FHIR Release 3 (STU) 5 Preview #3
This page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 4.0.1 . For a full list of available versions, see the Directory of published versions

8.20 Resource Communication - Content

Patient Care 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 was notified about communication to a provider/reporter in response to a case report for a reportable condition.

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.

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

This resource is a record of a communication. 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

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 may might not be known. As well, 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 may might or may 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, 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 itself.

This resource implements the Event pattern.

Structure

Name Flags Card. Type Description & Constraints doco
. . Communication I TU DomainResource A clinical or business level record of information being transmitted from a sender to a receiver + Not Done Reason can only be specified if NotDone is "true" or shared
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Unique identifier
. . . definition instantiatesCanonical Σ 0..* Reference 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 | suspended not-done | aborted on-hold | stopped | completed | entered-in-error | unknown
EventStatus ( Required )
. . notDone . statusReason ?! Σ 0..1 boolean CodeableConcept Communication did not occur Reason for current status
CommunicationNotDoneReason ( Example )
. . notDoneReason . category Σ I 0..1 0..* CodeableConcept Why communication did not occur Message category
CommunicationNotDoneReason CommunicationCategory ( Example )
. . category . priority Σ 0..* 0..1 CodeableConcept code Message category routine | urgent | asap | stat
CommunicationCategory Request priority ( Example Required )
. . . medium 0..* CodeableConcept A channel of communication
v3 Code System ParticipationMode ( Example )
. . . subject Σ 0..1 Reference ( Patient | Group ) Focus of message
. . recipient . topic 0..* 0..1 Reference ( Device | Organization | Patient | Practitioner CodeableConcept | RelatedPerson Description of the purpose/content
CommunicationTopic | Group ( Example ) Message recipient
. . . topic about 0..* Reference ( Any ) Focal resources Resources that pertain to this communication
. . context . encounter Σ 0..1 Reference ( Encounter | EpisodeOfCare ) The Encounter or episode leading to message during which this Communication was created
. . . sent 0..1 dateTime When sent
. . . received 0..1 dateTime When received
. . . sender recipient 0..1 0..* Reference ( CareTeam | Device | Group | HealthcareService | Location | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Endpoint ) Message sender Who the information is shared with
. . reasonCode . sender Σ 0..* CodeableConcept Indication for message 0..1 SNOMED CT Clinical Findings Reference ( Example Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService | Endpoint | CareTeam ) Who shares the information
. . . reasonReference reason Σ 0..* Reference CodeableReference ( Condition | Observation Any ) Why was communication done? Indication for message
SNOMED CT Clinical Findings ( Example )
. . . 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

UML Diagram ( Legend )

Communication ( DomainResource ) Identifiers associated with Business identifiers assigned to this Communication that are defined communication by business processes and/ the performer or used to refer to it when a direct URL reference to other systems which remain constant as the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation) updated and propagates from server to server identifier : Identifier [0..*] A The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that was is adhered to in whole or in part by this communication event Communication definition instantiatesCanonical : Reference 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. (Strength=Required) EventStatus ! » If true, indicates that Captures the described communication event did not actually occur (this element modifies reason for the meaning current state of other elements) notDone : boolean [0..1] Describes why the communication event did not occur in coded and/or textual form Communication notDoneReason statusReason : CodeableConcept [0..1] « Codes for the reason why a communication was did not done. happen. (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, instruction, instructions, etc. (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. (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. (Strength=Example) v3 Code System ParticipationM... ParticipationMode ?? » The patient or group that was the focus of this communication subject : Reference [0..1] « Patient | Group » The entity (e.g. person, organization, clinical information system, or device) which was the target Description of the communication. If receipts need to be tracked by individual, a separate resource instance will need purpose/content, similar to be created for each recipient. Multiple recipient communications are intended where either a receipt(s) is not tracked (e.g. a mass mail-out) or is captured subject line in aggregate (all emails confirmed received by a particular time) an email recipient topic : Reference [0..*] Device | Organization | Patient CodeableConcept | [0..1] « Practitioner | RelatedPerson | Group Codes describing the purpose or content of the communication. (Strength=Example) CommunicationTopic ?? » The Other resources which were responsible for or related that pertain to producing this communication and to which this communication should be associated topic about : Reference [0..*] « Any » The encounter within Encounter during which the communication this Communication was sent created or to which the creation of this record is tightly associated context encounter : Reference [0..1] « Encounter | EpisodeOfCare » 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 recipient : Reference [0..*] « CareTeam | Device | Group | HealthcareService | Location | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Endpoint » The entity (e.g. person, organization, clinical information system, or device) which 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 DataType [0..*] « Any ; Codes for describing reasons for the occurrence of a communication. (Strength=Example) SNOMED CT Clinical Findings SNOMEDCTClinicalFindings ?? » Indicates another resource whose existence justifies this communication reasonReference : Reference [0..*] Condition | Observation 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>
 <</definition>

