Release 5 Ballot

This page is part of the FHIR Specification (v5.0.0-ballot: FHIR R5 Ballot Preview). 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

12.5 Pattern Event - Content

FHIR Infrastructure Maturity Level: 1Informative

A pattern to be followed by resources that represent the performance of some activity, possibly in accordance with a request or service definition.

12.5.1 Scope and Usage

This is NOT a resource. It is not part of the FHIR schema and cannot appear directly in FHIR instances. It is a logical model that defines a pattern adhered to by other resources. This pattern serves two purposes:

  • It offers guidance to work groups designing resources and helps ensure consistency of content created by different work groups
  • It provides a standard "view" that might be useful for implementers in processing and manipulating all resources that adhere to the same pattern. (Tooling that supports this may become available in a future release.)

An "event" is any description of an activity that has already taken place or that is currently ongoing. It includes resources that primarily describe the "result" of an activity or what was found (e.g. a condition or observation). Examples include encounters, procedures, completed questionnaires, representations of state transitions, etc. It does not include resources that describe objects or roles (e.g. patient, device, location).

12.5.2 Boundaries and Relationships

This logical model is one of three common workflow patterns. The other two patterns are Request and Definition. This pattern is followed by (or is intended to be followed by a number of other FHIR resources

Events are distinct from requests in that an event is primarily focused on what has occurred or is occurring while requests deal with what is "desired" to occur. While creating a request or definition can be seen as a type of event, the focus of those other resources is not the "creation" but the desire/intention.

Events are related to Task in that events can be performed in fulfillment of a task and performing an event may involve the execution of one or more tasks. Events do not track the fulfillment of any requests they may be associated with. Tracking of fulfillment is managed through the Task resource.

12.5.3 Background and Context

This model represents a pattern. It provides a standard list of data elements with cardinalities, data types, definitions, rationale and usage notes that will ideally be adhered to by resources that fall into the "event" workflow category. However, adherence to this pattern is not mandatory. Not all healthcare domains are the same. Concepts that may be generally applicable (and thus are included in this standard pattern) might still not be relevant everywhere or may be sufficiently uncommon that they are more appropriate to include as extensions than as core properties of the resource. Work groups are encouraged to adjust descriptions, usage notes and rationale to be specific to their resource (e.g. use the term "procedure" or "observation" rather than "event"). As well, design notes in the comments column marked with [square brackets] identifies areas where domain variation is expected and encouraged. Other variation, including differences in names, cardinalities, data types and the decision to omit an element outright are also possible, but should be discussed with the FHIR Infrastructure work group's Workflow project to ensure the rationale for non-alignment is understood, to confirm that the deviation is necessary and to identify whether any adjustments to the pattern are appropriate.

This pattern provides a linkage to the W5 list of standard data elements. Resources that adhere to this pattern should ensure their w5 mappings are consistent, as is their data element ordering.

12.5.4 References to this Pattern

12.5.5 Pattern Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Event ILogicalEvent Pattern
+ Rule: Not Done Reason can only be specified if status is 'not-done'
+ Rule: reason elements can only be specified if status is NOT 'not-done'
... identifier Σ0..*IdentifierBusiness Identifier for {{title}}

... basedOn Σ0..*Reference(Request)Fulfills plan, proposal or order

... partOf Σ0..*Reference(Event)Part of referenced event

... status ?!Σ1..1codepreparation | in-progress | not-done | suspended | aborted | completed | entered-in-error | unknown
EventStatus (Required)
... statusReason 0..1CodeableConceptReason for current status
... category Σ0..*CodeableConceptHigh level categorization of {{title}}

... code Σ0..1CodeableConceptWhat service was done
... product Σ0..1CodeableReference(BiologicallyDerivedProduct | Device | DeviceDefinition | Medication | NutritionProduct | Substance)Product used/provided
... subject Σ1..1Reference(Patient | Group)Individual service was done for/to
... encounter Σ0..1Reference(Encounter)Encounter the {{title}} is part of
... occurrence[x] Σ0..1When {{title}} occurred/is occurring
.... occurrenceDateTimedateTime
.... occurrencePeriodPeriod
.... occurrenceTimingTiming
... recorded Σ0..1dateTimeWhen {{title}} was first captured in the subject's record
... reported[x] Σ0..1Reported rather than primary record
.... reportedBooleanboolean
.... reportedReferenceReference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)
... performer Σ0..*BackboneElementWho performed {{title}} and what they did

