FHIR Release 3 (STU)

This page is part of the FHIR Specification (v3.0.2: STU 3). 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: R4B R4 R3 R2

2.37 Resource Media - Content

FHIR Infrastructure

Work Group

Maturity Level: 1

Trial Use

Compartments: Device, Patient, Practitioner

A photo, video, or audio recording acquired or used in healthcare. The actual content may be inline or provided by direct reference.

2.37.1 Scope and Usage

The Media resource contains photos, videos, and audio recordings. It is used with media acquired or used as part of the healthcare process. Here are some typical usages:

Photos and videos of diagnostic or care provision procedures for recording purposes
Images contained in diagnostic reports

2.37.2 Boundaries and Relationships

This resource captures a specific type of Observation - an Observation whose value is audio, video or image data. This resource is the preferred representation of such forms of information as it exposes the metadata relevant for interpreting the information. However, in some legacy environments, media information may occasionally appear in Observation instead. Systems should be aware of this possibility.

The Media resource is able to contain medical images in a DICOM format. These images may also be made accessible through an ImagingStudy resource, which provides a direct reference to the image to a WADO-RS server.

For such images, the WADO-RS framework is a preferred method for representing the images - the WADO-RS service may include rendering the image with annotations and display parameters from an associated DICOM presentation state, for instance.

On the other hand, the media resource allows for a robust transfer of an image across boundaries where the WADO-RS service is not available. For this reason, medical images can also be represented in a Media resource, but the Media.content.url should provide a reference to a source WADO-RS service for the image.

This resource is referenced by diagnosticreport

Structure

Name	Flags	Card.	Type	Description & Constraints
Media	I		DomainResource	A photo, video, or audio recording acquired or used in healthcare. The actual content may be inline or provided by direct reference + Height can only be used for a photo or video + Width can only be used for a photo or video + Frames can only be used for a photo + Duration can only be used for an audio or a video Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Identifier(s) for the image
basedOn	Σ	0..*	Reference(ProcedureRequest)	Procedure that caused this media to be created
type	Σ	1..1	code	photo \| video \| audio DigitalMediaType (Required)
subtype	Σ	0..1	CodeableConcept	The type of acquisition equipment/process Media SubType (Example)
view	Σ	0..1	CodeableConcept	Imaging view, e.g. Lateral or Antero-posterior Media Collection View/Projection (Example)
subject	Σ	0..1	Reference(Patient \| Practitioner \| Group \| Device \| Specimen)	Who/What this Media is a record of
context	Σ	0..1	Reference(Encounter \| EpisodeOfCare)	Encounter / Episode associated with media
occurrence[x]	Σ	0..1		When Media was collected
occurrenceDateTime			dateTime
occurrencePeriod			Period
operator	Σ	0..1	Reference(Practitioner)	The person who generated the image
reasonCode	Σ	0..*	CodeableConcept	Why was event performed? Procedure Reason Codes (Example)
bodySite	Σ	0..1	CodeableConcept	Body part in media SNOMED CT Body Structures (Example)
device	Σ	0..1	Reference(Device \| DeviceMetric)	Observing Device
height	ΣI	0..1	positiveInt	Height of the image in pixels (photo/video)
width	ΣI	0..1	positiveInt	Width of the image in pixels (photo/video)
frames	ΣI	0..1	positiveInt	Number of frames if > 1 (photo)
duration	ΣI	0..1	unsignedInt	Length in seconds (audio / video)
content		1..1	Attachment	Actual Media - reference or data
note		0..*	Annotation	Comments made about the media
Documentation for this format

UML Diagram (Legend)

XML Template

<Media xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifier(s) for the image --></identifier>
 <basedOn><!-- 0..* Reference(ProcedureRequest) Procedure that caused this media to be created --></basedOn>
 <type value="[code]"/><!-- 1..1 photo | video | audio -->
 <subtype><!-- 0..1 CodeableConcept The type of acquisition equipment/process --></subtype>
 <view><!-- 0..1 CodeableConcept Imaging view, e.g. Lateral or Antero-posterior --></view>
 <subject><!-- 0..1 Reference(Patient|Practitioner|Group|Device|Specimen) Who/What this Media is a record of --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Encounter / Episode associated with media --></context>
 <occurrence[x]><!-- 0..1 dateTime|Period When Media was collected --></occurrence[x]>
 <operator><!-- 0..1 Reference(Practitioner) The person who generated the image --></operator>
 <reasonCode><!-- 0..* CodeableConcept Why was event performed? --></reasonCode>
 <bodySite><!-- 0..1 CodeableConcept Body part in media --></bodySite>
 <device><!-- 0..1 Reference(Device|DeviceMetric) Observing Device --></device>
 <height value="[positiveInt]"/><!--  0..1 Height of the image in pixels (photo/video) -->
 <width value="[positiveInt]"/><!--  0..1 Width of the image in pixels (photo/video) -->
 <frames value="[positiveInt]"/><!--  0..1 Number of frames if > 1 (photo) -->
 <duration value="[unsignedInt]"/><!--  0..1 Length in seconds (audio / video) -->
 <content><!-- 1..1 Attachment Actual Media - reference or data --></content>
 <note><!-- 0..* Annotation Comments made about the media --></note>
</Media>

