance Rule: In the case of an auto-discontinue activity, the creator of the latest prescription or renewal.\r\nConformance Rule: The practitionerRole, including Practitoner and Organization references must be specified where known. \r\n\r\nwhoIdentity should be used when the agent is not a Resource type.", "type": [ { "code": "Reference", "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "Provenance.agent.who.reference", "path": "Provenance.agent.who.reference", "mustSupport": true }, { "id": "Provenance.agent.who.display", "path": "Provenance.agent.who.display", "comment": "Conformance Rule: If the EMR has imported a record from an external source, this can be populated with a value of \"external\"\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "mustSupport": true }, { "id": "Provenance.agent.onBehalfOf", "path": "Provenance.agent.onBehalfOf", "comment": "Usage Note: There are no known use cases at this time for Organization (future use)\r\n\r\nonBehalfOfIdentity should be used when the agent is not a Resource type.", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://telus.com/fhir/StructureDefinition/profile-organization-patientchart" ], "aggregation": [ "bundled" ] } ] }, { "id": "Provenance.entity", "path": "Provenance.entity", "comment": "Usage Rule: In the context of sharing medication in the patient chart, this may be used to reference a medication order that is associated with the Plan. Example: The presence of a Medication Order (Prescription) or a Medicaiton Statement (stored as a Medication record in the EMR) will trigger the creation of a plan", "mustSupport": true }, { "id": "Provenance.entity.role", "path": "Provenance.entity.role", "mustSupport": true }, { "id": "Provenance.entity.what", "path": "Provenance.entity.what", "type": [ { "code": "Reference", "targetProfile": [ "http://telus.com/fhir/StructureDefinition/profile-medication-request-order-patient-chart", "http://telus.com/fhir/StructureDefinition/profile-medicationStatement-patientchart" ] } ], "mustSupport": true }, { "id": "Provenance.entity.what.reference", "path": "Provenance.entity.what.reference", "min": 1, "mustSupport": true }, { "id": "Provenance.entity.what.display", "path": "Provenance.entity.what.display", "comment": "Usage: Note: If the entity.what is a reference to http://telus.com/fhir/StructureDefinition/profile-medication-request-order-patient-chart this should contain the text \"Prescription for x\", where \"x\" is the name of the medication name (eg .Medication.code.text) from the Medication Order. \r\n\r\nUsage Note: If the entity.what is a reference to http://telus.com/fhir/StructureDefinition/profile-medicationStatement-patientchart this should contain the text \"Patient Statement for x\", where \"x\" is the name of the medication name (eg .Medication.code.text) from the Medication Statement.\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "min": 1, "mustSupport": true }, { "id": "Provenance.entity.agent", "path": "Provenance.entity.agent", "contentReference": "http://hl7.org/fhir/StructureDefinition/Provenance#Provenance.agent" } ] }, "id": "0036855f-b9f3-431f-b95f-561b1dab53bc", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.421+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/3b4a1421-1b56-4761-a87a-71b1f63635ac", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com//fhir/patientChart/StructureDefinition/provenance-device", "name": "ProvenanceDevice", "status": "draft", "description": "This profile provides details that are captured for the device in the context of provenance", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "udi", "uri": "http://fda.gov/UDI", "name": "UDI Mapping" } ], "kind": "resource", "abstract": false, "type": "Device", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Device", "derivation": "constraint", "differential": { "element": [ { "id": "Device", "path": "Device", "mustSupport": true }, { "id": "Device.id", "path": "Device.id", "comment": "Usage Note: This will usually be a GUID that is assigned by the sending application.\r\n\r\nThe only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "mustSupport": true }, { "id": "Device.meta", "path": "Device.meta", "mustSupport": true }, { "id": "Device.meta.lastUpdated", "path": "Device.meta.lastUpdated", "mustSupport": true }, { "id": "Device.meta.source", "path": "Device.meta.source", "mustSupport": true }, { "id": "Device.meta.profile", "path": "Device.meta.profile", "comment": "Usage: This will be determined by each implementation; this may be useful for validation of message instnaces against this profile.\r\n\r\nIt 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.", "mustSupport": true }, { "id": "Device.identifier", "path": "Device.identifier", "comment": "Conformance Rule: Application Instance Identifier is issued by the EMR and must be unique. \r\nUsage Notes: Consider situations where a single app instance is shared across multiple locations or orgs, and where a single physical location or organizations could have multiple multiple app instances. Generally speaking, an application instance is typically segmentation by patient base. \r\nExample: urn:telus:emr:pss:1234\r\n\r\nThe barcode string from a barcode present on a device label or package may identify the instance, include names given to the device in local usage, or may identify the type of device. If the identifier identifies the type of device, Device.type element should be used.", "min": 1, "max": "1", "mustSupport": true }, { "id": "Device.identifier.system", "path": "Device.identifier.system", "mustSupport": true }, { "id": "Device.identifier.value", "path": "Device.identifier.value", "min": 1, "mustSupport": true }, { "id": "Device.manufacturer", "path": "Device.manufacturer", "comment": "Usage Note: This will be populated with the manufacturer as known. For example, this will be \"TELUS Health\" for all TELUS EMRs.\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Device.deviceName", "path": "Device.deviceName", "comment": "Conformance Rule: This must be populated when known. This is the user friendly name of the physical device or application instance. eg , PEI EMR, 4th Floor EKG, River Room, Mary's Computer, TimelyCareBilling, Concordia", "max": "1", "mustSupport": true }, { "id": "Device.deviceName.name", "path": "Device.deviceName.name", "mustSupport": true }, { "id": "Device.deviceName.type", "path": "Device.deviceName.type", "comment": "Conformance Rule: This will always be the user-friendly-name \r\n\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "Device.modelNumber", "path": "Device.modelNumber", "comment": "Conformance Rule: This is the name of the EMR software; examples: PS Suite, Collaborative Health Record, Med Access, NetMedical\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "min": 1, "mustSupport": true }, { "id": "Device.version", "path": "Device.version", "comment": "Conformance Rule: The version number as assigned by the application", "min": 1, "max": "1", "mustSupport": true }, { "id": "Device.version.value", "path": "Device.version.value", "mustSupport": true } ] }, "id": "3b4a1421-1b56-4761-a87a-71b1f63635ac", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.408+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/e785f7e6-e9c0-4da8-bbb0-41c8fa83c0e7", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-questionnaire", "name": "Questionnaire", "status": "draft", "description": "This is created/used by the RAPIDS project within TELUS. May also have use within the Patient Chart project", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "Questionnaire", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Questionnaire", "derivation": "constraint", "differential": { "element": [ { "id": "Questionnaire.id", "path": "Questionnaire.id", "mustSupport": true }, { "id": "Questionnaire.identifier", "path": "Questionnaire.identifier", "mustSupport": true }, { "id": "Questionnaire.version", "path": "Questionnaire.version", "mustSupport": true }, { "id": "Questionnaire.name", "path": "Questionnaire.name", "mustSupport": true }, { "id": "Questionnaire.title", "path": "Questionnaire.title", "mustSupport": true }, { "id": "Questionnaire.status", "path": "Questionnaire.status", "mustSupport": true }, { "id": "Questionnaire.publisher", "path": "Questionnaire.publisher", "comment": "Usage: If the publisher is known, this can be included, eg MMSE, MOCA\r\n\r\nUsually an organization but may be an individual. The publisher (or steward) of the questionnaire is the organization or individual primarily responsible for the maintenance and upkeep of the questionnaire. