Meldung
https://demis.rki.de/fhir/StructureDefinition/Notification
Die Meldung ist ein abstraktes Profil und referenziert die Betroffene Person, den Melder und die Untersuchungsergebnisse. Spezifische Arten von Meldungen werden in abgeleiteten Profilen definiert.
Bildung und Anwendung des Identifiers der Meldung (Meldungs-Id) [Auszug aus den Grundlagen des Meldungs-Lifecyclemanagements]:
Eine Meldung (M) enthält meldepflichtige Informationen zu einem konkreten Fall (z.B. Erregernachweis CVDP für Person ABC durch Labor XYZ). Meldungen werden grundsätzlich eingebettet in Meldevorgängen (s.o.) transportiert. Eine logisch zusammengehörige Meldung (z.B. Initialmeldung + Ergänzungsmeldung, Initialmeldung + Korrekturmeldung) kann sich dabei über mehrere Meldevorgänge verteilen: Aus fachlicher Sicht wäre dann die Ergänzungsmeldung sozusagen eine neue Version der Initialmeldung.
Meldungen werden innerhalb des DEMIS-Informationsmodells als profilierte FHIR-Composition-Ressourcen (vgl. z.B. Erregernachweismeldung) abgebildet. Meldungen können eindeutig über die sogenannte Meldungs-Id (NotificationId) identifiziert werden, welche durch den Melder nach einem definierten Schema (s.u.) generiert werden muss. Ergänzungsmeldungen, Korrekturmeldungen usw. müssen jeweils die Meldungs-Id (NotificationId) der Initialmeldung tragen, um eine Zusammenführung der Inhalte in den verarbeitenden Fachverfahren im Gesundheitsamt zu ermöglichen. Dabei muss jedoch berücksichtigt werden, dass Meldungen verschiedener Melder (Primärlabor, Sekundärlabor) niemals die gleiche Meldungs-Id (NotificationId) tragen dürfen, auch wenn sie sich auf den gleichen Fall beziehen. Ähnlich wie die Meldevorgangs-Id wird auch die Meldungs-Id als Bestandteil der PDF-Quittung an den Melder zurück geliefert.
Repräsentation der Meldungs-Id (NotificationId) als Composition.identifier:
<Composition xmlns="http://hl7.org/fhir"> ... <identifier> <system value="https://demis.rki.de/fhir/NamingSystem/NotificationId"/> <value value="c13cd356-f147-5901-859d-31e6b2772465"/> </identifier> ... </Composition>
Hinweis: Sämtliche durch ein Primärlabor gesendeten Ergänzungs- und/oder Korrekturmeldungen zu einem Fall tragen grundsätzlich dieselbe Meldungs-Id (NotifciationId) wie die Initialmeldung. Sie wird in allen Fällen über das Element Composition.identifier dargestellt. Gesonderte Regelungen gelten für den Fall, dass ein Sekundärlabor sich auf die Meldung des jeweiligen Primärlabors beziehen und diese ggf. ergänzen möchte (vgl. "Verweis auf Meldungen anderer Melder").
Bildungsvorschrift für die Meldungs-Id
Als
system
MUSS https://demis.rki.de/fhir/NamingSystem/NotificationId verwendet werden.Der
value
MUSS eine durch das System des Melders generierte UUID sein, die gemäß einer der beiden im Folgenden beschriebenen Varianten gebildet wird:Variante 1 - Bildung einer Random-UUID (v4) gemäß RFC4122: Sendende Systeme KÖNNEN für die Darstellung der Meldungs-Id (NotificationId) für jeden Fall/Auftrag Random-UUIDs (v4) gemäß RFC4122 in eigener Verantwortung bilden. Um sicherzustellen, dass Ergänzungs- und Korrekturmeldungen zum entsprechenden Fall/Auftrag dieselbe Meldungs-Id (NotificationId) tragen, MÜSSEN die entsprechende Systeme intern sicherstellen, dass die generierte Id dauerhaft mit dem Fall/Auftrag assoziiert bleibt. Dies macht u.U. komplexere Anpassungen an den jeweiligen Systemen bzw. deren Datenmodell erforderlich.
