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FHIR Infrastructure Work Group Maturity Level : N/A Ballot Standards Status : Informative

The FHIR specification defines a set of resources, and an infrastructure for handling resources. In order to use FHIR to create solutions for integration requirements, implementers must map their problems to resources and their content.

The resources are classified into 6 sections: Clinical : The content Resource List provides views of a clinical record Identification : Supporting entities involved in the care process Workflow : Manage the healthcare process Financial : Resources that support the billing resources organized in several different ways, and payment parts of FHIR Conformance : Resources use is the primary entry point to manage specification, development and testing of FHIR solutions Infrastructure : General functionality, and resources for internal FHIR requirements the resources.

This page describes the resources and their functional intent in more detail to assist implementers to understand their purpose and scope, and their supporting classifications.

Where to find common concepts in this specification:

Concept Example Where to find
Clinical Findings
Laboratory Results Blood panels such as CBC with Differential, Liver Panel, etc. DiagnosticReport with Observations
Imaging Study Findings CT Scans, MRI, Plain Radiographs, Ultrasounds) DiagnosticReport (some with Observations )
Diagnostic Test Results EKG, pulmonary function test, EEG Observations (and maybe a DiagnosticReport )
Vital Signs Temperature, Blood Pressure, Heart Rate, Respiratory Rate Observation
Other Physical Exam Findings Auscultation findings Observation
Pulmonary Artery Catheter readings Pulmonary artery pressure Observation
Patient Problems, Allergies and Adverse Events
Allergy Food or drug allergies AllergyIntolerance
Clinical Diagnosis Diabetes, Congestive Heart Failure Condition
Adverse Event Adverse reaction to an agent, falls, adverse surgical events, hospital infections AdverseEvent
Patient History
Chief Complaint Cough, Pain, Fever, Fatigue Condition
Past Surgical History Appendectomy, Hernia repair Procedure
Past Medical History Diabetes, Congestive heart failure Condition
MAR (Medication Administration Record) Warfarin 5mg PO administered on 12/10/2013 at 3pm MedicationAdministration
Home Meds Warfarin 5mg, 30 day supply, dispensed on 12/01/2013 MedicationStatement MedicationUsage
Social History Sexual behavior, Smoking status, Alcohol intake, Illicit drug use Observation
Family History Mother has diabetes FamilyMemberHistory
Signs & Symptoms from a review of systems- Pain, Fever Condition
Suggested Physician Orders
Proposal for a laboratory test A blood panel, a stool analysis ProcedureRequest ServiceRequest
Proposal for an imaging procedure CT Scan, MRI, X-Rays ProcedureRequest ServiceRequest
Proposed Diet Order An oral diet order NutritionOrder
Proposed respiratory order Oxygen delivery Not done yet
Proposed Medications Aspirin, Lisinopril MedicationRequest
Proposed Supply Wheel Chair, Food Tray SupplyRequest
Interdisciplinary Care Planning
Patient Goal Reduce risk of falls, lose weight Goal (as part of a CarePlan )
Intervention Patient assessments ProcedureRequest ServiceRequest

In addition, to the information on this page, see also Common Use Cases . General AllergyIntolerance , Condition , and Procedure are common resources that appear throughout the patient record - summaries of the patient status or history. FamilyMemberHistory tracks significant health issues for relatives of the patient, since these are significant risk factors for the patient. These resources may be found in patient, episode, discharge summaries, and consultation records. ClinicalImpression (aka ClinicalAssessment) records the core of a clinical consultation/assessment/impression. When a single text note is inserted directly in the patient record, this is typically a ClinicalImpression.summary. A RiskAssessment is an assessment - usually, but not necessarily, by a decision support engine of the likely outcomes of some course of action for a patient. A DetectedIssue is an active alert that there is a clinical issue with/between one or more active or proposed clinical actions for a patient. One way it may be used is as part of an error message in response to an attempted operation. Resource Category RIM Lifecycle AllergyIntolerance Ongoing Act This has a Current List Condition Ongoing Act This has a Current List Procedure Past Act Clinical Workflow FamilyMemberHistory Past Act ClinicalImpression Past Act RiskAssessment Present Act Clinical Workflow DetectedIssue Present Act Care Provision These resources support planning of care provision - care and treatment plans. CarePlan and Goal are the primary structures around which future planning for the patient is based. These are used to define care and treatment planned for a patient in the future, and may be updated and adjusted as ongoing care is provided. ReferralRequest is the basis for a proposed/requested transfer of care from one clinician to another. Typically, these are associated with a transfer of records, and a physical relocation of the patient, but neither of these are required. A ProcedureRequest records a request for a procedure to be carried out.

