STU3
Candidate
Foundation
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
|
FHIR
Infrastructure
Work
Group
|
Maturity Level : N/A | Ballot Status : Draft |
The FHIR specification defines a set of resources, and an infrastructure for handling resources. In order to use FHIR to create solutions for integration requirements, implementers must map their problems to resources and their content.
The resources are classified into 6 sections:
This page describes the resources and their functional intent in more detail to assist implementers to understand their purpose and scope, and their supporting classifications.
Where to find common concepts in this specification:
| Concept | Example | Where to find |
| Clinical Findings | ||
| Laboratory Results | Blood panels such as CBC with Differential, Liver Panel, etc. | DiagnosticReport with Observations |
| Imaging Study Findings | CT Scans, MRI, Plain Radiographs, Ultrasounds) | DiagnosticReport (some with Observations ) |
| Diagnostic Test Results | EKG, pulmonary function test, EEG | Observations (and maybe a DiagnosticReport ) |
| Vital Signs | Temperature, Blood Pressure, Heart Rate, Respiratory Rate | Observation |
| Other Physical Exam Findings | Auscultation findings | Observation |
| Pulmonary Artery Catheter readings | Pulmonary artery pressure | Observation |
| Patient Problems, Allergies and Adverse Events | ||
| Allergy | Food or drug allergies | AllergyIntolerance |
| Clinical Diagnosis | Diabetes, Congestive Heart Failure | Condition |
| Adverse Event / Reaction | Adverse reaction to an agent, falls, adverse surgical events, hospital infections | (not done yet) |
| Patient History | ||
| Chief Complaint | Cough, Pain, Fever, Fatigue | Condition |
| Past Surgical History | Appendectomy, Hernia repair | Procedure |
| Past Medical History | Diabetes, Congestive heart failure | Condition |
| MAR (Medication Administration Record) | Warfarin 5mg PO administered on 12/10/2013 at 3pm | MedicationAdministration |
| Home Meds | Warfarin 5mg, 30 day supply, dispensed on 12/01/2013 | MedicationStatement |
| Social History | Sexual behavior, Smoking status, Alcohol intake, Illicit drug use | Observation |
| Family History | Mother has diabetes | FamilyMemberHistory |
| Signs & Symptoms | from a review of systems- Pain, Fever | Condition |
| Suggested Physician Orders | ||
| Proposal for a laboratory test | A blood panel, a stool analysis | DiagnosticRequest |
| Proposal for an imaging procedure | CT Scan, MRI, X-Rays | DiagnosticRequest |
| Proposed Diet Order | An oral diet order | NutritionRequest |
| Proposed respiratory order | Oxygen delivery | Not done yet |
| Proposed Medications | Aspirin, Lisinopril | MedicationRequest |
| Proposed Supply | Wheel Chair, Food Tray | SupplyRequest |
| Interdisciplinary Care Planning | ||
| Patient Goal | Reduce risk of falls, lose weight | Goal (as part of a CarePlan ) |
| Intervention | Patient assessments | ProcedureRequest |
In addition, to the information on this page, see also Common Use Cases .
In addition to the overall classification above, Resources and the data elements in them are tapped into an overall ontology that provides consistent meaning across the resources.
One of the most fundamental aspects of a resource is tense - where it fits into the time line. Some resources are records of past events, some are plans for the future, etc. This table summarizes the categories:
Note that even future records end up in the past after the event they are concerned with passes.
AllergyIntolerance
,
Condition
,
and
Procedure
are
common
resources
that
appear
throughout
the
patient
record
-
summaries
of
the
patient
status
or
history.
FamilyMemberHistory
tracks
significant
health
issues
for
relatives
of
the
patient,
since
these
are
significant
risk
factors
for
the
patient.
These
resources
may
be
found
in
patient,
episode,
discharge
summaries,
and
consultation
records.
ClinicalImpression
(aka
ClinicalAssessment)
records
the
core
of
a
clinical
consultation/assessment/impression.
