5.21 Resource Communication - Content

5.21.1 Scope and Usage

These resources have not yet undergone proper review by PC, CQI, CDS, and OO. At this time, they are to be considered only as draft resource proposals for potential submission for DSTU2. This resource is a record of a communication. A communication is a conveyance of information from one entity, a sender, to another entity, a receiver. The sender and receivers may be patients, practitioners, related persons, organizations, and or devices. Communication use cases include include:

• A reminder or alert delivered to a responsible provider
• A recorded notification from the nurse that a patient's temperature exceeds a value
• A notification to a public health agency of a patient presenting with a communicable disease reportable to the public health agency
• Patient educational material sent by a provider to a patient

Non-patient specific communication use cases may include:

• A nurse call from a hall bathroom
• Advisory for battery service from a pump

5.21.2 Boundaries and Relationships

This resource is a record of a communication that has occurred. It does not represent the actual flow of communication. The resource excludes While AuditEvent can track electronic disclosures of information, it cannot track conversations, phone calls, letters and other interactions that are not system-to-system. And even for system-to-system communications, the types specific end recipients may not be known. As well, AuditEvents are not considered to be "part" of communications supported by the Alert patient record, while Communication instances are. The Communication resource (need is not used as a general audit mechanism to better describe this overlap). It excludes the type track every disclosure of every record. Rather, it is used when a clinician or other user wants to ensure a record of a particular communication is itself maintained as part of the reviewable health record.

Flag resources represent a continuous ongoing "communication" alerting anyone dealing with the patient of certain precautions to take or issues to be aware of. The flags are continuously present as an ongoing reminder. This is distinct from Communication where two systems there is a specific intended sender and receiver and the information is delivered only once.

Communication and Encounter

The Communication is about the transfer of information (which may or may not occur as part of an encounter), while Encounter is about the coming together (in person or virtually) of a Patient with a Practitioner. Communication does not deal with the duration of a call, it represents the fact that information was transferred at a particular point in time.

The phone calls involving the Patient should be handled using Encounter . Phone calls not involving the patient (e.g. between practitioners or practitioner to relative) that are exchanging data. tracked for billing or other purposes can use Communication to represent the information transferred, but are not ideal to represent the call itself. A better mechanism for handling such calls will be explored in a future release.

• Structure
• UML
• XML
• JSON
• All

Structure

Communication medium

Name	Flags	Card.	Type	Description & Constraints
Communication	Σ		DomainResource	A record of information transmitted from a sender to a receiver
identifier	Σ	0..*	Identifier	Unique identifier
category	Σ	0..1	CodeableConcept	Message category
sender	Σ	0..1	Reference ( Device | Organization | Patient | Practitioner | Device | RelatedPerson | Organization )	Message sender
recipient	Σ	0..*	Reference ( Device | Organization | Patient | Device Practitioner | RelatedPerson | Practitioner Group )	Message recipient
payload	Σ	0..*	Element BackboneElement	Message payload
content[x]	Σ	1..1		Message part content
contentString	1..1		string
contentAttachment	1..1		Attachment
contentReference	1..1		Reference ( Any )
medium	Σ	0..*	CodeableConcept	A channel of communication v3 Code System ParticipationMode ( Example )
status	?! Σ	0..1	code	in-progress | completed | suspended | rejected | failed CommunicationStatus ( Required )
encounter	Σ	0..1	Reference ( Encounter )	Encounter leading to message
sent	Σ	0..1	dateTime	When sent
received	Σ	0..1	dateTime	When received
reason	Σ	0..*	CodeableConcept	Indication for message
subject	Σ	0..1	Reference ( Patient )	Focus of message
requestDetail	Σ	0..1	Reference ( CommunicationRequest )	CommunicationRequest producing this message
Documentation for this format

<

<Communication xmlns="http://hl7.org/fhir"> 

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <</category>
 <|
   </sender>
 <
     Message recipient</recipient>
 <
  <</content[x]>

 <identifier><!-- 0..* Identifier Unique identifier --></identifier>
 <category><!-- 0..1 CodeableConcept Message category --></category>
 <sender><!-- 0..1 Reference(Device|Organization|Patient|Practitioner|
   RelatedPerson) Message sender --></sender>

 <recipient><!-- 0..* Reference(Device|Organization|Patient|Practitioner|
   RelatedPerson|Group) Message recipient --></recipient>

 <payload>  <!-- 0..* Message payload -->
  <content[x]><!-- 1..1 string|Attachment|Reference(Any) Message part content --></content[x]>

 </payload>
 <</medium>
 <
 <</encounter>
 <
 <
 <</reason>
 <</subject>

 <medium><!-- 0..* CodeableConcept A channel of communication --></medium>
 <status value="[code]"/><!-- 0..1 in-progress | completed | suspended | rejected | failed -->
 <encounter><!-- 0..1 Reference(Encounter) Encounter leading to message --></encounter>
 <sent value="[dateTime]"/><!-- 0..1 When sent -->
 <received value="[dateTime]"/><!-- 0..1 When received -->
 <reason><!-- 0..* CodeableConcept Indication for message --></reason>
 <subject><!-- 0..1 Reference(Patient) Focus of message --></subject>
 <requestDetail><!-- 0..1 Reference(CommunicationRequest) CommunicationRequest producing this message --></requestDetail>

</Communication>

{
  "resourceType" : "",

  "resourceType" : "Communication",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "
  "|
   
  "
     Message recipient
  "