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the questionnaire. This item SHOULD be populated unless the information is available from context.", "mustSupport": true }, { "id": "Questionnaire.description", "path": "Questionnaire.description", "comment": "Usage Note: If present, this can be populated. PSS has a text area in the custom form that may map here. Other EMRs may also have this\r\n\r\nThis description can be used to capture details such as why the questionnaire was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the questionnaire as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the questionnaire is presumed to be the predominant language in the place the questionnaire was created).", "mustSupport": true }, { "id": "Questionnaire.code", "path": "Questionnaire.code", "comment": "Usage Note: This can be used to capture a LOINC code to represent the questionnaire, eg PHQ-9\r\n\r\nCodes 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.", "mustSupport": true }, { "id": "Questionnaire.code.system", "path": "Questionnaire.code.system", "mustSupport": true }, { "id": "Questionnaire.code.code", "path": "Questionnaire.code.code", "mustSupport": true }, { "id": "Questionnaire.code.display", "path": "Questionnaire.code.display", "mustSupport": true }, { "id": "Questionnaire.item", "path": "Questionnaire.item", "min": 1, "mustSupport": true }, { "id": "Questionnaire.item.linkId", "path": "Questionnaire.item.linkId", "comment": "Usage Note: A LOINC code should be used if it exists; otherwise create a GUID. eg for PHQ-9, each question has a LOINC code;. For other custom questionnaires this can be structured in any logical way. Example: Custom Form Name + version + field identifier/field name. \r\n\r\nThis ''can'' be a meaningful identifier (e.g. a LOINC code) but is not intended to have any meaning. GUIDs or sequential numbers are appropriate here.", "mustSupport": true }, { "id": "Questionnaire.item.definition", "path": "Questionnaire.item.definition", "comment": "Usage: If this is tied to a data dictionary, this can be referenced. This is not relevant to porting across and therefore will not be used.\r\n\r\nThe uri refers to an ElementDefinition in a [StructureDefinition](structuredefinition.html#) and always starts with the [canonical URL](references.html#canonical) for the target resource. When referring to a StructureDefinition, a fragment identifier is used to specify the element definition by its id [Element.id](element-definitions.html#Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x]. In the absence of a fragment identifier, the first/root element definition in the target is the matching element definition." }, { "id": "Questionnaire.item.code", "path": "Questionnaire.item.code", "comment": "Usage note: This should be populated with a LOINC code if it exists.\r\n\r\nThe value may come from the ElementDefinition referred to by .definition.", "mustSupport": true }, { "id": "Questionnaire.item.prefix", "path": "Questionnaire.item.prefix", "comment": "Usage Note: If this exists on a given form this may be populated.\r\n\r\nThese are generally unique within a questionnaire, though this is not guaranteed. Some questionnaires may have multiple questions with the same label with logic to control which gets exposed. Typically, these won't be used for \"display\" items, though such use is not prohibited. Systems SHOULD NOT generate their own prefixes if prefixes are defined for any items within a Questionnaire.", "mustSupport": true }, { "id": "Questionnaire.item.text", "path": "Questionnaire.item.text", "min": 1, "mustSupport": true }, { "id": "Questionnaire.item.type", "path": "Questionnaire.item.type", "comment": "Usage note: Every widget in the template maps to one of these choices.\r\n\r\nAdditional constraints on the type of answer can be conveyed by extensions. The value may come from the ElementDefinition referred to by .definition.", "mustSupport": true }, { "id": "Questionnaire.item.enableWhen", "path": "Questionnaire.item.enableWhen", "comment": "Usage Note: This may be difficult to extract from the template. For simple data structures this should be conveyed. \r\nUse case: This is valuable when migrating data from one EMR to another or when transferring a patient from one EMR to another.\r\n*See HL7 extensions for questionnaires\r\n\r\nIf multiple repetitions of this extension are present, the item should be enabled when the condition for *any* of the repetitions is true. I.e. treat \"enableWhen\"s as being joined by an \"or\" clause. This element is a modifier because if enableWhen is present for an item, \"required\" is ignored unless one of the enableWhen conditions is met. When an item is disabled, all of its descendants are disabled, regardless of what their own enablic might evaluate to.", "mustSupport": true }, { "id": "Questionnaire.item.enableBehavior", "path": "Questionnaire.item.enableBehavior", "comment": "Use case: This is valuable when migrating data from one EMR to another or when transferring a patient from one EMR to another.\r\n\r\nelement must be specified if more than one enableWhen value is provided.", "mustSupport": true }, { "id": "Questionnaire.item.required", "path": "Questionnaire.item.required", "comment": "Usage note: This applies to all use cases as there is some clinical value in knowing this, though its primary value is the migration use case.\r\n\r\nQuestionnaire.item.required only has meaning for elements that are conditionally enabled with enableWhen if the condition evaluates to true. If an item that contains other items is marked as required, that does not automatically make the contained elements required (though required groups must contain at least one child element). The value may come from the ElementDefinition referred to by .definition.", "mustSupport": true }, { "id": "Questionnaire.item.repeats", "path": "Questionnaire.item.repeats", "comment": "Use case: This is valuable when migrating data from one EMR to another or when transferring a patient from one EMR to another.\r\nUsage Note: If you are dealing with a group (repetition for each family member), this repeats for each relative. If you are allowed to pick one answer, repeats = false, if you are allowed to pick more than one, repeates = true\r\n\r\nIf a question is marked as repeats=true, then multiple answers can be provided for the question in the corresponding QuestionnaireResponse. When rendering the questionnaire, it is up to the rendering software whether to render the question text for each answer repetition (i.e. \"repeat the question\") or to simply allow entry/selection of multiple answers for the question (repeat the answers). Which is most appropriate visually may depend on the type of answer as well as whether there are nested items.