Release 4B

This page is part of the FHIR Specification (v4.3.0: R4B - STU). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

2.11 Differences from Release 4

FHIR Infrastructure Work GroupMaturity Level: N/AStandards Status: Informative

This is an automatically generated list of all the structural differences between FHIR R4 and this version. The following possible changes are checked when preparing this list (and others throughout the specification):

  • Addition or deletion of elements, or name change to elements
  • Changes to minimum and maximum cardinality
  • Changes to allowed types
  • Changes to bindings for Extensible/Required bindings, and changes to codes if it's a required binding on a code element
  • Changes to the is-modifier status of an element

This analysis only considers changes to data types and resources. Comparison of extensions, profiles and value sets will be added in a future version.

See also the version transforms (which are for R3 to R4, not R4 to R4B) and the note about version specific extensions.

This analysis is available as XML or JSON.

Types
Address
  • No Changes
Age
  • No Changes
Annotation
  • No Changes
Attachment
  • No Changes
BackboneElement
  • No Changes
CodeableConcept
  • No Changes
CodeableReference
  • Added Type
Coding
  • No Changes
ContactDetail
  • No Changes
ContactPoint
  • No Changes
Contributor
  • No Changes
Count
  • No Changes
DataRequirement
  • No Changes
Distance
  • No Changes
Dosage
  • No Changes
Duration
  • No Changes
Element
Element.id
  • Type changed from string to id
ElementDefinition
ElementDefinition.type.code
  • Change value set from http://hl7.org/fhir/ValueSet/defined-types to http://hl7.org/fhir/ValueSet/fhir-element-types
ElementDefinition.defaultValue[x]
  • Add Types CodeableReference, RatioRange
ElementDefinition.fixed[x]
  • Add Types CodeableReference, RatioRange
ElementDefinition.pattern[x]
  • Add Types CodeableReference, RatioRange
ElementDefinition.example.value[x]
  • Add Types CodeableReference, RatioRange
Expression
Expression.language
  • Change max value set from http://www.rfc-editor.org/bcp/bcp13.txt to http://hl7.org/fhir/ValueSet/mimetypes
Extension
Extension.url
  • Type changed from string to uri
Extension.value[x]
  • Add Types CodeableReference, RatioRange
HumanName
  • No Changes
Identifier
  • No Changes
MarketingStatus
MarketingStatus.country
  • Min Cardinality changed from 1 to 0
MarketingStatus.dateRange
  • Min Cardinality changed from 1 to 0
Meta
  • No Changes
Money
  • No Changes
MoneyQuantity
  • No Changes
Narrative
  • No Changes
ParameterDefinition
  • No Changes
Period
  • No Changes
Population
  • No Changes
ProdCharacteristic
  • No Changes
ProductShelfLife
  • No Changes
Quantity
  • No Changes
Range
  • No Changes
Ratio
  • No Changes
RatioRange
  • Added Type
Reference
  • No Changes
RelatedArtifact
  • No Changes
SampledData
  • No Changes
Signature
  • No Changes
SimpleQuantity
  • No Changes
Timing
  • No Changes
TriggerDefinition
  • No Changes
UsageContext
  • No Changes
base64Binary (No Changes)
boolean (No Changes)
canonical (No Changes)
code (No Changes)
date (No Changes)
dateTime (No Changes)
decimal (No Changes)
id (No Changes)
instant (No Changes)
integer (No Changes)
markdown (No Changes)
oid (No Changes)
positiveInt (No Changes)
string (No Changes)
time (No Changes)
unsignedInt (No Changes)
uri (No Changes)
url (No Changes)
uuid (No Changes)
xhtml (No Changes)
SubstanceAmount
  • deleted
Resources
Account
  • No Changes
ActivityDefinition