 <identifier><!-- 0..* Identifier Unique identifier --></identifier>
 <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>
 <
 <
 <</notDoneReason>

 <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>
 <</medium>
 <</subject>
 <|
   </recipient>
 <</topic>
 <</context>

 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <medium><!-- 0..* CodeableConcept A channel of communication  --></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><!-- 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 -->
 <|
   </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(ActivityDefinition|Measure|
   OperationDefinition|PlanDefinition|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 
  "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:Communication.identifier [ Identifier ], ... ; # 0..* Unique identifier
  fhir:Communication.instantiatesCanonical [ canonical(ActivityDefinition|Measure|OperationDefinition|PlanDefinition|Questionnaire) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:Communication.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition

  fhir:Communication.basedOn [ Reference(Any) ], ... ; # 0..* Request fulfilled by this communication
  fhir:
  fhir:
  fhir:
  fhir:

  fhir:Communication.partOf [ Reference(Any) ], ... ; # 0..* Part of referenced event (e.g. Communication, Procedure)
  fhir:Communication.inResponseTo [ Reference(Communication) ], ... ; # 0..* Reply to
  fhir:Communication.status [ code ]; # 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  fhir:Communication.statusReason [ CodeableConcept ]; # 0..1 Reason for current status

  fhir:Communication.category [ CodeableConcept ], ... ; # 0..* Message category
  fhir:Communication.priority [ code ]; # 0..1 routine | urgent | asap | stat

  fhir:Communication.medium [ CodeableConcept ], ... ; # 0..* A channel of communication
  fhir:
  fhir:
  fhir:
  fhir:

  fhir:Communication.subject [ Reference(Group|Patient) ]; # 0..1 Focus of message
  fhir:Communication.topic [ CodeableConcept ]; # 0..1 Description of the purpose/content
  fhir:Communication.about [ Reference(Any) ], ... ; # 0..* Resources that pertain to this communication
  fhir:Communication.encounter [ Reference(Encounter) ]; # 0..1 The Encounter during which this Communication was created

  fhir:Communication.sent [ dateTime ]; # 0..1 When sent
  fhir:Communication.received [ dateTime ]; # 0..1 When received
  fhir:
  fhir:
  fhir:

  fhir:Communication.recipient [ Reference(CareTeam|Device|Endpoint|Group|HealthcareService|Location|Organization|Patient|
  Practitioner|PractitionerRole|RelatedPerson) ], ... ; # 0..* Who the information is shared with
  fhir:Communication.sender [ Reference(CareTeam|Device|Endpoint|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ]; # 0..1 Who shares the information
  fhir:Communication.reason [ CodeableReference(Any) ], ... ; # 0..* Indication for message

  fhir:Communication.payload [ # 0..* Message payload
    # Communication.payload.content[x] : 1..1 Message part content. One of these 3
      fhir: ]

      fhir:Communication.payload.contentAttachment [ Attachment ]
      fhir:Communication.payload.contentReference [ Reference(Any) ]
      fhir:Communication.payload.contentCodeableConcept [ CodeableConcept ]

  ], ...;
  fhir:Communication.note [ Annotation ], ... ; # 0..* Comments made about the communication
]

