DocumentHeader

COFE-Composition-1

COFE-Composition-1

Composition
Definition

A set of healthcare-related information that is assembled together into a single logical document that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. While a Composition defines the structure, it does not actually contain the content: rather the full content of a document is contained in a Bundle, of which the Composition is the first resource contained.

Control 0..*
Type Composition
Comments

While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.

Composition.extension(Data Enterer Extension)
Definition

Optional Extensions Element - found in all resources.

Control 0..1
Type Extension
Comments
Composition.extension(Informant Extension)
Definition

Optional Extensions Element - found in all resources.

Control 0..*
Type Extension
Comments
Composition.extension(Information Recipient Extension)
Definition

Optional Extensions Element - found in all resources.

Control 0..*
Type Extension
Comments
Composition.extension(Participant Extension)
Definition

Optional Extensions Element - found in all resources.

Control 0..*
Type Extension
Comments
Composition.extension(Performer Extension)
Definition

Optional Extensions Element - found in all resources.

Control 0..*
Type Extension
Comments
Composition.extension(Authorization Extension)
Definition

Optional Extensions Element - found in all resources.

Control 0..*
Type Extension
Comments
Composition.identifier
Definition

Logical identifier for the composition, assigned when created. This identifier stays constant as the composition is changed over time.

Control 1..1
Type Identifier
Comments

See discussion in resource definition for how these relate.

Composition.identifier.value
Definition

The portion of the identifier typically displayed to the user and which is unique within the context of the system.

Control 1..1
Type String
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.

Example 871985a7-45f9-435a-89fa-fcedd7afa7a3
Composition.date
Definition

The composition editing time, when the composition was last logically changed by the author.

Control 1..1
Type DateTime
Requirements

dateTime is used for tracking, organizing versions and searching.

Comments

The Last Modified Date on the composition may be after the date of the document was attested without being changed.

Composition.type
Definition

Specifies the particular kind of composition (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the composition.

Control 1..1
Binding

Type of document.

The codes SHOULD be taken from http://fhir.nhs.net/ValueSet/document-type-1

; other codes may be used where these codes are not suitable
Type CodeableConcept
Requirements

Key metadata element describing the composition, used in searching/filtering.

Comments

For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.

Composition.type.extension(CareSettingType)
Definition

Optional Extensions Element - found in all resources.

Control 0..1
Type Extension
Comments
Composition.type.coding
Definition

A reference to a code defined by a terminology system.

Control 1..1
Binding

Type of a document.

The codes SHOULD be taken from http://fhir.nhs.net/ValueSet/document-type-1

; other codes may be used where these codes are not suitable
Type Coding
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

Composition.type.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control 1..1
Type Uri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Value http://snomed.info/sct
Composition.type.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control 1..1
Binding

A set of codes to classify the type of document.

The codes SHOULD be taken from http://fhir.nhs.net/ValueSet/document-type-1

; other codes may be used where these codes are not suitable
Type Code
Requirements

Need to refer to a particular code in the system.

Comments
Example 373942005
Composition.type.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control 1..1
Type String
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Comments
Example Discharge summary
Composition.class
Definition

A categorization for the type of the composition - helps for indexing and searching. This may be implied by or derived from the code specified in the Composition Type.

Control 0..1
Binding

High-level kind of a clinical document at a macro level.

For example codes, see http://hl7.org/fhir/ValueSet/doc-classcodes

; other codes may be used where these codes are not suitable
Type CodeableConcept
Requirements

Helps humans to assess whether the composition is of interest when viewing an index of compositions or documents.

Comments

This is a metadata field from XDS/MHD.

Composition.title
Definition

Official human-readable label for the composition.

Control 1..1
Type String
Comments

For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.

Composition.status
Definition

The workflow/clinical status of this composition. The status is a marker for the clinical standing of the document.

Control 1..1
Binding

The workflow/clinical status of the composition.

The codes SHALL be taken from http://hl7.org/fhir/ValueSet/composition-status

Type Code
Is Modifier True
Requirements

Need to be able to mark interim, amended, or withdrawn compositions or documents.

Comments

If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "withdrawn" is why this element is labeled as a modifier of other elements. Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required.

Composition.confidentiality
Definition

The code specifying the level of confidentiality of the Composition.

Control 1..1
Binding

Codes specifying the level of confidentiality of the composition.

The codes SHALL be taken from http://hl7.org/fhir/ValueSet/v3-Confidentiality

Type Code
Is Modifier True
Comments

The exact use of this element, and enforcement and issues related to highly sensitive documents are out of scope for the base specification, and delegated to implementation profiles (see security section).

Composition.subject
Definition

Who or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).

Control 1..1
Requirements

Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about.

