This page is part of the PACIO Advance Directive Information Implementation Guide (v2.0.0-ballot: STU 2 Ballot) based on FHIR (HL7® FHIR® Standard) R4. This version is a pre-release. The current official version is 1.0.0. For a full list of available versions, see the Directory of published versions

Change Log

Page standards status: Informative

STU2 Ballot Release Notes

The following changes occurred since the PACIO ADI STU1 publication in January 2024

Support for new AD document types

• Provider-authored advance directives
  • Portable Medical Orders (PMO)
• Guidance on Mental Health Advance Directives (MHAD)
• Minimally Structured Document (MSD)

Changes to STU1 based profiles

• Closer Alignment with US Core
  • ADI Care Plan
• Specifying Jurisdictions and Healthcare Facilitators
• Specifying attester and facilitator signatures

Integrative use cases

• Integrative use cases and examples to demonstrate clearer use of the ADI profiles.

JIRA Fixes

Compatible, substantive Changes

• FHIR-34472: Add example of Binary encoded document bundle and digital signature
• FHIR-34473: Add Binary profile
• FHIR-35568: Defining URL should be anchored in THO not hl7.org/fhir. Only those with required binding to a 'code' data type should be anchored in hl7.fhir.org.8
• FHIR-35574: Defining URL should be anchored in THO not hl7.org/fhir.1
• FHIR-36168: Add requirement that servers support CapabilityStatement.instantiates pointing to the included CapabilityStatement
• FHIR-40285: Add Preference Observations for handling of body after death
• FHIR-40374: Add "If you have it send it" requirement to Conformance Requirements
• FHIR-40375: Add ability to express CodeableConcept in Preference CarePlan.addresses
• FHIR-40376: Add a means to provide a location to additional documentation
• FHIR-40561: Replace PADIConsentTypeVS with VSAC value set
• FHIR-42104: Remove ADI Preference Care Plan reference from the GPP Upon Death section
• FHIR-43143: Extensions are defined with context that is too broad
• FHIR-44912: Change Personal Intervention Preference code to directly link to VSAC URL
• FHIR-46062: versionNumber in ADI Composition and in DocumentReference should be a string
• FHIR-46149: Update Category Coding and Type coding
• FHIR-46151: Fix DocumentReference.date and DocumentReference.content.attachment.creation to hold the correct date information
• FHIR-46153: Add docRevokeStatus extension to support document revocation use cases
• FHIR-46154: Create an IG-based codeSystem for temp codes not yet granted by codeSystem Stewards
• FHIR-46312: Add Temporary Codes CodeSystem to the IG
• FHIR-46446: Add constraints on Attester for Person-Authored Composition Profile
• FHIR-46475: Add constraints on Attester for Provider-Authored Composition Profile
• FHIR-46609: PMO Composition event needs further constraints for facilitators
• FHIR-46771: Tighten constraint on ServiceRequest.intent in Profiles for entries in the Medical Orders Section
• FHIR-46912: Add support for expressing a Goal associated with an Initial Treatment Order
• FHIR-46913: Need for Temporary Codes and Temporary Value Sets
• FHIR-48856: HCA Appointment Consent needs to be grounded to LOINC 81377-4
• FHIR-48858: Clarify Guidance on how to represent an ADI facilitator
• FHIR-48898: ADI Composition Header relatesTo incorrectly references Composition. Should be DocumentReference
• FHIR-48899: ADI PMO CarePlan should be removed
• FHIR-48900: ADI Consent needs guidance for permit and deny
• FHIR-48928: Create an ADI minimally structured document
• FHIR-49808: Constrains need to be added to the Composition Profiles to make the attester element a Key element
• FHIR-49914: Update Portable Medical Order Categories
• FHIR-49981: PMO attester signature needs tighter specification and guidance
• FHIR-50122: PMO Composition should include an ADI Decisional Capacity entry under the Administration Information section
• FHIR-50126: ADI Personal Goal category type and description need further constraints
• FHIR-50896: Bundle needs a profile to constrain ADI-specific profiles and elements
• FHIR-51102: ADI Composition Header needs to specify expiration dates

Non-substantive Changes

• FHIR-34471: Add example of Document Bundle with internal identifiers of UUID
• FHIR-34806: it's really hard to understand the intended exchange patterns
• FHIR-36659: Add better description as to the use of Contextual Value Extension
• FHIR-40345: Consent Category binding should be on a slice
• FHIR-40377: Add guidance on document status
• FHIR-40378: Add more guidance on when to write vs update a document
• FHIR-40380: Change order of sections identified in PACP Composition
• FHIR-41491: Change reference of "Portable Medical Order for Life Sustaining Treatment" to "Portable Medical Order"
• FHIR-41493: Support search for various known ADI document by adding details
• FHIR-41638: Missing guidance on metadata for specifying CDA document attachments
• FHIR-41779: Add where the advance directive came from
• FHIR-42718: Better describe how to implement the five use cases
• FHIR-43185: Add behavioral healthcare agent as an additional human actor
• FHIR-43315: Include 'behavioral healthcare agents' as an additional 'Healthcare Agent'
• FHIR-44103: Typo: The second sentence in the second paragraph should read Content Type 1 instead of Content Type I.
• FHIR-46150: 2. VersionNumber extension will be populated with a timestamp created when document is created in the system
• FHIR-46158: Organize the Profiles in a more logical order for the reader
• FHIR-46480: Capability $match missing from the RESTful Capabilities by Profile table
• FHIR-46590: Example for DocumentReference with "DocumentReference.docStatus" = final
• FHIR-50124: Remove all must-support sections (except for Medical Orders) from PMO Composition
• FHIR-50125: Pt-Authored Composition Healthcare Agent Appointment section should be required

Non-compatible Changes

• FHIR-36712: Remove inheritance of US Core DocumentReference from ADI Profile of DocumentReference
• FHIR-36962: Missing guidance on DocumentReference instances
• FHIR-37987: Make changes to ADI Participant Consent profile
• FHIR-40283: Remove Jurisdiction extension for Composition and pre-adopt R5 Composition.relatesTo RelatedArtifact
• FHIR-40373: Change Advance Directive Category VS and add to Document Reference
• FHIR-40379: Correct codes in DocumentationTypeValueSet and Documentation Observation
• FHIR-48545: Modify "ADI Participant Consent" and "ADI Participant" profile names to make the purpose of the profiles more clear