.... function Σ0..1CodeableConceptType of performance
.... actor Σ1..1Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson)Who performed {{title}}
... location Σ0..1Reference(Location)Where {{title}} occurred
... reason Σ0..*CodeableReference(Condition | Observation | DiagnosticReport | DocumentReference)Why was {{title}} performed?

... note 0..*AnnotationComments made about the event

... relevantHistory 0..*Reference(Provenance)Key events in history of {{title}}


doco Documentation for this format

UML Diagram (Legend)

Event (Base) «Pattern»Business identifiers assigned to this {{title}} by the performer and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to serveridentifier : Identifier [0..*]A plan, proposal or order that is fulfilled in whole or in part by this {{title}}basedOn : Reference [0..*] « Request »A larger event of which this particular {{title}} is a component or steppartOf : Reference [0..*] « Event »Indicates that this {{title}} is relevant to the specified research study(ies)researchStudy : Reference [0..*] « ResearchStudy »The current state of the {{title}} (this element modifies the meaning of other elements)status : code [1..1] « Codes identifying the lifecycle stage of an event. (Strength=Required)EventStatus! »Captures the reason for the current state of the {{title}}statusReason : CodeableConcept [0..1]Partitions the {{title}} into one or more categories that can be used to filter searching, to govern access control and/or to guide system behaviorcategory : CodeableConcept [0..*]A code that identifies the specific service or action that was or is being performedcode : CodeableConcept [0..1]Indicates the product supplied or manipulated by this {{title}}product : CodeableReference [0..1] « BiologicallyDerivedProduct| Device|DeviceDefinition|Medication|NutritionProduct|Substance »The individual or set of individuals the action is being or was performed onsubject : Reference [1..1] « Patient|Group »The Encounter during which this {{title}} was created or to which the creation of this record is tightly associatedencounter : Reference [0..1] « Encounter »The date, period or timing when the {{title}} did occur or is occurringoccurrence[x] : DataType [0..1] « dateTime|Period|Timing »The date the occurrence of the {{title}} was first captured in the record - potentially significantly after the occurrence of the eventrecorded : dateTime [0..1]Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the reportreported[x] : DataType [0..1] « boolean|Reference(Patient| RelatedPerson|Practitioner|PractitionerRole|Organization) »The principal physical location where the {{title}} was performedlocation : Reference [0..1] « Location »Describes why the {{title}} occurred in coded or textual form or Indicates another resource whose existence justifies this {{title}}reason : CodeableReference [0..*] « Condition|Observation| DiagnosticReport|DocumentReference »Comments made about the {{title}} by the performer, subject or other participantsnote : Annotation [0..*]Links to Provenance records for past versions of this resource or component resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resourcerelevantHistory : Reference [0..*] « Provenance »PerformerDistinguishes the type of involvement of the performer in the {{title}}. [Consider adding examples]function : CodeableConcept [0..1]Indicates who or what performed the {{title}}actor : Reference [1..1] « Practitioner|PractitionerRole| Organization|CareTeam|Patient|Device|RelatedPerson »Indicates who or what performed the {{title}} and how they were involvedperformer[0..*]

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Event ILogicalEvent Pattern
+ Rule: Not Done Reason can only be specified if status is 'not-done'
+ Rule: reason elements can only be specified if status is NOT 'not-done'
... identifier Σ0..*IdentifierBusiness Identifier for {{title}}

... basedOn Σ0..*Reference(Request)Fulfills plan, proposal or order

... partOf Σ0..*Reference(Event)Part of referenced event

... status ?!Σ1..1codepreparation | in-progress | not-done | suspended | aborted | completed | entered-in-error | unknown
EventStatus (Required)
... statusReason 0..1CodeableConceptReason for current status
... category Σ0..*CodeableConceptHigh level categorization of {{title}}