Changes since DSTU2 R3

Communication Communication.definition Added Element
Communication.basedOn Communication.status
  • Renamed from requestDetail to basedOn Max Cardinality changed from 1 to * Type changed Change value set from Reference(CommunicationRequest) http://hl7.org/fhir/ValueSet/event-status|4.0.0 to Reference(Resource) Communication.partOf Added Element http://hl7.org/fhir/ValueSet/event-status|4.5.0
Communication.status Communication.priority
  • Min Cardinality changed from 0 to 1 Change value set from http://hl7.org/fhir/ValueSet/communication-status http://hl7.org/fhir/ValueSet/request-priority|4.0.0 to http://hl7.org/fhir/ValueSet/event-status Communication.notDone Added Element Communication.notDoneReason Added Element http://hl7.org/fhir/ValueSet/request-priority|4.5.0
Communication.category Communication.recipient
  • Max Cardinality changed from 1 to * Type Reference: Added Target Types Location, Endpoint
Communication.subject Communication.sender
  • Add Reference(Group) Type Reference: Added Target Types Endpoint, CareTeam
Communication.topic Communication.reason
  • Added Element
Communication.context Communication.payload.content[x]
  • Renamed from encounter to context Add Type CodeableConcept
  • Add Reference(EpisodeOfCare) Remove Type string
Communication.reasonCode
  • Renamed from reason to reasonCode deleted
Communication.reasonReference
  • Added Element Communication.note Added Element deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R2 <--> R3 <--> R4 Conversion Maps (status = 2 3 tests that all execute ok. All tests pass round-trip testing and all 2 r3 resources are valid.). invalid (0 errors). )

Structure

Name Flags Card. Type Description & Constraints doco
. . Communication I TU DomainResource A clinical or business level record of information being transmitted from a sender to a receiver + Not Done Reason can only be specified if NotDone is "true" or shared
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Unique identifier
. . . definition instantiatesCanonical Σ 0..* Reference 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 | suspended not-done | aborted on-hold | stopped | completed | entered-in-error | unknown
EventStatus ( Required )
. . notDone . statusReason ?! Σ 0..1 boolean CodeableConcept Communication did not occur Reason for current status
CommunicationNotDoneReason ( Example )
. . notDoneReason . category Σ I 0..1 0..* CodeableConcept Why communication did not occur Message category
CommunicationNotDoneReason CommunicationCategory ( Example )
. . category . priority Σ 0..* 0..1 CodeableConcept code Message category routine | urgent | asap | stat
CommunicationCategory Request priority ( Example Required )
. . . medium 0..* CodeableConcept A channel of communication
v3 Code System ParticipationMode ( Example )
. . . subject Σ 0..1 Reference ( Patient | Group ) Focus of message
. . recipient . topic 0..* 0..1 Reference ( Device | Organization | Patient | Practitioner CodeableConcept | RelatedPerson Description of the purpose/content
CommunicationTopic | Group ( Example ) Message recipient
. . . topic about 0..* Reference ( Any ) Focal resources Resources that pertain to this communication
. . context . encounter Σ 0..1 Reference ( Encounter | EpisodeOfCare ) The Encounter or episode leading to message during which this Communication was created
. . . sent 0..1 dateTime When sent
. . . received 0..1 dateTime When received
. . . sender recipient 0..1 0..* Reference ( CareTeam | Device | Group | HealthcareService | Location | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Endpoint ) Message sender Who the information is shared with
. . reasonCode . sender Σ 0..* CodeableConcept Indication for message 0..1 SNOMED CT Clinical Findings Reference ( Example Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService | Endpoint | CareTeam ) Who shares the information
. . . reasonReference reason Σ 0..* Reference CodeableReference ( Condition | Observation Any ) Why was communication done? Indication for message
SNOMED CT Clinical Findings ( Example )
. . . 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

UML Diagram ( Legend )

