This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

8.22 Resource Communication - Content

Patient Care icon

Work Group

Maturity Level: 2

Trial Use

Security Category: Patient

Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson

A clinical or business level record of information being transmitted or shared; e.g. an alert that was sent to a responsible provider, a public health agency communication to a provider/reporter in response to a case report for a reportable condition.

8.22.1 Scope and Usage

The purpose of a Communication resource is to surface that data was shared to track adherence to guidelines or protocols or to provide business documentation of actions taken. Communication can also be used as part of an information exchange to provide context about the information sharing occurring. Please see below for guidance on when this is appropriate.

Communication is one of the event resources in the FHIR workflow specification.

This resource is a record of a communication even if it is planned or has failed. A communication is a record of the conveyance of information from one entity, a sender, to another entity, a receiver. The sender and receivers may be patients, practitioners, related persons, organizations, or devices. Communication use cases include:

A reminder or alert delivered to a responsible provider
A recorded notification from the nurse to the on-call physician (or any other specified person) that a patient's temperature exceeds a value
A response from a public health agency to a provider caring for a patient presenting with a communicable disease reportable to the public health agency
Patient educational material sent by a provider to a patient
Unable to deliver lab results to ordering physician
Submission of supplementary health information to a payer in support of a claim

Non-patient specific communication use cases may include:

A nurse call from a hall bathroom
Advisory for battery service from a pump

8.22.2 Boundaries and Relationships

This resource is a record of a communication that has occurred. It does not represent the actual flow of communication. While AuditEvent can track electronic disclosures of information, it cannot track conversations, phone calls, letters and other interactions that are not system-to-system. And even for system-to-system communications, the specific end recipients might not be known. Furthermore, AuditEvents are not considered to be "part" of the patient record, while Communication instances are. The Communication resource is not used as a general audit mechanism to track every disclosure of every record. Rather, it is used when a clinician or other user wants to ensure a record of a particular communication is itself maintained as part of the reviewable health record.

Flag resources represent a continuous ongoing "communication" alerting anyone dealing with the patient of certain precautions to take or issues to be aware of. The flags are continuously present as an ongoing reminder. This is distinct from Communication where there is a specific intended sender and receiver and the information is delivered only once.

When there is a need to organize clinical and administrative content into sections, the Composition resource should be used instead. For example, an initial case report to a public health agency may include organized sections for vital signs, immunizations, social history, etc.

Communication and Encounter

The Communication is about the transfer of information (which might or might not occur as part of an encounter), while Encounter is about the coming together (in person or virtually) of a Patient with a Practitioner. Communication does not deal with the duration of a call, it represents the fact that information was transferred at a particular point in time.

The phone calls involving the Patient should be handled using Encounter. Phone calls not involving the patient (e.g. between practitioners or practitioner to relative) that are tracked for billing or other purposes can use Communication to represent the information transferred but are not ideal to represent the call itself. A better mechanism for handling such calls will be explored in a future release.

8.22.3 References to this Resource

Implements: Event
Resource References: Appointment and itself

Structure

Name	Flags	Card.	Type	Description & Constraints
Communication	TU		DomainResource	A clinical or business level record of information being transmitted or shared Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Unique identifier
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition \| ActivityDefinition \| Measure \| OperationDefinition \| Questionnaire)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(Any)	Request fulfilled by this communication
partOf	Σ	0..*	Reference(Any)	Part of referenced event (e.g. Communication, Procedure)
inResponseTo		0..*	Reference(Communication)	Reply to
status	?!Σ	1..1	code	preparation \| in-progress \| not-done \| on-hold \| stopped \| completed \| entered-in-error \| unknown Binding: EventStatus (Required)
statusReason	Σ	0..1	CodeableConcept	Reason for current status Binding: Communication Not Done Reason (Example)
category		0..*	CodeableConcept	Message category Binding: Communication Category (Example)
priority	Σ	0..1	code	routine \| urgent \| asap \| stat Binding: RequestPriority (Required)
medium		0..*	CodeableConcept	A channel of communication Binding: ParticipationMode (Example)
subject	Σ	0..1	Reference(Patient \| Group)	Focus of message
topic		0..1	CodeableConcept	Description of the purpose/content Binding: Communication Topic (Example)
about		0..*	Reference(Any)	Resources that pertain to this communication
encounter	Σ	0..1	Reference(Encounter)	The Encounter during which this Communication was created
sent		0..1	dateTime	When sent
received		0..1	dateTime	When received
recipient		0..*	Reference(CareTeam \| Device \| Group \| HealthcareService \| Location \| Organization \| Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Endpoint)	Who the information is shared with
sender		0..1	Reference(Device \| Organization \| Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| HealthcareService \| Endpoint \| CareTeam)	Who shares the information
reason	Σ	0..*	CodeableReference(Any)	Indication for message Binding: SNOMED CT Clinical Findings (Example)
payload		0..*	BackboneElement	Message payload
content[x]		1..1		Message part content
contentAttachment			Attachment
contentReference			Reference(Any)
contentCodeableConcept			CodeableConcept
note		0..*	Annotation	Comments made about the communication
Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