Comments

For clinical documents, this is usually the patient.

Composition.subject.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control 1..1 ?
Type String
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Composition.subject.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control 0..1
Type String
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Composition.author
Definition

Identifies who is responsible for the information in the composition, not necessarily who typed it in.

Control 1..*
Type Choice of:
Requirements

Identifies who is responsible for the content.

Comments
Composition.attester
Definition

A participant who has attested to the accuracy of the composition/document.

Control 0..*
Type BackboneElement
Requirements

Identifies responsibility for the accuracy of the composition content.

Comments

Only list each attester once.

Composition.attester.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control 0..*
Type Extension
Is Modifier True
Aliases extensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Composition.attester.mode
Definition

The type of attestation the authenticator offers.

Control 1..*
Binding

The way in which a person authenticated a composition.

The codes SHALL be taken from http://hl7.org/fhir/ValueSet/composition-attestation-mode

Type Code
Requirements

Indicates the level of authority of the attestation.

Comments

Use more than one code where a single attester has more than one mode (professional and legal are often paired).

Composition.attester.time
Definition

When composition was attested by the party.

Control 0..1
Type DateTime
Requirements

Identifies when the information in the composition was deemed accurate. (Things may have changed since then.).

Comments
Composition.attester.party
Definition

Who attested the composition in the specified way.

Control 0..1
Type Choice of:
Requirements

Identifies who has taken on the responsibility for accuracy of the composition content.

Comments
Composition.custodian
Definition

Identifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information.

Control 1..1
Requirements

Identifies where to go to find the current version, where to report issues, etc.

Comments

This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However it is important that this information be known when working with a derived document, so providing a custodian is encouraged.

Composition.custodian.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control 1..1 ?
Type String
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Composition.custodian.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control 0..1
Type String
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Composition.event
Definition

The clinical service, such as a colonoscopy or an appendectomy, being documented.

Control 0..*
Type BackboneElement
Requirements

Provides context for the composition and creates a linkage between a resource describing an event and the composition created describing the event.

Comments

The event needs to be consistent with the type element, though can provide further information if desired.

Composition.event.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control 0..*
Type Extension
Is Modifier True
Aliases extensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Composition.event.code
Definition

This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the typeCode, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.

Control 0..*
Binding

This list of codes represents the main clinical acts being documented. It uses a code from any vocabulary to describe the type of service event. The vocabulary SnomedCT is a preferred vocabulary.

The codes SHOULD be taken from http://snomed.info/sct

; other codes may be used where these codes are not suitable
Type CodeableConcept
Comments

An event can further specialize the act inherent in the typeCode, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more eventCodes are included, they SHALL NOT conflict with the values inherent in the classCode, practiceSettingCode or typeCode, as such a conflict would create an ambiguous situation. This short list of codes is provided to be used as key words for certain types of queries.

Composition.event.code.coding
Definition

A reference to a code defined by a terminology system.

Control 0..*
Binding

A code defined by SNOMED CT

The codes SHOULD be taken from http://snomed.info/sct

; other codes may be used where these codes are not suitable
Type Coding
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

Composition.event.code.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control 0..1
Type Uri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Value http://snomed.info/sct
Composition.event.code.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control 0..1
Type Code
Requirements

Need to refer to a particular code in the system.

Comments
Composition.event.code.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control 0..1
Type String
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Comments
Composition.event.code.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control 0..1
Type String
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

Composition.event.period
Definition

The period of time covered by the documentation. There is no assertion that the documentation is a complete representation for this period, only that it documents events during this time.

Control 0..1
Type Period
Comments
Composition.event.period.start
Definition

The start of the period. The boundary is inclusive.

Control 0..1 ?
Type DateTime
Comments

If the low element is missing, the meaning is that the low boundary is not known.

Composition.event.period.end
Definition

The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

Control 0..1 ?
Type DateTime
Comments

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

Composition.event.detail
Definition

The description and/or reference of the event(s) being documented. For example, this could be used to document such a colonoscopy or an appendectomy.

Control 0..*
Type Resource
Comments
Composition.event.detail.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control 0..1 ?
Type String
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Composition.event.detail.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control 0..1
Type String
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Composition.encounter
Definition

Describes the clinical encounter or type of care this documentation is associated with.

Control 0..1
Requirements

Provides context for the composition and supports searching.

Comments
Composition.encounter.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control 1..1 ?
Type String
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Composition.encounter.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control 0..1
Type String
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Composition.section(section)
Definition

The root of the sections that make up the composition.

Control 0..*
Type BackboneElement
Comments
Composition.section.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control 0..*
Type Extension
Is Modifier True
Aliases extensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Composition.section.title
Definition

The label for this particular section. This will be part of the rendered content for the document, and is often used to build a table of contents.

