R6 Ballot (1st Draft)

This page is part of the FHIR Specification v6.0.0-ballot1: Release 6 Ballot (1st Draft) (see Ballot Notes). The current version is 5.0.0. For a full list of available versions, see the Directory of published versions

10.2.9 Resource DocumentReference - Mappings

Orders and Observations icon Work GroupMaturity Level: N/AStandards Status: InformativeSecurity Category: Not Classified Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson

Mappings:

FiveWs Pattern Mapping

Workflow Pattern

HL7 V2 Mapping

CDA (R2)

RIM Mapping

XDS metadata equivalent

FHIR Composition

Mappings for the documentreference resource (see Mappings to Other Standards for further information & status).

10.2.9.1 FiveWs Pattern Mapping (http://hl7.org/fhir/fivews icon)

DocumentReferenceinfrastructure.documents
    identifierFiveWs.identifier
    versionFiveWs.version
    statusFiveWs.status
    docStatusFiveWs.status
    modalityFiveWs.class
    typeFiveWs.what[x]
    categoryFiveWs.what[x]
    subjectFiveWs.subject[x]
    contextFiveWs.context
    dateFiveWs.recorded
        partyFiveWs.witness

10.2.9.2 Workflow Pattern (http://hl7.org/fhir/workflow icon)

DocumentReferenceEvent
    identifierEvent.identifier
    statusEvent.status
    typeEvent.code
    subjectEvent.subject
    contextEvent.encounter
    dateEvent.occurrence[x]
    authorEvent.performer.actor
    attesterEvent.performer.actor
    custodianEvent.performer.actor

10.2.9.3 HL7 V2 Mapping (http://hl7.org/v2 icon)

DocumentReference
    identifierTXA-12
    version
    basedOn
    statusTXA-19
    docStatusTXA-17
    modality
    typeTXA-2
    category
    subjectPID-3 (No standard way to define a Practitioner or Group subject in HL7 V2 MDM message)
    context
    event
    bodySite
    facilityType
    practiceSetting
    period
    date
    authorTXA-9 (No standard way to indicate a Device in HL7 V2 MDM message)
    attester
        mode
        time
        partyTXA-10
    custodian
    relatesTo
        code
        target
    descriptionTXA-25
    securityLabelTXA-18
    content
        attachmentTXA-3 for mime type
        profile
            value[x]

10.2.9.4 CDA (R2) (http://hl7.org/v3/cda icon)

DocumentReferencewhen describing a CDA
    identifierClinicalDocument/id
    version
    basedOn
    status
    docStatus
    modality
    typeClinicalDocument/code/@code

The typeCode should be mapped from the ClinicalDocument/code element to a set of document type codes configured in the affinity domain. One suggested coding system to use for typeCode is LOINC, in which case the mapping step can be omitted.
    categoryDerived from a mapping of /ClinicalDocument/code/@code to an Affinity Domain specified coded value to use and coding system. Affinity Domains are encouraged to use the appropriate value for Type of Service, based on the LOINC Type of Service (see Page 53 of the LOINC User's Manual). Must be consistent with /ClinicalDocument/code/@code
    subjectClinicalDocument/recordTarget/
    context
    event
    bodySite
    facilityTypeusually a mapping to a local ValueSet. Must be consistent with /clinicalDocument/code
    practiceSettingusually from a mapping to a local ValueSet
    periodClinicalDocument/documentationOf/
serviceEvent/effectiveTime/low/
@value --> ClinicalDocument/documentationOf/
serviceEvent/effectiveTime/high/
@value
    date
    authorClinicalDocument/author
    attester.authenticator/.legalAuthenticator
        modeimplied by .authenticator/.legalAuthenticator
        time.authenticator.time
        party.authenticator.assignedEnttty
    custodian
    relatesTo
        codeClinicalDocument/relatedDocument/typeCode
        targetClinicalDocument/relatedDocument/parentDocument
    description
    securityLabelClinicalDocument/confidentialityCode/@code
    content
        attachmentClinicalDocument/languageCode, ClinicalDocument/title, ClinicalDocument/date
        profilederived from the IHE Profile or Implementation Guide templateID
            value[x]derived from the IHE Profile or Implementation Guide templateID