XML Template

<Communication xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Unique identifier --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|Measure|
   OperationDefinition|PlanDefinition|Questionnaire) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(Any) Request fulfilled by this communication --></basedOn>
 <partOf><!-- 0..* Reference(Any) Part of referenced event (e.g. Communication, Procedure) --></partOf>
 <inResponseTo><!-- 0..* Reference(Communication) Reply to --></inResponseTo>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown -->
 <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason>
 <category><!-- 0..* CodeableConcept Message category --></category>
 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <medium><!-- 0..* CodeableConcept A channel of communication  --></medium>
 <subject><!-- 0..1 Reference(Group|Patient) Focus of message --></subject>
 <topic><!-- 0..1 CodeableConcept Description of the purpose/content --></topic>
 <about><!-- 0..* Reference(Any) Resources that pertain to this communication --></about>
 <encounter><!-- 0..1 Reference(Encounter) The Encounter during which this Communication was created --></encounter>
 <sent value="[dateTime]"/><!-- 0..1 When sent -->
 <received value="[dateTime]"/><!-- 0..1 When received -->
 <recipient><!-- 0..* Reference(CareTeam|Device|Endpoint|Group|HealthcareService|
   Location|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) Who the information is shared with --></recipient>
 <sender><!-- 0..1 Reference(CareTeam|Device|Endpoint|HealthcareService|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) Who shares the information --></sender>
 <reason><!-- 0..* CodeableReference(Any) Indication for message --></reason>
 <payload>  <!-- 0..* Message payload -->
  <content[x]><!-- 1..1 Attachment|Reference(Any)|CodeableConcept Message part content --></content[x]>
 </payload>
 <note><!-- 0..* Annotation Comments made about the communication --></note>
</Communication>

JSON Template

{
  "resourceType" : "Communication",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Unique identifier
  "instantiatesCanonical" : ["<canonical(PlanDefinition|ActivityDefinition|Measure|OperationDefinition|Questionnaire)>"], // Instantiates FHIR protocol or definition
  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(Any) }], // Request fulfilled by this communication
  "partOf" : [{ Reference(Any) }], // Part of referenced event (e.g. Communication, Procedure)
  "inResponseTo" : [{ Reference(Communication) }], // Reply to
  "status" : "<code>", // R!  preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  "statusReason" : { CodeableConcept }, // Reason for current status
  "category" : [{ CodeableConcept }], // Message category
  "priority" : "<code>", // routine | urgent | asap | stat
  "medium" : [{ CodeableConcept }], // A channel of communication 
  "subject" : { Reference(Group|Patient) }, // Focus of message
  "topic" : { CodeableConcept }, // Description of the purpose/content
  "about" : [{ Reference(Any) }], // Resources that pertain to this communication
  "encounter" : { Reference(Encounter) }, // The Encounter during which this Communication was created
  "sent" : "<dateTime>", // When sent
  "received" : "<dateTime>", // When received
  "recipient" : [{ Reference(CareTeam|Device|Endpoint|Group|HealthcareService|
   Location|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }], // Who the information is shared with
  "sender" : { Reference(CareTeam|Device|Endpoint|HealthcareService|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }, // Who shares the information
  "reason" : [{ CodeableReference(Any) }], // Indication for message
  "payload" : [{ // Message payload
    // content[x]: Message part content. One of these 3:
    "contentAttachment" : { Attachment },
    "contentReference" : { Reference(Any) },
    "contentCodeableConcept" : { CodeableConcept }
  }],
  "note" : [{ Annotation }] // Comments made about the communication
}