\n\nThe resulting QuestionnaireResponse will be populated the same way regardless of rendering - one 'question' item with multiple answer values.\n\n The value may come from the ElementDefinition referred to by .definition.", "mustSupport": true }, { "id": "Questionnaire.item.readOnly", "path": "Questionnaire.item.readOnly", "comment": "Use Case: This would apply to all use cases and should be populated when this is \"true\" only. A value of \"false\" is not required.\r\n\r\nThe value of readOnly elements can be established by asserting extensions for defaultValues, linkages that support pre-population and/or extensions that support calculation based on other answers.", "mustSupport": true }, { "id": "Questionnaire.item.maxLength", "path": "Questionnaire.item.maxLength", "comment": "Use case: This is valuable when migrating data from one EMR to another or when transferring a patient from one EMR to another.\r\n\r\nFor base64binary, reflects the number of characters representing the encoded data, not the number of bytes of the binary data. The value may come from the ElementDefinition referred to by .definition.", "mustSupport": true }, { "id": "Questionnaire.item.answerValueSet", "path": "Questionnaire.item.answerValueSet", "comment": "Usage Note: This could be used when migrating data from one EMR to another or when transferring a patient from one EMR to another, however this requires a fairly deep level of sophistication and will therefore not be used at this time. The real value comes from template maintenance.\r\n\r\nUsage Note: This is useful when defining a value set and pointing to that, rather than including all possible answers. If there is a value set, this can be included here. Terminology will need to be published as an external value set, or it could be contained within this resource, or you can define all answer options, in which case you do not need this data element.\r\n\r\nLOINC defines many useful value sets for questionnaire responses. See [LOINC Answer Lists](loinc.html#alist). The value may come from the ElementDefinition referred to by .definition." }, { "id": "Questionnaire.item.answerOption", "path": "Questionnaire.item.answerOption", "comment": "Use case: This is valuable when migrating data from one EMR to another or when transferring a patient from one EMR to another as we can transfer templates.\r\n\r\nThis element can be used when the value set machinery of answerValueSet is deemed too cumbersome or when there's a need to capture possible answers that are not codes.", "mustSupport": true }, { "id": "Questionnaire.item.answerOption.value[x]", "path": "Questionnaire.item.answerOption.value[x]", "mustSupport": true }, { "id": "Questionnaire.item.answerOption.initialSelected", "path": "Questionnaire.item.answerOption.initialSelected", "mustSupport": true }, { "id": "Questionnaire.item.initial", "path": "Questionnaire.item.initial", "comment": "Usage Note: This is setting the default value for your question \r\nUse Case: The primary value is migrating templates from one EMR to another. \r\n\r\nSee HL7 extension for Initial Exptression. http://build.fhir.org/ig/HL7/sdc/StructureDefinition-sdc-questionnaire-initialExpression.html\r\n\r\nThe user is allowed to change the value and override the default (unless marked as read-only). If the user doesn't change the value, then this initial value will be persisted when the QuestionnaireResponse is initially created. Note that initial values can influence results. The data type of initial[x] must agree with the item.type, and only repeating items can have more then one initial value.", "mustSupport": true }, { "id": "Questionnaire.item.initial.value[x]", "path": "Questionnaire.item.initial.value[x]", "mustSupport": true }, { "id": "Questionnaire.item.item", "path": "Questionnaire.item.item", "comment": "Usage Note: For nested items, the same rules apply as for Questionnarire.item \r\n\r\nThere is no specified limit to the depth of nesting. However, Questionnaire authors are encouraged to consider the impact on the user and user interface of overly deep nesting.", "contentReference": "http://hl7.org/fhir/StructureDefinition/Questionnaire#Questionnaire.item", "mustSupport": true }, { "id": "Questionnaire.item.item.linkId", "path": "Questionnaire.item.item.linkId", "mustSupport": true }, { "id": "Questionnaire.item.item.code", "path": "Questionnaire.item.item.code", "mustSupport": true }, { "id": "Questionnaire.item.item.prefix", "path": "Questionnaire.item.item.prefix", "mustSupport": true }, { "id": "Questionnaire.item.item.text", "path": "Questionnaire.item.item.text", "mustSupport": true }, { "id": "Questionnaire.item.item.type", "path": "Questionnaire.item.item.type", "mustSupport": true }, { "id": "Questionnaire.item.item.item", "path": "Questionnaire.item.item.item", "contentReference": "http://hl7.org/fhir/StructureDefinition/Questionnaire#Questionnaire.item", "mustSupport": true } ] }, "id": "e785f7e6-e9c0-4da8-bbb0-41c8fa83c0e7", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.421+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/2f3f6dd5-ceaf-4ce2-9ef6-2fc7c89d6341", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-questionnaire-response", "name": "QuestionnaireResponse", "status": "draft", "description": "This is created/used by the RAPIDS project within TELUS. May also be used in the Patient Chart", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "QuestionnaireResponse", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse", "derivation": "constraint", "differential": { "element": [ { "id": "QuestionnaireResponse", "path": "QuestionnaireResponse", "comment": "Usage Note: You cannot query against a Quesitonnnaire Response based on the answer. Information from the questionnaire can be extracted into observations which is then searchable. \r\n\r\nUsage Note: For referrals, we are likely going to send a PDF rather than use this. This profile is based on the TELUS RAPIDs project \r\n\r\nThe QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on. I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse." }, { "id": "QuestionnaireResponse.id", "path": "QuestionnaireResponse.id", "mustSupport": true }, { "id": "QuestionnaireResponse.meta", "path": "QuestionnaireResponse.meta", "mustSupport": true }, { "id": "QuestionnaireResponse.meta.lastUpdated", "path": "QuestionnaireResponse.meta.lastUpdated", "mustSupport": true }, { "id": "QuestionnaireResponse.meta.source", "path": "QuestionnaireResponse.meta.source", "mustSupport": true }, { "id": "QuestionnaireResponse.meta.profile", "path": "QuestionnaireResponse.meta.profile", "mustSupport": true }, { "id": "QuestionnaireResponse.text", "path": "QuestionnaireResponse.text", "comment": "Usage Note: This is used if a PDF image of the questionnaire response is included in the bundle, or if a text rendering if desired.\r\n\r\nContained 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.", "min": 1, "mustSupport": true }, { "id": "QuestionnaireResponse.text.status", "path": "QuestionnaireResponse.text.status", "mustSupport": true }, { "id": "QuestionnaireResponse.text.div", "path": "QuestionnaireResponse.text.div", "comment": "Usage Note: Used to reference the PDF, Image , XHTML - Image Tag - \"display this thing here\" - URL would be hash123, if 123 if the id of the contained resouce. This is a local reference to the contained binary resource.