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

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

An Extension

R4: Media.partOf (new:Reference(Resource))

Element Media.partOf has a context of Media based on following the parent source element upwards and mapping to Media. Element Media.partOf has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Not to be used to link an event to an Encounter - use Media.encounter for that.

[The allowed reference resources may be adjusted as appropriate for the event resource].

R4: Media.issued (new:instant)

Element Media.issued has a context of Media based on following the parent source element upwards and mapping to Media. Element Media.issued has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). It may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that does not require the new version to be reviewed and verified again.

R4: Media.deviceName (new:string)

Element Media.deviceName has a context of Media based on following the parent source element upwards and mapping to Media. Element Media.deviceName has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

An Extension

R4: Media.status (new:code)

Element Media.status has a context of Media based on following the parent source element upwards and mapping to Media. Element Media.status has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). A nominal state-transition diagram can be found in the [[event.html#statemachine | Event pattern]] documentation

Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

Whether the media is a photo (still image), an audio recording, or a video recording.

Whether the media is a photo, video, or audio

An Extension

R4: Media.type additional types (CodeableConcept) additional types from child elements (coding)

Element Media.type is mapped to FHIR STU3 element Media.type as SourceIsBroaderThanTarget. The mappings for Media.type do not cover the following types: CodeableConcept. The mappings for Media.type do not cover the following types based on type expansion: coding.

The actual content of the media - inline or by direct reference to the media source file.

Recommended content types: image/jpeg, image/png, image/tiff, video/mpeg, audio/mp4, application/dicom. Application/dicom can contain the transfer syntax as a parameter. For an media that covers a period of time (video/sound), the content.creationTime is the end time. Creation time is used for tracking, organizing versions and searching.

R4: Media.partOf (new:Reference(Resource))

Element Media.partOf has a context of Media based on following the parent source element upwards and mapping to Media. Element Media.partOf has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Not to be used to link an event to an Encounter - use Media.encounter for that.

[The allowed reference resources may be adjusted as appropriate for the event resource].

R4: Media.issued (new:instant)

Element Media.issued has a context of Media based on following the parent source element upwards and mapping to Media. Element Media.issued has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). It may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that does not require the new version to be reviewed and verified again.

R4: Media.deviceName (new:string)

Element Media.deviceName has a context of Media based on following the parent source element upwards and mapping to Media. Element Media.deviceName has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: Media.status (new:code)

Element Media.status has a context of Media based on following the parent source element upwards and mapping to Media. Element Media.status has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). A nominal state-transition diagram can be found in the [[event.html#statemachine | Event pattern]] documentation

Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

R4: Media.basedOn additional types from child elements (display, identifier, reference, type)

Element Media.basedOn is mapped to FHIR STU3 element Media.basedOn as SourceIsBroaderThanTarget. The mappings for Media.basedOn do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Media.basedOn with unmapped reference targets: CarePlan, ServiceRequest.

R4: Media.type additional types (CodeableConcept) additional types from child elements (coding)

Element Media.type is mapped to FHIR STU3 element Media.type as SourceIsBroaderThanTarget. The mappings for Media.type do not cover the following types: CodeableConcept. The mappings for Media.type do not cover the following types based on type expansion: coding.

R4: Media.subject

Element Media.subject is mapped to FHIR STU3 element Media.subject as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Media.subject with unmapped reference targets: Location, PractitionerRole.

R4: Media.operator

Element Media.operator is mapped to FHIR STU3 element Media.operator as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Media.operator with unmapped reference targets: CareTeam, Device, Organization, Patient, PractitionerRole, RelatedPerson.

R4: Media.duration additional types (decimal) additional types from child elements (value)

Element Media.duration is mapped to FHIR STU3 element Media.duration as SourceIsBroaderThanTarget. The mappings for Media.duration do not cover the following types: decimal. The mappings for Media.duration do not cover the following types based on type expansion: value. The duration might differ from occurrencePeriod if recording was paused.

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

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 may 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.

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

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).

A human language.

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

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 in formation 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.

An Extension

R4: Media.partOf (new:Reference(Resource))

Element Media.partOf has a context of Media based on following the parent source element upwards and mapping to Media. Element Media.partOf has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). Not to be used to link an event to an Encounter - use Media.encounter for that.

[The allowed reference resources may be adjusted as appropriate for the event resource].