10.2.9.5 RIM Mapping (http://hl7.org/v3 icon)

DocumentReferenceDocument[classCode="DOC" and moodCode="EVN"]
    identifier.id / .setId
    basedOn.outboundRelationship[typeCode=FLFS].target
    statusinterim: .completionCode="IN" & ./statusCode[isNormalDatatype()]="active"; final: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and not(./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseDocument", code) and isNormalAct()]); amended: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and ./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseDocument", code) and isNormalAct() and statusCode="completed"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]="obsolete"
    docStatus.statusCode
    type./code
    category.outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
    subject.participation[typeCode="SBJ"].role[typeCode="PAT"]
    contextunique(highest(./outboundRelationship[typeCode="SUBJ" and isNormalActRelationship()], priorityNumber)/target[moodCode="EVN" and classCode=("ENC", "PCPR") and isNormalAct])
    event.code
    bodySite.targetSiteCode
    facilityType.participation[typeCode="LOC"].role[classCode="DSDLOC"].code
    practiceSetting.participation[typeCode="LOC"].role[classCode="DSDLOC"].code
    period.effectiveTime
    date.availabilityTime[type="TS"]
    author.participation[typeCode="AUT"].role[classCode="ASSIGNED"]
    attester.participation[typeCode="AUTHEN"].role[classCode="ASSIGNED"]
        modeunique(./modeCode)
        time./time[type="TS" and isNormalDatatype()]
        party./role[classCode="ASSIGNED" and isNormalRole]/player[determinerCode="INST" and classCode=("DEV", "PSN") and isNormalEntity()] or ./role[classCode="ASSIGNED" and isNormalRole and not(player)]/scoper[determinerCode="INST" and classCode="ORG" and isNormalEntity()]
    custodian.participation[typeCode="RCV"].role[classCode="CUST"].scoper[classCode="ORG" and determinerCode="INST"]
    relatesTo.outboundRelationship
        code.outboundRelationship.typeCode
        target.target[classCode="DOC", moodCode="EVN"].id
    description.outboundRelationship[typeCode="SUBJ"].target.text
    securityLabel.confidentialityCode
    contentdocument.text
        attachmentdocument.text
        profiledocument.text
            value[x]document.text

10.2.9.6 XDS metadata equivalent (http://ihe.net/xds icon)

DocumentReferenceDocumentEntry
    identifierDocumentEntry.entryUUID, DocumentEntry.uniqueId
    version
    basedOnDocumentEntry.referenceIdList
    statusDocumentEntry.availabilityStatus
    docStatus
    modality
    typeDocumentEntry.typeCode
    categoryDocumentEntry.classCode
    subjectDocumentEntry.patientId
    context
    eventDocumentEntry.referenceIdList
    bodySite
    facilityTypeDocumentEntry.healthcareFacilityTypeCode
    practiceSettingDocumentEntry.practiceSettingCode
    periodDocumentEntry.serviceStartTime, DocumentEntry.serviceStopTime
    date
    authorDocumentEntry.author
    attesterDocumentEntry.legalAuthenticator
        mode
        time
        party
    custodian
    relatesToDocumentEntry Associations
        codeDocumentEntry Associations type
        targetDocumentEntry Associations reference
    descriptionDocumentEntry.comments
    securityLabelDocumentEntry.confidentialityCode
    content
        attachmentDocumentEntry.mimeType, DocumentEntry.languageCode, DocumentEntry.URI, DocumentEntry.size, DocumentEntry.hash, DocumentEntry.title, DocumentEntry.creationTime
        profileDocumentEntry.formatCode
            value[x]DocumentEntry.formatCode

10.2.9.7 FHIR Composition (http://hl7.org/fhir/composition icon)

DocumentReferencewhen describing a Composition
    identifierComposition.identifier
    versionComposition.version
    basedOn
    status
    docStatusComposition.status
    modality
    typeComposition.type
    categoryComposition.category
    subjectComposition.subject
    contextComposition.encounter
    eventComposition.event.detail
    bodySite
    facilityTypeusually from a mapping to a local ValueSet
    practiceSettingusually from a mapping to a local ValueSet
    periodComposition.event.period
    dateComposition.date
    authorComposition.author
    attesterComposition.attester
        modeComposition.attester.mode
        timeComposition.attester.time
        partyComposition.attester.party
    custodianComposition.custodian
    relatesToComposition.relatesTo
        codeComposition.relatesTo.type
        targetComposition.relatesTo.resourceReference
    description
    securityLabelBundle.meta.security
    contentBundle(Composition+*)
        attachmentComposition.language,
Composition.title,
Composition.date
        profileComposition.meta.profile
            value[x]Composition.meta.profile