R4 Draft for Comment

This page is part of the FHIR Specification (v3.2.0: R4 Ballot 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

FHIR Infrastructure Work GroupMaturity Level: N/ABallot Status: Informative

This specification is currently in its third round of trial use. While some parts of the specification are mature and stable, and HL7 is focusing on moving these to a formal standard, much work remains to be done in other areas. The following general areas of functionality have been deferred to a future version, or are incompletely covered in this version:

  • An alarm resource to represent current issues with the patient (e.g. device created)
  • Concern Tracking
  • Aggregated Data Reporting including Public Health Reporting
  • One or more resources for Advance Care Directive / Power of Attorney
  • A full server side query framework

For some of these, some draft content is included in the specification for implementer consideration.

In addition, there are a number of specific notes in the specification requesting feedback from implementers:

  • AllergyIntolerance: new codes needed for certainty?
  • AllergyIntolerance: How should "No Known Allergies" be represented?
  • Appointment: Values for Appointment.priority: how interoperable are they
  • ClinicalImpression: General Questions about use
  • Clinical Reasoning: Multiple questions about implementation and usage
  • Composition: Is title different to type? and open questions about document signatures
  • Condition: How should "No Known Problems" be represented?
  • Markdown: Probable that will recommend/require CommonMark in release 4 - implementation consequences?
  • Extensibility: Do we need to support modifier extensions on extensions?
  • RESTful API: Consequence of side effects in batches and transactions?
  • RESTful API: Should servers maintain ids when processing transactions?
  • RESTful API: What are the documentation requirements around transaction integrity?
  • Managing Resource Identity: Mandating Identification practices for cross-system interoperability?
  • Observation: Request for feedback on using the lastn operation and whether it should be applied to other resources
  • Operations: Do we need a way to execute operations asynchronously?
  • Patient: Should linking/merging affect the RESTful API?
  • Profiling Resources: Need feedback on using system profiles
  • JSON-LD format: Need feedback on the JSON-LD format and it's usefulness
  • References between Resources: Do we need to allow contained resources that reference the container?
  • Safety: Request for comments about further development
  • Search: does text search need to be standardized?
  • Search: Problems with which elements are marked as 'included in summary'
  • Security: Feedback about signatures on RESTful interfaces sought
  • Subscription: messaging details still to be resolved
  • Workflow: several implementation questions