ActivityDefinition.subject[x]
  • Add Type canonical
AdministrableProductDefinition
  • Added Resource
AdverseEvent
  • No Changes
AllergyIntolerance
  • No Changes
Appointment
  • No Changes
AppointmentResponse
  • No Changes
AuditEvent
  • No Changes
Basic
  • No Changes
Binary
  • No Changes
BiologicallyDerivedProduct
  • No Changes
BodyStructure
  • No Changes
Bundle
  • No Changes
CapabilityStatement
  • No Changes
CarePlan
  • No Changes
CareTeam
  • No Changes
CatalogEntry
  • No Changes
ChargeItem
  • No Changes
ChargeItemDefinition
  • No Changes
Citation
  • Added Resource
Claim
  • No Changes
ClaimResponse
  • No Changes
ClinicalImpression
  • No Changes
ClinicalUseDefinition
  • Added Resource
CodeSystem
  • No Changes
Communication
  • No Changes
CommunicationRequest
  • No Changes
CompartmentDefinition
  • No Changes
Composition
Composition.confidentiality
  • Change value set from http://terminology.hl7.org/ValueSet/v3-ConfidentialityClassification|4.0.0 to http://terminology.hl7.org/ValueSet/v3-Confidentiality|2.0.0
ConceptMap
  • No Changes
Condition
  • No Changes
Consent
  • No Changes
Contract
  • No Changes
Coverage
  • No Changes
CoverageEligibilityRequest
  • No Changes
CoverageEligibilityResponse
  • No Changes
DetectedIssue
  • No Changes
Device
  • No Changes
DeviceDefinition
  • No Changes
DeviceMetric
  • No Changes
DeviceRequest
  • No Changes
DeviceUseStatement
  • No Changes
DiagnosticReport
DiagnosticReport.subject
  • Type Reference: Added Target Types Organization, Procedure, Practitioner, Medication, Substance
DocumentManifest
  • No Changes
DocumentReference
  • No Changes
DomainResource
  • No Changes
Encounter
  • No Changes
Endpoint
  • No Changes
EnrollmentRequest
  • No Changes
EnrollmentResponse
  • No Changes
EpisodeOfCare
  • No Changes
EventDefinition
  • No Changes
Evidence
Evidence.citeAs[x]
  • Added Element
Evidence.assertion
  • Added Element
Evidence.variableDefinition
  • Added Mandatory Element
Evidence.variableDefinition.description
  • Added Element
Evidence.variableDefinition.note
  • Added Element
Evidence.variableDefinition.variableRole
  • Added Mandatory Element
Evidence.variableDefinition.observed
  • Added Element
Evidence.variableDefinition.intended
  • Added Element
Evidence.variableDefinition.directnessMatch
  • Added Element
Evidence.synthesisType
  • Added Element
Evidence.studyType
  • Added Element
Evidence.statistic
  • Added Element
Evidence.statistic.description
  • Added Element
Evidence.statistic.note
  • Added Element
Evidence.statistic.statisticType
  • Added Element
Evidence.statistic.category
  • Added Element
Evidence.statistic.quantity
  • Added Element
Evidence.statistic.numberOfEvents
  • Added Element
Evidence.statistic.numberAffected
  • Added Element
Evidence.statistic.sampleSize
  • Added Element
Evidence.statistic.sampleSize.description
  • Added Element
Evidence.statistic.sampleSize.note
  • Added Element
Evidence.statistic.sampleSize.numberOfStudies
  • Added Element
Evidence.statistic.sampleSize.numberOfParticipants
  • Added Element
Evidence.statistic.sampleSize.knownDataCount
  • Added Element
Evidence.statistic.attributeEstimate
  • Added Element
Evidence.statistic.attributeEstimate.description
  • Added Element
Evidence.statistic.attributeEstimate.note
  • Added Element
Evidence.statistic.attributeEstimate.type
  • Added Element
Evidence.statistic.attributeEstimate.quantity
  • Added Element
Evidence.statistic.attributeEstimate.level
  • Added Element
Evidence.statistic.attributeEstimate.range
  • Added Element