When
a
single
text
note
is
inserted
directly
in
the
patient
record,
this
is
typically
a
ClinicalImpression.summary.
A
RiskAssessment
is
an
assessment
-
usually,
but
not
necessarily,
by
a
decision
support
engine
of
the
likely
outcomes
of
some
course
of
action
for
a
patient.
A
DetectedIssue
is
an
active
alert
that
there
is
a
clinical
issue
with/between
one
or
more
active
or
proposed
clinical
actions
for
a
patient.
One
way
it
may
be
used
is
as
part
of
an
error
message
in
response
to
an
attempted
operation.
| Resource | Category | RIM | Lifecycle |
| AllergyIntolerance | Ongoing | Act | This has a Current List |
| Condition | Ongoing | Act | This has a Current List |
| Procedure | Past | Act | Clinical Workflow |
| FamilyMemberHistory | Past | Act | |
| ClinicalImpression | Past | Act | |
| RiskAssessment | Present | Act | Clinical Workflow |
| DetectedIssue | Present | Act |
These resources support planning of care provision - care and treatment plans.
CarePlan
and
Goal
are
the
primary
structures
around
which
future
planning
for
the
patient
is
based.
These
are
used
to
define
care
and
treatement
planned
for
a
patient
in
the
future,
and
may
be
updated
and
adjusted
as
ongoing
care
is
provided.
ReferralRequest
is
the
basis
for
a
proposed/requested
transfer
of
care
from
one
clinician
to
another.
Typically,
these
are
associated
with
a
transfer
of
records,
and
a
physical
relocation
of
the
patient,
but
neither
of
these
are
required.
A
ProcedureRequest
records
a
request
for
a
procedure
to
be
carried
out.
NutritionRequest
is
a
request
to
supply
a
diet,
formula
feeding
(enteral)
or
oral
nutritional
supplement
to
a
patient
and
VisionPrescription
contains
the
details
of
visual
aids
requested
for
a
patient.
| Resource | Category | RIM | Lifecycle |
| CarePlan | Ongoing | Act | |
| Goal | Future | Act | Clinical Workflow |
| ReferralRequest | Future | Act | Clinical Workflow |
| ProcedureRequest | Future | Act | Clinical Workflow |
| NutritionRequest | Future / Ongoing | Act | |
| VisionPrescription | Future | Act |
Supports the medication and immunization processes. Some points of note:
MedicationRequest
MedicationStatement
if
records
are
unclear
Medication
resource
is
not
used.
It
is
generally
used
to
represent
information
in
formularies
and
to
describe
custom
formulations
| Resource | Category | RIM | Lifecycle |
| Medication | Unrelated | Role | |
| Medication | Medication | Act | Clinical Workflow |
| MedicationDispense | Past | Act | Clinical Workflow |
| MedicationRequest | Future | Act | Request/Order . This has a current List |
| MedicationStatement | Ongoing / Past | Act | Entity Availability Workflow . This has a Current List |
| Immunization | Past | Act | |
| ImmunizationRecommendation | Future | Act |
Resources
concerned
with
observing
the
patient,
and
the
diagnostic
service
process
built
around
this.
The
Observation
resource
is
a
widely
used
general
purpose
tool.
Typical
uses
include
recording
the
following
kinds
of
data:
and many more things beside. Note that 'everything is an observation', but implementations should not use Observation where Condition is more appropriate.
DiagnosticRequest
and
DiagnosticReport
support
the
overall
diagnostic
process.
A
DiagnosticReport
connects
the
process
of
'reporting',
linking
process
identifiers,
visual
presentations
of
a
report,
and
conclusions/interpretations
with
the
Observations.
DiagnosticRequests
capture
the
request
from
an
authorized
clinician
to
initiate
the
diagnostic
process.
Specimen
and
BodySite
are
used
to
record
the
details
of
specimen
collection
although
BodySite
can
also
be
used
with
other
resources
(e.g.
Operation
location
details
on
a
Procedure).
