Resource type: composition

Description

A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).

Elements

PathShortDefinitionComments
A set of resources composed into a single coherent clinical statement with clinical attestationA set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.
identifierVersion-independent identifier for the CompositionA version-independent identifier for the Composition. This identifier stays constant as the composition is changed over time.Similar to ClinicalDocument/setId in CDA. See discussion in resource definition for how these relate.
statuspreliminary | final | amended | entered-in-errorThe workflow/clinical status of this composition. The status is a marker for the clinical standing of the document.If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "entered-in-error" is why this element is labeled as a modifier of other elements. Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required.
typeKind of composition (LOINC if possible)Specifies the particular kind of composition (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the composition.For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.
categoryCategorization of CompositionA categorization for the type of the composition - helps for indexing and searching. This may be implied by or derived from the code specified in the Composition Type.This is a metadata field from [XDS/MHD](http://wiki.ihe.net/index.php?title=Mobile_access_to_Health_Documents_(MHD)).
subjectWho and/or what the composition is aboutWho or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).For clinical documents, this is usually the patient.
encounterContext of the CompositionDescribes the clinical encounter or type of care this documentation is associated with.
dateComposition editing timeThe composition editing time, when the composition was last logically changed by the author.The Last Modified Date on the composition may be after the date of the document was attested without being changed.
authorWho and/or what authored the compositionIdentifies who is responsible for the information in the composition, not necessarily who typed it in.
titleHuman Readable name/titleOfficial human-readable label for the composition.For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.
confidentialityAs defined by affinity domainThe code specifying the level of confidentiality of the Composition.The exact use of this element, and enforcement and issues related to highly sensitive documents are out of scope for the base specification, and delegated to implementation profiles (see security section). This element is labeled as a modifier because highly confidential documents must not be treated as if they are not.
attesterAttests to accuracy of compositionA participant who has attested to the accuracy of the composition/document.Only list each attester once.
attester.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
attester.extensionAdditional content defined by implementationsMay 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.
attester.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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.
attester.modepersonal | professional | legal | officialThe type of attestation the authenticator offers.
attester.timeWhen the composition was attestedWhen the composition was attested by the party.
attester.partyWho attested the compositionWho attested the composition in the specified way.
custodianOrganization which maintains the compositionIdentifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information.This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However, it is important that this information be known when working with a derived document, so providing a custodian is encouraged.
relatesToRelationships to other compositions/documentsRelationships that this composition has with other compositions or documents that already exist.A document is a version specific composition.
relatesTo.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
relatesTo.extensionAdditional content defined by implementationsMay 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.
relatesTo.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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.
relatesTo.codereplaces | transforms | signs | appendsThe type of relationship that this composition has with anther composition or document.If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.
relatesTo.target[x]Target of the relationshipThe target composition/document of this relationship.
eventThe clinical service(s) being documentedThe clinical service, such as a colonoscopy or an appendectomy, being documented.The event needs to be consistent with the type element, though can provide further information if desired.
event.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
event.extensionAdditional content defined by implementationsMay 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.
event.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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.
event.codeCode(s) that apply to the event being documentedThis list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the typeCode, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.An event can further specialize the act inherent in the typeCode, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more eventCodes are included, they SHALL NOT conflict with the values inherent in the classCode, practiceSettingCode or typeCode, as such a conflict would create an ambiguous situation. This short list of codes is provided to be used as key words for certain types of queries.
event.periodThe period covered by the documentationThe period of time covered by the documentation. There is no assertion that the documentation is a complete representation for this period, only that it documents events during this time.
event.detailThe event(s) being documentedThe description and/or reference of the event(s) being documented. For example, this could be used to document such a colonoscopy or an appendectomy.
sectionComposition is broken into sectionsThe root of the sections that make up the composition.
section.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
section.extensionAdditional content defined by implementationsMay 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.
section.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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.
section.titleLabel for section (e.g. for ToC)The label for this particular section. This will be part of the rendered content for the document, and is often used to build a table of contents.The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.
section.codeClassification of section (recommended)A code identifying the kind of content contained within the section. This must be consistent with the section title.The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document. If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.
section.authorWho and/or what authored the sectionIdentifies who is responsible for the information in this section, not necessarily who typed it in.
section.focusWho/what the section is about, when it is not about the subject of compositionThe actual focus of the section when it is not the subject of the composition, but instead represents something or someone associated with the subject such as (for a patient subject) a spouse, parent, fetus, or donor. If not focus is specified, the focus is assumed to be focus of the parent section, or, for a section in the Composition itself, the subject of the composition. Sections with a focus SHALL only include resources where the logical subject (patient, subject, focus, etc.) matches the section focus, or the resources have no logical subject (few resources).Typically, sections in a doument are about the subject of the document, whether that is a patient, or group of patients, location, or device, or whatever. For some kind of documents, some sections actually contain data about related entities. Typical examples are a section in a newborn discharge summary concerning the mother, or family history documents, with a section about each family member, though there are many other examples.
section.textText summary of the section, for human interpretationA human-readable narrative that contains the attested content of the section, 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.Document profiles may define what content should be represented in the narrative to ensure clinical safety.
section.modeworking | snapshot | changesHow the entry list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted.This element is labeled as a modifier because a change list must not be misunderstood as a complete list.
section.orderedByOrder of section entriesSpecifies the order applied to the items in the section entries.Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.
section.entryA reference to data that supports this sectionA reference to the actual resource from which the narrative in the section is derived.If there are no entries in the list, an emptyReason SHOULD be provided.
section.emptyReasonWhy the section is emptyIf the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason.The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.
section.sectionNested SectionA nested sub-section within this section.Nested sections are primarily used to help human readers navigate to particular portions of the document.