Evidence.statistic.attributeEstimate.attributeEstimate
  • Added Element
Evidence.statistic.modelCharacteristic
  • Added Element
Evidence.statistic.modelCharacteristic.code
  • Added Mandatory Element
Evidence.statistic.modelCharacteristic.value
  • Added Element
Evidence.statistic.modelCharacteristic.variable
  • Added Element
Evidence.statistic.modelCharacteristic.variable.variableDefinition
  • Added Mandatory Element
Evidence.statistic.modelCharacteristic.variable.handling
  • Added Element
Evidence.statistic.modelCharacteristic.variable.valueCategory
  • Added Element
Evidence.statistic.modelCharacteristic.variable.valueQuantity
  • Added Element
Evidence.statistic.modelCharacteristic.variable.valueRange
  • Added Element
Evidence.statistic.modelCharacteristic.attributeEstimate
  • Added Element
Evidence.certainty
  • Added Element
Evidence.certainty.description
  • Added Element
Evidence.certainty.note
  • Added Element
Evidence.certainty.type
  • Added Element
Evidence.certainty.rating
  • Added Element
Evidence.certainty.rater
  • Added Element
Evidence.certainty.subcomponent
  • Added Element
Evidence.name
  • deleted
Evidence.shortTitle
  • deleted
Evidence.subtitle
  • deleted
Evidence.jurisdiction
  • deleted
Evidence.copyright
  • deleted
Evidence.effectivePeriod
  • deleted
Evidence.topic
  • deleted
Evidence.exposureBackground
  • deleted
Evidence.exposureVariant
  • deleted
Evidence.outcome
  • deleted
EvidenceReport
  • Added Resource
EvidenceVariable
EvidenceVariable.actual
  • Added Element
EvidenceVariable.characteristicCombination
  • Added Element
EvidenceVariable.characteristic
  • Min Cardinality changed from 1 to 0
EvidenceVariable.characteristic.definition[x]
  • Remove Types DataRequirement, TriggerDefinition
EvidenceVariable.characteristic.method
  • Added Element
EvidenceVariable.characteristic.device
  • Added Element
EvidenceVariable.characteristic.timeFromStart
  • Type changed from Duration to BackboneElement
EvidenceVariable.characteristic.timeFromStart.description
  • Added Element
EvidenceVariable.characteristic.timeFromStart.quantity
  • Added Element
EvidenceVariable.characteristic.timeFromStart.range
  • Added Element
EvidenceVariable.characteristic.timeFromStart.note
  • Added Element
EvidenceVariable.handling
  • Added Element
EvidenceVariable.category
  • Added Element
EvidenceVariable.category.name
  • Added Element
EvidenceVariable.category.value[x]
  • Added Element
EvidenceVariable.jurisdiction
  • deleted
EvidenceVariable.copyright
  • deleted
EvidenceVariable.approvalDate
  • deleted
EvidenceVariable.lastReviewDate
  • deleted
EvidenceVariable.effectivePeriod
  • deleted
EvidenceVariable.topic
  • deleted
EvidenceVariable.type
  • deleted
EvidenceVariable.characteristic.usageContext
  • deleted
EvidenceVariable.characteristic.participantEffective[x]
  • deleted
ExampleScenario
  • No Changes
ExplanationOfBenefit
  • No Changes
FamilyMemberHistory
FamilyMemberHistory.sex
  • Change value set from http://build.fhir.org/valueset-administrative-gender.html to http://hl7.org/fhir/ValueSet/administrative-gender
Flag
  • No Changes
Goal
  • No Changes
GraphDefinition
  • No Changes
Group
Group.member.entity
  • Type Reference: Added Target Type RelatedPerson
GuidanceResponse
  • No Changes
HealthcareService
  • No Changes
ImagingStudy
  • No Changes
Immunization
  • No Changes
ImmunizationEvaluation
  • No Changes
ImmunizationRecommendation
  • No Changes
ImplementationGuide
  • No Changes
Ingredient
  • Name Changed from MedicinalProductIngredient to Ingredient
