STU3 Candidate

This page is part of the FHIR Specification (v1.8.0: STU 3 Draft). 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 R2

2.37 Resource Composition - Content

Structured Documents Work Group Maturity Level : 2 Compartments : Device , Encounter , Patient , Practitioner , RelatedPerson

A 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.

2.37.1 Scope and Usage

A Composition is also 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 uses of the Composition resource, but for FHIR purposes, it would be usual to make more granular updates with individual provenance statements.

2.37.2 Boundaries and Relationships

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

  • The List resource - enumerates a flat collection of resources and provides features for managing the collection. While a particular List instance may represent a "snapshot", from a business process perspective, the notion of "list" is dynamic – items are added and removed over time. The List resource references other resources. Lists may be curated and have specific business meaning.
  • The Group resource - defines a group of specific people, animals, devices, etc. by enumerating them, or by describing qualities that group members have. The Group resource refers to other resources, possibly implicitly. Groups are intended to be acted upon or observed as a whole (e.g., performing therapy on a group, calculating risk for a group, etc.). This resource will commonly be used for public health (e.g., describing an at-risk population), clinical trials (e.g., defining a test subject pool) and similar purposes.
  • The Bundle resource - is an infrastructure container for a group of resources. It does not have narrative and is used to group collections of resources for transmission, persistence or processing (e.g., messages, documents, transactions, query responses, etc.). The content of bundles is typically algorithmically determined for a particular exchange or persistence purpose.
  • The Composition resource - defines a 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. The Composition resource provides the basic structure of a FHIR document . The full content of the document is expressed using a bundle containing the Composition and its entries.

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. The following list of Composition references SHALL be included in the bundle:

Other resources referred to by those resources may be included in the bundle at the discretion of the authoring system, or as specified by any applicable profiles.

2.37.3 Background and Context

2.37.3.1 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:

Code Definition
preliminary This is a preliminary composition (also known as initial or interim). The content may be incomplete or unverified.
final The composition is complete and verified by an appropriate person and no further work is planned.
appended The composition has been modified subsequent to being marked and/or released as "final" and is complete and verified by an authorized person. The modifications added new information to the composition, but did not revise existing content.
amended The composition content or the referenced resources have been modified subsequently to being released as "final", and the composition is complete and verified by an authorized person.
retracted The composition was originally created/issued in error and this is an amendment that marks that the entire composition and any past versions or copies should not be considered as valid.

Composition status generally only moves down through this list - it moves from preliminary to final and then it may progress to either appended or 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 "retracted" 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 retracted. Note that systems that handle compositions or derived documents and don't support the retracted 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.

2.37.3.2 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 principle inputs are other HL7 document specifications and EN13606). There are two important structural differences between CDA and the Composition resource:

  • A composition is a logical construct- its identifier matches to the CDA ClinicalDocument.setId. Composition resources are wrapped into Document structures, for exchange of the whole package (the composition and its parts), and this wrapped, sealed entity is equivalent to a CDA document, where the Bundle.id is equivalent in function to ClinicalDocument.id (but it is not identical when interconverting, since it's a transform between them).
  • The composition section defines a section (or sub-section) of the document, but unlike CDA, the section entries are actually references to other resources that hold the supporting data content for the section. This design means that the data can be reused in many other ways.
  • Unlike CDA, the context defined in the Composition (the confidentiality, subject, author, event, event period and encounter) apply to the composition and do not specifically apply to the resources referenced from the section.entry . There is no context flow model in FHIR, so each resource referenced from within a Composition expresses its own individual context. In this way, clinical content can safely be extracted from the composition.