Turtle Template

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


[ a fhir:Communication;
  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:identifier  ( [ Identifier ] ... ) ; # 0..* Unique identifier
  fhir:instantiatesCanonical  ( [ canonical(ActivityDefinition|Measure|OperationDefinition|PlanDefinition|Questionnaire) ] ... ) ; # 0..* Instantiates FHIR protocol or definition
  fhir:instantiatesUri  ( [ uri ] ... ) ; # 0..* Instantiates external protocol or definition
  fhir:basedOn  ( [ Reference(Any) ] ... ) ; # 0..* Request fulfilled by this communication
  fhir:partOf  ( [ Reference(Any) ] ... ) ; # 0..* Part of referenced event (e.g. Communication, Procedure)
  fhir:inResponseTo  ( [ Reference(Communication) ] ... ) ; # 0..* Reply to
  fhir:status [ code ] ; # 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  fhir:statusReason [ CodeableConcept ] ; # 0..1 Reason for current status
  fhir:category  ( [ CodeableConcept ] ... ) ; # 0..* Message category
  fhir:priority [ code ] ; # 0..1 routine | urgent | asap | stat
  fhir:medium  ( [ CodeableConcept ] ... ) ; # 0..* A channel of communication
  fhir:subject [ Reference(Group|Patient) ] ; # 0..1 Focus of message
  fhir:topic [ CodeableConcept ] ; # 0..1 Description of the purpose/content
  fhir:about  ( [ Reference(Any) ] ... ) ; # 0..* Resources that pertain to this communication
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 The Encounter during which this Communication was created
  fhir:sent [ dateTime ] ; # 0..1 When sent
  fhir:received [ dateTime ] ; # 0..1 When received
  fhir:recipient  ( [ Reference(CareTeam|Device|Endpoint|Group|HealthcareService|Location|Organization|Patient|
  Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Who the information is shared with
  fhir:sender [ Reference(CareTeam|Device|Endpoint|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ] ; # 0..1 Who shares the information
  fhir:reason  ( [ CodeableReference(Any) ] ... ) ; # 0..* Indication for message
  fhir:payload ( [ # 0..* Message payload
    # content[x] : 1..1 Message part content. One of these 3
      fhir:content [  a fhir:Attachment ; Attachment ]
      fhir:content [  a fhir:Reference ; Reference(Any) ]
      fhir:content [  a fhir:CodeableConcept ; CodeableConcept ]
  ] ... ) ;
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments made about the communication
]

Changes from both R4 and R4B

Communication

Communication.recipient

Type Reference: Added Target Types Location, Endpoint

Communication.sender

Type Reference: Added Target Types Endpoint, CareTeam

Communication.reason

Added Element

Communication.payload.content[x]

Add Type CodeableConcept
Remove Type string

Communication.reasonCode

Deleted (-> Communication.reason)

Communication.reasonReference

Deleted (-> Communication.reason)

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Structure

Name	Flags	Card.	Type	Description & Constraints
Communication	TU		DomainResource	A clinical or business level record of information being transmitted or shared Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Unique identifier
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition \| ActivityDefinition \| Measure \| OperationDefinition \| Questionnaire)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(Any)	Request fulfilled by this communication
partOf	Σ	0..*	Reference(Any)	Part of referenced event (e.g. Communication, Procedure)
inResponseTo		0..*	Reference(Communication)	Reply to
status	?!Σ	1..1	code	preparation \| in-progress \| not-done \| on-hold \| stopped \| completed \| entered-in-error \| unknown Binding: EventStatus (Required)
statusReason	Σ	0..1	CodeableConcept	Reason for current status Binding: Communication Not Done Reason (Example)
category		0..*	CodeableConcept	Message category Binding: Communication Category (Example)
priority	Σ	0..1	code	routine \| urgent \| asap \| stat Binding: RequestPriority (Required)
medium		0..*	CodeableConcept	A channel of communication Binding: ParticipationMode (Example)
subject	Σ	0..1	Reference(Patient \| Group)	Focus of message
topic		0..1	CodeableConcept	Description of the purpose/content Binding: Communication Topic (Example)
about		0..*	Reference(Any)	Resources that pertain to this communication
encounter	Σ	0..1	Reference(Encounter)	The Encounter during which this Communication was created
sent		0..1	dateTime	When sent
received		0..1	dateTime	When received
recipient		0..*	Reference(CareTeam \| Device \| Group \| HealthcareService \| Location \| Organization \| Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Endpoint)	Who the information is shared with
sender		0..1	Reference(Device \| Organization \| Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| HealthcareService \| Endpoint \| CareTeam)	Who shares the information
reason	Σ	0..*	CodeableReference(Any)	Indication for message Binding: SNOMED CT Clinical Findings (Example)
payload		0..*	BackboneElement	Message payload
content[x]		1..1		Message part content
contentAttachment			Attachment
contentReference			Reference(Any)
contentCodeableConcept			CodeableConcept
note		0..*	Annotation	Comments made about the communication
Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