Communication ( DomainResource ) Identifiers associated with Business identifiers assigned to this Communication that are defined communication by business processes and/ the performer or used to refer to it when a direct URL reference to other systems which remain constant as the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation) updated and propagates from server to server identifier : Identifier [0..*] A The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that was is adhered to in whole or in part by this communication event Communication definition instantiatesCanonical : Reference 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. (Strength=Required) EventStatus ! » If true, indicates that Captures the described communication event did not actually occur (this element modifies reason for the meaning current state of other elements) notDone : boolean [0..1] Describes why the communication event did not occur in coded and/or textual form Communication notDoneReason statusReason : CodeableConcept [0..1] « Codes for the reason why a communication was did not done. happen. (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, instruction, instructions, etc. (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. (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. (Strength=Example) v3 Code System ParticipationM... ParticipationMode ?? » The patient or group that was the focus of this communication subject : Reference [0..1] « Patient | Group » The entity (e.g. person, organization, clinical information system, or device) which was the target Description of the communication. If receipts need to be tracked by individual, a separate resource instance will need purpose/content, similar to be created for each recipient. Multiple recipient communications are intended where either a receipt(s) is not tracked (e.g. a mass mail-out) or is captured subject line in aggregate (all emails confirmed received by a particular time) an email recipient topic : Reference [0..*] Device | Organization | Patient CodeableConcept | [0..1] « Practitioner | RelatedPerson | Group Codes describing the purpose or content of the communication. (Strength=Example) CommunicationTopic ?? » The Other resources which were responsible for or related that pertain to producing this communication and to which this communication should be associated topic about : Reference [0..*] « Any » The encounter within Encounter during which the communication this Communication was sent created or to which the creation of this record is tightly associated context encounter : Reference [0..1] « Encounter | EpisodeOfCare » 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 recipient : Reference [0..*] « CareTeam | Device | Group | HealthcareService | Location | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Endpoint » The entity (e.g. person, organization, clinical information system, or device) which 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 DataType [0..*] « Any ; Codes for describing reasons for the occurrence of a communication. (Strength=Example) SNOMED CT Clinical Findings SNOMEDCTClinicalFindings ?? » Indicates another resource whose existence justifies this communication reasonReference : Reference [0..*] Condition | Observation 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>
 <</definition>

 <identifier><!-- 0..* Identifier Unique identifier --></identifier>
 <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>
 <
 <
 <</notDoneReason>

 <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>
 <</medium>
 <</subject>
 <|
   </recipient>
 <</topic>
 <</context>

 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <medium><!-- 0..* CodeableConcept A channel of communication  --></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><!-- 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 -->
 <|
   </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(ActivityDefinition|Measure|
   OperationDefinition|PlanDefinition|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 
  "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:Communication.identifier [ Identifier ], ... ; # 0..* Unique identifier
  fhir:Communication.instantiatesCanonical [ canonical(ActivityDefinition|Measure|OperationDefinition|PlanDefinition|Questionnaire) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:Communication.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition

  fhir:Communication.basedOn [ Reference(Any) ], ... ; # 0..* Request fulfilled by this communication
  fhir:
  fhir:
  fhir:
  fhir:

  fhir:Communication.partOf [ Reference(Any) ], ... ; # 0..* Part of referenced event (e.g. Communication, Procedure)
  fhir:Communication.inResponseTo [ Reference(Communication) ], ... ; # 0..* Reply to
  fhir:Communication.status [ code ]; # 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  fhir:Communication.statusReason [ CodeableConcept ]; # 0..1 Reason for current status

  fhir:Communication.category [ CodeableConcept ], ... ; # 0..* Message category
  fhir:Communication.priority [ code ]; # 0..1 routine | urgent | asap | stat

  fhir:Communication.medium [ CodeableConcept ], ... ; # 0..* A channel of communication
  fhir:
  fhir:
  fhir:
  fhir:

  fhir:Communication.subject [ Reference(Group|Patient) ]; # 0..1 Focus of message
  fhir:Communication.topic [ CodeableConcept ]; # 0..1 Description of the purpose/content
  fhir:Communication.about [ Reference(Any) ], ... ; # 0..* Resources that pertain to this communication
  fhir:Communication.encounter [ Reference(Encounter) ]; # 0..1 The Encounter during which this Communication was created

  fhir:Communication.sent [ dateTime ]; # 0..1 When sent
  fhir:Communication.received [ dateTime ]; # 0..1 When received
  fhir:
  fhir:
  fhir:

  fhir:Communication.recipient [ Reference(CareTeam|Device|Endpoint|Group|HealthcareService|Location|Organization|Patient|
  Practitioner|PractitionerRole|RelatedPerson) ], ... ; # 0..* Who the information is shared with
  fhir:Communication.sender [ Reference(CareTeam|Device|Endpoint|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ]; # 0..1 Who shares the information
  fhir:Communication.reason [ CodeableReference(Any) ], ... ; # 0..* Indication for message

  fhir:Communication.payload [ # 0..* Message payload
    # Communication.payload.content[x] : 1..1 Message part content. One of these 3
      fhir: ]

      fhir:Communication.payload.contentAttachment [ Attachment ]
      fhir:Communication.payload.contentReference [ Reference(Any) ]
      fhir:Communication.payload.contentCodeableConcept [ CodeableConcept ]