Variante 2 - Bildung einer namensbasierten UUID (v5) gemäß RFC4122 (SHA1-basiert): Sendende Systeme KÖNNEN für die Darstellung der Meldungs-Id (NotificationId) für jeden Fall/Auftrag namensbasierte UUIDs (v5) gemäß RFC4122 (SHA1-basiert) in eigener Verantwortung bilden. In diesem Zusammenhang MUSS durch die Implementierung sichergestellt werden, dass die in die UUID-Generierung einfließenden Parameter so gewählt werden, dass sowohl für unterschiedliche Fälle/Aufträge als auch für unterschiedliche Melder niemals dieselben UUIDs generiert werden. Folgendes Verfahren KANN in diesem Zusammenhang zum Einsatz kommen:
Für jedes meldende System MUSS einmalig eine individuelle Namespace UUID als Random-UUID (v4) gemäß RFC4122 gebildet werden (z.B. "db5da554-9bb0-4393-9ee3-4866cad38c1e" → Bitte diese Namespace UUID NICHT nutzen. Sie ist lediglich ein Beispiel). Die einmalig generierte Namespace UUID fließt fortan dauerhaft in die Generierung der namensbasierten UUID (v5) gemäß RFC4122 (SHA1-basiert) ein und stellt damit sicher, dass andere meldende Systeme keine identischen UUIDs bilden werden.
Für jedes meldende System MÜSSEN neben der Namespace UUID weitere Eingabeparameter definiert werden, die sicherstellen, dass die generierte UUID in Bezug auf den Fall/Auftrag DAUERHAFT eindeutig bleibt. Dies kann beispielsweise eine sinnvolle Konkatenierung der DEMIS Labor ID, der Jahreszahl und einer melderspezifischen Proben-/Auftragsnummer sein (z.B. "LAB12345_2021-007023"). Bei der Auswahl der jeweiligen Parameter sind insbesondere Situationen geschickt zu adressieren, in denen sich verwendete Parameter wiederholen könnten (z.B. Auftragsnummern beginnen jedes Jahr bei '00000').
Bildung der namensbasierte UUIDs (v5) gemäß RFC4122 (SHA1-basiert) unter Nutzung der Namespace UUID und der übrigen Eingabeparameter:
- UUIDv5.nameUUIDFromNsAndString("db5da554-9bb0-4393-9ee3-4866cad38c1e", "LAB12345_2021-007023") → c13cd356-f147-5901-859d-31e6b2772465
Die zweite Variante hat den Vorteil, dass das meldende System die generierte UUID nicht dauerhaft mit dem Fall/Auftrag assoziieren muss, da aus den bereits verwalteten Angaben zu einem Fall/Auftrag dieselbe Meldungs-Id jederzeit neu berechnet werden kann.
Wichtig: Die Gewährleistung der Eindeutigkeit der Meldungs-Id (NotificationId) für einen konkreten Fall/Auftrag ist ESSENTIELL wichtig für die empfangenden Gesundheitsämter, da insbesondere über diesen Mechanismus eine (teil)automatisierte Zusammenführung von Initial-, Ergänzungs- und Korrekturmeldungen leicht ermöglicht werden kann. Werden dieselben Meldungs-Ids (NotificationIds) jedoch für unterschiedliche Fälle/Aufträge verwendet, kann es u.U. zu größeren Verwerfungen in den Fachverfahren der Gesundheitsämtern kommen, da potentiell nicht zusammengehörige Meldungen einander zugeordnet werden. Bitte halten Sie sich daher zwingend an die formulierten Anforderungen!