Scope and Usage

A Composition is the basic structure from which FHIR Documents - immutable bundles with attested narrative - are built. A single logical composition may be associated with a series of derived documents, each of which is a frozen copy of the composition.

Note: EN 13606 uses the term "Composition" to refer to a single commit to an EHR system, and offers some common examples: a composition containing a consultation note, a progress note, a report or a letter, an investigation report, a prescription form or a set of bedside nursing observations. Using Composition for an attested EHR commit is a valid use of the Composition resource, but for FHIR purposes, it would be usual to make more granular updates with individual provenance statements.

The CDA on FHIR profile constrains Composition to match CDA and specify a clinical document. See also the comparison with CDA.

Boundaries and Relationships

Composition is a structure for grouping information for purposes of persistence and attestability. There are several other grouping structures in FHIR with distinct purposes:

The Composition resource organizes clinical and administrative content into sections, each of which contains a narrative, and references other resources for supporting data. The narrative content of the various sections in a Composition are supported by the resources referenced in the section entries. The complete set of content to make up a document includes the Composition resource together with various resources pointed to or indirectly connected to the Composition, all gathered together into a Bundle for transport and persistence. Resources associated with the following list of Composition references SHALL be included in the Bundle:

<%res-ref-list Composition%>

Other resources referred to by those resources MAY be included in the Bundle at the discretion of the authoring system as documented in the system's operation definition (such as $document operation), or as specified by any applicable profiles.

Background and Context

Composition Status Codes

Every composition has a status element, which describes the status of the content of the composition, taken from this list of codes:

<%codelist http://hl7.org/fhir/composition-status%>

Composition status generally only moves down through this list - it moves from preliminary to final and then it may progress to amended. Note that in many workflows, only final compositions are made available and the preliminary status is not used.

