Release 4 5

This page is part of the FHIR Specification (v4.0.1: R4 (v5.0.0: R5 - Mixed Normative and STU ) ). This is the current published version in it's permanent home (it will always be available at this URL). 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

8.20 8.22 Resource Communication - Content

Patient Care icon Work Group Maturity Level : 2   Trial Use Security Category : Patient Compartments : Device , Encounter , Patient , Practitioner , RelatedPerson

An occurrence A clinical or business level record of information being transmitted; transmitted or shared; e.g. an alert that was sent to a responsible provider, a public health agency that was notified about communication to a provider/reporter in response to a case report for a reportable condition.

8.20.1 8.22.1 Scope and Usage

The purpose of a Communication resource is to surface that data was shared to track adherence to guidelines or protocols or to provide business documentation of actions taken. Communication can also be used as part of an information exchange to provide context about the information sharing occurring. Please see below for guidance on when this is appropriate.

Communication is one of the event resources in the FHIR workflow specification.

This resource is a record of a communication even if it is planned or has failed. A communication is a record of the conveyance of information from one entity, a sender, to another entity, a receiver. The sender and receivers may be patients, practitioners, related persons, organizations, or devices. Communication use cases include:

  • A reminder or alert delivered to a responsible provider
  • A recorded notification from the nurse to the on-call physician (or any other specified person) that a patient's temperature exceeds a value
  • A notification to response from a public health agency of to a provider caring for a patient presenting with a communicable disease reportable to the public health agency
  • Patient educational material sent by a provider to a patient
  • Unable to deliver lab results to ordering physician
  • Submission of supplementary health information to a payer in support of a claim

Non-patient specific communication use cases may include:

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

8.20.2 8.22.2 Boundaries and Relationships

This resource is a record of a communication that has occurred. It does not represent the actual flow of communication. 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 specific end recipients might not be known. Furthermore, AuditEvents are not considered to be "part" of the patient record, while Communication instances are. The Communication resource is not used as a general audit mechanism to 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 there is a specific intended sender and receiver and the information is delivered only once.

When there is a need to organize clinical and administrative content into sections, the Composition resource should be used instead. For example, an initial case report to a public health agency may include organized sections for vital signs, immunizations, social history, etc.

Communication and Encounter

The Communication is about the transfer of information (which might or might 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 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.

This resource is referenced by

8.22.3 References to this Resource

8.20.3 8.22.4 Resource Content

Structure

Name Flags Card. Type Description & Constraints doco
. . Communication TU DomainResource A clinical or business level record of information being transmitted from a sender to a receiver or shared

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Unique identifier

. . . instantiatesCanonical Σ 0..* canonical ( PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire ) Instantiates FHIR protocol or definition

. . . instantiatesUri Σ 0..* uri Instantiates external protocol or definition

. . . partOf Σ 0..* Reference ( Any ) Part of this action referenced event (e.g. Communication, Procedure)

. . . inResponseTo 0..* Reference ( Communication ) Reply to

. . . status ?! Σ 1..1 code preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
Binding: EventStatus ( Required )
. . . statusReason Σ 0..1 CodeableConcept Reason for current status
CommunicationNotDoneReason Binding: Communication Not Done Reason ( Example )
. . . category 0..* CodeableConcept Message category
CommunicationCategory Binding: Communication Category ( Example )

. . . priority Σ 0..1 code routine | urgent | asap | stat
Request priority Binding: RequestPriority ( Required )
. . . medium 0..* CodeableConcept A channel of communication
v3 Code System Binding: ParticipationMode icon ( Example )

. . . subject Σ 0..1 Reference ( Patient | Group ) Focus of message
. . . topic 0..1 CodeableConcept Description of the purpose/content
CommunicationTopic Binding: Communication Topic ( Example )
. . . about 0..* Reference ( Any ) Resources that pertain to this communication

. . . encounter Σ 0..1 Reference ( Encounter ) The Encounter during which this Communication was created as part of
. . . sent 0..1 dateTime When sent
. . . received 0..1 dateTime When received
. . . recipient 0..* Reference ( CareTeam | Device | Group | HealthcareService | Location | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Group | CareTeam | HealthcareService Endpoint ) Message recipient Who the information is shared with

. . . sender 0..1 Reference ( Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService | Endpoint | CareTeam ) Message sender Who shares the information
. . reasonCode . reason Σ 0..* CodeableConcept CodeableReference ( Any ) Indication for message
Binding: SNOMED CT Clinical Findings ( Example )
reasonReference Σ 0..* Reference ( Condition | Observation | DiagnosticReport | DocumentReference ) Why was communication done?
. . . payload 0..* BackboneElement Message payload

