This is new content for the STU 2 ballot.

Introduction

This profile represents a Patient List. The resource instance contain information related to members who are grouped for a specific use case. For example, the Patient List could represent the Member Attribution List containing a list of patients attributed to a Provider. Attribution information such as the attributed period, attributed provider is also contained within the group resource. Members may be added or removed from the Patient List using member-add and member-remove operation. Group.member has a cardinality of 0..* because Groups may have zero members when they are initially created and members get added at a later point in time. The Group.member.inactive flag is used to indicate that the patient is no longer part of the Member Attribution List.

Implementation Requirements for Member Attribution List

Implementers are advised to read Data Model Requirements to implement the Group profile and create a Member Attribution List.

Handling Large Groups

Groups which have large number of members (for e.g > 100,000) end up consuming a large number of resources on server, client and the network to retrieve the Group either using search mechanisms or read mechanisms. In order to limit the amount of data being returned by the server the following requirements are being levied.

* All Group search operations or read operations should use the _summary=true parameter. This parameter will only return teh summary of the Group resource and does not include any members. This makes the operation light weight for clients and severs. 

* Once the Group is received, the client can perform the davinci-data-export operation on the Group resource which will create a NDJSON file for the Group itself. In this case the NDJSON file will only contain a single line with a large number of data based on the number of members present in the Group.

* NOTE: There is discussion on creating a new operation to page the Group resource based on the number of data elements. When this is made available, the IG will be revised to use the method for Group searches and reads without the _summary parameter. 

Using Sub Groups

A Group can contain other groups. This capability may be used by use cases where multiple characteristics have to be grouped into a composite group. For e.g if you want to create a group of patients attributed to an Organization (Say Org-AttributionList Group), which consists of a group of patients attributed to provider A (ProviderA-AttributionList) and Provider B (ProviderB-AttributionList). In this case the Org-AttributionList group may contain the sub-groups namely ProviderA-AttributionList and ProviderB-AttributionList. The existing DaVinci use cases do not require this level of complexity and hence it is not explicitly identifies as being required for DaVinci use cases.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Group

Name	Flags	Card.	Type	Description & Constraints
Group		0..*	Group	DaVinci Patient List
intendedRecipientIdentifier	S	0..1	Identifier	ATR Intended Recipient Extension URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-intended-recipient-identifier-extension
identifier	S	0..*	Identifier	Unique id
active	S	0..1	boolean	Whether this group's record is in active use
type	S	1..1	code	person | animal | practitioner | device | medication | substance Fixed Value: person
actual	S	1..1	boolean	Descriptive or actual Fixed Value: true
name	S	0..1	string	Label for Group
quantity	S	0..1	unsignedInt	Number of members
managingEntity	S	1..1	Reference(Davinci ATR Organization)	Entity that is the custodian of the Group's definition
characteristic		0..*	BackboneElement	Include / Exclude group members by Trait
code	S	1..1	CodeableConcept	Kind of characteristic Binding: DaVinci Group Characteristic (extensible): The set of characteristics shared by the members
value[x]	S	1..1	CodeableConcept, boolean, Quantity, Range, Reference()	Value held by characteristic
member		0..*	BackboneElement	Who or what is in group
associatedData	S	0..1	Reference()	ATR Any Resource Extension URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-any-resource-extension
entity	S	1..1	Reference(Davinci ATR Patient)	Reference to the group member
period	S	0..1	Period	Period member belonged to the group
inactive	S	0..1	boolean	If member is no longer in group
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Group.characteristic.code	extensible	DaVinciGroupCharacteristic (a valid code from Davinci Group Charactersitic Codes)