A very few compositions are created entirely in error in the workflow - usually the composition concerns the wrong patient or is written by the wrong author, and the error is only detected after the composition has been used or documents have been derived from it. To support resolution of this case, the composition is updated to be marked as entered-in-error and a new derived document can be created. This means that the entire series of derived documents is now considered to be created in error and systems receiving derived documents based on retracted compositions SHOULD remove data taken from earlier documents from routine use and/or take other appropriate actions. Systems are not required to provide this workflow or support documents derived from retracted compositions, but they SHALL NOT ignore a status of entered-in-error. Note that systems that handle compositions or derived documents and don't support the error status need to define some other way of handling compositions that are created in error; while this is not a common occurrence, some clinical systems have no provision for removing erroneous information from a patient's record, and there is no way for a user to know that it is not fit for use - this is not safe.

Note for CDA aware readers

Many users of this specification are familiar with the Clinical Document Architecture (CDA) and related specifications. CDA is a primary design input to the Composition resource (other principal inputs are other HL7 document specifications and EN13606). There are three important structural differences between CDA and the Composition resource:

In addition, note that both the code lists (e.g., Composition.status) and the Composition resource are mapped to HL7 v3 and/or CDA.

Notes:

Compositions about multiple entities

Typically, a composition is made about the subject - e.g. a patient, or group of patients, location, or device - and the distinction between the subject and the composition describes the subject. Some kinds of documents contain data about other parties or entities that are relevant to the subject of the document. Some examples:

In all these cases, the subject of the document is a single patient, but some of the details are actually related to other persons or entities. When this happens, these other entities are detailed in the Composition.section.focus element. In the absence of a focus, it is assumed that the subject of the composition is the focus.

If a focus is specified, then the resources referred to from the section SHALL either:

A few compositions genuinely cover multiple subjects - different sections are about different subjects. In such case, Composition.subject is omitted, and the extension section-subject is used on each section to indicate the subject.

[%stu-note%] Feedback is welcome on two issues related to Composition:

Feedback here. [%end-note%]

Search Parameters

attesterWho attested the compositionComposition.attester.party
authorWho and/or what authored the compositionComposition.author
categoryCategorization of CompositionComposition.category
confidentialityAs defined by affinity domainComposition.confidentiality
contextCode(s) that apply to the event being documentedComposition.event.code
encounterMultiple Resources: * [Composition](composition.html): Context of the Composition * [DeviceRequest](devicerequest.html): Encounter during which request was created * [DiagnosticReport](diagnosticreport.html): The Encounter when the order was made * [DocumentReference](documentreference.html): Context of the document content * [Flag](flag.html): Alert relevant during encounter * [List](list.html): Context in which list created * [NutritionOrder](nutritionorder.html): Return nutrition orders with this encounter identifier * [Observation](observation.html): Encounter related to the observation * [Procedure](procedure.html): Encounter created as part of * [RiskAssessment](riskassessment.html): Where was assessment performed? * [ServiceRequest](servicerequest.html): An encounter in which this request is made * [VisionPrescription](visionprescription.html): Return prescriptions with this encounter identifier Composition.encounter | DeviceRequest.encounter | DiagnosticReport.encounter | DocumentReference.context.encounter | Flag.encounter | List.encounter | NutritionOrder.encounter | Observation.encounter | Procedure.encounter | RiskAssessment.context.where(resolve() is Encounter) | ServiceRequest.encounter | VisionPrescription.encounter
entryA reference to data that supports this sectionComposition.section.entry
periodThe period covered by the documentationComposition.event.period
related-idTarget of the relationship(Composition.relatesTo.target as Identifier)
related-refTarget of the relationship(Composition.relatesTo.target as Reference)
sectionClassification of section (recommended)Composition.section.code
statuspreliminary | final | amended | entered-in-errorComposition.status
subjectWho and/or what the composition is aboutComposition.subject
titleHuman Readable name/titleComposition.title

Extension Definitions

These are extension definitions for this resource defined by the spec

Profiles based on this resource

CDA on FHIR

The CDA-in-FHIR profile constrains Composition to match CDA and specify a clinical document. The base Composition is a general resource for compositions or documents about any kind of subject that might be encountered in healthcare including such things as guidelines, medicines, etc. A clinical document is focused on documents related to the provision of care process, where the subject is a patient, a group of patients, or a closely related concept. A clinical document has additional requirements around confidentiality that do not apply in the same way to other kinds of documents