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

This resource is referenced by contract

2.37.4 Resource Content

Structure

Name Flags Card. Type Description & Constraints doco
. . Composition DomainResource A set of resources composed into a single coherent clinical statement with clinical attestation
. . . identifier Σ 0..1 Identifier Logical identifier of composition (version-independent)
. . . date Σ 1..1 dateTime Composition editing time
. . . type Σ 1..1 CodeableConcept Kind of composition (LOINC if possible)
FHIR Document Type Codes ( Preferred )
. . . class Σ 0..1 CodeableConcept Categorization of Composition
FHIR Document Class Codes ( Example )
. . . title Σ 1..1 string Human Readable name/title
. . . status ?! Σ 1..1 code preliminary | final | amended | entered-in-error
CompositionStatus ( Required )
. . . confidentiality ?! Σ 0..1 code As defined by affinity domain
ConfidentialityClassification ( Required )
. . . subject Σ 1..1 Reference ( Any ) Who and/or what the composition is about
. . . author Σ 1..* Reference ( Practitioner | Device | Patient | RelatedPerson ) Who and/or what authored the composition
. . . attester Σ 0..* BackboneElement Attests to accuracy of composition
. . . . mode Σ 1..* code personal | professional | legal | official
CompositionAttestationMode ( Required )
. . . . time Σ 0..1 dateTime When composition attested
. . . . party Σ 0..1 Reference ( Patient | Practitioner | Organization ) Who attested the composition
. . . custodian Σ 0..1 Reference ( Organization ) Organization which maintains the composition
. . . event Σ 0..* BackboneElement The clinical service(s) being documented
. . . . code Σ 0..* CodeableConcept Code(s) that apply to the event being documented
v3 Code System ActCode ( Example )
. . . . period Σ 0..1 Period The period covered by the documentation
. . . . detail Σ 0..* Reference ( Any ) The event(s) being documented
. . . encounter Σ 0..1 Reference ( Encounter ) Context of the Composition
. . . section I 0..* BackboneElement Composition is broken into sections
A section must at least one of text, entries, or sub-sections
A section can only have an emptyReason if it is empty
. . . . title 0..1 string Label for section (e.g. for ToC)
. . . . code 0..1 CodeableConcept Classification of section (recommended)
Document Section Codes ( Example )
. . . . text I 0..1 Narrative Text summary of the section, for human interpretation
. . . . mode ?! Σ 0..1 code working | snapshot | changes
ListMode ( Required )
. . . . orderedBy 0..1 CodeableConcept Order of section entries
List Order Codes ( Preferred )
. . . . entry I 0..* Reference ( Any ) A reference to data that supports this section
. . . . emptyReason I 0..1 CodeableConcept Why the section is empty
List Empty Reasons ( Preferred )
. . . . section I 0..* see section Nested Section

doco Documentation for this format

UML Diagram ( Legend )

Composition ( DomainResource ) Logical identifier for the composition, assigned when created. This identifier stays constant as the composition is changed over time identifier : Identifier [0..1] The composition editing time, when the composition was last logically changed by the author date : dateTime [1..1] 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 type : CodeableConcept [1..1] « Type of a composition. (Strength=Preferred) FHIR Document Type ? » A 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 class : CodeableConcept [0..1] « High-level kind of a clinical document at a macro level. (Strength=Example) FHIR Document Class ?? » Official human-readable label for the composition title : string [1..1] The workflow/clinical status of this composition. The status is a marker for the clinical standing of the document (this element modifies the meaning of other elements) status : code [1..1] « The workflow/clinical status of the composition. (Strength=Required) CompositionStatus ! » The code specifying the level of confidentiality of the Composition (this element modifies the meaning of other elements) confidentiality : code [0..1] « Codes specifying the level of confidentiality of the composition. (Strength=Required) ConfidentialityClassification ! » Who 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) subject : Reference [1..1] « Any » Identifies who is responsible for the information in the composition, not necessarily who typed it in author : Reference [1..*] « Practitioner | Device | Patient | RelatedPerson » Identifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information custodian : Reference [0..1] « Organization » Describes the clinical encounter or type of care this documentation is associated with encounter : Reference [0..1] « Encounter » Attester The type of attestation the authenticator offers mode : code [1..*] « The way in which a person authenticated a composition. (Strength=Required) CompositionAttestationMode ! » When composition was attested by the party time : dateTime [0..1] Who attested the composition in the specified way party : Reference [0..1] « Patient | Practitioner | Organization » Event This 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 code : CodeableConcept [0..*] « This list of codes represents the main clinical acts being documented. (Strength=Example) v3 Code System ActCode ?? » The 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 period : Period [0..1] The description and/or reference of the event(s) being documented. For example, this could be used to document such a colonoscopy or an appendectomy detail : Reference [0..*] « Any » Section 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 title : string [0..1] A code identifying the kind of content contained within the section. This must be consistent with the section title code : CodeableConcept [0..1] « Classification of a section of a composition/document. (Strength=Example) Document Section ?? » A 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 text : Narrative [0..1] How 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 modifies the meaning of other elements) mode : code [0..1] « The processing mode that applies to this section. (Strength=Required) ListMode ! » Specifies the order applied to the items in the section entries orderedBy : CodeableConcept [0..1] « What order applies to the items in the entry. (Strength=Preferred) List Order ? » A reference to the actual resource from which the narrative in the section is derived entry : Reference [0..*] « Any » If the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason emptyReason : CodeableConcept [0..1] « If a section is empty, why it is empty. (Strength=Preferred) List Empty Reasons ? » A participant who has attested to the accuracy of the composition/document attester [0..*] The clinical service, such as a colonoscopy or an appendectomy, being documented event [0..*] A nested sub-section within this section section [0..*] The root of the sections that make up the composition section [0..*]