R4: Media.issued (new:instant)

Element Media.issued has a context of Media based on following the parent source element upwards and mapping to Media. Element Media.issued has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). It may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that does not require the new version to be reviewed and verified again.

R4: Media.deviceName (new:string)

Element Media.deviceName has a context of Media based on following the parent source element upwards and mapping to Media. Element Media.deviceName has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

An Extension

R4: Media.status (new:code)

Element Media.status has a context of Media based on following the parent source element upwards and mapping to Media. Element Media.status has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). A nominal state-transition diagram can be found in the [[event.html#statemachine | Event pattern]] documentation

Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

Identifiers associated with the image - these may include identifiers for the image itself, identifiers for the context of its collection (e.g. series ids) and context ids such as accession numbers or other workflow identifiers.

The identifier label and use can be used to determine what kind of identifier it is.

A procedure that is fulfilled in whole or in part by the creation of this media.

Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

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

An Extension

R4: Media.basedOn additional types from child elements (display, identifier, reference, type)

Element Media.basedOn is mapped to FHIR STU3 element Media.basedOn as SourceIsBroaderThanTarget. The mappings for Media.basedOn do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Media.basedOn with unmapped reference targets: CarePlan, ServiceRequest.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Whether the media is a photo (still image), an audio recording, or a video recording.

Whether the media is a photo, video, or audio

unique id for the element within a resource (for internal references)

An Extension

R4: Media.type additional types (CodeableConcept) additional types from child elements (coding)

Element Media.type is mapped to FHIR STU3 element Media.type as SourceIsBroaderThanTarget. The mappings for Media.type do not cover the following types: CodeableConcept. The mappings for Media.type do not cover the following types based on type expansion: coding.

Primitive value for code

Details of the type of the media - usually, how it was acquired (what type of device). If images sourced from a DICOM system, are wrapped in a Media resource, then this is the modality.

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

The name of the imaging view e.g. Lateral or Antero-posterior (AP).

Imaging view (projection) used when collecting an image

Who/What this Media is a record of.

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

An Extension

R4: Media.subject

Element Media.subject is mapped to FHIR STU3 element Media.subject as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Media.subject with unmapped reference targets: Location, PractitionerRole.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The encounter or episode of care that establishes the context for this media.

This will typically be the encounter the media occurred within.

Links the media to the Encounter context.

The date and time(s) at which the media was collected.

The person who administered the collection of the image.

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

An Extension

R4: Media.operator

Element Media.operator is mapped to FHIR STU3 element Media.operator as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Media.operator with unmapped reference targets: CareTeam, Device, Organization, Patient, PractitionerRole, RelatedPerson.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Describes why the event occurred in coded or textual form.

Textual reasons can be caprued using reasonCode.text.

The reason for the media

Indicates the site on the subject's body where the media was collected (i.e. the target site).

If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use The standard extension body-site-instance.

Codes describing anatomical locations. May include laterality.

The device used to collect the media.

An extension should be used if further typing of the device is needed. Scondary devices used to support collecting a media can be represented using either extension or through the Observation.related element.

Height of the image in pixels (photo/video).

Width of the image in pixels (photo/video).

The number of frames in a photo. This is used with a multi-page fax, or an imaging acquisition context that takes multiple slices in a single image, or an animated gif. If there is more than one frame, this SHALL have a value in order to alert interface software that a multi-frame capable rendering widget is required.

The duration of the recording in seconds - for audio and video.

The duration might differ from occurrencePeriod if recording was paused.

unique id for the element within a resource (for internal references)

An Extension

R4: Media.duration additional types (decimal) additional types from child elements (value)

Element Media.duration is mapped to FHIR STU3 element Media.duration as SourceIsBroaderThanTarget. The mappings for Media.duration do not cover the following types: decimal. The mappings for Media.duration do not cover the following types based on type expansion: value. The duration might differ from occurrencePeriod if recording was paused.

Primitive value for unsignedInt

The actual content of the media - inline or by direct reference to the media source file.

Recommended content types: image/jpeg, image/png, image/tiff, video/mpeg, audio/mp4, application/dicom. Application/dicom can contain the transfer syntax as a parameter. For an media that covers a period of time (video/sound), the content.creationTime is the end time. Creation time is used for tracking, organizing versions and searching.

Comments made about the media by the performer, subject or other participants.