\r\n\r\nUsage Note: If there is no PDF, this can also be used to convey the XHTML\r\n\r\nhe contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.", "mustSupport": true }, { "id": "QuestionnaireResponse.contained", "path": "QuestionnaireResponse.contained", "comment": "Usage Note: This would be a binary, PDF\r\n\r\nThis 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.", "mustSupport": true }, { "id": "QuestionnaireResponse.identifier", "path": "QuestionnaireResponse.identifier", "comment": "Usage Note: This could be a transaction id or this type of concept in the EMR. If it exists in the EMR this should be populated.", "mustSupport": true }, { "id": "QuestionnaireResponse.identifier.system", "path": "QuestionnaireResponse.identifier.system", "mustSupport": true }, { "id": "QuestionnaireResponse.identifier.value", "path": "QuestionnaireResponse.identifier.value", "mustSupport": true }, { "id": "QuestionnaireResponse.questionnaire", "path": "QuestionnaireResponse.questionnaire", "comment": "Usage Note: This may be necessary if order or further context to the questions included in the Questionnaire Response are necessary. \r\nInternal Templates (specific to EMR), and universal templates (eg PHQ-9). As a general rule, universal templates are known and theefore the questionnaire is not typically required. For internal templates, the questionnnaire should be included, so the recipient clearly understands what was in the original form. \r\n\r\nUsage Note: The questionnaire (canonical URL) identifies the particular questionnnaire. The contents of the questionnaire will tell recipients the default values, questions that were not answered, etc. eg please identify relevant comorbilities; knowing that there was a limited choice set (eg 4 answers) becomes very relevant. \r\n\r\nUsage Note: The name questionnaire implies questions, but this could just be a tag, rather than an actual question. \r\n\r\nIf a QuestionnaireResponse references a Questionnaire, then the QuestionnaireResponse structure must be consistent with the Questionnaire (i.e. questions must be organized into the same groups, nested questions must still be nested, etc.).", "mustSupport": true }, { "id": "QuestionnaireResponse.status", "path": "QuestionnaireResponse.status", "mustSupport": true }, { "id": "QuestionnaireResponse.subject", "path": "QuestionnaireResponse.subject", "min": 1, "mustSupport": true }, { "id": "QuestionnaireResponse.subject.reference", "path": "QuestionnaireResponse.subject.reference", "mustSupport": true }, { "id": "QuestionnaireResponse.subject.display", "path": "QuestionnaireResponse.subject.display", "mustSupport": true }, { "id": "QuestionnaireResponse.item", "path": "QuestionnaireResponse.item", "comment": "Usage note: **** Confirm that we will use this for Progress Notes, and in this case there may not be any items. -- LL\r\nUsage Note: This includes the \"total score\" and any other calculated answers and/or pre-populated answers\r\n\r\nUsage Note: The same hierarchy and ordering is the same as the questionnaire; there will be some repetition in the response (eg for repeating group). There may be some items in the questionnaire that are not in the response as they are not required. If the receeiving system would like to understand what questions were not answered, the questionnaire is useful for this. \r\n\r\nGroups cannot have answers and therefore must nest directly within item. When dealing with questions, nesting must occur within each answer because some questions may have multiple answers (and the nesting occurs for each answer).", "mustSupport": true }, { "id": "QuestionnaireResponse.item.linkId", "path": "QuestionnaireResponse.item.linkId", "comment": "Usage Note: Where possible, this should be the LOINC code, eg for PHQ-9, each question has a LOINC code;. For other custom questionnairs this can be structured in any logical way. Example: Custom Form Name + version + field identifier/field name. \r\n\r\nTBD - we should publish the canonical URL for all standardized forms, for those in TELUS library and third partties such as OCEAN\r\n\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "QuestionnaireResponse.item.definition", "path": "QuestionnaireResponse.item.definition", "comment": "Usage Note: This is used to convey the LOINC code associated with this item., structured as http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x].\n\n\r\nThe ElementDefinition must be in a [StructureDefinition](structuredefinition.html#), and must have a fragment identifier that identifies the specific data element by its id (Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.", "mustSupport": true }, { "id": "QuestionnaireResponse.item.text", "path": "QuestionnaireResponse.item.text", "comment": "Usage Note: thiis is the question text\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "min": 1, "mustSupport": true }, { "id": "QuestionnaireResponse.item.answer", "path": "QuestionnaireResponse.item.answer", "comment": "Usage Note: For PHQ-9 and GAD-7 there will only be a single answer (1..1)\r\n\r\nThe value is nested because we cannot have a repeating structure that has variable type.", "min": 1, "mustSupport": true }, { "id": "QuestionnaireResponse.item.answer.value[x]", "path": "QuestionnaireResponse.item.answer.value[x]", "min": 1, "mustSupport": true }, { "id": "QuestionnaireResponse.item.answer.item", "path": "QuestionnaireResponse.item.answer.item", "contentReference": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item", "mustSupport": true }, { "id": "QuestionnaireResponse.item.answer.item.linkId", "path": "QuestionnaireResponse.item.answer.item.linkId", "mustSupport": true }, { "id": "QuestionnaireResponse.item.answer.item.text", "path": "QuestionnaireResponse.item.answer.item.text", "min": 1, "mustSupport": true }, { "id": "QuestionnaireResponse.item.answer.item.answer", "path": "QuestionnaireResponse.item.answer.item.answer", "min": 1, "mustSupport": true }, { "id": "QuestionnaireResponse.item.answer.item.answer.value[x]", "path": "QuestionnaireResponse.item.answer.item.answer.value[x]", "min": 1, "mustSupport": true }, { "id": "QuestionnaireResponse.item.answer.item.answer.item", "path": "QuestionnaireResponse.item.answer.item.answer.item", "contentReference": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item", "mustSupport": true }, { "id": "QuestionnaireResponse.item.answer.item.item", "path": "QuestionnaireResponse.item.answer.item.item", "contentReference": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item", "mustSupport": true }, { "id": "QuestionnaireResponse.item.item", "path": "QuestionnaireResponse.item.item", "contentReference": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item", "mustSupport": true }, { "id": "QuestionnaireResponse.item.item.text", "path": "QuestionnaireResponse.item.item.text", "mustSupport": true }, { "id": "QuestionnaireResponse.item.item.answer", "path": "QuestionnaireResponse.item.item.answer", "mustSupport": true }, { "id": "QuestionnaireResponse.item.item.item", "path": "QuestionnaireResponse.item.item.item", "contentReference": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item" } ] }, "id": "2f3f6dd5-ceaf-4ce2-9ef6-2fc7c89d6341", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.421+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/f24b7bde-1e7c-4088-b15a-116df7a49fdf", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-guidance-response", "name": "RAPIDSGuidanceResponse", "status": "draft", "description": "This