XML Template 

<Composition xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..1 Identifier Logical identifier of composition (version-independent) --></identifier>
 <date value="[dateTime]"/><!-- 1..1 Composition editing time -->
 <type><!-- 1..1 CodeableConcept Kind of composition (LOINC if possible) --></type>
 <class><!-- 0..1 CodeableConcept Categorization of Composition --></class>
 <title value="[string]"/><!-- 1..1 Human Readable name/title -->
 <status value="[code]"/><!-- 1..1 preliminary | final | amended | entered-in-error -->
 <confidentiality value="[code]"/><!-- 0..1 As defined by affinity domain -->
 <subject><!-- 1..1 Reference(Any) Who and/or what the composition is about --></subject>
 <author><!-- 1..* Reference(Practitioner|Device|Patient|RelatedPerson) Who and/or what authored the composition --></author>
 <attester>  <!-- 0..* Attests to accuracy of composition -->
  <mode value="[code]"/><!-- 1..* personal | professional | legal | official -->
  <time value="[dateTime]"/><!-- 0..1 When composition attested -->
  <party><!-- 0..1 Reference(Patient|Practitioner|Organization) Who attested the composition --></party>
 </attester>
 <custodian><!-- 0..1 Reference(Organization) Organization which maintains the composition --></custodian>
 <event>  <!-- 0..* The clinical service(s) being documented -->
  <code><!-- 0..* CodeableConcept Code(s) that apply to the event being documented --></code>
  <period><!-- 0..1 Period The period covered by the documentation --></period>
  <detail><!-- 0..* Reference(Any) The event(s) being documented --></detail>
 </event>
 <encounter><!-- 0..1 Reference(Encounter) Context of the Composition --></encounter>
 <section>  <!-- 0..* Composition is broken into sections -->
  <title value="[string]"/><!-- 0..1 Label for section (e.g. for ToC) -->
  <code><!-- 0..1 CodeableConcept Classification of section (recommended) --></code>
  <text><!-- ?? 0..1 Narrative Text summary of the section, for human interpretation --></text>
  <mode value="[code]"/><!-- 0..1 working | snapshot | changes -->
  <orderedBy><!-- 0..1 CodeableConcept Order of section entries --></orderedBy>
  <entry><!-- ?? 0..* Reference(Any) A reference to data that supports this section --></entry>
  <emptyReason><!-- ?? 0..1 CodeableConcept Why the section is empty --></emptyReason>
  <section><!-- ?? 0..* Content as for Composition.section Nested Section --></section>
 </section>
</Composition>