JSON Template

{
  "resourceType" : "Media",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifier(s) for the image
  "basedOn" : [{ Reference(ProcedureRequest) }], // Procedure that caused this media to be created
  "type" : "<code>", // R!  photo | video | audio
  "subtype" : { CodeableConcept }, // The type of acquisition equipment/process
  "view" : { CodeableConcept }, // Imaging view, e.g. Lateral or Antero-posterior
  "subject" : { Reference(Patient|Practitioner|Group|Device|Specimen) }, // Who/What this Media is a record of
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Encounter / Episode associated with media
  // occurrence[x]: When Media was collected. One of these 2:
  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "operator" : { Reference(Practitioner) }, // The person who generated the image
  "reasonCode" : [{ CodeableConcept }], // Why was event performed?
  "bodySite" : { CodeableConcept }, // Body part in media
  "device" : { Reference(Device|DeviceMetric) }, // Observing Device
  "height" : "<positiveInt>", // C? Height of the image in pixels (photo/video)
  "width" : "<positiveInt>", // C? Width of the image in pixels (photo/video)
  "frames" : "<positiveInt>", // C? Number of frames if > 1 (photo)
  "duration" : "<unsignedInt>", // C? Length in seconds (audio / video)
  "content" : { Attachment }, // R!  Actual Media - reference or data
  "note" : [{ Annotation }] // Comments made about the media
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:Media;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Media.identifier [ Identifier ], ... ; # 0..* Identifier(s) for the image
  fhir:Media.basedOn [ Reference(ProcedureRequest) ], ... ; # 0..* Procedure that caused this media to be created
  fhir:Media.type [ code ]; # 1..1 photo | video | audio
  fhir:Media.subtype [ CodeableConcept ]; # 0..1 The type of acquisition equipment/process
  fhir:Media.view [ CodeableConcept ]; # 0..1 Imaging view, e.g. Lateral or Antero-posterior
  fhir:Media.subject [ Reference(Patient|Practitioner|Group|Device|Specimen) ]; # 0..1 Who/What this Media is a record of
  fhir:Media.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Encounter / Episode associated with media
  # Media.occurrence[x] : 0..1 When Media was collected. One of these 2
    fhir:Media.occurrenceDateTime [ dateTime ]
    fhir:Media.occurrencePeriod [ Period ]
  fhir:Media.operator [ Reference(Practitioner) ]; # 0..1 The person who generated the image
  fhir:Media.reasonCode [ CodeableConcept ], ... ; # 0..* Why was event performed?
  fhir:Media.bodySite [ CodeableConcept ]; # 0..1 Body part in media
  fhir:Media.device [ Reference(Device|DeviceMetric) ]; # 0..1 Observing Device
  fhir:Media.height [ positiveInt ]; # 0..1 Height of the image in pixels (photo/video)
  fhir:Media.width [ positiveInt ]; # 0..1 Width of the image in pixels (photo/video)
  fhir:Media.frames [ positiveInt ]; # 0..1 Number of frames if > 1 (photo)
  fhir:Media.duration [ unsignedInt ]; # 0..1 Length in seconds (audio / video)
  fhir:Media.content [ Attachment ]; # 1..1 Actual Media - reference or data
  fhir:Media.note [ Annotation ], ... ; # 0..* Comments made about the media
]

Changes since DSTU2

Media

Media.basedOn

Added Element

Media.context

Added Element

Media.occurrence[x]

Added Element

Media.reasonCode

Added Element

Media.bodySite

Added Element

Media.device

Added Element

Media.note

Added Element

Media.deviceName

deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 3 tests that all execute ok. All tests pass round-trip testing and all r3 resources are valid.).