XML Template

<Communication xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Unique identifier --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|Measure|
   OperationDefinition|PlanDefinition|Questionnaire) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(Any) Request fulfilled by this communication --></basedOn>
 <partOf><!-- 0..* Reference(Any) Part of referenced event (e.g. Communication, Procedure) --></partOf>
 <inResponseTo><!-- 0..* Reference(Communication) Reply to --></inResponseTo>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown -->
 <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason>
 <category><!-- 0..* CodeableConcept Message category --></category>
 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <medium><!-- 0..* CodeableConcept A channel of communication  --></medium>
 <subject><!-- 0..1 Reference(Group|Patient) Focus of message --></subject>
 <topic><!-- 0..1 CodeableConcept Description of the purpose/content --></topic>
 <about><!-- 0..* Reference(Any) Resources that pertain to this communication --></about>
 <encounter><!-- 0..1 Reference(Encounter) The Encounter during which this Communication was created --></encounter>
 <sent value="[dateTime]"/><!-- 0..1 When sent -->
 <received value="[dateTime]"/><!-- 0..1 When received -->
 <recipient><!-- 0..* Reference(CareTeam|Device|Endpoint|Group|HealthcareService|
   Location|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) Who the information is shared with --></recipient>
 <sender><!-- 0..1 Reference(CareTeam|Device|Endpoint|HealthcareService|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) Who shares the information --></sender>
 <reason><!-- 0..* CodeableReference(Any) Indication for message --></reason>
 <payload>  <!-- 0..* Message payload -->
  <content[x]><!-- 1..1 Attachment|Reference(Any)|CodeableConcept Message part content --></content[x]>
 </payload>
 <note><!-- 0..* Annotation Comments made about the communication --></note>
</Communication>

JSON Template

{
  "resourceType" : "Communication",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Unique identifier
  "instantiatesCanonical" : ["<canonical(PlanDefinition|ActivityDefinition|Measure|OperationDefinition|Questionnaire)>"], // Instantiates FHIR protocol or definition
  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(Any) }], // Request fulfilled by this communication
  "partOf" : [{ Reference(Any) }], // Part of referenced event (e.g. Communication, Procedure)
  "inResponseTo" : [{ Reference(Communication) }], // Reply to
  "status" : "<code>", // R!  preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  "statusReason" : { CodeableConcept }, // Reason for current status
  "category" : [{ CodeableConcept }], // Message category
  "priority" : "<code>", // routine | urgent | asap | stat
  "medium" : [{ CodeableConcept }], // A channel of communication 
  "subject" : { Reference(Group|Patient) }, // Focus of message
  "topic" : { CodeableConcept }, // Description of the purpose/content
  "about" : [{ Reference(Any) }], // Resources that pertain to this communication
  "encounter" : { Reference(Encounter) }, // The Encounter during which this Communication was created
  "sent" : "<dateTime>", // When sent
  "received" : "<dateTime>", // When received
  "recipient" : [{ Reference(CareTeam|Device|Endpoint|Group|HealthcareService|
   Location|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }], // Who the information is shared with
  "sender" : { Reference(CareTeam|Device|Endpoint|HealthcareService|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }, // Who shares the information
  "reason" : [{ CodeableReference(Any) }], // Indication for message
  "payload" : [{ // Message payload
    // content[x]: Message part content. One of these 3:
    "contentAttachment" : { Attachment },
    "contentReference" : { Reference(Any) },
    "contentCodeableConcept" : { CodeableConcept }
  }],
  "note" : [{ Annotation }] // Comments made about the communication
}

