HL7 FHIR Implementation Guide: Objective FHIR, Release 0.8

HL7 FHIR Implementation Guide: Objective FHIR, Release 0.8 - Local Development build (v0.8.0). See the Directory of published versions

Primary extensions defined as part of this Implementation Guide

Name Definition
ActionStatement

Abstract class representing any type of action or event.

ActionTaken

The action taken as a result of the adverse reaction. May include changing or discontinuing medication, reducing dose, etc.

Additive

Additive associated with container.

AdministrativeGender

A gender classification used for administrative purposes. Administrative gender is not necessarily the same as a biological description or a gender identity. This attribute does not include terms related to clinical gender.

Alias

A list of alternate names the subject is or was known as.

Annotation

An added or follow-up note, often after the fact, that contains metadata about who made the statement and when.

ApplicableAgeRange

The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.

ApplicableSubpopulation

Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race.

AppointmentReasonReference

Reason the appointment is to take place (resource)

BasedOn

The proposal, order, or plan that is partly or wholly fulfilled by this item.

CareContext

The encounter or episode of care

CauseCategory

Whether the adverse event is attributed to a treatment, course of the disease, unrelated to either, or unknown.

Code

The main type identifier for a lab, procedure, condition, etc., usually drawn from a controlled vocabulary.

CommentOrDescription

A text note containing additional details, explanation, description, comment, or summarization.

Condition

A condition that is or may be present in a subject. ‘Condition’ is interpreted broadly and could be a disorder, abnormality, problem, injury, complaint, functionality, illness, disease, ailment, sickness, affliction, upset, difficulty, disorder, symptom, worry, or trouble. The Observation-based class, ConditionAbsent, should be used to describe conditions that are not present or negative findings. SHR Condition uses the SHR BodyLocation structure that includes not only a code, but optional laterality, direction, clock direction, and distance. If included, the distance is measured from the location specified by the code, laterality, and direction.

ContactPerson

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

DateOfDiagnosis

The date the disease was first clinically recognized with sufficient certainty, regardless of whether it was fully characterized at that time.

DiagnosisCode

Codes for a diagnosis.

Dosage

The dosage of the medication. The data structure is flexible and can describe a dosage prescribed, administered, or reported.

DoseSequenceNumber

Dose number within series.

EncounterDiagnosis

A diagnosis, which is a disease or injury determined to be present through evaluation of patient history, examination, and/or review of laboratory data. This element is not a stand-alone representation of the condition that was diagnosed, but is meant to be used as an sub-structure in a resource, such as Encounter.

EndDateTime

The time at which something is to end or did end. Boundary is considered inclusive.

ExpectedPerformanceTime

When an action should be done. If the action is a series or recurs (e.g. daily blood sugar testing in the morning) then a Timing can be used to describe the periodicity.

ExpectedPerformer

Who this request is being addressed to.

ExpectedPerformerType

What type of party should carry out the testing.

FocalSubject

The person or entity that the information in this resource relates to, if different than the person of record. The subject of information can be a reference or a code, the latter when the subject is described generically, for example, in terms of a relationship to the subject of record (e.g., wife).

HandlingRisk

Cautions on the handling of this specimen.

Identifier

Business identifier or external id for this resource.

ImagingSubstance

Substance used for this imaging procedure such as a contrast agent.

Indication

Conditions or situations where the procedure is recommended. In the Performed context, the actual indication should be reported.

InstructionCode

Coded instructions, e.g., ‘with meals’.

Laterality

Body side of the body location, if needed to distinguish from a similar location on the other side of the body.

The laterality element is part of BodyLocation, a flexible structure that allows the location to be determined by a single code, or a code plus laterality and/or orientation. The body location can also be specified in relation to one or more body landmarks. SNOMED CT is used in all cases.

  • Code only: The code should include (precoordinate) laterality and/orientation to the degree necessary to completely specify the body location.
  • Code plus laterality and/or orientation: The basic code augmented by codes specifying the body side and/or anatomical orientation.
  • Relation to landmark: The location relative to a landmark is specified by:
  • Establishing the location and type of landmark using a body site code and optional laterality/orientation, and
  • Specifying the direction and distance from the landmark to the body location.

Note that BodyLocation is a data type (a reusable structure), not a stand-alone entity. The concept is similar to how a postal address can apply to a person, location, or organization. This contrasts with FHIR’s stand-alone BodySite (aka BodyStructure in r4) which ‘is not … intended for describing the type of anatomical location but rather a specific body site on a specific patient’ (FHIR 3.5).

MedicationCodeOrReference

A choice of a medication code or reference.

MedicationNonAdherenceReason

Reason that patient did not adhere to a medication regimen.

Method

The technique used to carry out an action, for example, the specific imaging technical or assessment vehicle.

OccurrenceTimeOrPeriod

The point or period of time when the event takes place. Times can be precise (dateTime) or approximate (date). If a time period is used, and the start date or dateTime is missing, the start of the period is not known. If the end date or dateTime is missing, it means that the period is ongoing.

OnBehalfOf

The party represented by the actual participant.

Organization

A formally or informally recognized grouping of people or organizations formed for the purpose of achieving some form of collective action. Includes companies, institutions, corporations, departments, community groups, healthcare practice groups, payer/insurer, etc.

Organization type is restricted to 0..1 in FHIR DSTU2, similarly restricted here. Other required attributes come from STU 3 mapping to us-core-organization.

