R5 Final QA
AdministrationThis page is part of the FHIR Specification (v5.0.0-draft-final: Final QA Preview for R5 - see ballot notes). 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
| Patient Care Work Group | Maturity Level: 2 | Trial Use | Security Category: Patient | Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson |
A clinical or business level record of information being transmitted or shared; e.g. an alert that was sent to a responsible provider, a public health agency communication to a provider/reporter in response to a case report for a reportable condition.
The purpose of a Communication resource is to surface that data was shared to track adherence to guidelines or protocols or to provide business documentation of actions taken. Communication can also be used as part of an information exchange to provide context about the information sharing occurring.
Communication is one of the event resources in the FHIR workflow specification.
This resource is a record of a communication even if it is planned or has failed. A communication is a record of the conveyance of information from one entity, a sender, to another entity, a receiver. The sender and receivers may be patients, practitioners, related persons, organizations, or devices. Communication use cases include:
Non-patient specific communication use cases may include:
This resource is a record of a communication that has occurred. It does not represent the actual flow of communication. While AuditEvent can track electronic disclosures of information, it cannot track conversations, phone calls, letters and other interactions that are not system-to-system. And even for system-to-system communications, the specific end recipients might not be known. Furthermore, AuditEvents are not considered to be "part" of the patient record, while Communication instances are. The Communication resource is not used as a general audit mechanism to track every disclosure of every record. Rather, it is used when a clinician or other user wants to ensure a record of a particular communication is itself maintained as part of the reviewable health record.
Flag resources represent a continuous ongoing "communication" alerting anyone dealing with the patient of certain precautions to take or issues to be aware of. The flags are continuously present as an ongoing reminder. This is distinct from Communication where there is a specific intended sender and receiver and the information is delivered only once.
When there is a need to organize clinical and administrative content into sections, the Composition resource should be used instead. For example, an initial case report to a public health agency may include organized sections for vital signs, immunizations, social history, etc.
Communication and Encounter
The Communication is about the transfer of information (which might or might not occur as part of an encounter), while Encounter is about the coming together (in person or virtually) of a Patient with a Practitioner. Communication does not deal with the duration of a call, it represents the fact that information was transferred at a particular point in time.
The phone calls involving the Patient should be handled using Encounter. Phone calls not involving the patient (e.g. between practitioners or practitioner to relative) that are tracked for billing or other purposes can use Communication to represent the information transferred but are not ideal to represent the call itself. A better mechanism for handling such calls will be explored in a future release.
Structure
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Communication | TU | DomainResource | A clinical or business level record of information being transmitted or shared Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
  identifier | Σ | 0..* | Identifier | Unique identifier |
 instantiatesCanonical | Σ | 0..* | canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire) | Instantiates FHIR protocol or definition |
 instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition |
| basedOn | Σ | 0..* | Reference(Any) | Request fulfilled by this communication |
| partOf | Σ | 0..* | Reference(Any) | Part of referenced event (e.g. Communication, Procedure) |
| inResponseTo | 0..* | Reference(Communication) | Reply to | |
| status | ?!Σ | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (Required) |
| statusReason | Σ | 0..1 | CodeableConcept | Reason for current status Binding: Communication Not Done Reason (Example) |
| category | 0..* | CodeableConcept | Message category Binding: Communication Category (Example) | |
| priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (Required) |
| medium | 0..* | CodeableConcept | A channel of communication Binding: ParticipationMode (Example) | |