  ], ...;
  fhir:Communication.note [ Annotation ], ... ; # 0..* Comments made about the communication
]

Changes since DSTU2 Release 3

Communication Communication.definition Added Element
Communication.basedOn Communication.status
  • Renamed from requestDetail to basedOn Max Cardinality changed from 1 to * Type changed Change value set from Reference(CommunicationRequest) http://hl7.org/fhir/ValueSet/event-status|4.0.0 to Reference(Resource) Communication.partOf Added Element http://hl7.org/fhir/ValueSet/event-status|4.5.0
Communication.status Communication.priority
  • Min Cardinality changed from 0 to 1 Change value set from http://hl7.org/fhir/ValueSet/communication-status http://hl7.org/fhir/ValueSet/request-priority|4.0.0 to http://hl7.org/fhir/ValueSet/event-status Communication.notDone Added Element Communication.notDoneReason Added Element http://hl7.org/fhir/ValueSet/request-priority|4.5.0
Communication.category Communication.recipient
  • Max Cardinality changed from 1 to * Type Reference: Added Target Types Location, Endpoint
Communication.subject Communication.sender
  • Add Reference(Group) Type Reference: Added Target Types Endpoint, CareTeam
Communication.topic Communication.reason
  • Added Element
Communication.context Communication.payload.content[x]
  • Renamed from encounter to context Add Type CodeableConcept
  • Add Reference(EpisodeOfCare) Remove Type string
Communication.reasonCode
  • Renamed from reason to reasonCode deleted
Communication.reasonReference
  • Added Element Communication.note Added Element deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R2 <--> R3 <--> R4 Conversion Maps (status = 2 3 tests that all execute ok. All tests pass round-trip testing and all 2 r3 resources are valid.). invalid (0 errors). )

 

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

Path Definition Type Reference
Communication.status The status of the communication. Required EventStatus
Communication.notDoneReason Communication.statusReason Codes for the reason why a communication was did not done. happen. Example CommunicationNotDoneReason
Communication.category Codes for general categories of communications such as alerts, instruction, instructions, etc. Example CommunicationCategory
Communication.priority Codes indicating the relative importance of a communication. Required RequestPriority
Communication.medium Codes for communication mediums such as phone, fax, email, in person, etc. Example v3 Code System ParticipationMode
Communication.topic Codes describing the purpose or content of the communication. Example CommunicationTopic
Communication.reasonCode Communication.reason Codes for describing reasons for the occurrence of a communication. Example SNOMED CT Clinical Findings SNOMEDCTClinicalFindings

8.20.3.2 Constraints com-1 : Not Done Reason can only be specified if NotDone is "true" ( expression : notDone or notDoneReason.exists().not() )

Notes to reviewers:

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

Communication.sender allows Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService and Communication.recipient allow Patient|Practitioner|RelatedPerson 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, individual whose role is not known (practitioner, patient or related person), person) - for example, only email address is captured in the system; system - then RelatedPerson should be used by default.

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. 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.

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.

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

Name Type Description Expression In Common
based-on reference Request fulfilled by this communication Communication.basedOn
(Any)
category token Message category Communication.category
context encounter reference The Encounter or episode leading to message during which this Communication was created Communication.context Communication.encounter
( EpisodeOfCare , Encounter )
definition identifier reference token Instantiates protocol or definition Unique identifier Communication.definition ( PlanDefinition , ActivityDefinition ) Communication.identifier
encounter instantiates-canonical N reference Encounter leading to message Instantiates FHIR protocol or definition Communication.context Communication.instantiatesCanonical
( Encounter Questionnaire , Measure , PlanDefinition , OperationDefinition , ActivityDefinition )
identifier instantiates-uri N token uri Unique identifier Instantiates external protocol or definition Communication.identifier 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 Communication.subject.where(resolve() is Patient)
( Patient )
received N 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 N date When sent Communication.sent
status N token preparation | in-progress | suspended not-done | aborted 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