Structure

Name	Flags	Card.	Type	Description & Constraints
Media	I		DomainResource	A photo, video, or audio recording acquired or used in healthcare. The actual content may be inline or provided by direct reference + Height can only be used for a photo or video + Width can only be used for a photo or video + Frames can only be used for a photo + Duration can only be used for an audio or a video Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Identifier(s) for the image
basedOn	Σ	0..*	Reference(ProcedureRequest)	Procedure that caused this media to be created
type	Σ	1..1	code	photo \| video \| audio DigitalMediaType (Required)
subtype	Σ	0..1	CodeableConcept	The type of acquisition equipment/process Media SubType (Example)
view	Σ	0..1	CodeableConcept	Imaging view, e.g. Lateral or Antero-posterior Media Collection View/Projection (Example)
subject	Σ	0..1	Reference(Patient \| Practitioner \| Group \| Device \| Specimen)	Who/What this Media is a record of
context	Σ	0..1	Reference(Encounter \| EpisodeOfCare)	Encounter / Episode associated with media
occurrence[x]	Σ	0..1		When Media was collected
occurrenceDateTime			dateTime
occurrencePeriod			Period
operator	Σ	0..1	Reference(Practitioner)	The person who generated the image
reasonCode	Σ	0..*	CodeableConcept	Why was event performed? Procedure Reason Codes (Example)
bodySite	Σ	0..1	CodeableConcept	Body part in media SNOMED CT Body Structures (Example)
device	Σ	0..1	Reference(Device \| DeviceMetric)	Observing Device
height	ΣI	0..1	positiveInt	Height of the image in pixels (photo/video)
width	ΣI	0..1	positiveInt	Width of the image in pixels (photo/video)
frames	ΣI	0..1	positiveInt	Number of frames if > 1 (photo)
duration	ΣI	0..1	unsignedInt	Length in seconds (audio / video)
content		1..1	Attachment	Actual Media - reference or data
note		0..*	Annotation	Comments made about the media
Documentation for this format

UML Diagram (Legend)

XML Template

<Media xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifier(s) for the image --></identifier>
 <basedOn><!-- 0..* Reference(ProcedureRequest) Procedure that caused this media to be created --></basedOn>
 <type value="[code]"/><!-- 1..1 photo | video | audio -->
 <subtype><!-- 0..1 CodeableConcept The type of acquisition equipment/process --></subtype>
 <view><!-- 0..1 CodeableConcept Imaging view, e.g. Lateral or Antero-posterior --></view>
 <subject><!-- 0..1 Reference(Patient|Practitioner|Group|Device|Specimen) Who/What this Media is a record of --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Encounter / Episode associated with media --></context>
 <occurrence[x]><!-- 0..1 dateTime|Period When Media was collected --></occurrence[x]>
 <operator><!-- 0..1 Reference(Practitioner) The person who generated the image --></operator>
 <reasonCode><!-- 0..* CodeableConcept Why was event performed? --></reasonCode>
 <bodySite><!-- 0..1 CodeableConcept Body part in media --></bodySite>
 <device><!-- 0..1 Reference(Device|DeviceMetric) Observing Device --></device>
 <height value="[positiveInt]"/><!--  0..1 Height of the image in pixels (photo/video) -->
 <width value="[positiveInt]"/><!--  0..1 Width of the image in pixels (photo/video) -->
 <frames value="[positiveInt]"/><!--  0..1 Number of frames if > 1 (photo) -->
 <duration value="[unsignedInt]"/><!--  0..1 Length in seconds (audio / video) -->
 <content><!-- 1..1 Attachment Actual Media - reference or data --></content>
 <note><!-- 0..* Annotation Comments made about the media --></note>
</Media>

JSON Template

{
  "resourceType" : "Media",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifier(s) for the image
  "basedOn" : [{ Reference(ProcedureRequest) }], // Procedure that caused this media to be created
  "type" : "<code>", // R!  photo | video | audio
  "subtype" : { CodeableConcept }, // The type of acquisition equipment/process
  "view" : { CodeableConcept }, // Imaging view, e.g. Lateral or Antero-posterior
  "subject" : { Reference(Patient|Practitioner|Group|Device|Specimen) }, // Who/What this Media is a record of
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Encounter / Episode associated with media
  // occurrence[x]: When Media was collected. One of these 2:
  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "operator" : { Reference(Practitioner) }, // The person who generated the image
  "reasonCode" : [{ CodeableConcept }], // Why was event performed?
  "bodySite" : { CodeableConcept }, // Body part in media
  "device" : { Reference(Device|DeviceMetric) }, // Observing Device
  "height" : "<positiveInt>", // C? Height of the image in pixels (photo/video)
  "width" : "<positiveInt>", // C? Width of the image in pixels (photo/video)
  "frames" : "<positiveInt>", // C? Number of frames if > 1 (photo)
  "duration" : "<unsignedInt>", // C? Length in seconds (audio / video)
  "content" : { Attachment }, // R!  Actual Media - reference or data
  "note" : [{ Annotation }] // Comments made about the media
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:Media;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Media.identifier [ Identifier ], ... ; # 0..* Identifier(s) for the image
  fhir:Media.basedOn [ Reference(ProcedureRequest) ], ... ; # 0..* Procedure that caused this media to be created
  fhir:Media.type [ code ]; # 1..1 photo | video | audio
  fhir:Media.subtype [ CodeableConcept ]; # 0..1 The type of acquisition equipment/process
  fhir:Media.view [ CodeableConcept ]; # 0..1 Imaging view, e.g. Lateral or Antero-posterior
  fhir:Media.subject [ Reference(Patient|Practitioner|Group|Device|Specimen) ]; # 0..1 Who/What this Media is a record of
  fhir:Media.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Encounter / Episode associated with media
  # Media.occurrence[x] : 0..1 When Media was collected. One of these 2
    fhir:Media.occurrenceDateTime [ dateTime ]
    fhir:Media.occurrencePeriod [ Period ]
  fhir:Media.operator [ Reference(Practitioner) ]; # 0..1 The person who generated the image
  fhir:Media.reasonCode [ CodeableConcept ], ... ; # 0..* Why was event performed?
  fhir:Media.bodySite [ CodeableConcept ]; # 0..1 Body part in media
  fhir:Media.device [ Reference(Device|DeviceMetric) ]; # 0..1 Observing Device
  fhir:Media.height [ positiveInt ]; # 0..1 Height of the image in pixels (photo/video)
  fhir:Media.width [ positiveInt ]; # 0..1 Width of the image in pixels (photo/video)
  fhir:Media.frames [ positiveInt ]; # 0..1 Number of frames if > 1 (photo)
  fhir:Media.duration [ unsignedInt ]; # 0..1 Length in seconds (audio / video)
  fhir:Media.content [ Attachment ]; # 1..1 Actual Media - reference or data
  fhir:Media.note [ Annotation ], ... ; # 0..* Comments made about the media
]