| subject | Σ | 0..1 | Reference(Patient | Group) | Focus of message |
| topic | 0..1 | CodeableConcept | Description of the purpose/content Binding: Communication Topic (Example) | |
| about | 0..* | Reference(Any) | Resources that pertain to this communication | |
| encounter | Σ | 0..1 | Reference(Encounter) | The Encounter during which this Communication was created |
| sent | 0..1 | dateTime | When sent | |
| received | 0..1 | dateTime | When received | |
| recipient | 0..* | Reference(CareTeam | Device | Group | HealthcareService | Location | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Endpoint) | Who the information is shared with | |
| sender | 0..1 | Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService | Endpoint | CareTeam) | Who shares the information | |
| reason | Σ | 0..* | CodeableReference(Any) | Indication for message Binding: SNOMED CT Clinical Findings (Example) |
  payload | 0..* | BackboneElement | Message payload | |
   content[x] | 1..1 | Message part content | ||
 contentAttachment | Attachment | |||
| contentReference | Reference(Any) | |||
 contentCodeableConcept | CodeableConcept | |||
| note | 0..* | Annotation | Comments made about the communication | |
| Documentation for this format | ||||
See the Extensions for this resource
UML Diagram (Legend)
XML Template
<Communication xmlns="http://hl7.org/fhir"><!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier Unique identifier --></identifier> <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|Measure| OperationDefinition|PlanDefinition|Questionnaire) Instantiates FHIR protocol or definition --></instantiatesCanonical> <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition --> <basedOn><!-- 0..* Reference(Any) Request fulfilled by this communication --></basedOn> <partOf><!-- 0..* Reference(Any) Part of referenced event (e.g. Communication, Procedure) --></partOf> <inResponseTo><!-- 0..* Reference(Communication) Reply to --></inResponseTo> <status value="[code]"/><!-- 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown --> <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason> <category><!-- 0..* CodeableConcept Message category --></category> <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat --> <medium><!-- 0..* CodeableConcept A channel of communication
JSON Template
{
"resourceType" : "Communication",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // Unique identifier
"instantiatesCanonical" : ["<canonical(PlanDefinition|ActivityDefinition|Measure|OperationDefinition|Questionnaire)>"], // Instantiates FHIR protocol or definition
"instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
"basedOn" : [{ Reference(Any) }], // Request fulfilled by this communication
"partOf" : [{ Reference(Any) }], // Part of referenced event (e.g. Communication, Procedure)
"inResponseTo" : [{ Reference(Communication) }], // Reply to
"status" : "<code>", // R! preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
"statusReason" : { CodeableConcept }, // Reason for current status
"category" : [{ CodeableConcept }], // Message category
"priority" : "<code>", // routine | urgent | asap | stat
"medium" : [{ CodeableConcept }], // A channel of communication
"subject" : { Reference(Group|Patient) }, // Focus of message
"topic" : { CodeableConcept }, // Description of the purpose/content
"about" : [{ Reference(Any) }], // Resources that pertain to this communication
"encounter" : { Reference(Encounter) }, // The Encounter during which this Communication was created
"sent" : "<dateTime>", // When sent
"received" : "<dateTime>", // When received
"recipient" : [{ Reference(CareTeam|Device|Endpoint|Group|HealthcareService|
Location|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }], // Who the information is shared with
"sender" : { Reference(CareTeam|Device|Endpoint|HealthcareService|
Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }, // Who shares the information
"reason" : [{ CodeableReference(Any) }], // Indication for message
"payload" : [{ // Message payload
// content[x]: Message part content. One of these 3:
"contentAttachment" : { Attachment },
"contentReference" : { Reference(Any) },
"contentCodeableConcept" : { CodeableConcept }
}],
"note" : [{ Annotation }] // Comments made about the communication
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Changes since R4
| Communication | |
| Communication.recipient |
|
| Communication.sender |
|
| Communication.reason |
|
| Communication.payload.content[x] |
|
| Communication.reasonCode |
|
| Communication.reasonReference |
|
See the Full Difference for further information
This analysis is available as XML or JSON.
See R3 <--> R4 Conversion Maps (status = 3 tests that all execute ok. All tests pass round-trip testing and 2 r3 resources are invalid (0 errors).)