JSON Template 

{doco
  "resourceType" : "Composition",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : { Identifier }, // Logical identifier of composition (version-independent)
  "date" : "<dateTime>", // R!  Composition editing time
  "type" : { CodeableConcept }, // R!  Kind of composition (LOINC if possible)
  "class" : { CodeableConcept }, // Categorization of Composition
  "title" : "<string>", // R!  Human Readable name/title
  "status" : "<code>", // R!  preliminary | final | amended | entered-in-error
  "confidentiality" : "<code>", // As defined by affinity domain
  "subject" : { Reference(Any) }, // R!  Who and/or what the composition is about
  "author" : [{ Reference(Practitioner|Device|Patient|RelatedPerson) }], // R!  Who and/or what authored the composition
  "attester" : [{ // Attests to accuracy of composition
    "mode" : ["<code>"], // R!  personal | professional | legal | official
    "time" : "<dateTime>", // When composition attested
    "party" : { Reference(Patient|Practitioner|Organization) } // Who attested the composition
  }],
  "custodian" : { Reference(Organization) }, // Organization which maintains the composition
  "event" : [{ // The clinical service(s) being documented
    "code" : [{ CodeableConcept }], // Code(s) that apply to the event being documented
    "period" : { Period }, // The period covered by the documentation
    "detail" : [{ Reference(Any) }] // The event(s) being documented
  }],
  "encounter" : { Reference(Encounter) }, // Context of the Composition
  "section" : [{ // Composition is broken into sections
    "title" : "<string>", // Label for section (e.g. for ToC)
    "code" : { CodeableConcept }, // Classification of section (recommended)
    "text" : { Narrative }, // C? Text summary of the section, for human interpretation
    "mode" : "<code>", // working | snapshot | changes
    "orderedBy" : { CodeableConcept }, // Order of section entries
    "entry" : [{ Reference(Any) }], // C? A reference to data that supports this section
    "emptyReason" : { CodeableConcept }, // C? Why the section is empty
    "section" : [{ Content as for Composition.section }] // C? Nested Section
  }]
}

Turtle Template 

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


[ a fhir:Composition;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Composition.identifier [ Identifier ]; # 0..1 Logical identifier of composition (version-independent)
  fhir:Composition.date [ dateTime ]; # 1..1 Composition editing time
  fhir:Composition.type [ CodeableConcept ]; # 1..1 Kind of composition (LOINC if possible)
  fhir:Composition.class [ CodeableConcept ]; # 0..1 Categorization of Composition
  fhir:Composition.title [ string ]; # 1..1 Human Readable name/title
  fhir:Composition.status [ code ]; # 1..1 preliminary | final | amended | entered-in-error
  fhir:Composition.confidentiality [ code ]; # 0..1 As defined by affinity domain
  fhir:Composition.subject [ Reference(Any) ]; # 1..1 Who and/or what the composition is about
  fhir:Composition.author [ Reference(Practitioner|Device|Patient|RelatedPerson) ], ... ; # 1..* Who and/or what authored the composition
  fhir:Composition.attester [ # 0..* Attests to accuracy of composition
    fhir:Composition.attester.mode [ code ], ... ; # 1..* personal | professional | legal | official
    fhir:Composition.attester.time [ dateTime ]; # 0..1 When composition attested
    fhir:Composition.attester.party [ Reference(Patient|Practitioner|Organization) ]; # 0..1 Who attested the composition
  ], ...;
  fhir:Composition.custodian [ Reference(Organization) ]; # 0..1 Organization which maintains the composition
  fhir:Composition.event [ # 0..* The clinical service(s) being documented
    fhir:Composition.event.code [ CodeableConcept ], ... ; # 0..* Code(s) that apply to the event being documented
    fhir:Composition.event.period [ Period ]; # 0..1 The period covered by the documentation
    fhir:Composition.event.detail [ Reference(Any) ], ... ; # 0..* The event(s) being documented
  ], ...;
  fhir:Composition.encounter [ Reference(Encounter) ]; # 0..1 Context of the Composition
  fhir:Composition.section [ # 0..* Composition is broken into sections
    fhir:Composition.section.title [ string ]; # 0..1 Label for section (e.g. for ToC)
    fhir:Composition.section.code [ CodeableConcept ]; # 0..1 Classification of section (recommended)
    fhir:Composition.section.text [ Narrative ]; # 0..1 Text summary of the section, for human interpretation
    fhir:Composition.section.mode [ code ]; # 0..1 working | snapshot | changes
    fhir:Composition.section.orderedBy [ CodeableConcept ]; # 0..1 Order of section entries
    fhir:Composition.section.entry [ Reference(Any) ], ... ; # 0..* A reference to data that supports this section
    fhir:Composition.section.emptyReason [ CodeableConcept ]; # 0..1 Why the section is empty
    fhir:Composition.section.section [ See Composition.section ], ... ; # 0..* Nested Section
  ], ...;
]

Changes since DSTU2

Composition
Composition.confidentiality Change value set from http://hl7.org/fhir/ValueSet/v3-Confidentiality to http://hl7.org/fhir/ValueSet/v3-ConfidentialityClassification

