Release 4 Snapshot 3: Connectathon 32 Base

This page is part of the Snapshot #3 for FHIR Specification (v4.0.1: R4 - Mixed Normative and STU ) in it's permanent home (it will always be available at this URL). The current version which supercedes this version is 5.0.0 R5 , released to support Connectathon 32 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

7.17.4 Clinical Document Architecture (CDA) on FHIR

Example StructureDefinition/elementdefinition-minValueSet (JSON)

Structured Documents
FHIR Infrastructure Work Group Maturity Level : N/A Standards Status : Informative
7.17.4.1 What is CDA on FHIR?

Raw JSON 7.17.4.1 ( canonical form Major Components of a CDA on FHIR Document + also see JSON Format Specification )

This section serves as a high-level introduction to the major components of a CDA document, all of which are described again and in greater detail later on. The intent here is to familiarize the reader with the high-level concepts to facilitate an understanding of the sections that follow. [EDITORS: in CDA r2 there is a bunch of detail about how CDA is wrapped - and an example. Consider whether the discussion is relevant here: "A CDA document is wrapped by the <ClinicalDocument> element, and contains a header..."] minValueSet

7.17.4.2 Human Readability and Rendering CDA Documents
{
  "resourceType" : "StructureDefinition",
  "id" : "elementdefinition-minValueSet",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "fhir"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 1
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use"
  }],
  "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-minValueSet",
  "version" : "5.0.0-snapshot3",
  "name" : "minValueSet",
  "status" : "draft",
  "experimental" : false,
  "date" : "2015-02-28",
  "publisher" : "Health Level Seven, Inc. - FHIR Core WG",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "http://hl7.org/special/committees/FHIR"
    }]
  }],
  "description" : "The minimum allowable value set, for use when the binding strength is 'required' or 'extensible'. This value set is the minimum value set that any conformant system SHALL support.",
  "fhirVersion" : "5.0.0-snapshot3",
  "mapping" : [{
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  }],
  "kind" : "complex-type",
  "abstract" : false,
  "context" : [{
    "type" : "element",
    "expression" : "ElementDefinition.binding"
  }],
  "type" : "Extension",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Extension",
  "derivation" : "constraint",
  "snapshot" : {
    "element" : [{
      "id" : "Extension",
      "path" : "Extension",
      "short" : "Minimum Value Set (what system must support)",
      "definition" : "The minimum allowable value set, for use when the binding strength is 'required' or 'extensible'. This value set is the minimum value set that any conformant system SHALL support.",
      "comment" : "Generally, the context of use of this extension should be specific about what it means to 'support' the value set.",
      "min" : 0,
      "max" : "1",
      "base" : {
        "path" : "Extension",
        "min" : 0,
        "max" : "*"
      },
      "constraint" : [{
        "key" : "ele-1",
        "severity" : "error",
        "human" : "All FHIR elements must have a @value or children",
        "expression" : "hasValue() or (children().count() > id.count())",
        "source" : "http://hl7.org/fhir/StructureDefinition/Element"
      },
      {
        "key" : "ext-1",
        "severity" : "error",
        "human" : "Must have either extensions or value[x], not both",
        "expression" : "extension.exists() != value.exists()",
        "source" : "http://hl7.org/fhir/StructureDefinition/Extension"
      }],
      "isModifier" : false,
      "mapping" : [{
        "identity" : "rim",
        "map" : "N/A (MIF territory)"
      }]
    },
    {
      "id" : "Extension.id",
      "path" : "Extension.id",
      "representation" : ["xmlAttr"],
      "short" : "Unique id for inter-element referencing",
      "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "min" : 0,
      "max" : "1",
      "base" : {
        "path" : "Element.id",
        "min" : 0,
        "max" : "1"
      },
      "type" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
          "valueUrl" : "id"
        }],
        "code" : "http://hl7.org/fhirpath/System.String"
      }],
      "isModifier" : false,
      "isSummary" : false,
      "mapping" : [{
        "identity" : "rim",
        "map" : "n/a"
      }]
    },
    {
      "id" : "Extension.extension",
      "path" : "Extension.extension",
      "slicing" : {
        "discriminator" : [{
          "type" : "value",
          "path" : "url"
        }],
        "description" : "Extensions are always sliced by (at least) url",
        "rules" : "open"
      },
      "short" : "Extension",
      "definition" : "An Extension",
      "min" : 0,
      "max" : "0",
      "base" : {
        "path" : "Element.extension",
        "min" : 0,
        "max" : "*"
      },
      "type" : [{
        "code" : "Extension"
      }],