Verweis auf Meldungen anderer Melder
Es existieren Szenarien (s.u.), in denen verschiedene Melder (z.B. Primärlabor + Sekundärlabor), Meldungen an DEMIS versenden, die sich für alle Akteure erkennbar auf den selben Fall beziehen. Um eine automatisierte Zuordenbarkeit dieser Meldungen bei den empfangenden Gesundheitsämtern sicherstellen zu können, ist es möglich, innerhalb einer Meldung M2 auf eine Meldung M1 eines anderen Melders zu verweisen. Verweise auf Meldungen anderer Melder, die sich auf den selben Fall beziehen MÜSSEN dabei im
Composition.relatesTo
Element der jeweiligen Ressource entsprechend des im Folgenden dargestellten Schemas eingebettet werden. Der verwendete Identifier ist dabei die Meldungs-Id (NotificationId) der Meldung auf welche verwiesen wird.Verweise auf Meldungen anderer Melder, die sich auf den selben Fall beziehen:
<Composition xmlns="http://hl7.org/fhir"> ... <relatesTo> <code value="appends"/> <targetReference> <type value="Composition"/> <identifier> <system value="https://demis.rki.de/fhir/NamingSystem/NotificationId"/> <value value="c13cd356-f147-5901-859d-31e6b2772465"/> </identifier> </targetReference> </relatesTo> ... </Composition>
Voraussetzung für die Einbettung des entsprechenden Verweises in die Meldung ist, dass das Primärlabor dem Sekundärlabor die entsprechende Meldungs-Id im Rahmen der Auftragserteilung übermittelt hat. Wie und auf welchem Weg dies erfolgt, liegt außerhalb der Regelungshoheit von DEMIS. Denkbar ist hier beispielsweise die Übermittlung der Meldungs-Id vom Primär- zum Sekundärlabor als Bestandteil des Probenbegleitscheins. Sofern der Datenaustausch zwischen Primär- und Sekundärlabor noch nicht vollständig digitalisiert ist, sollten jedoch Mechanismen vorgesehen werden, die Sicherstellen, dass der entsprechende Identifier nicht "abgetippt" werden muss. Hier bietet sich - sofern papierbasierte Begleitscheine zum Einsatz kommen - u.U. eine Darstellung als QR-Code o.ä. an.
Wichtig: Unabhängig von der Verwendung des Composition.relatesTo Elements MUSS das meldende Sekundärlabor dennoch eine eigene Meldungs-Id zum jeweiligen Fall/Auftrag erzeugen und in Composition.identifier einbetten.
Die in diesem Abschnitt getroffenen Aussagen beziehen sich ausschließlich auf die Referenzierung von Meldungen ANDERER Melder. Eine Nutzung von Composition.relatesTo ist für eigene Ergänzungsmeldungen NICHT zielführend, da hier bereits die Zusammenführung der Inhalte über Composition.identifier (s.o.) erfolgt.
Notification (Composition) | I | Composition | There are no (further) constraints on this element Element idComposition A set of resources composed into a single coherent clinical statement with clinical attestation DefinitionA set of healthcare-related information that is assembled together into a single logical package 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. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.). 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.
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id | Σ | 0..1 | string | There are no (further) constraints on this element Element idComposition.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idComposition.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idComposition.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idComposition.language Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
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text | 0..1 | Narrative | There are no (further) constraints on this element Element idComposition.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be 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. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idComposition.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idComposition.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idComposition.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idComposition.identifier Version-independent identifier for the Composition DefinitionA version-independent identifier for the Composition. This identifier stays constant as the composition is changed over time. Similar to ClinicalDocument/setId in CDA. See discussion in resource definition for how these relate.
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status | S Σ ?! | 1..1 | codeBinding | Element idComposition.status Status der Meldungsinhalte DefinitionDer Status gibt, ob die Meldungsinhalte verbindlich oder vorläufig sind. Oder ob es sich um eine Korrektur-bzw. Ergänzungsmeldung handelt. Need to be able to mark interim, amended, or withdrawn compositions or documents. Der Status ist szenarienspezifisch folgendermaßen zu belegen: final - wenn keine weiteren Untersuchungen notwendig sind und der Meldetatbestand erfüllt ist preliminary - wenn ein Bestätigungstest notwendig ist amended - wenn die Meldung korrigiert oder um einen weiteren Erregernachweis ergänzt wird The workflow/clinical status of the composition.
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type | S Σ | 1..1 | CodeableConceptBinding | Element idComposition.type Typ der Composition DefinitionTyp der Composition Key metadata element describing the composition, used in searching/filtering. 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. Type of a composition.
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category | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idComposition.category Categorization of Composition DefinitionA 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. Helps humans to assess whether the composition is of interest when viewing an index of compositions or documents. This is a metadata field from XDS/MHD. High-level kind of a clinical document at a macro level.
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subject | Σ I | 0..1 | Reference(Resource) | There are no (further) constraints on this element Element idComposition.subject Who and/or what the composition is about DefinitionWho 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). Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about. For clinical documents, this is usually the patient.