Name	Flags	Card.	Type	Description & Constraints
Group	C	0..*	Group	DaVinci Patient List
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
intendedRecipientIdentifier	S	0..1	Identifier	ATR Intended Recipient Extension URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-intended-recipient-identifier-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Unique id
active	SΣ	0..1	boolean	Whether this group's record is in active use
type	SΣ	1..1	code	person | animal | practitioner | device | medication | substance Binding: GroupType (required): Types of resources that are part of group. Fixed Value: person
actual	SΣC	1..1	boolean	Descriptive or actual Fixed Value: true
name	SΣ	0..1	string	Label for Group
quantity	SΣ	0..1	unsignedInt	Number of members
managingEntity	SΣ	1..1	Reference(Davinci ATR Organization)	Entity that is the custodian of the Group's definition
characteristic		0..*	BackboneElement	Include / Exclude group members by Trait
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..1	CodeableConcept	Kind of characteristic Binding: DaVinci Group Characteristic (extensible): The set of characteristics shared by the members
value[x]	S	1..1		Value held by characteristic Binding: (unbound) (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.
valueCodeableConcept			CodeableConcept
valueBoolean			boolean
valueQuantity			Quantity
valueRange			Range
valueReference			Reference(Any)
exclude		1..1	boolean	Group includes or excludes
member	C	0..*	BackboneElement	Who or what is in group
associatedData	S	0..1	Reference()	ATR Any Resource Extension URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-any-resource-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
entity	S	1..1	Reference(Davinci ATR Patient)	Reference to the group member
period	S	0..1	Period	Period member belonged to the group
inactive	S	0..1	boolean	If member is no longer in group
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Group.type	required	Fixed Value: person
Group.characteristic.code	extensible	DaVinciGroupCharacteristic (a valid code from Davinci Group Charactersitic Codes)
Group.characteristic.value[x]	example

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Group	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Group	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Group	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Group	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Group	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
grp-1	error	Group	Can only have members if group is "actual" : member.empty() or (actual = true)

Name	Flags	Card.	Type	Description & Constraints
Group	C	0..*	Group	DaVinci Patient List
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
intendedRecipientIdentifier	S	0..1	Identifier	ATR Intended Recipient Extension URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-intended-recipient-identifier-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Unique id
active	SΣ	0..1	boolean	Whether this group's record is in active use
type	SΣ	1..1	code	person | animal | practitioner | device | medication | substance Binding: GroupType (required): Types of resources that are part of group. Fixed Value: person
actual	SΣC	1..1	boolean	Descriptive or actual Fixed Value: true
code	Σ	0..1	CodeableConcept	Kind of Group members Binding: (unbound) (example): Kind of particular resource; e.g. cow, syringe, lake, etc.
name	SΣ	0..1	string	Label for Group
quantity	SΣ	0..1	unsignedInt	Number of members
managingEntity	SΣ	1..1	Reference(Davinci ATR Organization)	Entity that is the custodian of the Group's definition
characteristic		0..*	BackboneElement	Include / Exclude group members by Trait
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..1	CodeableConcept	Kind of characteristic Binding: DaVinci Group Characteristic (extensible): The set of characteristics shared by the members
value[x]	S	1..1		Value held by characteristic Binding: (unbound) (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.
valueCodeableConcept			CodeableConcept
valueBoolean			boolean
valueQuantity			Quantity
valueRange			Range
valueReference			Reference(Any)
exclude		1..1	boolean	Group includes or excludes
period		0..1	Period	Period over which characteristic is tested
member	C	0..*	BackboneElement	Who or what is in group
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
associatedData	S	0..1	Reference()	ATR Any Resource Extension URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-any-resource-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
entity	S	1..1	Reference(Davinci ATR Patient)	Reference to the group member
period	S	0..1	Period	Period member belonged to the group
inactive	S	0..1	boolean	If member is no longer in group
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Group.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Group.type	required	Fixed Value: person
Group.code	example
Group.characteristic.code	extensible	DaVinciGroupCharacteristic (a valid code from Davinci Group Charactersitic Codes)
Group.characteristic.value[x]	example