. . . . content[x] 1..1 Message part content
. . . . contentString . contentAttachment string Attachment
. . . . contentAttachment . contentReference Attachment Reference ( Any )
. . . . contentReference . contentCodeableConcept Reference ( Any CodeableConcept )
. . . note 0..* Annotation Comments made about the communication


doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

Communication ( DomainResource ) Business identifiers assigned to this communication by the performer or other systems which remain constant as the resource is updated and propagates from server to server identifier : Identifier [0..*] The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication instantiatesCanonical : canonical [0..*] « PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire » The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication instantiatesUri : uri [0..*] An order, proposal or plan fulfilled in whole or in part by this Communication basedOn : Reference [0..*] « Any » Part A larger event (e.g. Communication, Procedure) of which this action particular communication is a component or step partOf : Reference [0..*] « Any » Prior communication that this communication is in response to inResponseTo : Reference [0..*] « Communication » The status of the transmission (this element modifies the meaning of other elements) status : code [1..1] « The status of the communication. null (Strength=Required) EventStatus ! » Captures the reason for the current state of the Communication statusReason : CodeableConcept [0..1] « Codes for the reason why a communication did not happen. null (Strength=Example) CommunicationNotDoneReason ?? » The type of message conveyed such as alert, notification, reminder, instruction, etc category : CodeableConcept [0..*] « Codes for general categories of communications such as alerts, instructions, etc. null (Strength=Example) CommunicationCategory ?? » Characterizes how quickly the planned or in progress communication must be addressed. Includes concepts such as stat, urgent, routine priority : code [0..1] « Codes indicating the relative importance of a communication. null (Strength=Required) RequestPriority ! » A channel that was used for this communication (e.g. email, fax) medium : CodeableConcept [0..*] « Codes for communication mediums such as phone, fax, email, in person, etc. null (Strength=Example) v3.ParticipationMode ParticipationMode ?? » The patient or group that was the focus of this communication subject : Reference [0..1] « Patient | Group » Description of the purpose/content, similar to a subject line in an email topic : CodeableConcept [0..1] « Codes describing the purpose or content of the communication. null (Strength=Example) CommunicationTopic ?? » Other resources that pertain to this communication and to which this communication should be associated about : Reference [0..*] « Any » The Encounter during which this Communication was created or to which the creation of this record is tightly associated encounter : Reference [0..1] « Encounter » The time when this communication was sent sent : dateTime [0..1] The time when this communication arrived at the destination received : dateTime [0..1] The entity (e.g. person, organization, clinical information system, care team or device) which was is the target of the communication. If receipts need to be tracked by an individual, a separate resource instance will need to be created for each recipient. Multiple recipient communications are intended where either receipts are not tracked (e.g. a mass mail-out) or a receipt is captured in aggregate (all emails confirmed received by a particular time) communication recipient : Reference [0..*] « Device CareTeam | Organization Device | Patient Group | Practitioner HealthcareService | PractitionerRole Location | RelatedPerson Organization | Group Patient | CareTeam Practitioner | HealthcareService PractitionerRole | RelatedPerson | Endpoint » The entity (e.g. person, organization, clinical information system, or device) which was is the source of the communication sender : Reference [0..1] « Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService | Endpoint | CareTeam » The reason or justification for the communication reasonCode reason : CodeableConcept CodeableReference [0..*] « Any ; Codes for describing reasons for the occurrence of a communication. null (Strength=Example) SNOMEDCTClinicalFindings ?? » Indicates another resource whose existence justifies this communication reasonReference : Reference [0..*] « Condition | Observation | DiagnosticReport | DocumentReference » Additional notes or commentary about the communication by the sender, receiver or other interested parties note : Annotation [0..*] Payload A communicated content (or for multi-part communications, one portion of the communication) content[x] : Type DataType [1..1] « string | Attachment | Reference ( Any ) )| CodeableConcept » Text, attachment(s), or resource(s) that was communicated to the recipient payload [0..*]

XML Template 

<

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

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Unique identifier --></identifier>
 <|
   </instantiatesCanonical>

 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|Measure|
   OperationDefinition|PlanDefinition|Questionnaire) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(Any) Request fulfilled by this communication --></basedOn>
 <</partOf>

 <partOf><!-- 0..* Reference(Any) Part of referenced event (e.g. Communication, Procedure) --></partOf>

