2nd DSTU Draft For Comment

This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

Profile Clinical Quality Framework (CQF) Patient Profile - Definitions

Todo

Definitions for the cqf-patient-cqf-patient Profile.

Patient(cqf-patient)
Definition

Demographics and other administrative information about a person or animal receiving care or other health-related services.

Control1..1
Requirements

Tracking patient is the center of the healthcare process.

Alternate NamesSubjectOfCare Client Resident, SubjectOfCare
Comments
Patient.id
Definition

The logical id of the resource, as used in the url for the resoure. Once assigned, this value never changes.

Control0..1
Typeid
Requirements
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.

Patient.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
Requirements
Comments
Patient.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Requirements
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.

Patient.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language
The codes SHALL be taken from http://tools.ietf.org/html/bcp47
Typecode
Requirements
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource

Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Patient.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Requirements
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

Patient.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Requirements
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

Patient.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices. The slicing rules are:
  • unordered
  • open
  • discriminators: url
Patient.extension (http://hl7.org/fhir/ExtensionDefinition/us-core-race)
Definition

A code classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality.

Control0..1
BindingA code classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality.
For codes, see v3 Code System Race
TypeCodeableConcept
Requirements
Comments
Patient.extension (http://hl7.org/fhir/ExtensionDefinition/us-core-ethnicity)
Definition

A code classifying the person into a named category of humans sharing a common real or presumed heritage.

Control0..1
BindingA code classifying the person into a named category of humans sharing a common real or presumed heritage.
For codes, see v3 Code System Ethnicity
TypeCodeableConcept
Requirements
Comments
Patient.extension (http://hl7.org/fhir/ExtensionDefinition/us-core-religion)
Definition

A code classifying a person's professed religion.

Control0..1
BindingA code classifying a person's professed religion
For codes, see v3 Code System ReligiousAffiliation
TypeCodeableConcept
Requirements
Comments
Patient.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Patient.identifier
Definition

An identifier that applies to this person as a patient.

Control0..*
TypeIdentifier
Requirements

Patients are almost always assigned specific numerical identifiers.

Comments
Patient.name
Definition

A name associated with the individual.

Control0..*
TypeHumanName
Must Supporttrue
Requirements

Need to be able to track the person by multiple names. Examples are your official name and a partner name.

Comments

Person 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.

Patient.telecom
Definition

A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.

Control0..*
TypeContactPoint
Must Supporttrue
Requirements

People have (primary) ways to contact them in some way such as phone, email.

Comments

Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address may not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

Patient.gender
Definition

Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.

Control0..1
BindingThe gender of a person used for administrative purposes
The codes SHALL be taken from AdministrativeGender
Typecode
Must Supporttrue
Requirements

Needed for identification of the individual, in combination with (at least) name and birth date. Gender of individual drives many clinical processes.

Comments

The gender may 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 M and F, though the vast majority of systems and contexts only support M and F.

Patient.birthDate
Definition

The date of birth for the individual.

Control0..1
Typedate
Must Supporttrue
Requirements

Age of the individual drives many clinical processes.

Comments

At least an estimated year should be provided as a guess if the real dob is unknown.

Patient.birthTime
Definition

The time of birth for the individual.

Control0..1
Typetime
Requirements

In some cases birth time is important (e.g. multiple births). Hospitals will capture the time of birth in most cases.

Comments
Patient.deceased[x]
Definition

Indicates if the individual is deceased or not.

Control0..1
TypeChoice of: boolean, dateTime
Is Modifiertrue
Must Supporttrue
Requirements

The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

Comments

If there's no value in the instance it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

Patient.address
Definition

Addresses for the individual.

Control0..*
TypeAddress
Must Supporttrue
Requirements

May need to keep track of persons addresses for contacting, billing or reporting requirements and also to help with identification.

Comments

Person may have multiple addresses with different uses or applicable periods.

Patient.maritalStatus
Definition

This field contains a patient's most recent marital (civil) status.

Control0..1
BindingThe domestic partnership status of a person
The codes SHOULD be taken from Marital Status Codes; other codes may be used where these codes are not suitable
TypeCodeableConcept
Must Supporttrue
Requirements

Most, if not all systems capture it.

Comments
Patient.multipleBirth[x]
Definition

Indicates whether the patient is part of a multiple or indicates the actual birth order.

Control0..1
TypeChoice of: boolean, integer
Requirements

For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

Comments
Patient.photo
Definition

Image of the person.

Control0..*
TypeAttachment
Requirements

Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.

Comments
Patient.contact
Definition

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

Control0..*
Requirements

Need to track people you can contact about the patient.

Comments

Contact 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.

InvariantsDefined on this element
pat-1: SHALL at least contain a contact's details or a reference to an organization (xpath: f:name or f:telecom or f:address or f:organization)
Patient.contact.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Requirements
Comments
Patient.contact.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Patient.contact.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Patient.contact.relationship
Definition

The nature of the relationship between the patient and the contact person.