NutritionOrder is a request to supply a diet, formula feeding (enteral) or oral nutritional supplement to a patient and VisionPrescription contains the details of visual aids requested for a patient. Resource Category RIM Lifecycle CarePlan Ongoing Act Goal Future Act Clinical Workflow ReferralRequest Future Act Clinical Workflow ProcedureRequest Future Act Clinical Workflow NutritionOrder Future / Ongoing Act VisionPrescription Future Act Medication Management Supports the medication and immunization processes. Some points of note: Prescription = a MedicationRequest In some records, medication orders, administration, and statements may not be well differentiated. Generally, use MedicationStatement if records are unclear A medication chart (or variants) will use multiple different types of medication resources When prescribing is done by an external system (e.g. most ambulatory e-prescribing), the Medication resource is not used. It is generally used to represent information in formularies and to describe custom formulations Resource Category RIM Lifecycle Medication Unrelated Role Medication Medication Act Clinical Workflow MedicationDispense Past Act Clinical Workflow MedicationRequest Future Act Request/Order . This has a current List MedicationStatement Ongoing / Past Act Entity Availability Workflow . This has a Current List Immunization Past Act ImmunizationRecommendation Future Act Diagnostics Resources concerned with observing the patient, and the diagnostic service process built around this. The Observation resource is a widely used general purpose tool. Typical uses include recording the following kinds of data: Laboratory Results Vital Signs (including Blood Pressure) Physical Examinations Social history (e.g. Smoking History) and many more things beside. Note that 'everything is an observation', but implementations should not use Observation where Condition is more appropriate. ProcedureRequest and DiagnosticReport support the overall diagnostic process. A DiagnosticReport connects the process of 'reporting', linking process identifiers, visual presentations of a report, and conclusions/interpretations with the Observations. ProcedureRequests capture the request from an authorized clinician to initiate the diagnostic process. Specimen and BodySite are used to record the details of specimen collection although BodySite can also be used with other resources (e.g. Operation location details on a Procedure). The resources ImagingManifest and ImagingStudy frameworks are provided to make links to diagnostic images available within the clinical record, where the actual images will be provided by dedicated systems (the Media resource is intended for sharing actual images directly, which is not generally suitable for high resolution, high volume diagnostic images). Resource Category RIM Lifecycle Observation Past Act DiagnosticReport Past Act Entity Availability Workflow ProcedureRequest Future Act Request/Order Specimen Unrelated Role Entity Availability Workflow BodySite Unrelated Role ImagingManifest Past Act ImagingStudy Past Act 2.33.3 Administrative Resources These resources provide support for identifying the various entities involved in healthcare: people, organizations, substances, devices, etc. Individuals The Patient resource represents the recipient of healthcare. This concept is not always referred to as a 'patient' - other words such as client, customer, resident, etc. are commonly used, but in this specification, the recipient of healthcare is simply known as the patient. The patient resource includes basic demographics and next of kin information. The Practitioner resource is used to identify and describe any person (or even animal) involved in the provision of care, including doctors, nurses, clerical staff, specialist support staff, etc. RelatedPerson is used to describe individuals who are related helping to understand the patient who are involved in the healthcare process, beyond merely being next of kin - they may sign documents, administer medications, be the source of information, or simply provide care by chance at an accident. Resource Category RIM Lifecycle Patient Unrelated Role Entity Availability Workflow Practitioner Unrelated Role RelatedPerson Unrelated Role Groups In most provision of healthcare, some Organization is responsible and accountable for the care, and references appear throughout the clinical record. The organization is a legal entity that may operate at multiple locations. A HealthcareService represents the services offered by one or more organizations at a single location. A Group is used to describe one or more individuals - usually people, though other kinds of entities are allowed. Typically, these are used with aggregate reporting, though sometimes care is provided to a set of individuals at once (some counseling procedures, public health procedures, herds of cattle, etc.). Resource Category RIM Lifecycle Organization Unrelated Role HealthcareService Unrelated Role Group Unrelated Entity Entities Location - for where things happen. Locations are either by instance (e.g. this particular room at a given address or GPS coordinates) or by kind (e.g. the back of some ambulance). The same applies to Substance , for some kind of material (e.g. chemical) used in healthcare - it may refer to an identified instance (e.g. bottle) or a kind of chemical. The Person resource is used to track associations between different patient records across the provision of healthcare (e.g. "master patient indexes"). Person resources are not referred directly from other resources; their use is for dedicated person registries. Resource Category RIM Lifecycle Location Unrelated Role Entity Availability Workflow Substance Unrelated Entity Person Unrelated Entity Device Device is used to track non-consumable manufactured materials through the healthcare process. It includes implants, large instruments, non-medical things (including software), and containers. Devices - and therefore the device resource - have many purposes, including stock control, locating devices, and tracking implants. DeviceComponent and DeviceMetric are used to report the status and characteristics of the kinds of medical devices that produce a stream of one or more data points ( Observations ), usually about a patient. Resource Category RIM Lifecycle Device Unrelated Role DeviceComponent Unrelated Role DeviceMetric Unrelated Role Research ResearchStudy is used to capture information related to the planning and execution of clinical and pre-clinical studies. It covers both human and veterinary studies and safety, efficacy, comparative effectiveness and retrospective trials. ResearchSubject capture the information around the participation of a specific individual ( Patient ) provided in a specific ResearchStudy . This information includes their time of participation, associated study arm, status within the study, etc. Resource Category RIM Lifecycle ResearchStudy Unrelated Act ResearchSubject Unrelated Role 2.33.4 Work Flow Encounters Encounter tracks an interaction between a patient and healthcare provider(s). Specifically, this resource tracks the administrative details of the interaction, not the clinical details (though these usual link to it). Aliases for this include 'admission', 'consultation', and sometimes 'appointment'. Encounters may be nested - e.g. when the patient goes to physiotherapy as part of a hospital admission. An EpisodeOfCare is an association between a patient and a care provider that may last over several encounters. The purpose of EpisodeOfCare is track a provider (person or organization) that has an interest in the ongoing care of the patient. A Communication is a record of a formal communication with a patient or another party with an interest in their care - a letter, email, phone call etc. A Flag is warning maintained in the system that alerts care providers to potential issues they should be aware of when providing care to a patient, or at a location. Resource Category RIM Lifecycle Encounter Future / Ongoing / Past Act EpisodeOfCare Act Communication Past Act Clinical Workflow Flag Ongoing Act Entity Availability Workflow Scheduling These resources are concerned with planning times and locations for future delivery of care: specification:

  • A Schedule describes a set of times in the future that a service or individual may be available A Slot is an instance of a time in a schedule that may be reserved An Appointment is proposed or confirmed future event, with a list of participants who may or may not have confirmed their attendance An AppointmentResponse is an individual's acceptance or rejection of an appointment The scheduling systems is closely aligned with the iCal system so that systems may leverage web bookings while maintaining integrity with the rest of the clinical record. Resource Category RIM Lifecycle Appointment Future Act AppointmentResponse Future Act Schedule Future Slot Future Act Order Management Todo: these resources are all draft. Bringing them to maturity and testing their support for real-world scenarios is a major ongoing focus of the FHIR project. Resource Category RIM Lifecycle Task Present Act CommunicationRequest Future Act Request/Order DeviceRequest Present Act Request/Order DeviceUseStatement Past Act ProcessRequest Present Act Request/Order ProcessResponse Present Act SupplyDelivery Present Act SupplyRequest Future Act 2.33.5 Infrastructure These resources provide generally useful functionality, and/or are referenced directly from the base FHIR framework ( RESTful API , messaging , documents ). Information Management Questionnaire and QuestionnaireResponse are for general purpose data collection from a patient or other information source. They represent the set of questions to be answered, and an individual's responses to those questions. A questionnaire can contain any kind of data, including the data represented in all other resources. It is anticipated that the data will be processed into other kinds of resources for further usage and exchange. The Provenance resource is used to make statements about where a resource came from - that is, who, what, why, when and where for its creation. This may be used in assessing the integrity, reliability and usefulness of a resource or the data in it. Note that many resources contain some limited amount of this information directly, because it is deemed essential to using/finding/filtering/understanding the resource directly. Whenever information is found in both a resource, and in the provenance statements for the resource, it is expected to be the same. An AuditEvent is an observation by a system that a record was altered (created, updated, deleted) or otherwise accessed (queried, transferred, copied), with audit information about the event. Typically, the provenance record is created before the resource is altered, by the (sub)system causing the change to the resource, while the audit record is created after the change by the (sub)system responsible for storing it. Resource Category RIM Lifecycle Questionnaire Past Act QuestionnaireResponse Past Act Provenance Past Act AuditEvent Past Act Documents Modules In clinical practice, there are use cases for both exchanging information in a highly granular form, and for exchanging it in packages known as 'documents'. This specification provides two different kinds of support for creating and exchanging documents: Composition allows for the construction of a detailed document package using other resources for all content of the document
  • DocumentReference and DocumentManifest are used for referring to and/or exchanging external documents ( CDA , PDF, other kinds of records, etc.) either as single documents or groups of documents respectively The List resource is used to link a set of other kinds of resources into a single list. This might be done for many reasons - maintaining a list of work to do, of patients of interest, or of a set of current problems for a patient. Resource Category RIM Lifecycle Composition Unrelated Unrelated DocumentManifest Unrelated Document Entity Availability Workflow DocumentReference Document Entity Availability Workflow List Unrelated Act Structures Basic support structure Resources with general usefulness: Media stores an image, video, or sound recording, with metadata that can be used to link it into the rest of the healthcare record as represented in resources Binary is a container for content of any type, to include content that is in some format other than a FHIR resource Bundle acts as an envelope for a set of other resources as they are gathered together for