Ingredient
  • Moved from MedicinalProductIngredient to Ingredient
Ingredient.status
  • Added Mandatory Element
Ingredient.for
  • Added Element
Ingredient.function
  • Added Element
Ingredient.manufacturer
  • Type changed from Reference(Organization) to BackboneElement
Ingredient.manufacturer.role
  • Added Element
Ingredient.manufacturer.manufacturer
  • Added Mandatory Element
Ingredient.substance
  • Min Cardinality changed from 0 to 1
Ingredient.substance.code
  • Type changed from CodeableConcept to CodeableReference
Ingredient.substance.strength.presentation[x]
  • Added Element
Ingredient.substance.strength.textPresentation
  • Added Element
Ingredient.substance.strength.concentration[x]
  • Added Element
Ingredient.substance.strength.textConcentration
  • Added Element
Ingredient.substance.strength.measurementPoint
  • Added Element
Ingredient.substance.strength.country
  • Added Element
Ingredient.substance.strength.referenceStrength
  • Added Element
Ingredient.substance.strength.referenceStrength.substance
  • Added Element
Ingredient.substance.strength.referenceStrength.strength[x]
  • Added Mandatory Element
Ingredient.substance.strength.referenceStrength.measurementPoint
  • Added Element
Ingredient.substance.strength.referenceStrength.country
  • Added Element
MedicinalProductIngredient.specifiedSubstance
  • deleted
InsurancePlan
  • No Changes
Invoice
  • No Changes
Library
  • No Changes
Linkage
  • No Changes
List
  • No Changes
Location
  • No Changes
ManufacturedItemDefinition
  • Added Resource
Measure
  • No Changes
MeasureReport
  • No Changes
Media
  • No Changes
Medication
  • No Changes
MedicationAdministration
  • No Changes
MedicationDispense
  • No Changes
MedicationKnowledge
  • No Changes
MedicationRequest
  • No Changes
MedicationStatement
  • No Changes
MedicinalProductDefinition
  • Name Changed from MedicinalProduct to MedicinalProductDefinition
MedicinalProductDefinition
  • Moved from MedicinalProduct to MedicinalProductDefinition
MedicinalProductDefinition.domain
  • Type changed from Coding to CodeableConcept
MedicinalProductDefinition.version
  • Added Element
MedicinalProductDefinition.status
  • Added Element
MedicinalProductDefinition.statusDate
  • Added Element
MedicinalProductDefinition.description
  • Added Element
MedicinalProductDefinition.route
  • Added Element
MedicinalProductDefinition.indication
  • Added Element
MedicinalProductDefinition.specialMeasures
  • Type changed from string to CodeableConcept
MedicinalProductDefinition.pediatricUseIndicator
  • Added Element
MedicinalProductDefinition.classification
  • Added Element
MedicinalProductDefinition.packagedMedicinalProduct
  • Type changed from Reference(MedicinalProductPackaged) to CodeableConcept
MedicinalProductDefinition.ingredient
  • Added Element
MedicinalProductDefinition.impurity
  • Added Element
MedicinalProductDefinition.contact
  • Type changed from Reference(Organization | PractitionerRole) to BackboneElement
MedicinalProductDefinition.contact.type
  • Added Element
MedicinalProductDefinition.contact.contact
  • Added Mandatory Element
MedicinalProductDefinition.code
  • Added Element
MedicinalProductDefinition.name.type
  • Added Element
MedicinalProductDefinition.name.namePart.type
  • Type changed from Coding to CodeableConcept
MedicinalProductDefinition.name.countryLanguage.language
  • Add Binding http://hl7.org/fhir/ValueSet/languages (preferred), max =http://hl7.org/fhir/ValueSet/all-languages
MedicinalProductDefinition.crossReference
  • Type changed from Identifier to BackboneElement