... code Σ0..1CodeableConceptWhat service was done
... product Σ0..1CodeableReference(BiologicallyDerivedProduct | Device | DeviceDefinition | Medication | NutritionProduct | Substance)Product used/provided
... subject Σ1..1Reference(Patient | Group)Individual service was done for/to
... encounter Σ0..1Reference(Encounter)Encounter the {{title}} is part of
... occurrence[x] Σ0..1When {{title}} occurred/is occurring
.... occurrenceDateTimedateTime
.... occurrencePeriodPeriod
.... occurrenceTimingTiming
... recorded Σ0..1dateTimeWhen {{title}} was first captured in the subject's record
... reported[x] Σ0..1Reported rather than primary record
.... reportedBooleanboolean
.... reportedReferenceReference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)
... performer Σ0..*BackboneElementWho performed {{title}} and what they did

.... function Σ0..1CodeableConceptType of performance
.... actor Σ1..1Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson)Who performed {{title}}
... location Σ0..1Reference(Location)Where {{title}} occurred
... reason Σ0..*CodeableReference(Condition | Observation | DiagnosticReport | DocumentReference)Why was {{title}} performed?

... note 0..*AnnotationComments made about the event

... relevantHistory 0..*Reference(Provenance)Key events in history of {{title}}


doco Documentation for this format

UML Diagram (Legend)

Event (Base) «Pattern»Business identifiers assigned to this {{title}} by the performer and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to serveridentifier : Identifier [0..*]A plan, proposal or order that is fulfilled in whole or in part by this {{title}}basedOn : Reference [0..*] « Request »A larger event of which this particular {{title}} is a component or steppartOf : Reference [0..*] « Event »Indicates that this {{title}} is relevant to the specified research study(ies)researchStudy : Reference [0..*] « ResearchStudy »The current state of the {{title}} (this element modifies the meaning of other elements)status : code [1..1] « Codes identifying the lifecycle stage of an event. (Strength=Required)EventStatus! »Captures the reason for the current state of the {{title}}statusReason : CodeableConcept [0..1]Partitions the {{title}} into one or more categories that can be used to filter searching, to govern access control and/or to guide system behaviorcategory : CodeableConcept [0..*]A code that identifies the specific service or action that was or is being performedcode : CodeableConcept [0..1]Indicates the product supplied or manipulated by this {{title}}product : CodeableReference [0..1] « BiologicallyDerivedProduct| Device|DeviceDefinition|Medication|NutritionProduct|Substance »The individual or set of individuals the action is being or was performed onsubject : Reference [1..1] « Patient|Group »The Encounter during which this {{title}} was created or to which the creation of this record is tightly associatedencounter : Reference [0..1] « Encounter »The date, period or timing when the {{title}} did occur or is occurringoccurrence[x] : DataType [0..1] « dateTime|Period|Timing »The date the occurrence of the {{title}} was first captured in the record - potentially significantly after the occurrence of the eventrecorded : dateTime [0..1]Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the reportreported[x] : DataType [0..1] « boolean|Reference(Patient| RelatedPerson|Practitioner|PractitionerRole|Organization) »The principal physical location where the {{title}} was performedlocation : Reference [0..1] « Location »Describes why the {{title}} occurred in coded or textual form or Indicates another resource whose existence justifies this {{title}}reason : CodeableReference [0..*] « Condition|Observation| DiagnosticReport|DocumentReference »Comments made about the {{title}} by the performer, subject or other participantsnote : Annotation [0..*]Links to Provenance records for past versions of this resource or component resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resourcerelevantHistory : Reference [0..*] « Provenance »PerformerDistinguishes the type of involvement of the performer in the {{title}}. [Consider adding examples]function : CodeableConcept [0..1]Indicates who or what performed the {{title}}actor : Reference [1..1] « Practitioner|PractitionerRole| Organization|CareTeam|Patient|Device|RelatedPerson »Indicates who or what performed the {{title}} and how they were involvedperformer[0..*]

 

Alternate definitions: Master Definition XML + JSON.