exchange. Bundles may be long lived (documents) or very short lived (search results) Basic is a general container that can be used to represent data for which a specific resource doesn't yet exist (general extension point) Resource Category RIM Lifecycle Media Past Act Binary Unrelated Entity Bundle Unrelated Entity Basic Unrelated InfrastructureRoot Exchange These resources support the exchange process directly: MessageHeader is the header for a message - identifies its context, sender and receiver, and content OperationOutcome is returned to indicate the detailed outcome of a particular FHIR operation or interaction - success, or failure Parameters is input or output to Operations Patterns : Event , Request , Definition
  • Subscription allows one system to subscribe to events on another system Resource Category RIM Lifecycle MessageHeader Present Act OperationOutcome Present Act Parameters Present InfrastructureRoot Subscription Present Act 2.33.6 Conformance This specification is a base platform specification that defines a set of general capabilities. Specific systems build on top of that to create interoperable solutions by making a set of conformance rules . These conformance rules are supported by a this set of "conformance" resources. Terminology A ValueSet defines a set of codes from one or more code systems that are used for validation, lookup etc. A ConceptMap maps value sets between different code systems. A NamingSystem resource represents an external provider of codes or identifiers (e.g. an external code system such as SNOMED CT, or an identification system such as an institution MRN). The naming system resource exists to share the identification and registration of these systems, to foster consistency in their identification. Resource Category RIM Lifecycle ValueSet Unrelated ConceptMap Unrelated NamingSystem Unrelated Content StructureDefinition and DataElement both describe a set of data elements that can represent data for the purposes of collection, analysis and exchange. They have slightly different purposes: StructureDefinition is used specifically to describe the structures used by or with this specification DataElement describes more general data items that are represented and exchanged in many formats and/or contexts Mappings (todo)
StructureMap supports a general purpose mapping language that can be used to transfer data from one structure to another. Resource Category RIM Lifecycle StructureDefinition Unrelated StructureMap Unrelated Unrelated DataElement Unrelated Entity Behavior A CapabilityStatement is a statement of a set of system capabilities for use as system discovery, or conformance expectations. An OperationDefinition describes an operation that can be executed on a server, and a SearchParameter defines a search parameter that can be used on a server. CompartmentDefinition provides information about how resources are associated on a server. MessageDefintion describes the behavior associated with receiving a particular message. Resource Category RIM Lifecycle CapabilityStatement Unrelated OperationDefinition Unrelated SearchParameter Unrelated CompartmentDefinition Unrelated Miscellaneous ImplementationGuide is used to gather all the other resources into a single package for publication, and also to define the bounds of an interoperability solution. A TestScript specifies a series of operations and outcomes that a system is expected to meet. TestScripts are for development and acceptance testing, but may also be considered for use with production systems, if the tests are carefully constructed and vetted. A TestReport contains the test execution results of a TestScript against a series of operations and outcomes that a system is expected to meet. TestReports provide a static recording of TestScript results for subsequent retrieval and review.. Resource Category RIM Lifecycle ImplementationGuide Unrelated TestScript Unrelated TestReport Unrelated 2.33.7 Financial These resources are all in draft status and more details will be provided here in due course. Resource Category RIM Lifecycle Coverage Ongoing Act EligibilityRequest Present Act EligibilityResponse Present Act EnrollmentRequest Present Act EnrollmentResponse Present Act Claim Present Act ClaimResponse Present Act PaymentNotice Past Act PaymentReconciliation Past Act ExplanationOfBenefit Past Act