See the Full Difference for further information

Structure

Name Flags Card. Type Description & Constraints doco
. . Composition DomainResource A set of resources composed into a single coherent clinical statement with clinical attestation
. . . identifier Σ 0..1 Identifier Logical identifier of composition (version-independent)
. . . date Σ 1..1 dateTime Composition editing time
. . . type Σ 1..1 CodeableConcept Kind of composition (LOINC if possible)
FHIR Document Type Codes ( Preferred )
. . . class Σ 0..1 CodeableConcept Categorization of Composition
FHIR Document Class Codes ( Example )
. . . title Σ 1..1 string Human Readable name/title
. . . status ?! Σ 1..1 code preliminary | final | amended | entered-in-error
CompositionStatus ( Required )
. . . confidentiality ?! Σ 0..1 code As defined by affinity domain
ConfidentialityClassification ( Required )
. . . subject Σ 1..1 Reference ( Any ) Who and/or what the composition is about
. . . author Σ 1..* Reference ( Practitioner | Device | Patient | RelatedPerson ) Who and/or what authored the composition
. . . attester Σ 0..* BackboneElement Attests to accuracy of composition
. . . . mode Σ 1..* code personal | professional | legal | official
CompositionAttestationMode ( Required )
. . . . time Σ 0..1 dateTime When composition attested
. . . . party Σ 0..1 Reference ( Patient | Practitioner | Organization ) Who attested the composition
. . . custodian Σ 0..1 Reference ( Organization ) Organization which maintains the composition
. . . event Σ 0..* BackboneElement The clinical service(s) being documented
. . . . code Σ 0..* CodeableConcept Code(s) that apply to the event being documented
v3 Code System ActCode ( Example )
. . . . period Σ 0..1 Period The period covered by the documentation
. . . . detail Σ 0..* Reference ( Any ) The event(s) being documented
. . . encounter Σ 0..1 Reference ( Encounter ) Context of the Composition
. . . section I 0..* BackboneElement Composition is broken into sections
A section must at least one of text, entries, or sub-sections
A section can only have an emptyReason if it is empty
. . . . title 0..1 string Label for section (e.g. for ToC)
. . . . code 0..1 CodeableConcept Classification of section (recommended)
Document Section Codes ( Example )
. . . . text I 0..1 Narrative Text summary of the section, for human interpretation
. . . . mode ?! Σ 0..1 code working | snapshot | changes
ListMode ( Required )
. . . . orderedBy 0..1 CodeableConcept Order of section entries
List Order Codes ( Preferred )
. . . . entry I 0..* Reference ( Any ) A reference to data that supports this section
. . . . emptyReason I 0..1 CodeableConcept Why the section is empty
List Empty Reasons ( Preferred )
. . . . section I 0..* see section Nested Section

doco Documentation for this format

UML Diagram ( Legend )