      "constraint" : [{
        "key" : "ele-1",
        "severity" : "error",
        "human" : "All FHIR elements must have a @value or children",
        "expression" : "hasValue() or (children().count() > id.count())",
        "source" : "http://hl7.org/fhir/StructureDefinition/Element"
      },
      {
        "key" : "ext-1",
        "severity" : "error",
        "human" : "Must have either extensions or value[x], not both",
        "expression" : "extension.exists() != value.exists()",
        "source" : "http://hl7.org/fhir/StructureDefinition/Extension"
      }],
      "isModifier" : false,
      "isSummary" : false
    },
    {
      "id" : "Extension.url",
      "path" : "Extension.url",
      "representation" : ["xmlAttr"],
      "short" : "identifies the meaning of the extension",
      "definition" : "Source of the definition for the extension code - a logical name or a URL.",
      "comment" : "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
      "min" : 1,
      "max" : "1",
      "base" : {
        "path" : "Extension.url",
        "min" : 1,
        "max" : "1"
      },
      "type" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
          "valueUrl" : "uri"
        }],
        "code" : "http://hl7.org/fhirpath/System.String"
      }],
      "fixedUri" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-minValueSet",
      "isModifier" : false,
      "isSummary" : false,
      "mapping" : [{
        "identity" : "rim",
        "map" : "N/A"
      }]
    },
    {
      "id" : "Extension.value[x]",
      "path" : "Extension.value[x]",
      "short" : "Value of extension",
      "definition" : "Value of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).",
      "min" : 1,
      "max" : "1",
      "base" : {
        "path" : "Extension.value[x]",
        "min" : 0,
        "max" : "1"
      },
      "type" : [{
        "code" : "uri"
      },
      {
        "code" : "canonical",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/ValueSet"]
      }],
      "constraint" : [{
        "key" : "ele-1",
        "severity" : "error",
        "human" : "All FHIR elements must have a @value or children",
        "expression" : "hasValue() or (children().count() > id.count())",
        "source" : "http://hl7.org/fhir/StructureDefinition/Element"
      }],
      "isModifier" : false,
      "isSummary" : false,
      "mapping" : [{
        "identity" : "rim",
        "map" : "N/A"
      }]
    }]
  },
  "differential" : {
    "element" : [{
      "id" : "Extension",
      "path" : "Extension",
      "short" : "Minimum Value Set (what system must support)",
      "definition" : "The minimum allowable value set, for use when the binding strength is 'required' or 'extensible'. This value set is the minimum value set that any conformant system SHALL support.",
      "comment" : "Generally, the context of use of this extension should be specific about what it means to 'support' the value set.",
      "min" : 0,
      "max" : "1",
      "mapping" : [{
        "identity" : "rim",
        "map" : "N/A (MIF territory)"
      }]
    },
    {
      "id" : "Extension.extension",
      "path" : "Extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.url",
      "path" : "Extension.url",
      "fixedUri" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-minValueSet"
    },
    {
      "id" : "Extension.value[x]",
      "path" : "Extension.value[x]",
      "min" : 1,
      "type" : [{
        "code" : "uri"
      },
      {
        "code" : "canonical",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/ValueSet"]
      }]
    }]
  }
}

The CDA requirement for human readability guarantees that a receiver of a CDA document can algorithmically display the clinical content of the note on a standard Web browser. There must be a deterministic way for a recipient of an arbitrary CDA document to render the attested content. Human readability shall not require a sender to transmit a special style sheet along with a CDA document. It must be possible to render all CDA documents with a single style sheet and general-market display tools. Human readability applies Usage note: every effort has been made to the authenticated content. There may be additional information conveyed in the document that is there primarily for machine processing ensure that is not authenticated the examples are correct and need useful, but they are not be rendered. When structured content is derived from narrative, there must be a mechanism to describe the process (e.g. by author, by human coder, by natural language processing algorithm, by specific software) by which machine-processable portions were derived from a block normative part of narrative. When narrative is derived from structured content, there must be a mechanism to identify the process by which narrative was generated from structured data. These principles and requirements have led to the current approach, where the material to be rendered is placed into the Section.content. [EDITORS: The current design doesn't make it clear where to consistently find narrative.] specification.