MedicinalProductDefinition.crossReference.product
  • Added Mandatory Element
MedicinalProductDefinition.crossReference.type
  • Added Element
MedicinalProductDefinition.operation
  • Added Element
MedicinalProductDefinition.operation.type
  • Added Element
MedicinalProductDefinition.operation.effectiveDate
  • Added Element
MedicinalProductDefinition.operation.organization
  • Added Element
MedicinalProductDefinition.operation.confidentialityIndicator
  • Added Element
MedicinalProductDefinition.characteristic
  • Added Element
MedicinalProductDefinition.characteristic.type
  • Added Mandatory Element
MedicinalProductDefinition.characteristic.value[x]
  • Added Element
MedicinalProduct.paediatricUseIndicator
  • deleted
MedicinalProduct.productClassification
  • deleted
MedicinalProduct.pharmaceuticalProduct
  • deleted
MedicinalProduct.manufacturingBusinessOperation
  • deleted
MedicinalProduct.specialDesignation
  • deleted
MessageDefinition
  • No Changes
MessageHeader
  • No Changes
MolecularSequence
  • No Changes
NamingSystem
  • No Changes
NutritionOrder
  • No Changes
NutritionProduct
  • Added Resource
Observation
Observation.subject
  • Type Reference: Added Target Types Organization, Procedure, Practitioner, Medication, Substance
ObservationDefinition
  • No Changes
OperationDefinition
  • No Changes
OperationOutcome
  • No Changes
Organization
  • No Changes
OrganizationAffiliation
  • No Changes
PackagedProductDefinition
  • Added Resource
Parameters
Parameters.parameter.value[x]
  • Add Type Meta
Patient
  • No Changes
PaymentNotice
  • No Changes
PaymentReconciliation
  • No Changes
Person
  • No Changes
PlanDefinition
PlanDefinition.subject[x]
  • Add Type canonical(MedicinalProductDefinition | SubstanceDefinition | AdministrableProductDefinition | ManufacturedItemDefinition | PackagedProductDefinition)
PlanDefinition.action.subject[x]
  • Add Type canonical
Practitioner
  • No Changes
PractitionerRole
  • No Changes
Procedure
  • No Changes
Provenance
  • No Changes
Questionnaire
  • No Changes
QuestionnaireResponse
  • No Changes
RegulatedAuthorization
  • Added Resource
RelatedPerson
  • No Changes
RequestGroup
  • No Changes
ResearchDefinition
  • No Changes
ResearchElementDefinition
  • No Changes
ResearchStudy
  • No Changes
ResearchSubject
  • No Changes
Resource
  • No Changes
RiskAssessment
  • No Changes
Schedule
  • No Changes
SearchParameter
  • No Changes
ServiceRequest
  • No Changes
Slot
  • No Changes
Specimen
  • No Changes
SpecimenDefinition
  • No Changes
StructureDefinition
  • No Changes
StructureMap
StructureMap.group.rule.source.defaultValue[x]
  • Add Type Meta
Subscription
  • No Changes
SubscriptionStatus
  • Added Resource
SubscriptionTopic
  • Added Resource
Substance
  • No Changes
SubstanceDefinition
  • Name Changed from SubstanceSpecification to SubstanceDefinition
SubstanceDefinition
  • Moved from SubstanceSpecification to SubstanceDefinition
SubstanceDefinition.identifier
  • Max Cardinality changed from 1 to *
SubstanceDefinition.version
  • Added Element
SubstanceDefinition.classification
  • Added Element
SubstanceDefinition.grade
  • Added Element
SubstanceDefinition.description
  • Type changed from string to markdown
SubstanceDefinition.informationSource
  • Added Element
SubstanceDefinition.note
  • Added Element
SubstanceDefinition.manufacturer
  • Added Element
SubstanceDefinition.supplier
  • Added Element
SubstanceDefinition.moiety.measurementType
  • Added Element
SubstanceDefinition.property.type
  • Added Mandatory Element