12.5.5.1 Terminology Bindings

PathDefinitionTypeReference
Event.status

Codes identifying the lifecycle stage of an event.

RequiredEventStatus
Event.statusReason Codes identifying the reason for the current state of an event.UnknownNo details provided yet
Event.code Codes indicating the details of what is/was done. These will vary significantly based on the type of event resource and will often be example/preferred rather than extensible/required.UnknownNo details provided yet
Event.performer.function Codes that describe the specific involvement of a performer in an event. E.g. Primary vs. secondary vs. supervising, etc.UnknownNo details provided yet
Event.reason Codes identifying why this event was necessary. These may be clinical reasons (e.g. diagnoses, symptoms) and/or administrative reasons. While the detailed constraints of relevant reasons will vary by resource, some degree of consistency across resources around recommended codes would be desirable.UnknownNo details provided yet

12.5.5.2 Constraints

UniqueKeyLevelLocationDescriptionExpression
 inv-1Rule (base)Not Done Reason can only be specified if status is 'not-done'status='not-done' or notDoneReason.exists().not()
 inv-2Rule (base)reason elements can only be specified if status is NOT 'not-done'status!='not-done' or (reasonCode.exists().not() and reasonReference.exists().not())

12.5.6 Extensions

Not all resources that follow the 'Event' pattern will necessarily include all of the above elements. A set of standard extensions have been defined for use with resources where an element might be "applicable" but is not commonly supported. A list of these can be found on the Event Extensions(event-specific) and Workflow Extensions(shared by events and requests).

12.5.7 State Machine

The following diagram shows the "typical" state machine diagram for resources following the Event pattern. Note that not all resources will support all states, some resources may choose different names for certain states and some resources may introduce sub-states to the listed states. As well, additional transitions may be supported, including from terminal nodes (e.g. from "completed" back to "in-progress"). That said, most resources should align with this state machine fairly well.

Typical state machine diagram for resources following the Event pattern

12.5.8 Event history

This pattern contains an element called "eventHistory" that points to Provenance. This allows the resource to summarize key events that have happened over the lifespan of the resource. For example, when the event started, when it was suspended, when it was resumed, etc. The list of referenced Provenence entries don't necessarily include all events that have occurred over the lifespan of the resource. Instead, they list those the author considers 'significant' and relevant to downstream users. Modifications to drafts or small corrections that do not impact fulfillment might not be needed. In some cases, Provenance for changes to other resources (e.g. component events) might also be included if the source system tracks those as 'events' tied to the Event.

IMPORTANT: the eventHistory generally excludes the most recent change on 'pure' FHIR repositories. That is because in pure FHIR environments, the Provenance instance must be created after the update has been made - because it needs to point to the new 'version' of the resource that has been created. This means that if there is a desire to include the 'current' change in relevant history, it is necessary to first make the change, then update the resource to add the event to recentHistory. More typically, recentHistory simply won't include the most recent event. If the full history is needed, the system will need to retrieve both the history as well as the Provenance that points to the current release.

For systems that don't store history separately from the base resource, the eventHistory Provenance instances can be conveyed as contained resources. In this circumstance, there might also not be an issue with eventHistory also including the 'most recent' change as the history is updated at the same time the change is applied.

The full set of potential Provenance information may be overkill for those systems that are only interested in it from a eventHistory perspective. The Provenance Relevant History profile is included to give guidance on what data elements are most likely to be relevant for systems looking at Provenance from the perspective of eventHistory.