Composition ( DomainResource ) Logical identifier for the composition, assigned when created. This identifier stays constant as the composition is changed over time identifier : Identifier [0..1] The composition editing time, when the composition was last logically changed by the author date : dateTime [1..1] 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 type : CodeableConcept [1..1] « Type of a composition. (Strength=Preferred) FHIR Document Type ? » A 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 class : CodeableConcept [0..1] « High-level kind of a clinical document at a macro level. (Strength=Example) FHIR Document Class ?? » Official human-readable label for the composition title : string [1..1] The workflow/clinical status of this composition. The status is a marker for the clinical standing of the document (this element modifies the meaning of other elements) status : code [1..1] « The workflow/clinical status of the composition. (Strength=Required) CompositionStatus ! » The code specifying the level of confidentiality of the Composition (this element modifies the meaning of other elements) confidentiality : code [0..1] « Codes specifying the level of confidentiality of the composition. (Strength=Required) ConfidentialityClassification ! » Who 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) subject : Reference [1..1] « Any » Identifies who is responsible for the information in the composition, not necessarily who typed it in author : Reference [1..*] « Practitioner | Device | Patient | RelatedPerson » Identifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information custodian : Reference [0..1] « Organization » Describes the clinical encounter or type of care this documentation is associated with encounter : Reference [0..1] « Encounter » Attester The type of attestation the authenticator offers mode : code [1..*] « The way in which a person authenticated a composition. (Strength=Required) CompositionAttestationMode ! » When composition was attested by the party time : dateTime [0..1] Who attested the composition in the specified way party : Reference [0..1] « Patient | Practitioner | Organization » Event This 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 code : CodeableConcept [0..*] « This list of codes represents the main clinical acts being documented. (Strength=Example) v3 Code System ActCode ?? » The 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 period : Period [0..1] The description and/or reference of the event(s) being documented. For example, this could be used to document such a colonoscopy or an appendectomy detail : Reference [0..*] « Any » Section 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 title : string [0..1] A code identifying the kind of content contained within the section. This must be consistent with the section title code : CodeableConcept [0..1] « Classification of a section of a composition/document. (Strength=Example) Document Section ?? » A 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 text : Narrative [0..1] How 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 modifies the meaning of other elements) mode : code [0..1] « The processing mode that applies to this section. (Strength=Required) ListMode ! » Specifies the order applied to the items in the section entries orderedBy : CodeableConcept [0..1] « What order applies to the items in the entry. (Strength=Preferred) List Order ? » A reference to the actual resource from which the narrative in the section is derived entry : Reference [0..*] « Any » If the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason emptyReason : CodeableConcept [0..1] « If a section is empty, why it is empty. (Strength=Preferred) List Empty Reasons ? » A participant who has attested to the accuracy of the composition/document attester [0..*] The clinical service, such as a colonoscopy or an appendectomy, being documented event [0..*] A nested sub-section within this section section [0..*] The root of the sections that make up the composition section [0..*]

XML Template 

<Composition xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..1 Identifier Logical identifier of composition (version-independent) --></identifier>
 <date value="[dateTime]"/><!-- 1..1 Composition editing time -->
 <type><!-- 1..1 CodeableConcept Kind of composition (LOINC if possible) --></type>
 <class><!-- 0..1 CodeableConcept Categorization of Composition --></class>
 <title value="[string]"/><!-- 1..1 Human Readable name/title -->
 <status value="[code]"/><!-- 1..1 preliminary | final | amended | entered-in-error -->
 <confidentiality value="[code]"/><!-- 0..1 As defined by affinity domain -->
 <subject><!-- 1..1 Reference(Any) Who and/or what the composition is about --></subject>
 <author><!-- 1..* Reference(Practitioner|Device|Patient|RelatedPerson) Who and/or what authored the composition --></author>
 <attester>  <!-- 0..* Attests to accuracy of composition -->
  <mode value="[code]"/><!-- 1..* personal | professional | legal | official -->
  <time value="[dateTime]"/><!-- 0..1 When composition attested -->
  <party><!-- 0..1 Reference(Patient|Practitioner|Organization) Who attested the composition --></party>
 </attester>
 <custodian><!-- 0..1 Reference(Organization) Organization which maintains the composition --></custodian>
 <event>  <!-- 0..* The clinical service(s) being documented -->
  <code><!-- 0..* CodeableConcept Code(s) that apply to the event being documented --></code>
  <period><!-- 0..1 Period The period covered by the documentation --></period>
  <detail><!-- 0..* Reference(Any) The event(s) being documented --></detail>
 </event>
 <encounter><!-- 0..1 Reference(Encounter) Context of the Composition --></encounter>
 <section>  <!-- 0..* Composition is broken into sections -->
  <title value="[string]"/><!-- 0..1 Label for section (e.g. for ToC) -->
  <code><!-- 0..1 CodeableConcept Classification of section (recommended) --></code>
  <text><!-- ?? 0..1 Narrative Text summary of the section, for human interpretation --></text>
  <mode value="[code]"/><!-- 0..1 working | snapshot | changes -->
  <orderedBy><!-- 0..1 CodeableConcept Order of section entries --></orderedBy>
  <entry><!-- ?? 0..* Reference(Any) A reference to data that supports this section --></entry>
  <emptyReason><!-- ?? 0..1 CodeableConcept Why the section is empty --></emptyReason>
  <section><!-- ?? 0..* Content as for Composition.section Nested Section --></section>
 </section>
</Composition>