Control 0..1
Type String
Requirements

Section headings are often standardized for different types of documents. They give guidance to humans on how the document is organized.

Aliases header, label, caption
Comments

The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.

Composition.section.code
Definition

A code identifying the kind of content contained within the section. This must be consistent with the section title.

Control 0..1
Binding

A code from the SNOMED Clinical Terminology UK coding system which represent the type of section.

The codes SHOULD be taken from http://fhir.nhs.net/ValueSet/section-type-snct-1

; other codes may be used where these codes are not suitable
Type CodeableConcept
Requirements

Provides computable standardized labels to topics within the document.

Comments

The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document. If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.

Composition.section.code.coding
Definition

A reference to a code defined by a terminology system.

Control 0..1
Binding

A code from the SNOMED Clinical Terminology UK coding system which represent the type of section.

The codes SHOULD be taken from http://fhir.nhs.net/ValueSet/section-type-snct-1

; other codes may be used where these codes are not suitable
Type Coding
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

Composition.section.code.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control 0..1
Type Uri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Value http://snomed.info/sct
Composition.section.code.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

Control 0..1
Type String
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

Composition.section.code.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control 0..1
Type Code
Requirements

Need to refer to a particular code in the system.

Comments
Composition.section.code.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control 0..1
Type String
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Comments
Composition.section.code.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control 0..1
Type Boolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

Composition.section.code.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control 0..1
Type String
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

Composition.section.text
Definition

A human-readable narrative that contains the attested content of the section, used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative.

Control 0..1 ?
Type Narrative
Comments

Document profiles may define what content should be represented in the narrative to ensure clinical safety.

Composition.section.text.status
Definition

The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

Control 1..1
Binding

The status of a resource narrative

The codes SHALL be taken from http://hl7.org/fhir/ValueSet/narrative-status

Type Code
Comments
Composition.section.text.div
Definition

The actual narrative content, a stripped down version of XHTML.

Control 1..1
Type Xhtml
Comments

The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content may not contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

Composition.section.mode
Definition

How the entry list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted.

Control 0..1
Binding

The processing mode that applies to this section.

The codes SHALL be taken from http://hl7.org/fhir/ValueSet/list-mode

Type Code
Is Modifier True
Requirements

Sections are used in various ways, and it must be known in what way it is safe to use the entries in them.

Comments
Composition.section.orderedBy
Definition

Specifies the order applied to the items in the section entries.

Control 0..1
Binding

What order applies to the items in the entry.

The codes SHOULD be taken from http://hl7.org/fhir/ValueSet/list-order

; other codes may be used where these codes are not suitable
Type CodeableConcept
Requirements

Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries.

Comments

Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.

Composition.section.orderedBy.coding
Definition

A reference to a code defined by a terminology system.

Control 0..*
Type Coding
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

Composition.section.orderedBy.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control 0..1
Type Uri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Composition.section.orderedBy.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

Control 0..1
Type String
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

Composition.section.orderedBy.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control 0..1
Type Code
Requirements

Need to refer to a particular code in the system.

Comments
Composition.section.orderedBy.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control 0..1
Type String
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Comments
Composition.section.orderedBy.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control 0..1
Type Boolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

Composition.section.orderedBy.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control 0..1
Type String
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

Composition.section.entry
Definition

A reference to the actual resource from which the narrative in the section is derived.

Control 0..* ?
Type Resource
Comments

If there are no entries in the list, an emptyReason SHOULD be provided.

Composition.section.emptyReason
Definition

If the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason.

Control 0..1 ?
Binding

If a section is empty, why it is empty.

The codes SHOULD be taken from http://hl7.org/fhir/ValueSet/list-empty-reason

; other codes may be used where these codes are not suitable
Type CodeableConcept
Requirements

Allows capturing things like "none exist" or "not asked" which can be important for most lists.

Comments

The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.

Composition.section.emptyReason.coding
Definition

A reference to a code defined by a terminology system.

Control 0..*
Type Coding
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

Composition.section.emptyReason.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control 0..1
Type Uri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Composition.section.emptyReason.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

Control 0..1
Type String
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

Composition.section.emptyReason.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control 0..1
Type Code
Requirements

Need to refer to a particular code in the system.

Comments
Composition.section.emptyReason.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control 0..1
Type String
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Comments
Composition.section.emptyReason.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control 0..1
Type Boolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

Composition.section.emptyReason.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control 0..1
Type String
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

Composition.section.section
Definition

A nested sub-section within this section.

Control 0..* ?
Type See section
Comments

Nested sections are primarily used to help human readers navigate to particular portions of the document.