Elements

PathShortDefinitionComments
A set of resources composed into a single coherent clinical statement with clinical attestationA set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.
identifierVersion-independent identifier for the CompositionA version-independent identifier for the Composition. This identifier stays constant as the composition is changed over time.Similar to ClinicalDocument/setId in CDA. See discussion in resource definition for how these relate.
statuspreliminary | final | amended | entered-in-errorThe workflow/clinical status of this composition. The status is a marker for the clinical standing of the document.If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "entered-in-error" is why this element is labeled as a modifier of other elements. Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required.
typeKind of composition (LOINC if possible)Specifies the particular kind of composition (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the composition.For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.
categoryCategorization of CompositionA categorization for the type of the composition - helps for indexing and searching. This may be implied by or derived from the code specified in the Composition Type.This is a metadata field from [XDS/MHD](http://wiki.ihe.net/index.php?title=Mobile_access_to_Health_Documents_(MHD)).
subjectWho and/or what the composition is aboutWho or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).For clinical documents, this is usually the patient.
encounterContext of the CompositionDescribes the clinical encounter or type of care this documentation is associated with.
dateComposition editing timeThe composition editing time, when the composition was last logically changed by the author.The Last Modified Date on the composition may be after the date of the document was attested without being changed.
authorWho and/or what authored the compositionIdentifies who is responsible for the information in the composition, not necessarily who typed it in.
titleHuman Readable name/titleOfficial human-readable label for the composition.For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.
confidentialityAs defined by affinity domainThe code specifying the level of confidentiality of the Composition.The exact use of this element, and enforcement and issues related to highly sensitive documents are out of scope for the base specification, and delegated to implementation profiles (see security section). This element is labeled as a modifier because highly confidential documents must not be treated as if they are not.
attesterAttests to accuracy of compositionA participant who has attested to the accuracy of the composition/document.Only list each attester once.
attester.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
attester.extensionAdditional content defined by implementationsMay 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.
attester.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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.
attester.modepersonal | professional | legal | officialThe type of attestation the authenticator offers.
attester.timeWhen the composition was attestedWhen the composition was attested by the party.
attester.partyWho attested the compositionWho attested the composition in the specified way.
custodianOrganization which maintains the compositionIdentifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information.This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However, it is important that this information be known when working with a derived document, so providing a custodian is encouraged.
relatesToRelationships to other compositions/documentsRelationships that this composition has with other compositions or documents that already exist.A document is a version specific composition.
relatesTo.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
relatesTo.extensionAdditional content defined by implementationsMay 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.
relatesTo.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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.
relatesTo.codereplaces | transforms | signs | appendsThe type of relationship that this composition has with anther composition or document.If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.
relatesTo.target[x]Target of the relationshipThe target composition/document of this relationship.
eventThe clinical service(s) being documentedThe clinical service, such as a colonoscopy or an appendectomy, being documented.The event needs to be consistent with the type element, though can provide further information if desired.
event.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
event.extensionAdditional content defined by implementationsMay 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.
event.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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.
event.codeCode(s) that apply to the event being documentedThis list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the typeCode, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.An event can further specialize the act inherent in the typeCode, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more eventCodes are included, they SHALL NOT conflict with the values inherent in the classCode, practiceSettingCode or typeCode, as such a conflict would create an ambiguous situation. This short list of codes is provided to be used as key words for certain types of queries.
event.periodThe period covered by the documentationThe period of time covered by the documentation. There is no assertion that the documentation is a complete representation for this period, only that it documents events during this time.
event.detailThe event(s) being documentedThe description and/or reference of the event(s) being documented. For example, this could be used to document such a colonoscopy or an appendectomy.
sectionComposition is broken into sectionsThe root of the sections that make up the composition.
section.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
section.extensionAdditional content defined by implementationsMay 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.
section.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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.
section.titleLabel for section (e.g. for ToC)The label for this particular section. This will be part of the rendered content for the document, and is often used to build a table of contents.The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.
section.codeClassification of section (recommended)A code identifying the kind of content contained within the section. This must be consistent with the section title.The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document. If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.
section.authorWho and/or what authored the sectionIdentifies who is responsible for the information in this section, not necessarily who typed it in.
section.focusWho/what the section is about, when it is not about the subject of compositionThe actual focus of the section when it is not the subject of the composition, but instead represents something or someone associated with the subject such as (for a patient subject) a spouse, parent, fetus, or donor. If not focus is specified, the focus is assumed to be focus of the parent section, or, for a section in the Composition itself, the subject of the composition. Sections with a focus SHALL only include resources where the logical subject (patient, subject, focus, etc.) matches the section focus, or the resources have no logical subject (few resources).Typically, sections in a doument are about the subject of the document, whether that is a patient, or group of patients, location, or device, or whatever. For some kind of documents, some sections actually contain data about related entities. Typical examples are a section in a newborn discharge summary concerning the mother, or family history documents, with a section about each family member, though there are many other examples.
section.textText summary of the section, for human interpretationA human-readable narrative that contains the attested content of the section, 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.Document profiles may define what content should be represented in the narrative to ensure clinical safety.
section.modeworking | snapshot | changesHow the entry list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted.This element is labeled as a modifier because a change list must not be misunderstood as a complete list.
section.orderedByOrder of section entriesSpecifies the order applied to the items in the section entries.Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.
section.entryA reference to data that supports this sectionA reference to the actual resource from which the narrative in the section is derived.If there are no entries in the list, an emptyReason SHOULD be provided.
section.emptyReasonWhy the section is emptyIf the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason.The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.
section.sectionNested SectionA nested sub-section within this section.Nested sections are primarily used to help human readers navigate to particular portions of the document.