The
resources
ImagingManifest
and
ImagingStudy
are
provided
to
make
links
to
diagnostic
images
available
within
the
clinical
record,
where
the
actual
images
will
be
provided
by
dedicated
systems
(the
Media
resource
is
intended
for
sharing
actual
images
directly,
which
is
not
generally
suitable
for
high
resolution,
high
volume
diagnostic
images).
| Resource | Category | RIM | Lifecycle |
| Observation | Past | Act | |
| DiagnosticReport | Past | Act | Entity Availability Workflow |
| DiagnosticRequest | Future | Act | Request/Order |
| Specimen | Unrelated | Role | Entity Availability Workflow |
| BodySite | Unrelated | Role | |
| ImagingManifest | Past | Act | |
| ImagingStudy | Past | Act |
These resources provide support for identifying the various entities involved in healthcare: people, organizations, substances, devices, etc.
The
Patient
resource
represents
the
recipient
of
healthcare.
This
concept
is
not
always
referred
to
as
a
'patient'
-
other
words
such
as
client,
customer,
resident,
etc.
are
commonly
used,
but
in
this
specification,
the
recipient
of
healthcare
is
simply
known
as
the
patient.
The
patient
resource
includes
basic
demographics
and
next
of
kin
information.
The
Practitioner
resource
is
used
to
identify
and
describe
any
person
(or
even
animal)
involved
in
the
provision
of
care,
including
doctors,
nurses,
clerical
staff,
specialist
support
staff,
etc.
RelatedPerson
is
used
to
describe
individuals
who
are
related
to
the
patient
who
are
involved
in
the
healthcare
process,
beyond
merely
being
next
of
kin
-
they
may
sign
documents,
administer
medications,
be
the
source
of
information,
or
simply
provide
care
by
chance
at
an
accident.
| Resource | Category | RIM | Lifecycle |
| Patient | Unrelated | Role | Entity Availability Workflow |
| Practitioner | Unrelated | Role | |
| RelatedPerson | Unrelated | Role |
In
most
provision
of
healthcare,
some
Organization
is
responsible
and
accountable
for
the
care,
and
references
appear
throughout
the
clinical
record.
The
organization
is
a
legal
entity
that
may
operate
at
multiple
locations.
A
HealthcareService
represents
the
services
offered
by
one
or
more
organizations
at
a
single
location.
A
Group
is
used
to
describe
one
or
more
individuals
-
usually
people,
though
other
kinds
of
entities
are
allowed.
Typically,
these
are
used
with
aggregate
reporting,
though
sometimes
care
is
provided
to
a
set
of
individuals
at
once
(some
counseling
procedures,
public
health
procedures,
herds
of
cattle,
etc.).
| Resource | Category | RIM | Lifecycle |
| Organization | Unrelated | Role | |
| HealthcareService | Unrelated | Role | |
| Group | Unrelated | Entity |
Location
-
for
where
things
happen.
Locations
are
either
by
instance
(e.g.
this
particular
room
at
a
given
address
or
GPS
coordinates)
or
by
kind
(e.g.
the
back
of
some
ambulance).
The
same
applies
to
Substance
,
for
some
kind
of
material
(e.g.
chemical)
used
in
healthcare
-
it
may
refer
to
an
identified
instance
(e.g.
bottle)
or
a
kind
of
chemical.
The
Person
resource
is
used
to
track
associations
between
different
patient
records
across
the
provision
of
healthcare
(e.g.
"master
patient
indexes").
Person
resources
are
not
referred
directly
from
other
resources;
their
use
is
for
dedicated
person
registries.
| Resource | Category | RIM | Lifecycle |
| Location | Unrelated | Role | Entity Availability Workflow |
| Substance | Unrelated | Entity | |
| Person | Unrelated | Entity |
Device
is
used
to
track
non-consumable
manufactured
materials
through
the
healthcare
process.
It
includes
implants,
large
instruments,
non-medical
things
(including
software),
and
containers.
Devices
-
and
therefore
the
device
resource
-
have
many
purposes,
including
stock
control,
locating
devices,
and
tracking
implants.