SubstanceDefinition.property.value[x]
  • Added Element
SubstanceDefinition.molecularWeight.method
  • Added Element
SubstanceDefinition.molecularWeight.type
  • Added Element
SubstanceDefinition.molecularWeight.amount
  • Added Mandatory Element
SubstanceDefinition.structure.technique
  • Added Element
SubstanceDefinition.structure.sourceDocument
  • Added Element
SubstanceDefinition.structure.representation.format
  • Added Element
SubstanceDefinition.structure.representation.document
  • Added Element
SubstanceDefinition.code.note
  • Added Element
SubstanceDefinition.name.language
  • Add Binding http://hl7.org/fhir/ValueSet/languages (preferred), max =http://hl7.org/fhir/ValueSet/all-languages
SubstanceDefinition.relationship.substanceDefinition[x]
  • Added Element
SubstanceDefinition.relationship.type
  • Added Mandatory Element
SubstanceDefinition.relationship.amount[x]
  • Remove Type Range
SubstanceDefinition.relationship.ratioHighLimitAmount
  • Added Element
SubstanceDefinition.relationship.comparator
  • Added Element
SubstanceDefinition.sourceMaterial
  • Type changed from Reference(SubstanceSourceMaterial) to BackboneElement
SubstanceDefinition.sourceMaterial.type
  • Added Element
SubstanceDefinition.sourceMaterial.genus
  • Added Element
SubstanceDefinition.sourceMaterial.species
  • Added Element
SubstanceDefinition.sourceMaterial.part
  • Added Element
SubstanceDefinition.sourceMaterial.countryOfOrigin
  • Added Element
SubstanceSpecification.type
  • deleted
SubstanceSpecification.source
  • deleted
SubstanceSpecification.comment
  • deleted
SubstanceSpecification.property.category
  • deleted
SubstanceSpecification.property.code
  • deleted
SubstanceSpecification.property.parameters
  • deleted
SubstanceSpecification.property.definingSubstance[x]
  • deleted
SubstanceSpecification.property.amount[x]
  • deleted
SubstanceSpecification.referenceInformation
  • deleted
SubstanceSpecification.structure.isotope
  • deleted
SubstanceSpecification.structure.source
  • deleted
SubstanceSpecification.structure.representation.attachment
  • deleted
SubstanceSpecification.code.comment
  • deleted
SubstanceSpecification.relationship.substance[x]
  • deleted
SubstanceSpecification.relationship.relationship
  • deleted
SubstanceSpecification.relationship.amountRatioLowLimit
  • deleted
SubstanceSpecification.relationship.amountType
  • deleted
SubstanceSpecification.nucleicAcid
  • deleted
SubstanceSpecification.polymer
  • deleted
SubstanceSpecification.protein
  • deleted
SupplyDelivery
  • No Changes
SupplyRequest
  • No Changes
Task
Task.input.value[x]
  • Add Type Meta
Task.output.value[x]
  • Add Type Meta
TerminologyCapabilities
  • No Changes
TestReport
  • No Changes
TestScript
  • No Changes
ValueSet
  • No Changes
VerificationResult
  • No Changes
VisionPrescription
  • No Changes
EffectEvidenceSynthesis
  • deleted
MedicinalProduct
  • deleted
MedicinalProductAuthorization
  • deleted
MedicinalProductContraindication
  • deleted
MedicinalProductIndication
  • deleted
MedicinalProductIngredient
  • deleted
MedicinalProductInteraction
  • deleted
MedicinalProductManufactured
  • deleted
MedicinalProductPackaged
  • deleted
MedicinalProductPharmaceutical
  • deleted
MedicinalProductUndesirableEffect
  • deleted
MetadataResource
  • deleted
RiskEvidenceSynthesis
  • deleted
SubstanceNucleicAcid
  • deleted
SubstancePolymer
  • deleted
SubstanceProtein
  • deleted
SubstanceReferenceInformation
  • deleted
SubstanceSourceMaterial
  • deleted
SubstanceSpecification
  • deleted