Profile for Catalog

A set of resources composed into a single coherent clinical statement with clinical attestation

Elements

PathShortDefinitionComments
A set of resources composed into a single coherent clinical statement with clinical attestationA set of healthcare-related information that is assembled together into a single logical document that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. While a Composition defines the structure, it does not actually contain the content: rather the full content of a document is contained in a Bundle, of which the Composition is the first resource contained.While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.
identifierVersion-independent identifier for the CompositionA version-independent identifier for the Composition. This identifier stays constant as the composition is changed over time.Similar to ClinicalDocument/setId in CDA. See discussion in resource definition for how these relate.
statuspreliminary | final | amended | entered-in-errorThe workflow/clinical status of this composition. The status is a marker for the clinical standing of the document.If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "entered-in-error" is why this element is labeled as a modifier of other elements. Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required.
typeThe type of document - a CatalogThe type of document - a Catalog.For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.
categoryThe Content of the sectionThe content (narrative and data) associated with the section.This is a metadata field from [XDS/MHD](http://wiki.ihe.net/index.php?title=Mobile_access_to_Health_Documents_(MHD)).
subjectWho and/or what the composition is aboutWho or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).For clinical documents, this is usually the patient.
encounterContext of the CompositionDescribes the clinical encounter or type of care this documentation is associated with.
dateWhen the Catalog was createdWhen the Catalog was created.The Last Modified Date on the composition may be after the date of the document was attested without being changed.
authorWho and/or what authored the compositionIdentifies who is responsible for the information in the composition, not necessarily who typed it in.
titleHuman Readable name/titleOfficial human-readable label for the composition.For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.
confidentialityAs defined by affinity domainThe code specifying the level of confidentiality of the Composition.The exact use of this element, and enforcement and issues related to highly sensitive documents are out of scope for the base specification, and delegated to implementation profiles (see security section). This element is labeled as a modifier because highly confidential documents must not be treated as if they are not.
attesterAttests to accuracy of compositionA participant who has attested to the accuracy of the composition/document.Only list each attester once.
attester.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
attester.extensionAdditional content defined by implementationsMay 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.
attester.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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.
attester.modepersonal | professional | legal | officialThe type of attestation the authenticator offers.
attester.timeWhen the composition was attestedWhen the composition was attested by the party.
attester.partyWho attested the compositionWho attested the composition in the specified way.
custodianOrganization which maintains the compositionIdentifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information.This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However, it is important that this information be known when working with a derived document, so providing a custodian is encouraged.
relatesToRelationships to other compositions/documentsRelationships that this composition has with other compositions or documents that already exist.A document is a version specific composition.
relatesTo.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
relatesTo.extensionAdditional content defined by implementationsMay 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.
relatesTo.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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.
relatesTo.codereplaces | transforms | signs | appendsThe type of relationship that this composition has with anther composition or document.If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.
relatesTo.target[x]Target of the relationshipThe target composition/document of this relationship.