DeviceComponent
and
DeviceMetric
are
used
to
report
the
status
and
characteristics
of
the
kinds
of
medical
devices
that
produce
a
stream
of
one
or
more
data
points
(
Observations
),
usually
about
a
patient.
| Resource | Category | RIM | Lifecycle |
| Device | Unrelated | Role | |
| DeviceComponent | Unrelated | Role | |
| DeviceMetric | Unrelated | Role |
ResearchStudy
is
used
to
capture
information
related
to
the
planning
and
execution
of
clinical
and
pre-clinical
studies.
It
covers
both
human
and
veterinary
studies
and
safety,
efficacy,
comparative
effectiveness
and
retrospective
trials.
ResearchSubject
capture
the
information
around
the
participation
of
a
specific
individual
(
Patient
)
in
a
specific
ResearchStudy
.
This
information
includes
their
time
of
participation,
associated
study
arm,
status
within
the
study,
etc.
| Resource | Category | RIM | Lifecycle |
| ResearchStudy | Unrelated | Act | |
| ResearchSubject | Unrelated | Role |
Encounter
tracks
an
interaction
between
a
patient
and
healthcare
provider(s).
Specifically,
this
resource
tracks
the
administrative
details
of
the
interaction,
not
the
clinical
details
(though
these
usual
link
to
it).
Aliases
for
this
include
'admission',
'consultation',
and
sometimes
'appointment'.
Encounters
may
be
nested
-
e.g.
when
the
patient
goes
to
physiotherapy
as
part
of
a
hospital
admission.
An
EpisodeofCare
is
an
association
between
a
patient
and
a
care
provider
that
may
last
over
several
encounters.
The
purpose
of
EpisodeOfCare
is
track
a
provider
(person
or
organization)
that
has
an
interest
in
the
ongoing
care
of
the
patient.
A
Communication
is
a
record
of
a
formal
communication
with
a
patient
or
another
party
with
an
interest
in
their
care
-
a
letter,
email,
phone
call
etc.
A
Flag
is
warning
maintained
in
the
system
that
alerts
care
providers
to
potential
issues
they
should
be
aware
of
when
providing
care
to
a
patient,
or
at
a
location.
| Resource | Category | RIM | Lifecycle |
| Encounter | Future / Ongoing / Past | Act | |
| EpisodeOfCare | Act | ||
| Communication | Past | Act | Clinical Workflow |
| Flag | Ongoing | Act | Entity Availability Workflow |
These resources are concerned with planning times and locations for future delivery of care:
Schedule
describes
a
set
of
times
in
the
future
that
a
service
or
individual
may
be
available
Slot
is
an
instance
of
a
time
in
a
schedule
that
may
be
reserved
Appointment
is
proposed
or
confirmed
future
event,
with
a
list
of
participants
who
may
or
may
not
have
confirmed
their
attendance
AppointmentResponse
is
an
individual's
acceptance
or
rejection
of
an
appointment
The scheduling systems is closely aligned with the iCal system so that systems may leverage web bookings while maintaining integrity with the rest of the clinical record.
| Resource | Category | RIM | Lifecycle |
| Appointment | Future | Act | |
| AppointmentResponse | Future | Act | |
| Schedule | Future | ||
| Slot | Future | Act |
Todo: these resources are all draft. Bringing them to maturity and testing their support for real-world scenarios is a major ongoing focus of the FHIR project.
| Resource | Category | RIM | Lifecycle |
| Task | Present | Act | |
| CommunicationRequest | Future | Act | Request/Order |
| DeviceUseRequest | Present | Act | Request/Order |
| DeviceUseStatement | Past | Act | |
| ProcessRequest | Present | Act | Request/Order |
| ProcessResponse | Present | Act | |
| SupplyDelivery | Present | Act | |
| SupplyRequest | Future | Act |
These resources provide generally useful functionality, and/or are referenced directly from the base FHIR framework ( RESTful API , messaging , documents ).
Questionnaire
and
QuestionnaireResponse
are
for
general
purpose
data
collection
from
a
patient
or
other
information
source.
