Path | Short | Definition | Comments |
---|---|---|---|
A record of information transmitted from a sender to a receiver | An occurrence of information being transmitted; e.g. an alert that was sent to a responsible provider, a public health agency was notified about a reportable condition. | ||
identifier | Unique identifier | 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. | This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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. |
instantiatesCanonical | Instantiates FHIR protocol or definition | 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. | |
instantiatesUri | Instantiates external protocol or definition | 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. |
basedOn | Request fulfilled by this communication | 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. |
partOf | Part of this action | Part of this action. | |
inResponseTo | Reply to | Prior communication that this communication is in response to. | |
status | preparation | in-progress | not-done | suspended | aborted | completed | entered-in-error | 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. |
statusReason | Reason for current status | 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. |
category | Message category | 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. |
priority | Message urgency | 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. |
medium | A channel of communication | A channel that was used for this communication (e.g. email, fax). | |
subject | Focus of message | The patient or group that was the focus of this communication. | |
topic | Description of the purpose/content | Description of the purpose/content, similar to a subject line in an email. | Communication.topic.text can be used without any codings. |
about | Resources that pertain to this communication | 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. |
encounter | Encounter created as part of | The Encounter during which this Communication was created or to which the creation of this record is tightly associated. | 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. |
sent | When sent | The time when this communication was sent. | |
received | When received | The time when this communication arrived at the destination. | |
recipient | Message recipient | The entity (e.g. person, organization, clinical information system, care team or device) which was the target of the communication. If receipts need to be tracked by individual, a separate resource instance will need to be created for each recipient. Multiple recipient communications are intended where either a receipt(s) is not tracked (e.g. a mass mail-out) or is captured in aggregate (all emails confirmed received by a particular time). | |
sender | Message sender | The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication. | |
reasonCode | Indication for message | The reason or justification for the communication. | Textual reasons can be captured using reasonCode.text. |
reasonReference | Why was communication done? | Indicates another resource whose existence justifies this communication. | |
payload | Message payload | Text, attachment(s), or resource(s) that was communicated to the recipient. | |
payload.id | Unique id for inter-element referencing | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | |
payload.extension | Additional content defined by implementations | 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. |
payload.modifierExtension | Extensions that cannot be ignored even if unrecognized | 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). | 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. |
payload.content[x] | Message part content | A communicated content (or for multi-part communications, one portion of the communication). | |
note | Comments made about the communication | Additional notes or commentary about the communication by the sender, receiver or other interested parties. |
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 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:
Non-patient specific communication use cases may include:
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. As well, 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.
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.
Notes to reviewers:
At this time, the code bindings are placeholders to be fleshed out upon further review by the community.
Communication.sender allows Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService and Communication.recipient allows Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Group | CareTeam | HealthcareService - but it is not unusual to have a communication target - even a defined one - where it is unknown what kind of role the person is playing.
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.
based-on | Request fulfilled by this communication | Communication.basedOn |
category | Message category | Communication.category |
encounter | Encounter created as part of | Communication.encounter |
identifier | Unique identifier | Communication.identifier |
instantiates-canonical | Instantiates FHIR protocol or definition | Communication.instantiatesCanonical |
instantiates-uri | Instantiates external protocol or definition | Communication.instantiatesUri |
medium | A channel of communication | Communication.medium |
part-of | Part of this action | Communication.partOf |
patient | Focus of message | Communication.subject.where(resolve() is Patient) |
received | When received | Communication.received |
recipient | Message recipient | Communication.recipient |
sender | Message sender | Communication.sender |
sent | When sent | Communication.sent |
status | preparation | in-progress | not-done | suspended | aborted | completed | entered-in-error | Communication.status |
subject | Focus of message | Communication.subject |