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encounter | Σ I | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element idComposition.encounter Context of the Composition DefinitionDescribes the clinical encounter or type of care this documentation is associated with. Provides context for the composition and supports searching. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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date | S Σ | 1..1 | dateTime | Element idComposition.date Zeitpunkt der Erstellung/Bearbeitung der aktuellen Version der Meldung DefinitionZeitpunkt der Erstellung/Bearbeitung der aktuellen Version der Meldung dateTime is used for tracking, organizing versions and searching. Note that this is the time of authoring. When packaged in a document, Bundle.timestamp is the date of packaging. The Last Modified Date on the composition may be after the date of the document was attested without being changed.
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author | S Σ I | 1..1 | Reference(NotifierRole) | Element idComposition.author Verweis auf die Melder-Rolle. DefinitionVerweis auf die Melder-Rolle. Über die Melder-Rolle kann eine Person oder eine Organisation als Melder referenziert werden. Identifies who is responsible for the content. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Allowed aggregation: bundled Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idComposition.author.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idComposition.author.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | S Σ I | 1..1 | string | There are no (further) constraints on this element Element idComposition.author.reference Literal reference, Relative, internal or absolute URL DefinitionA 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. 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.
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type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idComposition.author.type Type the reference refers to (e.g. "Patient") DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Aa resource (or, for logical models, the URI of the logical model).
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idComposition.author.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idComposition.author.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. 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.
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title | S Σ | 1..1 | string | Element idComposition.title Titel der Meldung DefinitionTitel der Meldung 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.
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confidentiality | Σ | 0..0 | codeBinding | There are no (further) constraints on this element Element idComposition.confidentiality As defined by affinity domain DefinitionThe code specifying the level of confidentiality of the Composition. 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). This element is labeled as a modifier because highly confidential documents must not be treated as if they are not. Codes specifying the level of confidentiality of the composition.
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attester | 0..0 | BackboneElement | There are no (further) constraints on this element Element idComposition.attester Attests to accuracy of composition DefinitionA participant who has attested to the accuracy of the composition/document. Identifies responsibility for the accuracy of the composition content. Only list each attester once.
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custodian | Σ I | 0..0 | Reference(Organization) | There are no (further) constraints on this element Element idComposition.custodian Organization which maintains the composition DefinitionIdentifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information. Identifies where to go to find the current version, where to report issues, etc. 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.
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relatesTo | S | 0..1 | BackboneElement | Element idComposition.relatesTo Verweis auf eine Meldung DefinitionEs kann eine Meldung referenziert werden, z.B. eine vorangegangene Meldung eines Primärlabors. Dazu wird die NotificationId der Meldung, auf die verwiesen werden soll, im relatesTo-Identifier angegeben. A document is a version specific composition.
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id | 0..1 | string | There are no (further) constraints on this element Element idComposition.relatesTo.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idComposition.relatesTo.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idComposition.relatesTo.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. 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.
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code | S | 1..1 | codeBindingFixed Value | Element idComposition.relatesTo.code replaces | transforms | signs | appends DefinitionThe type of relationship that this composition has with anther composition or document. If this document appends another document, then the document cannot be fully understood without also accessing the referenced document. The type of relationship between documents.
appends
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target[x] | S | 1..1 | There are no (further) constraints on this element Element idComposition.relatesTo.target[x] Target of the relationship DefinitionThe target composition/document of this relationship.
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id | 0..1 | string | There are no (further) constraints on this element Element idComposition.relatesTo.target[x].id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idComposition.relatesTo.target[x].extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idComposition.relatesTo.target[x].reference Literal reference, Relative, internal or absolute URL DefinitionA 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. 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.
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type | S Σ | 1..1 | uriBindingFixed Value | Element idComposition.relatesTo.target[x].type Type the reference refers to (e.g. "Patient") DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Aa resource (or, for logical models, the URI of the logical model).
Composition
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identifier | S Σ | 1..1 | Identifier | There are no (further) constraints on this element Element idComposition.relatesTo.target[x].identifier Logical reference, when literal reference is not known DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
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id | 0..1 | string | There are no (further) constraints on this element Element idComposition.relatesTo.target[x].identifier.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idComposition.relatesTo.target[x].identifier.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idComposition.relatesTo.target[x].identifier.use usual | official | temp | secondary | old (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Identifies the purpose for this identifier, if known .