They
represent
the
set
of
questions
to
be
answered,
and
an
individual's
responses
to
those
questions.
A
questionnaire
can
contain
any
kind
of
data,
including
the
data
represented
in
all
other
resources.
It
is
anticipated
that
the
data
will
be
processed
into
other
kinds
of
resources
for
further
usage
and
exchange.
The
Provenance
resource
is
used
to
make
statements
about
where
a
resource
came
from
-
that
is,
who,
what,
why,
when
and
where
for
its
creation.
This
may
be
used
in
assessing
the
integrity,
reliability
and
usefulness
of
a
resource
or
the
data
in
it.
Note
that
many
resources
contain
some
limited
amount
of
this
information
directly,
because
it
is
deemed
essential
to
using/finding/filtering/understanding
the
resource
directly.
Whenever
information
is
found
in
both
a
resource,
and
in
the
provenance
statements
for
the
resource,
it
is
expected
to
be
the
same.
An
AuditEvent
is
an
observation
by
a
system
that
a
record
was
altered
(created,
updated,
deleted)
or
otherwise
accessed
(queried,
transferred,
copied),
with
audit
information
about
the
event.
Typically,
the
provenance
record
is
created
before
the
resource
is
altered,
by
the
(sub)system
causing
the
change
to
the
resource,
while
the
audit
record
is
created
after
the
change
by
the
(sub)system
responsible
for
storing
it.
| Resource | Category | RIM | Lifecycle |
| Questionnaire | Past | Act | |
| QuestionnaireResponse | Past | Act | |
| Provenance | Past | Act | |
| AuditEvent | Past | Act |
In clinical practice, there are use cases for both exchanging information in a highly granular form, and for exchanging it in packages known as 'documents'. This specification provides two different kinds of support for creating and exchanging documents:
Composition
allows
for
the
construction
of
a
detailed
document
package
using
other
resources
for
all
content
of
the
document
DocumentReference
and
DocumentManifest
are
used
for
referring
to
and/or
exchanging
external
documents
(
CDA
,
PDF,
other
kinds
of
records,
etc.)
either
as
single
documents
or
groups
of
documents
respectively
The
List
resource
is
used
to
link
a
set
of
other
kinds
of
resources
into
a
single
list.
This
might
be
done
for
many
reasons
-
maintaining
a
list
of
work
to
do,
of
patients
of
interest,
or
of
a
set
of
current
problems
for
a
patient.
| Resource | Category | RIM | Lifecycle |
| Composition | Unrelated | Unrelated | |
| DocumentManifest | Unrelated | Document | Entity Availability Workflow |
| DocumentReference | Document | Entity Availability Workflow | |
| List | Unrelated | Act |
Basic support structure Resources with general usefulness:
Media
stores
an
image,
video,
or
sound
recording,
with
metadata
that
can
be
used
to
link
it
into
the
rest
of
the
healthcare
record
as
represented
in
resources
Binary
is
a
container
for
content
of
any
type,
to
include
content
that
is
in
some
format
other
than
a
FHIR
resource
Bundle
acts
as
an
envelope
for
a
set
of
other
resources
as
they
are
gathered
together
for
exchange.
Bundles
may
be
long
lived
(documents)
or
very
short
lived
(search
results)
Basic
is
a
general
container
that
can
be
used
to
represent
data
for
which
a
specific
resource
doesn't
yet
exist
(general
extension
point)
| Resource | Category | RIM | Lifecycle |
| Media | Past | Act | |
| Binary | Unrelated | Entity | |
| Bundle | Unrelated | Entity | |
| Basic | Unrelated | InfrastructureRoot |
These resources support the exchange process directly:
MessageHeader
is
the
header
for
a
message
-
identifies
its
context,
sender
and
receiver,
and
content
OperationOutcome
is
returned
to
indicate
the
detailed
outcome
of
a
particular
FHIR
operation
or
interaction
-
success,
or
failure
Parameters
is
input
or
output
to
Operations
Subscription
allows
one
system
to
subscribe
to
events
on
another
system
| Resource | Category | RIM | Lifecycle |
| MessageHeader | Present | Act | |
| OperationOutcome | Present | Act | |
| Parameters | Present | InfrastructureRoot | |
| Subscription | Present | Act |
This specification is a base platform specification that defines a set of general capabilities. Specific systems build on top of that to create interoperable solutions by making a set of conformance rules . These conformance rules are supported by a this set of "conformance" resources.