Control0..*
BindingThe nature of the relationship between a patient and a contact person for that patient
The codes SHOULD be taken from PatientContactRelationship; other codes may be used where these codes are not suitable
TypeCodeableConcept
Requirements

Used to determine which contact person is the most relevant to approach, depending on circumstances.

Comments
Patient.contact.name
Definition

A name associated with the person.

Control0..1
TypeHumanName
Requirements

Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that person.

Comments
Patient.contact.telecom
Definition

A contact detail for the person, e.g. a telephone number or an email address.

Control0..*
TypeContactPoint
Requirements

People have (primary) ways to contact them in some way such as phone, email.

Comments

Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.

Patient.contact.address
Definition

Address for the contact person.

Control0..1
TypeAddress
Requirements

Need to keep track where the contact person can be contacted per postal mail or visited.

Comments
Patient.contact.gender
Definition

Administrative Gender - the gender that the person is considered to have for administration and record keeping purposes.

Control0..1
BindingThe gender of a person used for administrative purposes
The codes SHALL be taken from AdministrativeGender
Typecode
Requirements

Needed to address the person correctly.

Comments
Patient.contact.organization
Definition

Organization on behalf of which the contact is acting or for which the contact is working.

Control0..1 This element is affected by the following invariants: pat-1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Organization))
Requirements

For guardians or business related contacts, the organization is relevant.

Comments
Patient.contact.period
Definition

The period during which this person or organization is valid to be contacted relating to this patient.

Control0..1
TypePeriod
Requirements
Comments
Patient.animal
Definition

This element has a value if the patient is an animal.

Control0..1
Is Modifiertrue
Requirements

Many clinical systems are extended to care for animal patients as well as human.

Comments

The animal element is labeled "Is Modifier" since patients may be non-human. Systems SHALL either handle patient details appropriately (e.g. inform users patient is not human) or reject non-human patient records.

Patient.animal.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Requirements
Comments
Patient.animal.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Patient.animal.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Patient.animal.species
Definition

Identifies the high level categorization of the kind of animal.

Control1..1
BindingThe species of an animal
For example codes, see AnimalSpecies
TypeCodeableConcept
Requirements

Need to know what kind of animal.

Comments

If the patient is non-human, at least a species SHALL be specified.

Patient.animal.breed
Definition

Identifies the detailed categorization of the kind of animal.

Control0..1
BindingThe breed of an animal
For example codes, see AnimalBreeds
TypeCodeableConcept
Requirements

May need to know the specific kind within the species.

Comments
Patient.animal.genderStatus
Definition

Indicates the current state of the animal's reproductive organs.

Control0..1
BindingThe state of the animal's reproductive organs
For example codes, see GenderStatus
TypeCodeableConcept
Requirements

Gender status can affect housing and animal behavior.

Comments
Patient.communication
Definition

Languages which may be used to communicate with the patient about his or her health.

Control0..*
BindingA human language
The codes SHALL be taken from http://tools.ietf.org/html/bcp47
TypeCodeableConcept
Must Supporttrue
Requirements

If a patient does not speak the local language, interpreters may be required, so languages spoken is an important things to keep track of both for patient and other persons of interest.

Alternate Nameslanguage
Comments

If no language is specified, this implies that the default local language is spoken. For animals, language is not a relevant field, and should be absent from the instance.

Patient.careProvider
Definition

Patient's nominated care provider.

Control0..*
TypeChoice of: Reference(Profile = (Profile = http://hl7.org/fhir/Profile/Organization)), Reference(Profile = (Profile = http://hl7.org/fhir/Profile/Practitioner))
Requirements
Comments
Patient.managingOrganization
Definition

Organization that is the custodian of the patient record.

Control0..1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Organization))
Requirements

Need to know who recognizes this patient record, manages and updates it.

Comments
Patient.link
Definition

Link to another patient resource that concerns the same actual person.

Control0..*
Is Modifiertrue
Requirements

There are multiple usecases: * Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and * Distribution of patient information across multiple servers.

Comments

There is no assumption that linked patient records have mutual links.

Patient.link.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Requirements
Comments
Patient.link.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Patient.link.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Patient.link.other
Definition

The other patient resource that the link refers to.

Control1..1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Patient))
Is Modifiertrue
Requirements
Comments
Patient.link.type
Definition

The type of link between this patient resource and another patient resource.

Control1..1
BindingThe type of link between this patient resource and another patient resource.
The codes SHALL be taken from LinkType
Typecode
Is Modifiertrue
Requirements
Comments
Patient.active
Definition

Whether this patient record is in active use.

Control0..1
Typeboolean
Is Modifiertrue
Requirements

Need to be able to mark a patient record as not to be used because it was created in error.

Comments

Default is true. If a record is inactive, and linked to an active record, then future patient/person/record updates should occur on the other patient.

Default Valuetrue