JSON Template 

{doco
  "resourceType" : "Composition",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : { Identifier }, // Logical identifier of composition (version-independent)
  "date" : "<dateTime>", // R!  Composition editing time
  "type" : { CodeableConcept }, // R!  Kind of composition (LOINC if possible)
  "class" : { CodeableConcept }, // Categorization of Composition
  "title" : "<string>", // R!  Human Readable name/title
  "status" : "<code>", // R!  preliminary | final | amended | entered-in-error
  "confidentiality" : "<code>", // As defined by affinity domain
  "subject" : { Reference(Any) }, // R!  Who and/or what the composition is about
  "author" : [{ Reference(Practitioner|Device|Patient|RelatedPerson) }], // R!  Who and/or what authored the composition
  "attester" : [{ // Attests to accuracy of composition
    "mode" : ["<code>"], // R!  personal | professional | legal | official
    "time" : "<dateTime>", // When composition attested
    "party" : { Reference(Patient|Practitioner|Organization) } // Who attested the composition
  }],
  "custodian" : { Reference(Organization) }, // Organization which maintains the composition
  "event" : [{ // The clinical service(s) being documented
    "code" : [{ CodeableConcept }], // Code(s) that apply to the event being documented
    "period" : { Period }, // The period covered by the documentation
    "detail" : [{ Reference(Any) }] // The event(s) being documented
  }],
  "encounter" : { Reference(Encounter) }, // Context of the Composition
  "section" : [{ // Composition is broken into sections
    "title" : "<string>", // Label for section (e.g. for ToC)
    "code" : { CodeableConcept }, // Classification of section (recommended)
    "text" : { Narrative }, // C? Text summary of the section, for human interpretation
    "mode" : "<code>", // working | snapshot | changes
    "orderedBy" : { CodeableConcept }, // Order of section entries
    "entry" : [{ Reference(Any) }], // C? A reference to data that supports this section
    "emptyReason" : { CodeableConcept }, // C? Why the section is empty
    "section" : [{ Content as for Composition.section }] // C? Nested Section
  }]
}

Turtle Template 

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


[ a fhir:Composition;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Composition.identifier [ Identifier ]; # 0..1 Logical identifier of composition (version-independent)
  fhir:Composition.date [ dateTime ]; # 1..1 Composition editing time
  fhir:Composition.type [ CodeableConcept ]; # 1..1 Kind of composition (LOINC if possible)
  fhir:Composition.class [ CodeableConcept ]; # 0..1 Categorization of Composition
  fhir:Composition.title [ string ]; # 1..1 Human Readable name/title
  fhir:Composition.status [ code ]; # 1..1 preliminary | final | amended | entered-in-error
  fhir:Composition.confidentiality [ code ]; # 0..1 As defined by affinity domain
  fhir:Composition.subject [ Reference(Any) ]; # 1..1 Who and/or what the composition is about
  fhir:Composition.author [ Reference(Practitioner|Device|Patient|RelatedPerson) ], ... ; # 1..* Who and/or what authored the composition
  fhir:Composition.attester [ # 0..* Attests to accuracy of composition
    fhir:Composition.attester.mode [ code ], ... ; # 1..* personal | professional | legal | official
    fhir:Composition.attester.time [ dateTime ]; # 0..1 When composition attested
    fhir:Composition.attester.party [ Reference(Patient|Practitioner|Organization) ]; # 0..1 Who attested the composition
  ], ...;
  fhir:Composition.custodian [ Reference(Organization) ]; # 0..1 Organization which maintains the composition
  fhir:Composition.event [ # 0..* The clinical service(s) being documented
    fhir:Composition.event.code [ CodeableConcept ], ... ; # 0..* Code(s) that apply to the event being documented
    fhir:Composition.event.period [ Period ]; # 0..1 The period covered by the documentation
    fhir:Composition.event.detail [ Reference(Any) ], ... ; # 0..* The event(s) being documented
  ], ...;
  fhir:Composition.encounter [ Reference(Encounter) ]; # 0..1 Context of the Composition
  fhir:Composition.section [ # 0..* Composition is broken into sections
    fhir:Composition.section.title [ string ]; # 0..1 Label for section (e.g. for ToC)
    fhir:Composition.section.code [ CodeableConcept ]; # 0..1 Classification of section (recommended)
    fhir:Composition.section.text [ Narrative ]; # 0..1 Text summary of the section, for human interpretation
    fhir:Composition.section.mode [ code ]; # 0..1 working | snapshot | changes
    fhir:Composition.section.orderedBy [ CodeableConcept ]; # 0..1 Order of section entries
    fhir:Composition.section.entry [ Reference(Any) ], ... ; # 0..* A reference to data that supports this section
    fhir:Composition.section.emptyReason [ CodeableConcept ]; # 0..1 Why the section is empty
    fhir:Composition.section.section [ See Composition.section ], ... ; # 0..* Nested Section
  ], ...;
]