 <inResponseTo><!-- 0..* Reference(Communication) Reply to --></inResponseTo>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown -->
 <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason>
 <category><!-- 0..* CodeableConcept Message category --></category>
 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <</medium>
 <</subject>

 <medium><!-- 0..* CodeableConcept A channel of communication icon --></medium>
 <subject><!-- 0..1 Reference(Group|Patient) Focus of message --></subject>

 <topic><!-- 0..1 CodeableConcept Description of the purpose/content --></topic>
 <about><!-- 0..* Reference(Any) Resources that pertain to this communication --></about>
 <</encounter>

 <encounter><!-- 0..1 Reference(Encounter) The Encounter during which this Communication was created --></encounter>

 <sent value="[dateTime]"/><!-- 0..1 When sent -->
 <received value="[dateTime]"/><!-- 0..1 When received -->
 <|
   </recipient>
 <|
   </sender>
 <</reasonCode>
 <|
   </reasonReference>

 <recipient><!-- 0..* Reference(CareTeam|Device|Endpoint|Group|HealthcareService|
   Location|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) Who the information is shared with --></recipient>

 <sender><!-- 0..1 Reference(CareTeam|Device|Endpoint|HealthcareService|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) Who shares the information --></sender>

 <reason><!-- 0..* CodeableReference(Any) Indication for message --></reason>

 <payload>  <!-- 0..* Message payload -->
  <</content[x]>

  <content[x]><!-- 1..1 Attachment|Reference(Any)|CodeableConcept Message part content --></content[x]>

 </payload>
 <note><!-- 0..* Annotation Comments made about the communication --></note>
</Communication>

JSON Template 

{doco
  "resourceType" : "",

  "resourceType" : "Communication",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Unique identifier
  "|
   

  "instantiatesCanonical" : ["<canonical(PlanDefinition|ActivityDefinition|Measure|OperationDefinition|Questionnaire)>"], // Instantiates FHIR protocol or definition

  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(Any) }], // Request fulfilled by this communication
  "

  "partOf" : [{ Reference(Any) }], // Part of referenced event (e.g. Communication, Procedure)

  "inResponseTo" : [{ Reference(Communication) }], // Reply to
  "status" : "<code>", // R!  preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  "statusReason" : { CodeableConcept }, // Reason for current status
  "category" : [{ CodeableConcept }], // Message category
  "priority" : "<code>", // routine | urgent | asap | stat
  "
  "

  "medium" : [{ CodeableConcept }], // A channel of communication icon
  "subject" : { Reference(Group|Patient) }, // Focus of message

  "topic" : { CodeableConcept }, // Description of the purpose/content
  "about" : [{ Reference(Any) }], // Resources that pertain to this communication
  "

  "encounter" : { Reference(Encounter) }, // The Encounter during which this Communication was created

  "sent" : "<dateTime>", // When sent
  "received" : "<dateTime>", // When received
  "|
   
  "|
   
  "
  "|
   

  "recipient" : [{ Reference(CareTeam|Device|Endpoint|Group|HealthcareService|
   Location|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }], // Who the information is shared with

  "sender" : { Reference(CareTeam|Device|Endpoint|HealthcareService|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }, // Who shares the information

  "reason" : [{ CodeableReference(Any) }], // Indication for message

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

    "contentAttachment" : { Attachment },
    "contentReference" : { Reference(Any) },
    "contentCodeableConcept" : { CodeableConcept }

  }],
  "note" : [{ Annotation }] // Comments made about the communication
}

Turtle Template 

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


[ a fhir:;

[ a fhir:Communication;

  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:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:|
  
  fhir:|
  
  fhir:
  fhir:
  fhir:
    # . One of these 3
      fhir: ]
      fhir: ]
      fhir:) ]
  ], ...;
  fhir:

  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Unique identifier
  fhir:instantiatesCanonical  ( [ canonical(ActivityDefinition|Measure|OperationDefinition|PlanDefinition|Questionnaire) ] ... ) ; # 0..* Instantiates FHIR protocol or definition
  fhir:instantiatesUri  ( [ uri ] ... ) ; # 0..* Instantiates external protocol or definition
  fhir:basedOn  ( [ Reference(Any) ] ... ) ; # 0..* Request fulfilled by this communication
  fhir:partOf  ( [ Reference(Any) ] ... ) ; # 0..* Part of referenced event (e.g. Communication, Procedure)
  fhir:inResponseTo  ( [ Reference(Communication) ] ... ) ; # 0..* Reply to
  fhir:status [ code ] ; # 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  fhir:statusReason [ CodeableConcept ] ; # 0..1 Reason for current status
  fhir:category  ( [ CodeableConcept ] ... ) ; # 0..* Message category
  fhir:priority [ code ] ; # 0..1 routine | urgent | asap | stat
  fhir:medium  ( [ CodeableConcept ] ... ) ; # 0..* A channel of communication
  fhir:subject [ Reference(Group|Patient) ] ; # 0..1 Focus of message
  fhir:topic [ CodeableConcept ] ; # 0..1 Description of the purpose/content
  fhir:about  ( [ Reference(Any) ] ... ) ; # 0..* Resources that pertain to this communication
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 The Encounter during which this Communication was created
  fhir:sent [ dateTime ] ; # 0..1 When sent
  fhir:received [ dateTime ] ; # 0..1 When received
  fhir:recipient  ( [ Reference(CareTeam|Device|Endpoint|Group|HealthcareService|Location|Organization|Patient|
  Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Who the information is shared with

  fhir:sender [ Reference(CareTeam|Device|Endpoint|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ] ; # 0..1 Who shares the information

  fhir:reason  ( [ CodeableReference(Any) ] ... ) ; # 0..* Indication for message
  fhir:payload ( [ # 0..* Message payload
    # content[x] : 1..1 Message part content. One of these 3
      fhir:content [  a fhir:Attachment ; Attachment ]
      fhir:content [  a fhir:Reference ; Reference(Any) ]
      fhir:content [  a fhir:CodeableConcept ; CodeableConcept ]
  ] ... ) ;
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments made about the communication

]

Changes since R3 from both R4 and R4B

Communication.instantiatesCanonical Added Element Communication.instantiatesUri Added Element Communication.inResponseTo Added Element Communication.status Change value set from http://hl7.org/fhir/ValueSet/event-status to http://hl7.org/fhir/ValueSet/event-status|4.0.1 Communication.statusReason Added Element Communication.priority Added Element Communication.topic Max Cardinality changed from * to 1 Type changed from Reference(Resource) to CodeableConcept Communication.about Added Element Communication.encounter Added Element
Communication
Communication.recipient
  • Type Reference: Added Target Types PractitionerRole, CareTeam, HealthcareService Location, Endpoint
Communication.sender
  • Type Reference: Added Target Types PractitionerRole, HealthcareService Endpoint, CareTeam
Communication.reasonReference Communication.reason
  • Type Reference: Added Target Types DiagnosticReport, DocumentReference Element
Communication.definition Communication.payload.content[x]
  • deleted Add Type CodeableConcept
    • Communication.notDone
  • deleted Remove Type string
Communication.notDoneReason Communication.reasonCode
  • deleted Deleted (-> Communication.reason)
Communication.context Communication.reasonReference
  • deleted Deleted (-> Communication.reason)

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON .

See R3 <--> R4 <--> R5 Conversion Maps (status = 3 tests that all execute ok. All tests pass round-trip testing and 2 r3 resources are invalid (0 errors). ) See Conversions Summary .)

Structure

Name Flags Card. Type Description & Constraints doco
. . Communication TU DomainResource A clinical or business level record of information being transmitted from a sender to a receiver or shared

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Unique identifier

. . . instantiatesCanonical Σ 0..* canonical ( PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire ) Instantiates FHIR protocol or definition

. . . instantiatesUri Σ 0..* uri Instantiates external protocol or definition

. . . partOf Σ 0..* Reference ( Any ) Part of this action referenced event (e.g. Communication, Procedure)

. . . inResponseTo 0..* Reference ( Communication ) Reply to

. . . status ?! Σ 1..1 code preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
Binding: EventStatus ( Required )
. . . statusReason Σ 0..1 CodeableConcept Reason for current status
CommunicationNotDoneReason Binding: Communication Not Done Reason ( Example )
. . . category 0..* CodeableConcept Message category
CommunicationCategory Binding: Communication Category ( Example )

. . . priority Σ 0..1 code routine | urgent | asap | stat
Request priority Binding: RequestPriority ( Required )
. . . medium 0..* CodeableConcept A channel of communication
v3 Code System Binding: ParticipationMode icon ( Example )

. . . subject Σ 0..1 Reference ( Patient | Group ) Focus of message
. . . topic 0..1 CodeableConcept Description of the purpose/content
CommunicationTopic Binding: Communication Topic ( Example )
. . . about 0..* Reference ( Any ) Resources that pertain to this communication