Turtle Template

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


[ a fhir:Communication;
  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:identifier  ( [ Identifier ] ... ) ; # 0..* Unique identifier
  fhir:instantiatesCanonical  ( [ canonical(ActivityDefinition|Measure|OperationDefinition|PlanDefinition|Questionnaire) ] ... ) ; # 0..* Instantiates FHIR protocol or definition
  fhir:instantiatesUri  ( [ uri ] ... ) ; # 0..* Instantiates external protocol or definition
  fhir:basedOn  ( [ Reference(Any) ] ... ) ; # 0..* Request fulfilled by this communication
  fhir:partOf  ( [ Reference(Any) ] ... ) ; # 0..* Part of referenced event (e.g. Communication, Procedure)
  fhir:inResponseTo  ( [ Reference(Communication) ] ... ) ; # 0..* Reply to
  fhir:status [ code ] ; # 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  fhir:statusReason [ CodeableConcept ] ; # 0..1 Reason for current status
  fhir:category  ( [ CodeableConcept ] ... ) ; # 0..* Message category
  fhir:priority [ code ] ; # 0..1 routine | urgent | asap | stat
  fhir:medium  ( [ CodeableConcept ] ... ) ; # 0..* A channel of communication
  fhir:subject [ Reference(Group|Patient) ] ; # 0..1 Focus of message
  fhir:topic [ CodeableConcept ] ; # 0..1 Description of the purpose/content
  fhir:about  ( [ Reference(Any) ] ... ) ; # 0..* Resources that pertain to this communication
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 The Encounter during which this Communication was created
  fhir:sent [ dateTime ] ; # 0..1 When sent
  fhir:received [ dateTime ] ; # 0..1 When received
  fhir:recipient  ( [ Reference(CareTeam|Device|Endpoint|Group|HealthcareService|Location|Organization|Patient|
  Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Who the information is shared with
  fhir:sender [ Reference(CareTeam|Device|Endpoint|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ] ; # 0..1 Who shares the information
  fhir:reason  ( [ CodeableReference(Any) ] ... ) ; # 0..* Indication for message
  fhir:payload ( [ # 0..* Message payload
    # content[x] : 1..1 Message part content. One of these 3
      fhir:content [  a fhir:Attachment ; Attachment ]
      fhir:content [  a fhir:Reference ; Reference(Any) ]
      fhir:content [  a fhir:CodeableConcept ; CodeableConcept ]
  ] ... ) ;
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments made about the communication
]

Changes from both R4 and R4B

Communication

Communication.recipient

Type Reference: Added Target Types Location, Endpoint

Communication.sender

Type Reference: Added Target Types Endpoint, CareTeam

Communication.reason

Added Element

Communication.payload.content[x]

Add Type CodeableConcept
Remove Type string

Communication.reasonCode

Deleted (-> Communication.reason)

Communication.reasonReference

Deleted (-> Communication.reason)

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

8.22.4.1 Terminology Bindings

Path	ValueSet	Type	Documentation
Communication.status	EventStatus	Required	Codes identifying the lifecycle stage of an event.
Communication.statusReason	CommunicationNotDoneReason	Example	Codes for the reason why a communication did not happen.
Communication.category	CommunicationCategory	Example	Codes for general categories of communications such as alerts, instructions, etc.
Communication.priority	RequestPriority	Required	Identifies the level of importance to be assigned to actioning the request.
Communication.medium	ParticipationMode	Example	Identifies the primary means by which an Entity participates in an Act.
Communication.topic	CommunicationTopic	Example	Codes describing the purpose or content of the communication.
Communication.reason	SNOMEDCTClinicalFindings	Example	This value set includes all the "Clinical finding" SNOMED CT codes - concepts where concept is-a 404684003 (Clinical finding (finding)).

Path

ValueSet

Type

Documentation

Communication.status

EventStatus

Required

Codes identifying the lifecycle stage of an event.

Communication.statusReason

CommunicationNotDoneReason

Example

Codes for the reason why a communication did not happen.