is created/used by the RAPIDS project within TELUS", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "GuidanceResponse", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/GuidanceResponse", "derivation": "constraint", "differential": { "element": [ { "id": "GuidanceResponse.id", "path": "GuidanceResponse.id", "mustSupport": true }, { "id": "GuidanceResponse.meta", "path": "GuidanceResponse.meta", "mustSupport": true }, { "id": "GuidanceResponse.meta.lastUpdated", "path": "GuidanceResponse.meta.lastUpdated", "mustSupport": true }, { "id": "GuidanceResponse.meta.source", "path": "GuidanceResponse.meta.source", "mustSupport": true }, { "id": "GuidanceResponse.meta.profile", "path": "GuidanceResponse.meta.profile", "mustSupport": true }, { "id": "GuidanceResponse.text", "path": "GuidanceResponse.text", "mustSupport": true }, { "id": "GuidanceResponse.contained", "path": "GuidanceResponse.contained", "mustSupport": true }, { "id": "GuidanceResponse.module[x]", "path": "GuidanceResponse.module[x]", "mustSupport": true }, { "id": "GuidanceResponse.status", "path": "GuidanceResponse.status", "mustSupport": true } ] }, "id": "f24b7bde-1e7c-4088-b15a-116df7a49fdf", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.410+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/4796c47e-aa31-423d-8dfa-9040c89a0c5f", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-risk-assessment", "name": "RAPIDSRiskAssessment", "status": "draft", "description": "This is created/used by the RAPIDS project within TELUS", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "RiskAssessment", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/RiskAssessment", "derivation": "constraint", "differential": { "element": [ { "id": "RiskAssessment.id", "path": "RiskAssessment.id", "mustSupport": true }, { "id": "RiskAssessment.meta", "path": "RiskAssessment.meta", "mustSupport": true }, { "id": "RiskAssessment.meta.lastUpdated", "path": "RiskAssessment.meta.lastUpdated", "mustSupport": true }, { "id": "RiskAssessment.meta.source", "path": "RiskAssessment.meta.source", "mustSupport": true }, { "id": "RiskAssessment.meta.profile", "path": "RiskAssessment.meta.profile", "mustSupport": true }, { "id": "RiskAssessment.text", "path": "RiskAssessment.text", "mustSupport": true }, { "id": "RiskAssessment.status", "path": "RiskAssessment.status", "mustSupport": true }, { "id": "RiskAssessment.subject", "path": "RiskAssessment.subject", "mustSupport": true }, { "id": "RiskAssessment.subject.reference", "path": "RiskAssessment.subject.reference", "mustSupport": true }, { "id": "RiskAssessment.subject.display", "path": "RiskAssessment.subject.display", "mustSupport": true }, { "id": "RiskAssessment.occurrence[x]", "path": "RiskAssessment.occurrence[x]", "mustSupport": true }, { "id": "RiskAssessment.basis", "path": "RiskAssessment.basis", "mustSupport": true }, { "id": "RiskAssessment.basis.reference", "path": "RiskAssessment.basis.reference", "mustSupport": true }, { "id": "RiskAssessment.basis.display", "path": "RiskAssessment.basis.display", "mustSupport": true } ] }, "id": "4796c47e-aa31-423d-8dfa-9040c89a0c5f", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.422+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/940c5f52-1546-457a-99c6-cd1287c6132e", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-service-request", "name": "ServiceRequest", "status": "draft", "date": "2022-08-12T20:30:19.0036288+00:00", "description": "This profile service requisitions for diagnostic tests and imaging, lab requisitions, as well as referrals,", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "ServiceRequest", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest", "derivation": "constraint", "differential": { "element": [ { "id": "ServiceRequest", "path": "ServiceRequest", "comment": "Usage Note: There are two referral use cases: Sending referral in real time to a specialist; and Sending a referral record as recorded in the database for a past event. Referrals can be either internally within a clinic or to an external provider. \r\nUsage Note: This single profile will cover all service requisitions including such items as lab requests, diagnostic imagining, amd referrals. Generally speaking the category and code will be used to distinguish the type of service request." }, { "id": "ServiceRequest.id", "path": "ServiceRequest.id", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.meta", "path": "ServiceRequest.meta", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.meta.lastUpdated", "path": "ServiceRequest.meta.lastUpdated", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.meta.source", "path": "ServiceRequest.meta.source", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.meta.profile", "path": "ServiceRequest.meta.profile", "mustSupport": true }, { "id": "ServiceRequest.text", "path": "ServiceRequest.text", "mustSupport": true }, { "id": "ServiceRequest.text.status", "path": "ServiceRequest.text.status", "mustSupport": true }, { "id": "ServiceRequest.text.div", "path": "ServiceRequest.text.div", "mustSupport": true }, { "id": "ServiceRequest.identifier", "path": "ServiceRequest.identifier", "comment": "Usage Note: This is a stable identifier that is recognized by both sending and receiving applicaitons. This is mandatory for use cases that may be updating a record as this is the key identifier. If it is not present in the EMR this must be generated, and must be unique (eg PSS: combination of the application instance + patient identifier + patient piece transaction id)\r\n\r\nThe identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.", "mustSupport": true }, { "id": "ServiceRequest.identifier.type", "path": "ServiceRequest.identifier.type", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.identifier.type.coding", "path": "ServiceRequest.identifier.type.coding", "min": 1, "max": "1", "mustSupport": true }, { "id": "ServiceRequest.identifier.type.coding.system", "path": "ServiceRequest.identifier.type.coding.system", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.identifier.type.coding.code", "path": "ServiceRequest.identifier.type.coding.code", "min": 1, "fixedCode": "PLAC", "mustSupport": true }, { "id": "ServiceRequest.identifier.system", "path": "ServiceRequest.identifier.system", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.identifier.value", "path": "ServiceRequest.identifier.value", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.basedOn", "path": "ServiceRequest.basedOn", "comment": "Usage Note: Must provide if this is supported and available in the sending EMR\r\nUsage note: MA - If there is a Care plan resource created for a detailed care plan include the reference to the careplan during which this service request was created\r\n\r\nPSS - N/A\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "mustSupport": true }, { "id": "ServiceRequest.basedOn.reference", "path": "ServiceRequest.basedOn.reference", "mustSupport": true }, { "id": "ServiceRequest.basedOn.display", "path": "ServiceRequest.basedOn.display", "mustSupport": true }, { "id": "ServiceRequest.requisition", "path": "ServiceRequest.requisition", "comment": "Usage Note: This is used for grouping service requests that are part of the same grouping/service request in the EMR. This may not be supported by all implementation projects but should be considered. This type of identifier likely doesn't exist in the EMR, but can created by the EMR for linking purposes. For referrals