  "identifier" : [{ Identifier }], // Unique identifier
  "category" : { CodeableConcept }, // Message category
  "sender" : { Reference(Device|Organization|Patient|Practitioner|
   RelatedPerson) }, // Message sender

  "recipient" : [{ Reference(Device|Organization|Patient|Practitioner|
   RelatedPerson|Group) }], // Message recipient

  "payload" : [{ // Message payload

    // content[x]: Message part content. One of these 3:
    ">"
    " }
    " }

    "contentString" : "<string>"
    "contentAttachment" : { Attachment }
    "contentReference" : { Reference(Any) }

  }],
  "
  "
  "
  "
  "
  "
  "

  "medium" : [{ CodeableConcept }], // A channel of communication
  "status" : "<code>", // in-progress | completed | suspended | rejected | failed
  "encounter" : { Reference(Encounter) }, // Encounter leading to message
  "sent" : "<dateTime>", // When sent
  "received" : "<dateTime>", // When received
  "reason" : [{ CodeableConcept }], // Indication for message
  "subject" : { Reference(Patient) }, // Focus of message
  "requestDetail" : { Reference(CommunicationRequest) } // CommunicationRequest producing this message

}

Structure

Communication medium

Name	Flags	Card.	Type	Description & Constraints
Communication	Σ		DomainResource	A record of information transmitted from a sender to a receiver
identifier	Σ	0..*	Identifier	Unique identifier
category	Σ	0..1	CodeableConcept	Message category
sender	Σ	0..1	Reference ( Device | Organization | Patient | Practitioner | Device | RelatedPerson | Organization )	Message sender
recipient	Σ	0..*	Reference ( Device | Organization | Patient | Device Practitioner | RelatedPerson | Practitioner Group )	Message recipient
payload	Σ	0..*	Element BackboneElement	Message payload
content[x]	Σ	1..1		Message part content
contentString	1..1		string
contentAttachment	1..1		Attachment
contentReference	1..1		Reference ( Any )
medium	Σ	0..*	CodeableConcept	A channel of communication v3 Code System ParticipationMode ( Example )
status	?! Σ	0..1	code	in-progress | completed | suspended | rejected | failed CommunicationStatus ( Required )
encounter	Σ	0..1	Reference ( Encounter )	Encounter leading to message
sent	Σ	0..1	dateTime	When sent
received	Σ	0..1	dateTime	When received
reason	Σ	0..*	CodeableConcept	Indication for message
subject	Σ	0..1	Reference ( Patient )	Focus of message
requestDetail	Σ	0..1	Reference ( CommunicationRequest )	CommunicationRequest producing this message
Documentation for this format

UML Diagram

XML Template

<

<Communication xmlns="http://hl7.org/fhir"> 

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <</category>
 <|
   </sender>
 <
     Message recipient</recipient>
 <
  <</content[x]>

 <identifier><!-- 0..* Identifier Unique identifier --></identifier>
 <category><!-- 0..1 CodeableConcept Message category --></category>
 <sender><!-- 0..1 Reference(Device|Organization|Patient|Practitioner|
   RelatedPerson) Message sender --></sender>

 <recipient><!-- 0..* Reference(Device|Organization|Patient|Practitioner|
   RelatedPerson|Group) Message recipient --></recipient>

 <payload>  <!-- 0..* Message payload -->
  <content[x]><!-- 1..1 string|Attachment|Reference(Any) Message part content --></content[x]>

 </payload>
 <</medium>
 <
 <</encounter>
 <
 <
 <</reason>
 <</subject>

 <medium><!-- 0..* CodeableConcept A channel of communication --></medium>
 <status value="[code]"/><!-- 0..1 in-progress | completed | suspended | rejected | failed -->
 <encounter><!-- 0..1 Reference(Encounter) Encounter leading to message --></encounter>
 <sent value="[dateTime]"/><!-- 0..1 When sent -->
 <received value="[dateTime]"/><!-- 0..1 When received -->
 <reason><!-- 0..* CodeableConcept Indication for message --></reason>
 <subject><!-- 0..1 Reference(Patient) Focus of message --></subject>
 <requestDetail><!-- 0..1 Reference(CommunicationRequest) CommunicationRequest producing this message --></requestDetail>

</Communication>

JSON Template

{
  "resourceType" : "",

  "resourceType" : "Communication",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "
  "|
   
  "
     Message recipient
  "

  "identifier" : [{ Identifier }], // Unique identifier
  "category" : { CodeableConcept }, // Message category
  "sender" : { Reference(Device|Organization|Patient|Practitioner|
   RelatedPerson) }, // Message sender

  "recipient" : [{ Reference(Device|Organization|Patient|Practitioner|
   RelatedPerson|Group) }], // Message recipient

  "payload" : [{ // Message payload

    // content[x]: Message part content. One of these 3:
    ">"
    " }
    " }

    "contentString" : "<string>"
    "contentAttachment" : { Attachment }
    "contentReference" : { Reference(Any) }

  }],
  "
  "
  "
  "
  "
  "
  "

  "medium" : [{ CodeableConcept }], // A channel of communication
  "status" : "<code>", // in-progress | completed | suspended | rejected | failed
  "encounter" : { Reference(Encounter) }, // Encounter leading to message
  "sent" : "<dateTime>", // When sent
  "received" : "<dateTime>", // When received
  "reason" : [{ CodeableConcept }], // Indication for message
  "subject" : { Reference(Patient) }, // Focus of message
  "requestDetail" : { Reference(CommunicationRequest) } // CommunicationRequest producing this message

}