Changes since DSTU2

Media

Media.basedOn

Added Element

Media.context

Added Element

Media.occurrence[x]

Added Element

Media.reasonCode

Added Element

Media.bodySite

Added Element

Media.device

Added Element

Media.note

Added Element

Media.deviceName

deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 3 tests that all execute ok. All tests pass round-trip testing and all r3 resources are valid.).

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)

2.37.3.1 Terminology Bindings

Path	Definition	Type	Reference
Media.type	Whether the media is a photo, video, or audio	Required	DigitalMediaType
Media.subtype	Detailed information about the type of the image - its kind, purpose, or the kind of equipment used to generate it	Example	Media SubType
Media.view	Imaging view (projection) used when collecting an image	Example	Media Collection View/Projection
Media.reasonCode	The reason for the media	Example	Procedure Reason Codes
Media.bodySite	Codes describing anatomical locations. May include laterality.	Example	SNOMED CT Body Structures

Path

Definition

Type

Reference

Media.type

Whether the media is a photo, video, or audio

Required

DigitalMediaType

Media.subtype

Detailed information about the type of the image - its kind, purpose, or the kind of equipment used to generate it

Example

Media SubType

Media.view

Imaging view (projection) used when collecting an image

Example

Media Collection View/Projection

Media.reasonCode

The reason for the media

Example

Procedure Reason Codes

Media.bodySite

Codes describing anatomical locations. May include laterality.

Example

SNOMED CT Body Structures

2.37.3.2 Constraints

mda-1: Height can only be used for a photo or video (expression : height.empty() or type != 'audio')
mda-2: Width can only be used for a photo or video (expression : width.empty() or type != 'audio')
mda-3: Frames can only be used for a photo (expression : frames.empty() or type = 'photo')
mda-4: Duration can only be used for an audio or a video (expression : duration.empty() or type != 'photo')

2.37.3.3 Implementation Notes

The media resource contains several date/times:

Media.occurrence[x] - The date(/time) of collection, or the period over which collection occured
Media.duration - The duration of the media. The duration might differ from occurrencePeriod if recording was paused
Media.content.creation - This should be consistent with the Media.occurrence[x] but might be different due to partial / edited recordings

This resource can embed the image information directly through the attachment.data element. However, good practice is generally to use the attachment.url element to point to a Binary resource. Servers will frequently be able to persist Binary resources in purpose-dedicated repositories more suitable to potentially large artifacts.

2.37.4 Search Parameters

Search parameters for 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	Procedure that caused this media to be created	Media.basedOn (ProcedureRequest)
context	reference	Encounter / Episode associated with media	Media.context (EpisodeOfCare, Encounter)
created	date	Date attachment was first created	Media.content.creation
date	date	When Media was collected	Media.occurrence
device	reference	Observing Device	Media.device (Device, DeviceMetric)
identifier	token	Identifier(s) for the image	Media.identifier
operator	reference	The person who generated the image	Media.operator (Practitioner)
patient	reference	Who/What this Media is a record of	Media.subject (Patient)
site	token	Body part in media	Media.bodySite
subject	reference	Who/What this Media is a record of	Media.subject (Practitioner, Group, Specimen, Device, Patient)
subtype	token	The type of acquisition equipment/process	Media.subtype
type	token	photo \| video \| audio	Media.type
view	token	Imaging view, e.g. Lateral or Antero-posterior	Media.view