This Reportability Response Communication will be created in response to an electronic Initial Case Report Composition and the sharing of the Reportability Response with clinical care will serve several functions, including to:

• Communicate the reportability status, for the responsible PHA(s) of each condition included in the electronic Initial Case Report (eICR)
• Identify who (a PHA or an intermediary) prepared the Reportability Response
• Indicate whether the eICR has been sent to one or more PHA(s)
• Identify which PHA(s) has/have been sent the eICR
• Provide contact information for the responsible PHA(s)
• Provide suggested or required clinical follow-up activities from the responsible PHA(s), including any additional reporting needs or infection control activities
• Provide access to clinical support resources suggested by the responsible PHA(s) for identified reportable conditions
• Confirm eICR receipt and processing

A Reportability Response will also, when requested, be shared with the responsible PHAs (when they have not constructed it) for their internal use, so they understand what has been shared with clinical care and, and to monitor/audit decision support algorithm effectivesness and implementation. When a condition is considered reportable to more than one PHA, the Reportability Response can be helpful in communicating reporting that has been done to other PHAs.

The Reportability Response Communication is also structured to allow:

• Notification, alerting, routing and queueing in work or message management systems for healthcare personnel
• Dynamic and static URIs for supplemental data collection and the provision of information resources

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

The narrative structure of a Reportability Response Comminication can take two different forms, depending on the processing status of the eICR Composition document to which it is a response. These forms are as follows:

• If the eICR was processed, then the narrative text will be populated with data from Communication.topic, Communication.payload[Reportability Response Summary], Communication.payload[Relevant Reportable Condition], and Communication.payload[Electronic Initial Case Report Information]

• If the eICR was not processed and has errors, then the narrative text will only be populated with data from Communication.payload[Electronic Initial Case Report Information]

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

An Extension

• value @ url

Represents a priority for the reportability response communication overall. It has been calculated from the highest priority of any included External Resources or the highest priority of included conditions based on a separate, jurisdictionally developed priority list. This 'communication'-level priority should be used for EHR workflow including notification, alerting, routing and queueing.

Represents either a 'transforms' or a 'replaces' structure that this Communication is related to.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Business identifiers assigned to this communication by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

Allows identification of the communication as it is known by various participating systems and in a way that remains consistent across servers.

This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication.

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication.

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

An order, proposal or plan fulfilled in whole or in part by this Communication.

This must point to some sort of a 'Request' resource, such as CarePlan, CommunicationRequest, ServiceRequest, MedicationRequest, etc.

Part of this action.

Prior communication that this communication is in response to.

The status of the transmission.

This element is labeled as a modifier because the status contains the codes aborted and entered-in-error that mark the communication as not currently valid.

Captures the reason for the current state of the Communication.

This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.

The type of message conveyed such as alert, notification, reminder, instruction, etc.

There may be multiple axes of categorization and one communication may serve multiple purposes.

Characterizes how quickly the planned or in progress communication must be addressed. Includes concepts such as stat, urgent, routine.

Used to prioritize workflow (such as which communication to read first) when the communication is planned or in progress.

A channel that was used for this communication (e.g. email, fax).

The patient or group that was the focus of this communication.

Contains a short high-level description of the determination of reportability. This information can be used to route and prioritize Reportability Responses in a work queue or an email subject.

Communication.topic.text can be used without any codings.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

A reference to a code defined by a terminology system.

Allows for alternative encodings within a code system, and translations to other code systems.

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Contains a short high-level description of the determination of reportability.

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Very often the text is the same as a displayName of one of the codings.

Other resources that pertain to this communication and to which this communication should be associated.

Don't use Communication.about element when a more specific element exists, such as basedOn or reasonReference.

The encounter in which the eICR was triggered.

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

The time when this communication was sent.

The time when this communication arrived at the destination.

Reporting may be identified for multiple PHAs by the PHA system (or its intermediary) (because the patient's residence and the provider location are in separate jurisdictions) including other identified organization (such as an HIE) to which the eICR (if deemed reportable) and/or the Reportability Response will be routed.

For the Reportability Response communication, this will most likely be the software that is generating the response, though this will not always the be case.

The reason or justification for the communication.

Textual reasons can be captured using reasonCode.text.

Indicates another resource whose existence justifies this communication.

Text, attachment(s), or resource(s) that was communicated to the recipient.

• value @ id

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A communicated content (or for multi-part communications, one portion of the communication).

This payload slice is present in the Reportabilty Response if the eICR was processed and is not present if the eICR was not processed. Contains a detailed text description of the reportable condition(s) including actions the provider needs to take, any supplemental information that may be required, and where the initial case report was sent.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A communicated content (or for multi-part communications, one portion of the communication).

This payload slice contains information about the eICR Document to which this Communication is a response. The date/time of receipt and a document reference are represented in the Electronic Initial Case Report Composition Profile (contained in the eICR Document Bundle) and the processing status of the eICR Document is contained in the eICR Processing Status profile. If the eICR Document was manually or alternately initiated by a healthcare provider, this is indicated by the presence of the Initiation Type eICR extension.

This payload slice is always present in the Reportability Response Communication.

The text element (narrative block) in this section is only populated and displayed when the eICR Document was not processed (eICR Processing Status/code="RRVS22", "eICR was not processed - error") and that text element contains the eICR processing status reason(s).

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

• value @ url

This extension constains processing status information about the eICR.

The presence of this extension indicates whether or not the eICR CDA document for which this Reportability Response is a response, was either alternately or manually initiated. The eICR could also contain RCTC trigger codes (automatic trigger code initiation).

This extension contains the date and time of eICR receipt.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Reference to eICR Document Bundle or eICR CDA document. If Reference: 1. Use id for eICR Document Bundle id 2. Use display for eICR file name (or other identifying string): recommended primarily for dealing with eICR error cases. In the case where an eICR document is unreadable for some reason, it is possible that the only identifying information is the eICR filename (or other identifying string). If Attachment: 1. Use url for eICR Document id. 2. Use title for eICR file name (or other identifying string).

This payload slice is present in the Reportabilty Response if the eICR was processed and is not present if the eICR was not processed. It contains a Reportability Response PlanDefinition and repeats for each uniqe condition-PHA pair.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A communicated content (or for multi-part communications, one portion of the communication).

Additional notes or commentary about the communication by the sender, receiver or other interested parties.