Changes since DSTU2

Composition
Composition.confidentiality Change value set from http://hl7.org/fhir/ValueSet/v3-Confidentiality to http://hl7.org/fhir/ValueSet/v3-ConfidentialityClassification

See the Full Difference for further information

 

Alternate definitions: Master Definition ( XML , JSON ), XML Schema / Schematron (for ) + JSON Schema , ShEx (for Turtle ), JSON-LD (for RDF as JSON-LD ),

2.37.4.1 Terminology Bindings

Path Definition Type Reference
Composition.type Type of a composition. Preferred FHIR Document Type Codes
Composition.class High-level kind of a clinical document at a macro level. Example FHIR Document Class Codes
Composition.status The workflow/clinical status of the composition. Required CompositionStatus
Composition.confidentiality Codes specifying the level of confidentiality of the composition. Required ConfidentialityClassification
Composition.attester.mode The way in which a person authenticated a composition. Required CompositionAttestationMode
Composition.event.code This list of codes represents the main clinical acts being documented. Example v3 Code System ActCode
Composition.section.code Classification of a section of a composition/document. Example Document Section Codes
Composition.section.mode The processing mode that applies to this section. Required ListMode
Composition.section.orderedBy What order applies to the items in the entry. Preferred List Order Codes
Composition.section.emptyReason If a section is empty, why it is empty. Preferred List Empty Reasons

2.37.4.2 Constraints

  • cmp-1 : On Composition.section: A section must at least one of text, entries, or sub-sections ( expression on Composition.section: text.exists() or entry.exists() or section.exists() )
  • cmp-2 : On Composition.section: A section can only have an emptyReason if it is empty ( expression on Composition.section: emptyReason.empty() or entry.empty() )

2.37.5 Notes:

  • The author and the attester are often the same person, but this may not be the case in some clinical workflows.
  • The attester attests contents of the document resource, the subject resource and the resources referred to in the Composition.section.content references. Because documents are often derived Compositions and the attestation from the composition is held to apply to the document, the method for presenting a document should be used when/if attesters review the content of the composition.
  • The custodian is responsible for the maintenance of the composition and any documents derived from it. With regard to the documents, they are responsible for the policy regarding persistence of the documents. Although they need not actually retain a copy of the document, they SHOULD do so.

STU Note: Feedback is welcome on two issues related to 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 during the trial use period.
  • A client can ask a server to generate a fully bundled document from a Composition resource using the $generate operation. This operation definition does not resolve the question how document signatures are created. This is an open issue during the period of trial use, and feedback is requested regarding this question.

Feedback here .

2.37.6 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Paths In Common
attester reference Who attested the composition Composition.attester.party
( Practitioner , Organization , Patient )
author reference Who and/or what authored the composition Composition.author
( Practitioner , Device , Patient , RelatedPerson )
class token Categorization of Composition Composition.class
confidentiality token As defined by affinity domain Composition.confidentiality
context token Code(s) that apply to the event being documented Composition.event.code
date date Composition editing time Composition.date 18 Resources
encounter reference Context of the Composition Composition.encounter
( Encounter ) 		12 Resources
entry reference A reference to data that supports this section Composition.section.entry
(Any)
identifier token Logical identifier of composition (version-independent) Composition.identifier 26 Resources
patient reference Who and/or what the composition is about Composition.subject
( Patient ) 		31 Resources
period date The period covered by the documentation Composition.event.period
section token Classification of section (recommended) Composition.section.code
status token preliminary | final | amended | entered-in-error Composition.status
subject reference Who and/or what the composition is about Composition.subject
(Any)
title string Human Readable name/title Composition.title
type token Kind of composition (LOINC if possible) Composition.type 6 Resources