. . . encounter Σ 0..1 Reference ( Encounter ) The Encounter during which this Communication was created as part of
. . . sent 0..1 dateTime When sent
. . . received 0..1 dateTime When received
. . . recipient 0..* Reference ( CareTeam | Device | Group | HealthcareService | Location | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Group | CareTeam | HealthcareService Endpoint ) Message recipient Who the information is shared with

. . . sender 0..1 Reference ( Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService | Endpoint | CareTeam ) Message sender Who shares the information
. . reasonCode . reason Σ 0..* CodeableConcept CodeableReference ( Any ) Indication for message
Binding: SNOMED CT Clinical Findings ( Example )
reasonReference Σ 0..* Reference ( Condition | Observation | DiagnosticReport | DocumentReference ) Why was communication done?
. . . payload 0..* BackboneElement Message payload

. . . . content[x] 1..1 Message part content
. . . . contentString . contentAttachment string Attachment
. . . . contentAttachment . contentReference Attachment Reference ( Any )
. . . . contentReference . contentCodeableConcept Reference ( Any CodeableConcept )
. . . note 0..* Annotation Comments made about the communication


doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

Communication ( DomainResource ) Business identifiers assigned to this communication by the performer or other systems which remain constant as the resource is updated and propagates from server to server identifier : Identifier [0..*] The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication instantiatesCanonical : canonical [0..*] « PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire » The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication instantiatesUri : uri [0..*] An order, proposal or plan fulfilled in whole or in part by this Communication basedOn : Reference [0..*] « Any » Part A larger event (e.g. Communication, Procedure) of which this action particular communication is a component or step partOf : Reference [0..*] « Any » Prior communication that this communication is in response to inResponseTo : Reference [0..*] « Communication » The status of the transmission (this element modifies the meaning of other elements) status : code [1..1] « The status of the communication. null (Strength=Required) EventStatus ! » Captures the reason for the current state of the Communication statusReason : CodeableConcept [0..1] « Codes for the reason why a communication did not happen. null (Strength=Example) CommunicationNotDoneReason ?? » The type of message conveyed such as alert, notification, reminder, instruction, etc category : CodeableConcept [0..*] « Codes for general categories of communications such as alerts, instructions, etc. null (Strength=Example) CommunicationCategory ?? » Characterizes how quickly the planned or in progress communication must be addressed. Includes concepts such as stat, urgent, routine priority : code [0..1] « Codes indicating the relative importance of a communication. null (Strength=Required) RequestPriority ! » A channel that was used for this communication (e.g. email, fax) medium : CodeableConcept [0..*] « Codes for communication mediums such as phone, fax, email, in person, etc. null (Strength=Example) v3.ParticipationMode ParticipationMode ?? » The patient or group that was the focus of this communication subject : Reference [0..1] « Patient | Group » Description of the purpose/content, similar to a subject line in an email topic : CodeableConcept [0..1] « Codes describing the purpose or content of the communication. null (Strength=Example) CommunicationTopic ?? » Other resources that pertain to this communication and to which this communication should be associated about : Reference [0..*] « Any » The Encounter during which this Communication was created or to which the creation of this record is tightly associated encounter : Reference [0..1] « Encounter » The time when this communication was sent sent : dateTime [0..1] The time when this communication arrived at the destination received : dateTime [0..1] The entity (e.g. person, organization, clinical information system, care team or device) which was is the target of the communication. If receipts need to be tracked by an individual, a separate resource instance will need to be created for each recipient. Multiple recipient communications are intended where either receipts are not tracked (e.g. a mass mail-out) or a receipt is captured in aggregate (all emails confirmed received by a particular time) communication recipient : Reference [0..*] « Device CareTeam | Organization Device | Patient Group | Practitioner HealthcareService | PractitionerRole Location | RelatedPerson Organization | Group Patient | CareTeam Practitioner | HealthcareService PractitionerRole | RelatedPerson | Endpoint » The entity (e.g. person, organization, clinical information system, or device) which was is the source of the communication sender : Reference [0..1] « Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService | Endpoint | CareTeam » The reason or justification for the communication reasonCode reason : CodeableConcept CodeableReference [0..*] « Any ; Codes for describing reasons for the occurrence of a communication. null (Strength=Example) SNOMEDCTClinicalFindings ?? » Indicates another resource whose existence justifies this communication reasonReference : Reference [0..*] « Condition | Observation | DiagnosticReport | DocumentReference » Additional notes or commentary about the communication by the sender, receiver or other interested parties note : Annotation [0..*] Payload A communicated content (or for multi-part communications, one portion of the communication) content[x] : Type DataType [1..1] « string | Attachment | Reference ( Any ) )| CodeableConcept » Text, attachment(s), or resource(s) that was communicated to the recipient payload [0..*]