12.5.8.1 Mappings

identifier basedOn partOf researchStudy status statusReason category code product subject encounter occurrence[x] recorded reported[x] performer .function .actor location reason note relevantHistory
AdverseEvent 1 1 1 1 1 1 N 1 N 1 1 1
AuditEvent 3 NC 1 N 1 N 1 N 1
ChargeItem 1 0|1 E 1 1 1 1 1 1 1 2 NC 1
ClaimResponse 1 1 N 1 1 N 1 N 1 N
ClinicalImpression 1 0|1 E 1 1 1 1 N 1 NC 1
Communication 1 1 1 1 1 1 C 2 N 2 NC 1
Composition 1 0|1 E 0|1 E 1 1 N 1 C 1 1 N 1 N
Consent 1 0|1 E 0|1 E 1 1 NC 1 N
Contract
Coverage 1 0|1 E 1 1 N 1 N
CoverageEligibilityResponse 1 1 N 1 1 N 1 N
DetectedIssue 1 0|1 E 1 1 1 1 C 1 N 1 NC 1 N
DeviceDispense 1 1 1 1 N 1 1 N 1 1 1
DeviceUsage 1 1 0|1 E 1 0|1 E 1 N 1 N 1 NC 2 N
DiagnosticReport 1 1 0|1 E 0|1 E 1 0|1 E 1 1 C 1 1 N 2 NC 0|1 E
DocumentManifest 2 N 0|1 E 1 1 N 1 C 1 N 1 N 1 NC
DocumentReference 1 0|1 E 1 0|1 E 1 N 1 C 1 N 3 NC 0|1 E
Encounter 1 2 N 1 0|1 E 1 2 NC 1 C 2 N 1 N 1 NC 2 NC 1 1
EnrollmentResponse 1 1 N 1 C 1 N 1 N 1 NC
EpisodeOfCare 1 1|1 EN 1 1 NC 1 N 1 N 3 NC
ExplanationOfBenefit 1 0|1 E 1 1 N 1 N 1 N
FamilyMemberHistory 1 0|1 E 0|1 E 1 1 N 1 1
GenomicStudy 1
GuidanceResponse 1 1 N 1 1 C 1 1 N 1 NC 1 1
ImagingSelection 1 1 1 1 C 1 NC
ImagingStudy 1 1 1 N 1 1 1 1 N 1 1 1 1
Immunization 1 1 0|1 E 1 1 2 N 1 N 1 1 1 1 1 1 1
ImmunizationEvaluation 1 0|1 E 1 1 N 1 N
InventoryReport 1 0|1 E 1
Invoice 1 N 1 C 1
MedicationAdministration 1 1 N 1 0|1 E 1 1 C 1 N 1 1 N 1 1 1 1 1
MedicationDispense 1 1 N 1 0|1 E 1 1 N 1 1 N 1 1 1
MedicationUsage 1 0|1 E 0|1 E 1 1 N 1 1 N 1 1
NutritionIntake 1 1 1 1 1 C 1 N 1 1 1 1
Observation 1 1 1 0|1 E 1 0|1 E 1 1 C 1 N 1 NC 0|1 E
PaymentNotice 1 1|1 EN 1 1 N 1 N
PaymentReconciliation 1 0|1 E 1 1 N 1 NC 1 N
Procedure 1 1 1 0|1 E 1 1 1 1 1 1 1 1 1 1 1 1
Provenance 3 NC 1 N 1 N 1 N 1
QuestionnaireResponse 1 1 1 0|1 E 1 1 C 1 1 N 1 N
RiskAssessment 1 1 1 N 0|1 E 1 1 1 1 1 1 NC 1 1
SupplyDelivery 1 1 1 0|1 E 1 C 0|1 E 1 N 1 NC 1 1 N 0|1 E
Task 1 0|1 E 1 N 1 NC 1
Transport 1 1 1 C 1 N 1 NC 1 N

Each non-grey cell contains a number, the number of elements and extensions (if > 0) mapped in the resource that are mapped to the pattern element in the column. If there are 0 elements and extensions, the number is not shown. In addition, the cell has a color and some character flags.

Colors:

  • Grey: the resource has no element or extension for the pattern element
  • White: the resource has an element that implements the pattern element with the same name
  • Yellow: the resource has a documented extension that implements the pattern element with the same name
  • Blue: the resource has an element that implements the pattern element with a different name
  • Red: the resource has an element that implements that pattern element, but the type or cardinality does not match

Flags:

  • E: pattern element implemented by an extension
  • N: pattern element implemented by an element with a different name
  • T: pattern element implemented by an element with a different type
  • C: pattern element implemented by an element with a different cardinality