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type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idComposition.relatesTo.target[x].identifier.type Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Allows users to make use of identifiers when the identifier system is not known. This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
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system | S Σ | 1..1 | uriFixed Value | Element idComposition.relatesTo.target[x].identifier.system The namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique. There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Identifier.system is always case sensitive.
https://demis.rki.de/fhir/NamingSystem/NotificationId
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value | S Σ | 1..1 | string | There are no (further) constraints on this element Element idComposition.relatesTo.target[x].identifier.value The value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system. If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
General 123456 Mappings
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period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idComposition.relatesTo.target[x].identifier.period Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
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assigner | Σ I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idComposition.relatesTo.target[x].identifier.assigner Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idComposition.relatesTo.target[x].display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. 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.
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targetReference | Reference(Composition) | Data type | ||
event | Σ | 0..0 | BackboneElement | There are no (further) constraints on this element Element idComposition.event The clinical service(s) being documented DefinitionThe clinical service, such as a colonoscopy or an appendectomy, being documented. Provides context for the composition and creates a linkage between a resource describing an event and the composition created describing the event. The event needs to be consistent with the type element, though can provide further information if desired.
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section | I | 0..* | BackboneElement | There are no (further) constraints on this element Element idComposition.section Composition is broken into sections DefinitionThe root of the sections that make up the composition.
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id | 0..1 | string | There are no (further) constraints on this element Element idComposition.section.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idComposition.section.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idComposition.section.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. 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.
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title | 0..1 | string | There are no (further) constraints on this element Element idComposition.section.title Label for section (e.g. for ToC) Alternate namesheader, label, caption DefinitionThe 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. Section headings are often standardized for different types of documents. They give guidance to humans on how the document is organized. 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.
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code | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idComposition.section.code Classification of section (recommended) DefinitionA code identifying the kind of content contained within the section. This must be consistent with the section title. Provides computable standardized labels to topics within the document. 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. Classification of a section of a composition/document.
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author | I | 0..* | Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) | There are no (further) constraints on this element Element idComposition.section.author Who and/or what authored the section DefinitionIdentifies who is responsible for the information in this section, not necessarily who typed it in. Identifies who is responsible for the content. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) Constraints
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focus | I | 0..1 | Reference(Resource) | There are no (further) constraints on this element Element idComposition.section.focus Who/what the section is about, when it is not about the subject of composition DefinitionThe actual focus of the section when it is not the subject of the composition, but instead represents something or someone associated with the subject such as (for a patient subject) a spouse, parent, fetus, or donor. If not focus is specified, the focus is assumed to be focus of the parent section, or, for a section in the Composition itself, the subject of the composition. Sections with a focus SHALL only include resources where the logical subject (patient, subject, focus, etc.) matches the section focus, or the resources have no logical subject (few resources). Typically, sections in a doument are about the subject of the document, whether that is a patient, or group of patients, location, or device, or whatever. For some kind of documents, some sections actually contain data about related entities. Typical examples are a section in a newborn discharge summary concerning the mother, or family history documents, with a section about each family member, though there are many other examples.
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text | I | 0..1 | Narrative | There are no (further) constraints on this element Element idComposition.section.text Text summary of the section, for human interpretation DefinitionA 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. Document profiles may define what content should be represented in the narrative to ensure clinical safety.
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mode | 0..1 | codeBinding | There are no (further) constraints on this element Element idComposition.section.mode working | snapshot | changes DefinitionHow 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. Sections are used in various ways, and it must be known in what way it is safe to use the entries in them. This element is labeled as a modifier because a change list must not be misunderstood as a complete list. The processing mode that applies to this section.
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orderedBy | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idComposition.section.orderedBy Order of section entries DefinitionSpecifies the order applied to the items in the section entries. Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries. 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. What order applies to the items in the entry.
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entry | I | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idComposition.section.entry A reference to data that supports this section DefinitionA reference to the actual resource from which the narrative in the section is derived. If there are no entries in the list, an emptyReason SHOULD be provided.
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emptyReason | I | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idComposition.section.emptyReason Why the section is empty DefinitionIf the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason. Allows capturing things like "none exist" or "not asked" which can be important for most lists. 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. If a section is empty, why it is empty.
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section | I | 0..* | see (section) | There are no (further) constraints on this element Element idComposition.section.section Nested Section DefinitionA nested sub-section within this section. Nested sections are primarily used to help human readers navigate to particular portions of the document.
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Beispiele finden sich in den Projekten, die jeweils einen spezifischen Meldungstyp gemäß Infektionsschutzgesetz abbilden, siehe hierzu DEMIS-Erregernachweismeldung oder DEMIS-Erkrankungsmeldung.