XML Template 

<

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

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Unique identifier --></identifier>
 <|
   </instantiatesCanonical>

 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|Measure|
   OperationDefinition|PlanDefinition|Questionnaire) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(Any) Request fulfilled by this communication --></basedOn>
 <</partOf>

 <partOf><!-- 0..* Reference(Any) Part of referenced event (e.g. Communication, Procedure) --></partOf>

 <inResponseTo><!-- 0..* Reference(Communication) Reply to --></inResponseTo>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown -->
 <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason>
 <category><!-- 0..* CodeableConcept Message category --></category>
 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <</medium>
 <</subject>

 <medium><!-- 0..* CodeableConcept A channel of communication icon --></medium>
 <subject><!-- 0..1 Reference(Group|Patient) Focus of message --></subject>

 <topic><!-- 0..1 CodeableConcept Description of the purpose/content --></topic>
 <about><!-- 0..* Reference(Any) Resources that pertain to this communication --></about>
 <</encounter>

 <encounter><!-- 0..1 Reference(Encounter) The Encounter during which this Communication was created --></encounter>

 <sent value="[dateTime]"/><!-- 0..1 When sent -->
 <received value="[dateTime]"/><!-- 0..1 When received -->
 <|
   </recipient>
 <|
   </sender>
 <</reasonCode>
 <|
   </reasonReference>

 <recipient><!-- 0..* Reference(CareTeam|Device|Endpoint|Group|HealthcareService|
   Location|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) Who the information is shared with --></recipient>

 <sender><!-- 0..1 Reference(CareTeam|Device|Endpoint|HealthcareService|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) Who shares the information --></sender>

 <reason><!-- 0..* CodeableReference(Any) Indication for message --></reason>

 <payload>  <!-- 0..* Message payload -->
  <</content[x]>

  <content[x]><!-- 1..1 Attachment|Reference(Any)|CodeableConcept Message part content --></content[x]>

 </payload>
 <note><!-- 0..* Annotation Comments made about the communication --></note>
</Communication>

JSON Template 

{doco
  "resourceType" : "",

  "resourceType" : "Communication",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Unique identifier
  "|
   

  "instantiatesCanonical" : ["<canonical(PlanDefinition|ActivityDefinition|Measure|OperationDefinition|Questionnaire)>"], // Instantiates FHIR protocol or definition

  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(Any) }], // Request fulfilled by this communication
  "

  "partOf" : [{ Reference(Any) }], // Part of referenced event (e.g. Communication, Procedure)

  "inResponseTo" : [{ Reference(Communication) }], // Reply to
  "status" : "<code>", // R!  preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  "statusReason" : { CodeableConcept }, // Reason for current status
  "category" : [{ CodeableConcept }], // Message category
  "priority" : "<code>", // routine | urgent | asap | stat
  "
  "

  "medium" : [{ CodeableConcept }], // A channel of communication icon
  "subject" : { Reference(Group|Patient) }, // Focus of message

  "topic" : { CodeableConcept }, // Description of the purpose/content
  "about" : [{ Reference(Any) }], // Resources that pertain to this communication
  "

  "encounter" : { Reference(Encounter) }, // The Encounter during which this Communication was created

  "sent" : "<dateTime>", // When sent
  "received" : "<dateTime>", // When received
  "|
   
  "|
   
  "
  "|
   

  "recipient" : [{ Reference(CareTeam|Device|Endpoint|Group|HealthcareService|
   Location|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }], // Who the information is shared with

  "sender" : { Reference(CareTeam|Device|Endpoint|HealthcareService|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }, // Who shares the information

  "reason" : [{ CodeableReference(Any) }], // Indication for message

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

    "contentAttachment" : { Attachment },
    "contentReference" : { Reference(Any) },
    "contentCodeableConcept" : { CodeableConcept }

  }],
  "note" : [{ Annotation }] // Comments made about the communication
}

Turtle Template 

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


[ a fhir:;

[ a fhir:Communication;

  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:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:|
  
  fhir:|
  
  fhir:
  fhir:
  fhir:
    # . One of these 3
      fhir: ]
      fhir: ]
      fhir:) ]
  ], ...;
  fhir:

  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Unique identifier
  fhir:instantiatesCanonical  ( [ canonical(ActivityDefinition|Measure|OperationDefinition|PlanDefinition|Questionnaire) ] ... ) ; # 0..* Instantiates FHIR protocol or definition
  fhir:instantiatesUri  ( [ uri ] ... ) ; # 0..* Instantiates external protocol or definition
  fhir:basedOn  ( [ Reference(Any) ] ... ) ; # 0..* Request fulfilled by this communication
  fhir:partOf  ( [ Reference(Any) ] ... ) ; # 0..* Part of referenced event (e.g. Communication, Procedure)
  fhir:inResponseTo  ( [ Reference(Communication) ] ... ) ; # 0..* Reply to
  fhir:status [ code ] ; # 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  fhir:statusReason [ CodeableConcept ] ; # 0..1 Reason for current status
  fhir:category  ( [ CodeableConcept ] ... ) ; # 0..* Message category
  fhir:priority [ code ] ; # 0..1 routine | urgent | asap | stat
  fhir:medium  ( [ CodeableConcept ] ... ) ; # 0..* A channel of communication
  fhir:subject [ Reference(Group|Patient) ] ; # 0..1 Focus of message
  fhir:topic [ CodeableConcept ] ; # 0..1 Description of the purpose/content
  fhir:about  ( [ Reference(Any) ] ... ) ; # 0..* Resources that pertain to this communication
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 The Encounter during which this Communication was created
  fhir:sent [ dateTime ] ; # 0..1 When sent
  fhir:received [ dateTime ] ; # 0..1 When received
  fhir:recipient  ( [ Reference(CareTeam|Device|Endpoint|Group|HealthcareService|Location|Organization|Patient|
  Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Who the information is shared with

  fhir:sender [ Reference(CareTeam|Device|Endpoint|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ] ; # 0..1 Who shares the information

  fhir:reason  ( [ CodeableReference(Any) ] ... ) ; # 0..* Indication for message
  fhir:payload ( [ # 0..* Message payload
    # content[x] : 1..1 Message part content. One of these 3
      fhir:content [  a fhir:Attachment ; Attachment ]
      fhir:content [  a fhir:Reference ; Reference(Any) ]
      fhir:content [  a fhir:CodeableConcept ; CodeableConcept ]
  ] ... ) ;
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments made about the communication

]

Changes since Release 3 from both R4 and R4B

Communication.instantiatesCanonical Added Element Communication.instantiatesUri Added Element Communication.inResponseTo Added Element Communication.status Change value set from http://hl7.org/fhir/ValueSet/event-status to http://hl7.org/fhir/ValueSet/event-status|4.0.1 Communication.statusReason Added Element Communication.priority Added Element Communication.topic Max Cardinality changed from * to 1 Type changed from Reference(Resource) to CodeableConcept Communication.about Added Element Communication.encounter Added Element
Communication
Communication.recipient
  • Type Reference: Added Target Types PractitionerRole, CareTeam, HealthcareService Location, Endpoint
Communication.sender
  • Type Reference: Added Target Types PractitionerRole, HealthcareService Endpoint, CareTeam
Communication.reasonReference Communication.reason
  • Type Reference: Added Target Types DiagnosticReport, DocumentReference Element
Communication.definition Communication.payload.content[x]
  • deleted Add Type CodeableConcept
    • Communication.notDone
  • deleted Remove Type string
Communication.notDoneReason Communication.reasonCode
  • deleted Deleted (-> Communication.reason)
Communication.context Communication.reasonReference
  • deleted Deleted (-> Communication.reason)

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON .

See R3 <--> R4 <--> R5 Conversion Maps (status = 3 tests that all execute ok. All tests pass round-trip testing and 2 r3 resources are invalid (0 errors). ) See Conversions Summary .)

 

See the Profiles & Extensions and the alternate Additional definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis

8.20.3.1 8.22.4.1 Terminology Bindings

Example Communication.category
Path Definition ValueSet Type Reference Documentation
Communication.status The status of the communication. EventStatus Required EventStatus

Codes identifying the lifecycle stage of an event.

Communication.statusReason CommunicationNotDoneReason Example

Codes for the reason why a communication did not happen.

Communication.category CommunicationNotDoneReason CommunicationCategory Example

Codes for general categories of communications such as alerts, instructions, etc. Example CommunicationCategory

Communication.priority Codes indicating the relative importance of a communication. RequestPriority Required RequestPriority

Identifies the level of importance to be assigned to actioning the request.