eventThe clinical service(s) being documentedThe clinical service, such as a colonoscopy or an appendectomy, being documented.The event needs to be consistent with the type element, though can provide further information if desired.
event.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
event.extensionAdditional content defined by implementationsMay 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.
event.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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.
event.codeCode(s) that apply to the event being documentedThis list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the typeCode, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.An event can further specialize the act inherent in the typeCode, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more eventCodes are included, they SHALL NOT conflict with the values inherent in the classCode, practiceSettingCode or typeCode, as such a conflict would create an ambiguous situation. This short list of codes is provided to be used as key words for certain types of queries.
event.periodThe period covered by the documentationThe period of time covered by the documentation. There is no assertion that the documentation is a complete representation for this period, only that it documents events during this time.
event.detailThe event(s) being documentedThe description and/or reference of the event(s) being documented. For example, this could be used to document such a colonoscopy or an appendectomy.
sectionComposition is broken into sectionsThe root of the sections that make up the composition.
section.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
section.extensionAdditional content defined by implementationsMay 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.
section.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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.
section.titleLabel for section (e.g. for ToC)The label for this particular section. This will be part of the rendered content for the document, and is often used to build a table of contents.The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.
section.codeClassification of section (recommended)A code identifying the kind of content contained within the section. This must be consistent with the section title.The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document. If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.
section.authorWho and/or what authored the sectionIdentifies who is responsible for the information in this section, not necessarily who typed it in.
section.focusWho/what the section is about, when it is not about the subject of compositionThe actual focus of the section when it is not the subject of the composition, but instead represents something or someone associated with the subject such as (for a patient subject) a spouse, parent, fetus, or donor. If not focus is specified, the focus is assumed to be focus of the parent section, or, for a section in the Composition itself, the subject of the composition. Sections with a focus SHALL only include resources where the logical subject (patient, subject, focus, etc.) matches the section focus, or the resources have no logical subject (few resources).Typically, sections in a doument are about the subject of the document, whether that is a patient, or group of patients, location, or device, or whatever. For some kind of documents, some sections actually contain data about related entities. Typical examples are a section in a newborn discharge summary concerning the mother, or family history documents, with a section about each family member, though there are many other examples.
section.textText summary of the section, for human interpretationA human-readable narrative that contains the attested content of the section, 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.Document profiles may define what content should be represented in the narrative to ensure clinical safety.
section.modeworking | snapshot | changesHow the entry list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted.This element is labeled as a modifier because a change list must not be misunderstood as a complete list.
section.orderedByOrder of section entriesSpecifies the order applied to the items in the section entries.Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.
section.entryThe Content of the sectionThe content (narrative and data) associated with the section.If there are no entries in the list, an emptyReason SHOULD be provided.
section.emptyReasonWhy the section is emptyIf the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason.The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.
section.sectionNested SectionA nested sub-section within this section.Nested sections are primarily used to help human readers navigate to particular portions of the document.