there is typically only one service request. \r\n\r\nUsage Note: Not supported by DW; EMRs do not have this identifier. \r\n\r\neReferral Ontario Notes: It is highly recommended that the common elements should match between multiple ServiceRequests (e.g., patient, requester, etc...) Requests are linked either by a \"basedOn\" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.", "mustSupport": true }, { "id": "ServiceRequest.requisition.system", "path": "ServiceRequest.requisition.system", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.requisition.value", "path": "ServiceRequest.requisition.value", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.status", "path": "ServiceRequest.status", "comment": "Usage note: draft, active, completed or unknown are likely status relevant\r\n\r\nPSS --> FHIR\r\nActive --> active\r\nMore Information Requested --> Active \r\nCompleted --> Completed\r\nCancelled --> revoked\r\nRequest Refused--> revoked\r\nPatient Never Went/Missed Appointment --> on-hold\r\n\r\n\r\nMA --FHIR\r\nActive -- >Active\r\nCompeleted -->completed\r\nDeleted --> entered-in-error\r\n\r\nThe status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see [Event Pattern](event.html) for general discussion) or using the [Task](task.html) resource.", "mustSupport": true }, { "id": "ServiceRequest.intent", "path": "ServiceRequest.intent", "comment": "Usage note: Value of \"order\" as the EMRs treat this as an order if it has completed. If it is a request, this should be a \"proposal\", when there is no intent to ensure that this has occurred. ***** confirm this\r\n\r\nDW Usage Note: Will always set a value of \"order\" as it is treated as such in the EMR.\r\nOntario eReferral: Has a fixed value of \"proposal\". \r\n\r\nThis element is labeled as a modifier because the intent alters when and how the resource is actually applicable.", "mustSupport": true }, { "id": "ServiceRequest.category", "path": "ServiceRequest.category", "comment": "Usage Note: The following codes will be supported:\r\n108252007 Laboratory procedure \r\n363679005 Imaging\r\n44383000 Patient referral for consultation\r\n386053000 investigation \r\n\r\nUsage Note: Investigation will cover diagnostic testing, reports. eg EEG, PFT\r\n\r\nOntario eReferral Binding to Infoway code set: https://fhir.infoway-inforoute.ca/ValueSet/interventioncodesubsetcare; over 3000 codes and doesn't make much sense to ues this value set which doe snot include the above codes. We do not need to align with this\r\n\r\nThere may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.", "mustSupport": true }, { "id": "ServiceRequest.category.coding", "path": "ServiceRequest.category.coding", "mustSupport": true }, { "id": "ServiceRequest.category.coding.system", "path": "ServiceRequest.category.coding.system", "mustSupport": true }, { "id": "ServiceRequest.category.coding.code", "path": "ServiceRequest.category.coding.code", "mustSupport": true }, { "id": "ServiceRequest.category.text", "path": "ServiceRequest.category.text", "mustSupport": true }, { "id": "ServiceRequest.priority", "path": "ServiceRequest.priority", "comment": "Usage Note: This will be supported when the EMR can determine this (eg MA can specify a code of urgent). Most EMRs do not support this discretely.\r\n\r\neReferral Ontario - this is a supported data element\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size", "mustSupport": true }, { "id": "ServiceRequest.code", "path": "ServiceRequest.code", "comment": "Usage Note: Coding is not always possible and in these cases text may be used.\r\n\r\nOntario eReferral Note: The meaning of this field is to be used in conjunction with ServiceRequest.performing pointing to a HealthCareservice, and .code further specifies the service, for example code could be a specific procedure under the specificed HealthcareService (e.g., HealthcareService = Orthopaedic Surgeon, code=Knee Surgery).\r\n\r\n\r\nMany laboratory and radiology procedure codes embed the specimen/organ system in the test order name, for example, serum or serum/plasma glucose, or a chest x-ray. The specimen might not be recorded separately from the test code.", "min": 1, "mustSupport": true }, { "id": "ServiceRequest.code.coding", "path": "ServiceRequest.code.coding", "comment": "Usage Note: Where possible a code must be provided, though it is recognized that this is not always possible .\r\n\r\nCodes 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.", "mustSupport": true }, { "id": "ServiceRequest.code.coding.system", "path": "ServiceRequest.code.coding.system", "mustSupport": true }, { "id": "ServiceRequest.code.coding.code", "path": "ServiceRequest.code.coding.code", "mustSupport": true }, { "id": "ServiceRequest.code.text", "path": "ServiceRequest.code.text", "mustSupport": true }, { "id": "ServiceRequest.orderDetail", "path": "ServiceRequest.orderDetail", "comment": "Usage Note: Any further information will be in a referral letter and not discretely tracked in the EMR for exporting. Therefore this need not be supported by sending systems at this point in time.\r\n\r\nAlignment: Ontario eReferral: Supported; code not text\r\n\r\nFor information from the medical record intended to support the delivery of the requested services, use the `supportingInformation` element.", "mustSupport": true }, { "id": "ServiceRequest.subject", "path": "ServiceRequest.subject", "comment": "Usage Note: Only patient will be supported at this time.\r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/Group" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "ServiceRequest.subject.reference", "path": "ServiceRequest.subject.reference", "mustSupport": true }, { "id": "ServiceRequest.subject.display", "path": "ServiceRequest.subject.display", "mustSupport": true }, { "id": "ServiceRequest.encounter", "path": "ServiceRequest.encounter", "mustSupport": true }, { "id": "ServiceRequest.encounter.reference", "path": "ServiceRequest.encounter.reference", "mustSupport": true }, { "id": "ServiceRequest.encounter.display", "path": "ServiceRequest.encounter.display", "mustSupport": true }, { "id": "ServiceRequest.occurrence[x]", "path": "ServiceRequest.occurrence[x]", "comment": "Usage note: When the service is scheduled to take place when available, provided there is a date in the EMR\r\n\r\nAlignment: Ontario eReferral does not support this data element", "mustSupport": true }, { "id": "ServiceRequest.authoredOn", "path": "ServiceRequest.authoredOn", "comment": "Ontario eReferral Note: : authoredOn is the submission time of the sending system", "mustSupport": true }, { "id": "ServiceRequest.requester", "path": "ServiceRequest.requester", "comment": "Usage Note: Populate with the practitioner who requested this service\r\nThis not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ], "aggregation": [ "bundled" ] } ], "mustSupport": true }, { "id": "ServiceRequest.requester.reference", "path": "ServiceRequest.requester.reference", "mustSupport": true }, { "id": "ServiceRequest.requester.display", "path": "ServiceRequest.requester.display", "mustSupport": true }, { "id": "ServiceRequest.performer", "path": "ServiceRequest.performer", "comment": "Usage: If this is an external request, there is often only a name and will be conveyed as display. For internal requests, it will often be possible to reference a practitioner resource in addition to the display. HealthcareService is not supported at this point in time.