Communication.medium Codes for communication mediums such as phone, fax, email, in person, etc. ParticipationMode icon Example v3.ParticipationMode

Identifies the primary means by which an Entity participates in an Act.

Communication.topic Codes describing the purpose or content of the communication. CommunicationTopic Example CommunicationTopic

Codes describing the purpose or content of the communication.

Communication.reasonCode Communication.reason Codes for describing reasons for the occurrence of a communication. SNOMEDCTClinicalFindings Example SNOMEDCTClinicalFindings

This value set includes all the "Clinical finding" SNOMED CT icon codes - concepts where concept is-a 404684003 (Clinical finding (finding)).

Notes to reviewers:

At this time, the code bindings are placeholders to be fleshed out upon further review by the community.

8.20.3.2 8.22.4.2 Communication.sender and Communication.recipient

Communication.sender allows Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService and Communication.recipient allows Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Group | CareTeam | HealthcareService - but it is not unusual to have a communication target - even a defined one - where it is unknown what kind of role the person is playing.

If the communication is to or from an individual whose role is not known (practitioner, patient or related person) - for example, only email address is captured in the system - then RelatedPerson should be used by default.

8.22.4.3 Using Communication to wrap or accompany data

In FHIR, data is typically shared between systems without any need for the Communication resource to accompany or contain the data being shared, i.e. all FHIR exchanges are communications of some form, but that doesn't mean they need the Communication resource. However, in some cases, when data is shared there is a need to provide context about why the data is being conveyed and Communication is one of the mechanisms that FHIR provides that can share this context. Specifically, Communication allows conveying information about reasons for sharing, encounter that provides context for sharing, order or protocol that drove the need to share, etc. Note that some contextual information is expected to be captured by most FHIR systems even in absence of Communication, such as where did the data come from and when was the data received. This metadata is generally captured in Provenance. In addition to Communication, MessageHeader can capture similar metadata and Composition in FHIR documents can also serve a similar purpose. Refer to the decision tree in Approaches to Exchanging FHIR Data for guidance on which data sharing mechanism is appropriate in which circumstances. If mixing multiple mechanisms to convey communication metadata, care should be taken to ensure that each mechanism is necessary and the information conveyed in each layer is appropriately consistent.

8.22.4.4 Communication and CommunicationRequest

There is no requirement that Communication and CommunicationRequest always go together. Communication can exist without there having been a CommunicationRequest. For example, a practitioner might capture that they have provided a smoking cessation pamphlet to a patient that would be a Communication instance, but there would have been no "request" that led to the action (unsolicited). As well, a CommunicationRequest can be fulfilled in many ways, e.g. by phone call, email, system to system data sharing and there might not be a requirement to surface this data sharing at the clinical / business level, i.e. no need for a Communication instance.

Where there is a need to explicitly track fulfillment of a CommunicationRequest, Communication is the most natural resource to establish this linkage. The event can be tied to the request using Communication.basedOn.

8.20.4 8.22.5 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource , and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
based-on reference Request fulfilled by this communication Communication.basedOn
(Any)
category token Message category Communication.category
encounter reference The Encounter during which this Communication was created as part of Communication.encounter
( Encounter ) 		29 Resources
identifier token Unique identifier Communication.identifier 65 Resources
instantiates-canonical reference Instantiates FHIR protocol or definition Communication.instantiatesCanonical
( Questionnaire , Measure , PlanDefinition , OperationDefinition , ActivityDefinition )
instantiates-uri uri Instantiates external protocol or definition Communication.instantiatesUri
medium token A channel of communication Communication.medium
part-of reference Part of this action referenced event (e.g. Communication, Procedure) Communication.partOf
(Any)
patient reference Focus of message Communication.subject.where(resolve() is Patient)
( Patient ) 		66 Resources
received date When received Communication.received
recipient reference Message recipient Who the information is shared with Communication.recipient
( Practitioner , Group , Organization , CareTeam , Endpoint , Device , Patient , HealthcareService , PractitionerRole , RelatedPerson , Location )
sender reference Message sender Who shares the information Communication.sender
( Practitioner , Organization , Endpoint , CareTeam , Device , Patient , HealthcareService , PractitionerRole , RelatedPerson )
sent date When sent Communication.sent
status token preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Communication.status
subject reference Focus of message Communication.subject
( Group , Patient )
topic token Description of the purpose/content Communication.topic