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from Group

Name	Flags	Card.	Type	Description & Constraints
Group		0..*	Group	DaVinci Patient List
intendedRecipientIdentifier	S	0..1	Identifier	ATR Intended Recipient Extension URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-intended-recipient-identifier-extension
identifier	S	0..*	Identifier	Unique id
active	S	0..1	boolean	Whether this group's record is in active use
type	S	1..1	code	person | animal | practitioner | device | medication | substance Fixed Value: person
actual	S	1..1	boolean	Descriptive or actual Fixed Value: true
name	S	0..1	string	Label for Group
quantity	S	0..1	unsignedInt	Number of members
managingEntity	S	1..1	Reference(Davinci ATR Organization)	Entity that is the custodian of the Group's definition
characteristic		0..*	BackboneElement	Include / Exclude group members by Trait
code	S	1..1	CodeableConcept	Kind of characteristic Binding: DaVinci Group Characteristic (extensible): The set of characteristics shared by the members
value[x]	S	1..1	CodeableConcept, boolean, Quantity, Range, Reference()	Value held by characteristic
member		0..*	BackboneElement	Who or what is in group
associatedData	S	0..1	Reference()	ATR Any Resource Extension URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-any-resource-extension
entity	S	1..1	Reference(Davinci ATR Patient)	Reference to the group member
period	S	0..1	Period	Period member belonged to the group
inactive	S	0..1	boolean	If member is no longer in group
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Group.characteristic.code	extensible	DaVinciGroupCharacteristic (a valid code from Davinci Group Charactersitic Codes)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Group	C	0..*	Group	DaVinci Patient List
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
intendedRecipientIdentifier	S	0..1	Identifier	ATR Intended Recipient Extension URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-intended-recipient-identifier-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Unique id
active	SΣ	0..1	boolean	Whether this group's record is in active use
type	SΣ	1..1	code	person | animal | practitioner | device | medication | substance Binding: GroupType (required): Types of resources that are part of group. Fixed Value: person
actual	SΣC	1..1	boolean	Descriptive or actual Fixed Value: true
name	SΣ	0..1	string	Label for Group
quantity	SΣ	0..1	unsignedInt	Number of members
managingEntity	SΣ	1..1	Reference(Davinci ATR Organization)	Entity that is the custodian of the Group's definition
characteristic		0..*	BackboneElement	Include / Exclude group members by Trait
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..1	CodeableConcept	Kind of characteristic Binding: DaVinci Group Characteristic (extensible): The set of characteristics shared by the members
value[x]	S	1..1		Value held by characteristic Binding: (unbound) (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.
valueCodeableConcept			CodeableConcept
valueBoolean			boolean
valueQuantity			Quantity
valueRange			Range
valueReference			Reference(Any)
exclude		1..1	boolean	Group includes or excludes
member	C	0..*	BackboneElement	Who or what is in group
associatedData	S	0..1	Reference()	ATR Any Resource Extension URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-any-resource-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
entity	S	1..1	Reference(Davinci ATR Patient)	Reference to the group member
period	S	0..1	Period	Period member belonged to the group
inactive	S	0..1	boolean	If member is no longer in group
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Group.type	required	Fixed Value: person
Group.characteristic.code	extensible	DaVinciGroupCharacteristic (a valid code from Davinci Group Charactersitic Codes)
Group.characteristic.value[x]	example

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Group	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Group	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Group	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Group	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Group	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
grp-1	error	Group	Can only have members if group is "actual" : member.empty() or (actual = true)

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Group	C	0..*	Group	DaVinci Patient List
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
intendedRecipientIdentifier	S	0..1	Identifier	ATR Intended Recipient Extension URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-intended-recipient-identifier-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Unique id
active	SΣ	0..1	boolean	Whether this group's record is in active use
type	SΣ	1..1	code	person | animal | practitioner | device | medication | substance Binding: GroupType (required): Types of resources that are part of group. Fixed Value: person
actual	SΣC	1..1	boolean	Descriptive or actual Fixed Value: true
code	Σ	0..1	CodeableConcept	Kind of Group members Binding: (unbound) (example): Kind of particular resource; e.g. cow, syringe, lake, etc.
name	SΣ	0..1	string	Label for Group
quantity	SΣ	0..1	unsignedInt	Number of members
managingEntity	SΣ	1..1	Reference(Davinci ATR Organization)	Entity that is the custodian of the Group's definition
characteristic		0..*	BackboneElement	Include / Exclude group members by Trait
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..1	CodeableConcept	Kind of characteristic Binding: DaVinci Group Characteristic (extensible): The set of characteristics shared by the members
value[x]	S	1..1		Value held by characteristic Binding: (unbound) (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.
valueCodeableConcept			CodeableConcept
valueBoolean			boolean
valueQuantity			Quantity
valueRange			Range
valueReference			Reference(Any)
exclude		1..1	boolean	Group includes or excludes
period		0..1	Period	Period over which characteristic is tested
member	C	0..*	BackboneElement	Who or what is in group
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
associatedData	S	0..1	Reference()	ATR Any Resource Extension URL: http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-any-resource-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
entity	S	1..1	Reference(Davinci ATR Patient)	Reference to the group member
period	S	0..1	Period	Period member belonged to the group
inactive	S	0..1	boolean	If member is no longer in group
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Group.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Group.type	required	Fixed Value: person
Group.code	example
Group.characteristic.code	extensible	DaVinciGroupCharacteristic (a valid code from Davinci Group Charactersitic Codes)
Group.characteristic.value[x]	example

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Group

Summary

Mandatory: 3 elements (3 nested mandatory elements)
Must-Support: 14 elements
Fixed Value: 2 elements

Structures

This structure refers to these other structures:

• Davinci ATR Organization (http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-organization)
• Davinci ATR Patient (http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-patient)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-intended-recipient-identifier-extension
• http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-any-resource-extension