\r\n\r\nIf multiple performers are present, it is interpreted as a list of *alternative* performers without any preference regardless of order. If order of preference is needed use the [request-performerOrder extension](extension-request-performerorder.html). Use CareTeam to represent a group of performers (for example, Practitioner A *and* Practitioner B).", "mustSupport": true }, { "id": "ServiceRequest.performer.reference", "path": "ServiceRequest.performer.reference", "mustSupport": true }, { "id": "ServiceRequest.performer.display", "path": "ServiceRequest.performer.display", "mustSupport": true }, { "id": "ServiceRequest.reasonCode", "path": "ServiceRequest.reasonCode", "comment": "Usage Note: Support when available in the sending EMR. This may be a local code or ICD-9, ICD-10, PIN (MA), SNOMED, ENCODE. As this may not be understood by the receiving application, either text and display is strongly recommended\r\n\r\nMA - may have reason as a code or text\r\n\r\nThis element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use `CodeableConcept.text` element if the data is free (uncoded) text as shown in the [CT Scan example](servicerequest-example-di.html).", "mustSupport": true }, { "id": "ServiceRequest.reasonCode.coding", "path": "ServiceRequest.reasonCode.coding", "mustSupport": true }, { "id": "ServiceRequest.reasonCode.coding.system", "path": "ServiceRequest.reasonCode.coding.system", "mustSupport": true }, { "id": "ServiceRequest.reasonCode.coding.code", "path": "ServiceRequest.reasonCode.coding.code", "mustSupport": true }, { "id": "ServiceRequest.reasonCode.coding.display", "path": "ServiceRequest.reasonCode.coding.display", "mustSupport": true }, { "id": "ServiceRequest.reasonCode.text", "path": "ServiceRequest.reasonCode.text", "mustSupport": true }, { "id": "ServiceRequest.supportingInfo", "path": "ServiceRequest.supportingInfo", "comment": "Use Case: Sending referral record from the DB: In PSS: where there is a pending test, additional data may be available, eg a composition of the Patient Chart data that accompanyed the referral letter if the data is linked to the referral in the EMR. \r\nUse Case - Sending Referral record from DB: A note that a graph of hemoglobin was sent as part of the referral may be included\r\nUse Case: Sending Referral record from DB: This may be a document reference for the attached PDF/letter. This could also be used to attach lab results, observations, previous consult letters, etc. Generally speaking, the allergies, conditions, medications are in the letter and are not discretely linked in the EMR and are therefore not available to include as resources.\r\n\r\nUse Case - Sending Referral to Specialist: This could also be a reference to an image (eg graph of hemoglobin) that is generated at the time of the referral. \r\n\r\nTo represent information about how the services are to be delivered use the `instructions` element.", "mustSupport": true }, { "id": "ServiceRequest.supportingInfo.reference", "path": "ServiceRequest.supportingInfo.reference", "mustSupport": true }, { "id": "ServiceRequest.supportingInfo.display", "path": "ServiceRequest.supportingInfo.display", "mustSupport": true }, { "id": "ServiceRequest.note", "path": "ServiceRequest.note", "comment": "Usage note: Any notes related to the service Request or the updates to the service request as additional note. \r\n\r\nUsage Notes: The EMRs have a detailed section which could be included here.\r\n\r\nFor systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. *Annotations SHOULD NOT* be used to communicate \"modifying\" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).", "mustSupport": true }, { "id": "ServiceRequest.note.author[x]", "path": "ServiceRequest.note.author[x]", "mustSupport": true }, { "id": "ServiceRequest.note.time", "path": "ServiceRequest.note.time", "mustSupport": true }, { "id": "ServiceRequest.note.text", "path": "ServiceRequest.note.text", "mustSupport": true } ] }, "id": "940c5f52-1546-457a-99c6-cd1287c6132e", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.422+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/patient-sexForClinicalUse", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "patient-sexForClinicalUse", "extension": [ { "url": "http://telus.com/fhir/patientChart/StructureDefinition/patient-sexForClinicalUse" } ], "url": "http://telus.com/fhir/patientChart/StructureDefinition/ext-patient-sexForClinicaUse", "version": "4.0.1", "name": "SexForClinicalUse", "title": "sexForClinicalUse", "status": "draft", "experimental": false, "date": "2022-01-24T16:55:11+11:00", "publisher": "HL7", "description": "**Sex for Clinical Use (SFCU) Overview** Sex for Clinical Use is a categorization of sex derived from observable information such as an organ inventory, recent hormone lab tests, genetic testing, menstrual status, obstetric history, etc. This property is intended for use in clinical decision making and indicates that treatment or diagnostic tests should consider best practices associated with the relevant reference population. While clinical decision-making processes could account for the specific physiological or anatomical attributes of the patient, there are several practical considerations, such as patient privacy and limited capabilities of existing systems which create the need for a categorization that is easy to exchange. The Sex for Clinical Use categorization is intended to bridge the gap between the hypothetical ideal and the practical needs of operational systems. **Sex for Clinical Use (SFCU) Contexts** Sex for Clinical Use is a contextual concept. For example, a patient may generally be categorized as male, but for a specific lab test, the resulting lab should use the reference ranges associated with a female reference population. In this case, systems may provide a patient-context [sexForClinicalUse](extension-patient-sexforclinicaluse.html) that acts as a 'default' for most care and annotate the lab order with a context-specific sexForClinicalUse. Systems may determine what enclosing contexts are useful, but Patient, Encounter and EpisodeOfCare are three enclosing contexts that may often apply. The [sexForClinicalUse](extension-patient-sexforclinicaluse.html) extension can be used to communicate a clinical sex category on the on relevant clinical resources (e.g., DiagnosticReport , ServiceRequest) or enclosing contexts (e.g., Patient, Encounter, EpisodeOfCare). **Sex for Clinical Use (SFCU) Categorization** For ease of interoperability, a patient’s sex for clinical use is constrained to four possible categories. Any patient for which special considerations apply should be categorized as 'Specified'. The 'Specified' category is often represented as 'Other' in existing systems. **Female** - Available data indicates that diagnostics, analytics, and treatments should consider best practices associated with female reference populations. **Male** - Available data indicates that diagnostics, analytics, and treatments should consider best practices associated with male reference populations. **Specified** - Available data indicates that diagnostics, analytics, and treatment best practices may be undefined or not aligned with existing sex-derived reference populations. Individuals or systems providing care should either use default behavior that is safe for both male and female populations, individually review treatment options with the patient, or carefully inspect relevant observations before proceeding with treatment. **Unknown** - The sex for clinical use cannot be determined because there are no relevant evidence or documentation, or the evidence or documentation are not sufficient