Communication.category

CommunicationCategory

Example

Codes for general categories of communications such as alerts, instructions, etc.

Communication.priority

RequestPriority

Required

Identifies the level of importance to be assigned to actioning the request.

Communication.medium

ParticipationMode icon

Example

Identifies the primary means by which an Entity participates in an Act.

Communication.topic

CommunicationTopic

Example

Codes describing the purpose or content of the communication.

Communication.reason

SNOMEDCTClinicalFindings

Example

This value set includes all the "Clinical finding" SNOMED CT icon codes - concepts where concept is-a 404684003 (Clinical finding (finding)).

Notes to reviewers:

At this time, the code bindings are placeholders to be fleshed out upon further review by the community.

8.22.4.2 Communication.sender and Communication.recipient

If the communication is to or from an individual whose role is not known (practitioner, patient or related person) - for example, only email address is captured in the system - then RelatedPerson should be used by default.

8.22.4.3 Using Communication to wrap or accompany data

In FHIR, data is typically shared between systems without any need for the Communication resource to accompany or contain the data being shared, i.e. all FHIR exchanges are communications of some form, but that doesn't mean they need the Communication resource. However, in some cases, when data is shared there is a need to provide context about why the data is being conveyed and Communication is one of the mechanisms that FHIR provides that can share this context. Specifically, Communication allows conveying information about reasons for sharing, encounter that provides context for sharing, order or protocol that drove the need to share, etc. Note that some contextual information is expected to be captured by most FHIR systems even in absence of Communication, such as where did the data come from and when was the data received. This metadata is generally captured in Provenance. In addition to Communication, MessageHeader can capture similar metadata and Composition in FHIR documents can also serve a similar purpose. Refer to the decision tree in Approaches to Exchanging FHIR Data for guidance on which data sharing mechanism is appropriate in which circumstances. If mixing multiple mechanisms to convey communication metadata, care should be taken to ensure that each mechanism is necessary and the information conveyed in each layer is appropriately consistent.

8.22.4.4 Communication and CommunicationRequest

There is no requirement that Communication and CommunicationRequest always go together. Communication can exist without there having been a CommunicationRequest. For example, a practitioner might capture that they have provided a smoking cessation pamphlet to a patient that would be a Communication instance, but there would have been no "request" that led to the action (unsolicited). As well, a CommunicationRequest can be fulfilled in many ways, e.g. by phone call, email, system to system data sharing and there might not be a requirement to surface this data sharing at the clinical / business level, i.e. no need for a Communication instance.

Where there is a need to explicitly track fulfillment of a CommunicationRequest, Communication is the most natural resource to establish this linkage. The event can be tied to the request using Communication.basedOn.

8.22.5 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to 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	Request fulfilled by this communication	Communication.basedOn (Any)
category	token	Message category	Communication.category
encounter	reference	The Encounter during which this Communication was created	Communication.encounter (Encounter)	29 Resources
identifier	token	Unique identifier	Communication.identifier	65 Resources
instantiates-canonical	reference	Instantiates FHIR protocol or definition	Communication.instantiatesCanonical (Questionnaire, Measure, PlanDefinition, OperationDefinition, ActivityDefinition)
instantiates-uri	uri	Instantiates external protocol or definition	Communication.instantiatesUri
medium	token	A channel of communication	Communication.medium
part-of	reference	Part of referenced event (e.g. Communication, Procedure)	Communication.partOf (Any)
patient	reference	Focus of message	Communication.subject.where(resolve() is Patient) (Patient)	66 Resources
received	date	When received	Communication.received
recipient	reference	Who the information is shared with	Communication.recipient (Practitioner, Group, Organization, CareTeam, Endpoint, Device, Patient, HealthcareService, PractitionerRole, RelatedPerson, Location)
sender	reference	Who shares the information	Communication.sender (Practitioner, Organization, Endpoint, CareTeam, Device, Patient, HealthcareService, PractitionerRole, RelatedPerson)
sent	date	When sent	Communication.sent
status	token	preparation \| in-progress \| not-done \| on-hold \| stopped \| completed \| entered-in-error \| unknown	Communication.status
subject	reference	Focus of message	Communication.subject (Group, Patient)
topic	token	Description of the purpose/content	Communication.topic