A
ValueSet
defines
a
set
of
codes
from
one
or
more
code
systems
that
are
used
for
validation,
lookup
etc.
A
ConceptMap
maps
value
sets
between
different
code
systems.
A
NamingSystem
resource
represents
an
external
provider
of
codes
or
identifiers
(e.g.
an
external
code
system
such
as
SNOMED
CT,
or
an
identification
system
such
as
an
institution
MRN).
The
naming
system
resource
exists
to
share
the
identification
and
registration
of
these
systems,
to
foster
consistency
in
their
identification.
| Resource | Category | RIM | Lifecycle |
| ValueSet | Unrelated | ||
| ConceptMap | Unrelated | ||
| NamingSystem | Unrelated |
StructureDefinition
and
DataElement
both
describe
a
set
of
data
elements
that
can
represent
data
for
the
purposes
of
collection,
analysis
and
exchange.
They
have
slightly
different
purposes:
StructureMap
supports
a
general
purpose
mapping
language
that
can
be
used
to
transfer
data
from
one
structure
to
another.
| Resource | Category | RIM | Lifecycle |
| StructureDefinition | Unrelated | ||
| StructureMap | Unrelated | Unrelated | |
| DataElement | Unrelated | Entity |
A
CapabilityStatement
is
a
statement
of
a
set
of
system
capabilities
for
use
as
system
discovery,
or
conformance
expectations.
An
OperationDefinition
describes
an
operation
that
can
be
executed
on
a
server,
and
a
SearchParameter
defines
a
search
parameter
that
can
be
used
on
a
server.
CompartmentDefinition
provides
information
about
how
resources
are
associated
on
a
server.
MessageDefintion
describes
the
behavior
associated
with
receiving
a
particular
message.
| Resource | Category | RIM | Lifecycle |
| CapabilityStatement | Unrelated | ||
| OperationDefinition | Unrelated | ||
| SearchParameter | Unrelated | ||
| CompartmentDefinition | Unrelated |
ImplementationGuide
is
used
to
gather
all
the
other
resources
into
a
single
package
for
publication,
and
also
to
define
the
bounds
of
an
interoperability
solution.
A
TestScript
specifies
a
series
of
operations
and
outcomes
that
a
system
is
expected
to
meet.
TestScripts
are
for
development
and
acceptance
testing,
but
may
also
be
considered
for
use
with
production
systems,
if
the
tests
are
carefully
constructed
and
vetted.
A
TestReport
contains
the
test
execution
results
of
a
TestScript
against
a
series
of
operations
and
outcomes
that
a
system
is
expected
to
meet.
TestReports
provide
a
static
recording
of
TestScript
results
for
subsequent
retrieval
and
review..
| Resource | Category | RIM | Lifecycle |
| ImplementationGuide | Unrelated | ||
| TestScript | Unrelated | ||
| TestReport | Unrelated |
These resources are all in draft status and more details will be provided here in due course.
| Resource | Category | RIM | Lifecycle |
| Coverage | Ongoing | Act | |
| EligibilityRequest | Present | Act | |
| EligibilityResponse | Present | Act | |
| EnrollmentRequest | Present | Act | |
| EnrollmentResponse | Present | Act | |
| Claim | Present | Act | |
| ClaimResponse | Present | Act | |
| PaymentNotice | Past | Act | |
| PaymentReconciliation | Past | Act | |
| ExplanationOfBenefit | Past | Act |
©
HL7.org
2011+.
FHIR
STU3
Candidate
(v1.8.0-10521)
generated
on
Tue,
Dec
6,
2016
12:27+1100.
QA
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Links:
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