to determine a value. **Sex for Clinical Use (SFCU) History and Practices** Prior to the definition of Sex for Clinical Use as a concept, systems may have used administrative gender as an approximation of patient-level sex for clinical use. This practice required pre-coordination among exchange parters to explicitly overload the administrative sex concept for use as a clinical sex concept. In cases where there was no pre-coordination, some systems may have incorrectly inferred information about a patient's clinical sex from administrative gender. In the context of ordering workflows, systems may use Ask at Order Entry (AOE) questions to collect concepts similar to sex for clinical use.", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "complex-type", "abstract": false, "context": [ { "type": "element", "expression": "Resource" } ], "type": "Extension", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension", "derivation": "constraint", "differential": { "element": [ { "id": "Extension", "path": "Extension", "short": "A context-specific sex for clinical use", "definition": "A context-specific categorization of a patient's sex for the purpose of clinical use", "comment": "Usage Note: This may be added to any resource where it is necessary to specify the Sex for Clinical Use. For example, on a lab order, lab result or service request. This is not supported currently by EMRs but is included as it is expected to be supported in the near future.\r\n\r\nAlignment: This is a pre-adoption of an R5 HL7 extension. This is published as a TELUS extension and implementers will need to update the URL in the future. The datatype on supportingInfo has been changed to a codeableConcept in order to be compliant with R4; it is not supported at this time." }, { "id": "Extension.extension", "path": "Extension.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "rules": "open" }, "min": 1 }, { "id": "Extension.extension:value", "path": "Extension.extension", "sliceName": "value", "short": "A context-specific sex for clinical use", "definition": "A context-specific categorization of a patient's sex for the purpose of clinical use", "comment": "Sex for clinical use may be contexual. For example, the sex for clinical use for mammogram health maintenance may by different than the sex for clinical use for the purpose of selecting a reference range for a lab test. There may also be a patient-context sex for clinical use that is a general categorization that would apply across all contexts if more specific information is not available.", "min": 1, "max": "1", "mustSupport": true }, { "id": "Extension.extension:value.url", "path": "Extension.extension.url", "type": [ { "code": "uri" } ], "fixedUri": "value" }, { "id": "Extension.extension:value.value[x]", "path": "Extension.extension.value[x]", "min": 1, "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "sexForClinicalUse" } ], "strength": "required", "valueSet": "http://hl7.org/fhir/ValueSet/sex-for-clinical-use" } }, { "id": "Extension.extension:period", "path": "Extension.extension", "sliceName": "period", "short": "When the sex for clinical use applies", "definition": "The time period during which the sex for clinical use applies to the patient", "min": 0, "max": "1", "mustSupport": true }, { "id": "Extension.extension:period.url", "path": "Extension.extension.url", "type": [ { "code": "uri" } ], "fixedUri": "period" }, { "id": "Extension.extension:period.value[x]", "path": "Extension.extension.value[x]", "min": 1, "type": [ { "code": "Period" } ] }, { "id": "Extension.extension:comment", "path": "Extension.extension", "sliceName": "comment", "short": "Context about the sex for clinical use", "definition": "Further explanation about the context for the sex for clinical use", "min": 0, "max": "1", "mustSupport": true }, { "id": "Extension.extension:comment.url", "path": "Extension.extension.url", "type": [ { "code": "uri" } ], "fixedUri": "comment" }, { "id": "Extension.extension:comment.value[x]", "path": "Extension.extension.value[x]", "min": 1, "type": [ { "code": "string" } ] }, { "id": "Extension.extension:supportingInfo", "path": "Extension.extension", "sliceName": "supportingInfo", "short": "Source of the sex for clincal use", "definition": "Other clinical evidence or documentation that was used to determine the sex for clincal use", "comment": "For example, a patient with an initial diagnosis of an intersex condition could have supporting clinical observations specific to the diagnosis. Additional information may be provided in the comment attribute.", "min": 0 }, { "id": "Extension.extension:supportingInfo.url", "path": "Extension.extension.url", "type": [ { "code": "uri" } ], "fixedUri": "supportingInfo" }, { "id": "Extension.extension:supportingInfo.value[x]", "path": "Extension.extension.value[x]", "min": 1, "type": [ { "code": "CodeableConcept" } ] }, { "id": "Extension.url", "path": "Extension.url", "fixedUri": "http://telus.com/fhir/patientChart/StructureDefinition/patient-sexForClinicalUse" }, { "id": "Extension.value[x]", "path": "Extension.value[x]", "max": "0" } ] }, "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.403+00:00" } } }, { "fullUrl": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition/profile-patientchart-ImplementationGuide", "search": { "mode": "match" }, "resource": { "resourceType": "StructureDefinition", "id": "profile-patientchart-ImplementationGuide", "meta": { "versionId": "1", "lastUpdated": "2022-12-14T16:33:39.410+00:00" }, "url": "http://telus.com/fhir/patientChart/StructureDefinition/profile-implementationGuide", "name": "TELUSPatientChartImplementationGuide", "title": "TELUS Patient Chart Implementation Guide", "status": "draft", "date": "2020-11-09T22:33:31.5196609+00:00", "description": "The TELUS Patient Chart Implementation Guide will be used in Canada for sharing clinical information from the TELUS EMR's including medications, conditions, obervations, allergies, etc. This will align with the International Patient Summary and the Core Canadian profiles where possible.", "purpose": "This implementation guide is intended to include all resources required to create a Patient Chart (aka Patient Summary) from EMR's in Canada for the purpose of sharing clinical data with parties such as Radiology clinics, labs or other clinics.", "fhirVersion": "4.0.1", "mapping": [ { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "objimpl", "uri": "http://hl7.org/fhir/object-implementation", "name": "Object Implementation Information" } ], "kind": "resource", "abstract": false, "type": "ImplementationGuide", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/ImplementationGuide", "derivation": "constraint", "differential": { "element": [ { "id": "ImplementationGuide.name", "path": "ImplementationGuide.name", "fixedString": "TELUS Patient Summary" }, { "id": "ImplementationGuide.date", "path": "ImplementationGuide.date", "fixedDateTime": "2020-11-09", "mustSupport": true }, { "id": "ImplementationGuide.description", "path": "ImplementationGuide.description", "fixedMarkdown": "Patient Chart" }, { "id": "ImplementationGuide.jurisdiction", "path": "ImplementationGuide.jurisdiction", "fixedCodeableConcept": { "text": "Canada" } }, { "id": "ImplementationGuide.fhirVersion", "path": "ImplementationGuide.fhirVersion", "fixedCode": "4.0.1" } ] } } } ], "total": 89, "link": [ { "relation": "self", "url": "https://fhir.simplifier.net/TELUSPatientChart/StructureDefinition?_total=accurate&_count=100&_skip=0" } ], "id": "26f54237-10dd-40e4-b393-6db8ca28f9ce" }