Structure
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Communication | TU | DomainResource | A clinical or business level record of information being transmitted or shared Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
| identifier | Σ | 0..* | Identifier | Unique identifier |
| instantiatesCanonical | Σ | 0..* | canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire) | Instantiates FHIR protocol or definition |
| instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition |
| basedOn | Σ | 0..* | Reference(Any) | Request fulfilled by this communication |
| partOf | Σ | 0..* | Reference(Any) | Part of referenced event (e.g. Communication, Procedure) |
| inResponseTo | 0..* | Reference(Communication) | Reply to | |
| status | ?!Σ | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (Required) |
| statusReason | Σ | 0..1 | CodeableConcept | Reason for current status Binding: Communication Not Done Reason (Example) |
| category | 0..* | CodeableConcept | Message category Binding: Communication Category (Example) | |
| priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (Required) |
| medium | 0..* | CodeableConcept | A channel of communication Binding: ParticipationMode (Example) | |
| subject | Σ | 0..1 | Reference(Patient | Group) | Focus of message |
| topic | 0..1 | CodeableConcept | Description of the purpose/content Binding: Communication Topic (Example) | |
| about | 0..* | Reference(Any) | Resources that pertain to this communication | |
| encounter | Σ | 0..1 | Reference(Encounter) | The Encounter during which this Communication was created |
| sent | 0..1 | dateTime | When sent | |
| received | 0..1 | dateTime | When received | |
| recipient | 0..* | Reference(CareTeam | Device | Group | HealthcareService | Location | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Endpoint) | Who the information is shared with | |
| sender | 0..1 | Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService | Endpoint | CareTeam) | Who shares the information | |
| reason | Σ | 0..* | CodeableReference(Any) | Indication for message Binding: SNOMED CT Clinical Findings (Example) |
| payload | 0..* | BackboneElement | Message payload | |
| content[x] | 1..1 | Message part content | ||
| contentAttachment | Attachment | |||
| contentReference | Reference(Any) | |||
| contentCodeableConcept | CodeableConcept | |||
| note | 0..* | Annotation | Comments made about the communication | |
| Documentation for this format | ||||
See the Extensions for this resource
XML Template
<Communication xmlns="http://hl7.org/fhir">
JSON Template
{
"resourceType" : "Communication",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // Unique identifier
"instantiatesCanonical" : ["<canonical(PlanDefinition|ActivityDefinition|Measure|OperationDefinition|Questionnaire)>"], // Instantiates FHIR protocol or definition
"instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
"basedOn" : [{ Reference(Any) }], // Request fulfilled by this communication
"partOf" : [{ Reference(Any) }], // Part of referenced event (e.g. Communication, Procedure)
"inResponseTo" : [{ Reference(Communication) }], // Reply to
"status" : "<code>", // R! preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
"statusReason" : { CodeableConcept }, // Reason for current status
"category" : [{ CodeableConcept }], // Message category
"priority" : "<code>", // routine | urgent | asap | stat
"medium" : [{ CodeableConcept }], // A channel of communication
"subject" : { Reference(Group|Patient) }, // Focus of message
"topic" : { CodeableConcept }, // Description of the purpose/content
"about" : [{ Reference(Any) }], // Resources that pertain to this communication
"encounter" : { Reference(Encounter) }, // The Encounter during which this Communication was created
"sent" : "<dateTime>", // When sent
"received" : "<dateTime>", // When received
"recipient" : [{ Reference(CareTeam|Device|Endpoint|Group|HealthcareService|
Location|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }], // Who the information is shared with
"sender" : { Reference(CareTeam|Device|Endpoint|HealthcareService|
Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }, // Who shares the information
"reason" : [{ CodeableReference(Any) }], // Indication for message
"payload" : [{ // Message payload
// content[x]: Message part content. One of these 3:
"contentAttachment" : { Attachment },
"contentReference" : { Reference(Any) },
"contentCodeableConcept" : { CodeableConcept }
}],
"note" : [{ Annotation }] // Comments made about the communication
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Changes since Release 4
| Communication | |
| Communication.recipient |
|
| Communication.sender |
|
| Communication.reason |
|
| Communication.payload.content[x] |
|
| Communication.reasonCode |
|
| Communication.reasonReference |
|
See the Full Difference for further information
This analysis is available as XML or JSON.
See R3 <--> R4 Conversion Maps (status = 3 tests that all execute ok. All tests pass round-trip testing and 2 r3 resources are invalid (0 errors).)
Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis
| Path | ValueSet | Type | Documentation |
|---|---|---|---|
| Communication.status | EventStatus | Required | Codes identifying the lifecycle stage of an event. |
| Communication.statusReason | CommunicationNotDoneReason | Example | Codes for the reason why a communication did not happen. |
| Communication.category | CommunicationCategory | Example | Codes for general categories of communications such as alerts, instructions, etc. |
| Communication.priority | RequestPriority | Required | Identifies the level of importance to be assigned to actioning the request. |
| Communication.medium | ParticipationMode | Example | Identifies the primary means by which an Entity participates in an Act. |
| Communication.topic | CommunicationTopic | Example | Codes describing the purpose or content of the communication. |
| Communication.reason | SNOMEDCTClinicalFindings | Example | This value set includes all the "Clinical finding" SNOMED CT |
Notes to reviewers:
At this time, the code bindings are placeholders to be fleshed out upon further review by the community.
Communication.sender allows Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService and Communication.recipient allows Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Group | CareTeam | HealthcareService - but it is not unusual to have a communication target - even a defined one - where it is unknown what kind of role the person is playing.
If the communication is to or from an individual whose role is not known (practitioner, patient or related person) - for example, only email address is captured in the system - then RelatedPerson should be used by default.
In FHIR, data is typically shared between systems without any need for the Communication resource to accompany or contain the data being shared, i.e. all FHIR exchanges are communications of some form, but that doesn't mean they need the Communication resource. However, in some cases, when data is shared there is a need to provide context about why the data is being conveyed and Communication is one of the mechanisms that FHIR provides that can share this context. Specifically, Communication allows conveying information about reasons for sharing, encounter that provides context for sharing, order or protocol that drove the need to share, etc. Note that some contextual information is expected to be captured by most FHIR systems even in absence of Communication, such as where did the data come from and when was the data received. This metadata is generally captured in Provenance. In addition to Communication, MessageHeader can capture similar metadata and Composition in FHIR documents can also serve a similar purpose. If mixing multiple mechanisms to convey communication metadata, care should be taken to ensure that each mechanism is necessary and the information conveyed in each layer is appropriately consistent.
There is no requirement that Communication and CommunicationRequest always go together. Communication can exist without there having been a CommunicationRequest. For example, a practitioner might capture that they have provided a smoking cessation pamphlet to a patient that would be a Communication instance, but there would have been no "request" that led to the action (unsolicited). As well, a CommunicationRequest can be fulfilled in many ways, e.g. by phone call, email, system to system data sharing and there might not be a requirement to surface this data sharing at the clinical / business level, i.e. no need for a Communication instance.
Where there is a need to explicitly track fulfillment of a CommunicationRequest, Communication is the most natural resource to establish this linkage. The event can be tied to the request using Communication.basedOn.
Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
| Name | Type | Description | Expression | In Common |
| based-on | reference | Request fulfilled by this communication | Communication.basedOn (Any) | |
| category | token | Message category | Communication.category | |
| encounter | reference | The Encounter during which this Communication was created | Communication.encounter (Encounter) | 29 Resources |
| identifier | token | Unique identifier | Communication.identifier | 65 Resources |
| instantiates-canonical | reference | Instantiates FHIR protocol or definition | Communication.instantiatesCanonical (Questionnaire, Measure, PlanDefinition, OperationDefinition, ActivityDefinition) | |
| instantiates-uri | uri | Instantiates external protocol or definition | Communication.instantiatesUri | |
| medium | token | A channel of communication | Communication.medium | |
| part-of | reference | Part of referenced event (e.g. Communication, Procedure) | Communication.partOf (Any) | |
| patient | reference | Focus of message | Communication.subject.where(resolve() is Patient) (Patient) | 66 Resources |
| received | date | When received | Communication.received | |
| recipient | reference | Who the information is shared with | Communication.recipient (Practitioner, Group, Organization, CareTeam, Endpoint, Device, Patient, HealthcareService, PractitionerRole, RelatedPerson, Location) | |
| sender | reference | Who shares the information | Communication.sender (Practitioner, Organization, Endpoint, CareTeam, Device, Patient, HealthcareService, PractitionerRole, RelatedPerson) | |
| sent | date | When sent | Communication.sent | |
| status | token | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown | Communication.status | |
| subject | reference | Focus of message | Communication.subject (Group, Patient) | |
| topic | token | Description of the purpose/content | Communication.topic |
FHIR ®© HL7.org 2011+. FHIR R5 hl7.fhir.core#5.0.0-draft-final generated on Wed, Mar 1, 2023 23:06+1100.
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