Orientation

Orientation of the body location, if needed to distinguish from a similar location in another orientation. The orientation element is part of BodyLocation, a flexible structure that allows the location to be determined by a single code, or a code plus laterality and/or orientation. The body location can also be specified in relation to one or more body landmarks. SNOMED CT is used in all cases.

  • Code only: The code should include (precoordinate) laterality and/orientation to the degree necessary to completely specify the body location.
  • Code plus laterality and/or orientation: The basic code augmented by codes specifying the body side and/or anatomical orientation.
  • Relation to landmark: The location relative to a landmark is specified by:
  • Establishing the location and type of landmark using a body site code and optional laterality/orientation, and
  • Specifying the direction and distance from the landmark to the body location.

Note that BodyLocation is a data type (a reusable structure), not a stand-alone entity. The concept is similar to how a postal address can apply to a person, location, or organization. This contrasts with FHIR’s stand-alone BodySite (aka BodyStructure in r4) which ‘is not … intended for describing the type of anatomical location but rather a specific body site on a specific patient’ (FHIR 3.5).

PartOf

The larger entity that the asserted item is a portion of. For example, an organization part of a larger organization, or an encounter with a hospitalist might be part of a larger hospitalization encounter.

Participant

An entity (usually a Practitioner, Patient, or Organization but potentially a device or other entity) that participates in a healthcare task or activity. The participant is not necessarily the performer, and the role (ParticipationType), the ParticipationPeriod, and other details of the participation are by the Participation structure.

Participation

Record of someone or something involvement in an activity or event.

ParticipationPeriod

The point in time or span of time the participant is involved.

ParticipationType

The role played by the participant engaged in the action, for example, as the attending physician, surgical assistant, etc.

PatientInstruction

Patient or consumer-oriented instructions.

RadiationDosePerFraction

The total number of treatment sessions (fractions) administered during a course of radiation therapy therapy. A fraction is a portion of the total radiation dose, delivered as a series of treatments that make up the full course of radiotherapy. (source: LOINC)

RadiationFractionsDelivered

The total number of treatment sessions (fractions) administered during a course of radiation therapy therapy. A fraction is a portion of the total radiation dose, delivered as a series of treatments that make up the full course of radiotherapy. (source: LOINC)

ReasonCode

The explanation or justification for the current item or action, as a code. Reason is a string or CodeableConcept in DSTU2 but in later versions only a CodeableConcept.

ReasonReference

The justification, as reference to a condition or observation.

ReferenceRange

The usual or acceptable range for a test result.

RelationToLandmark

The relationship between a landmark that helps determine a body location and the body location itself. The location relative to a landmark is specified by:

  • Specifying the location and type of landmark using a body site code and optional laterality/orientation,
  • Specifying the direction from the landmark to the body location, and
  • Specifying the distance from the landmark to the body location.

The RelationToLandmark element is part of BodyLocation, a flexible structure that allows the location to be determined by a single code, or a code plus laterality and/or orientation. The body location can also be specified in relation to one or more body landmarks. SNOMED CT is used in all cases.

  • Code only: The code should include (precoordinate) laterality and/orientation to the degree necessary to completely specify the body location.
  • Code plus laterality and/or orientation: The basic code augmented by codes specifying the body side and/or anatomical orientation.
  • Relation to landmark: The location relative to a landmark is specified by:
  • Establishing the location and type of landmark using a body site code and optional laterality/orientation, and
  • Specifying the direction and distance from the landmark to the body location.

Note that BodyLocation is a data type (a reusable structure), not a stand-alone entity. The concept is similar to how a postal address can apply to a person, location, or organization. This contrasts with FHIR’s stand-alone BodySite (aka BodyStructure in r4) which ‘is not … intended for describing the type of anatomical location but rather a specific body site on a specific patient’ (FHIR 3.5).

RequestIntent

Indicates the level of authority/intentionality associated with the request and where the request fits into the workflow chain.

Requester

The person or organization originating this referral

Severity

Degree of harshness or extent of a symptom, disorder, or condition.

SpecialHandling

Information about the proper handling of the specimen.

Specimen

A specimen is a substance, physical object, or collection of objects, that the laboratory considers a single discrete, uniquely identified unit that is the subject of one or more steps in the laboratory workflow. A specimen may include multiple physical pieces as long as they are considered a single unit within the laboratory workflow. A specimen results from one to many specimen collection procedures, and may be contained in multiple specimen containers. Specimen may have one or more processing activities.

SpecimenTreatment

Additives added to the specimen.

StatementDateTime

The point in time when the statement was created.

Status

A state that relates to the workflow or interpretation of this resource. Certain status values can modify the meaning of the resource, for example, entered-in-error. When a boolean value is used, Status of true indicates the record is active, false means inactive.

StatusHistory

List of past encounter statuses

SubjectOfRecord

The subject of a clinical statement, often called the Patient or the Subject. The SubjectOfRecord typically identifies the clinical record in which this statement is contained. If the statement should be in John Doe’s patient record, then John Doe is the subject of record. When there is no patient, the SubjectOfRecord can also be a location, group, or other entity that statement pertains to. For example, observations concerning a hospital ward would have a Location as the SubjectOfRecord.

Note that the word ‘Subject’ is used here in the sense of a person or entity subjected to observations or actions, not subject as in a conceptual topic, like heart disease.

SubjectType

Resource that can be subject of QuestionnaireResponse

TerminationReason

A code explaining unplanned or premature termination of a plan of treatment, course of medication, or research study.

TotalRadiationDoseDelivered

The total amount of radiation dose delivered for the course of therapy. (source: SNOMED, ASTRO)

TreatmentIntent

The purpose of a treatment.