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![© 2015 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR®
Coded datatypes
• Code: "status" : "confirmed"
• Coding: {
"system":
"http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "C3214954",
"display": "cashew nut allergenic extract Injectable"
}
• CodeableConcept: {
"coding": [{
"system": "http://snomed.info/sct",
"code": "39579001",
"display": "Anaphylactic reaction“
}],
"text" : "Anaphylaxis"
}](https://image.slidesharecdn.com/fhir-220918174116-5736509d/85/FHIR-pptx-31-320.jpg)
![© 2015 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR®
ValueSet
{
"resourceType": "ValueSet",
"id": "condition-code",
"url": "http://hl7.org/fhir/ValueSet/condition-code",
"compose": {
"include": [
{
"system": "http://snomed.info/sct",
"filter": [
{
"property": "concept",
"op": "is-a",
"value": "404684003"
}
]
},
{
"system": "http://snomed.info/sct",
"concept": [
{
"code": "160245001",
"display": "No current problems or disability"
}
]
}
]
}
}
A context specific subset of one
or more Code Systems
Promotes consistency between
applications
Key component of Terminology
Also CodeSystem
Target of a number of services](https://image.slidesharecdn.com/fhir-220918174116-5736509d/85/FHIR-pptx-36-320.jpg)
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FHIR.pptx
- 1. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® BASICS OF FHIR
- 2. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Overview of FHIR • Fast Healthcare Interoperability Resources (FHIR) • Consistent, simple to use content model (resources) • Controlled extensibility • Supports all paradigms of exchange • Real-time APIs • Documents, Messages & Operations • Designed with implementers in mind • Freely available • Detailed on-line, hyperlinked specification • Freely available tooling, servers, libraries • Written into latest HHS regulations • Massive supporting community
- 3. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Informed by and Related to other Healthcare Standards • HL7 • Version 2 • Version 3 • CDA • openEHR • CIMI • IHE • DICOM • Terminologies • SNOMED • ICD Incorporates lessons learned from prior efforts
- 4. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® FHIR Documentation • How to use FHIR • Contains detailed requirements with Code Snippets • Where appears – the content is a balloted standard and in production. • A few important areas for us: • Documents – “A document is an immutable set of resources with a fixed presentation.” • Data Types --
- 5. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Resources: What are they? • The Thing that is exchanged • Via REST ( FHIR Restful API), Messages, Documents • The Content model • Small logically discrete units of exchange • Defined behaviour and meaning • Known identity / location • Smallest unit of transaction • “of interest” to healthcare • Informed by much past work inside & outside of HL7 • HL7: version 2, version 3 (RIM), CDA • V2: Sort of like Segments • V3: Sort of like CMETs • Other SDO: openEHR, CIMI, ISO 13606, IHE, DICOM
- 6. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® FHIR the basics | Resources A simple office encounter
- 7. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Resources: How are they organized? • https://www.hl7.org/fhir/overview-arch.html#framework
- 8. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Clinical Resources General: AllergyIntolerance Condition (Problem) Procedure ClinicalImpression FamilyMemberHistory RiskAssessment DetectedIssue Care Provision: CarePlan CareTeam Goal ReferralRequest ProcedureRequest NutritionOrder VisionPrescription Medication & Immunization: Medication MedicationOrder MedicationAdministration MedicationDispense MedicationStatement Immunization ImmunizationRecommendation Diagnostics: Observation DiagnosticReport DiagnosticOrder Specimen BodySite ImagingStudy ImagingObjectSelection
- 9. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® FHIR the basics | References between resources
- 10. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Encounter Encounter Practitioner Patient Asserter Performer Performer Performer Performer Performer Performer Asserter Asserter Prescriber Asserter Pain right ear 3 days Otitis media Itchy skin rash No breathing difficulties Elevated temperature Temperature 38°C Inflamed right drum Urticarial Rash Amoxicillin 250mg Erythromycin 250mg Penicillin Allergy As linked resources…
- 11.
- 12. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® clinFHIR: Server roles • Specific server roles (according to clinFHIR) • Data/patient – patient related (clinical) and ‘reference’ (Practitioner, Organization) • Conformance – profile, extensionDefinition (both StructureDefinition) • Terminology – ValueSet & Terminology operations • Important to be STU consistent! clinFHIR Patient and Data Profiles (Conformance) Terminology
- 13. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Why have structured / coded data? • Structured vs Coded • Coded: • Improves UI possibilities • Improves exchange • ‘Secondary’ uses • Allows Decision Support • Population health
- 14. Page 14 •HL7 New Zealand Clinical Scenario • First consultation – Complaining of pain in the r) ear for 3 days with an elevated temperature. On examination, temperature 38.5 degrees and an inflamed r) ear drum with no perforation. Diagnosis Otitis Media, and prescribed Amoxil 250mg TDS for 5 days • Follow up consultation – 5 days later returned with an itchy skin rash. No breathing difficulties. On examination, urticarial rash on both arms. No evidence meningitis. Diagnosis of penicillin allergy. Antibiotics changes to erythromycin and advised not to take penicillin in the future. Condition Observation Med Adv Rean. Allergy Encounter 5 year old boy Patient
- 15. Page 15 •HL7 New Zealand Organizing Resources: Lists of things • Examples – Medication list – Problem List (Conditions) – Allergies – Past Medical History – Past Social History – Social History – ‘Organizer’ in Document • Manage ‘points in time’ and changes • Explicit ‘none known’ List
- 16. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® FHIR Documents • Formed from the Composition Resource • Bundles resources into a single document • The results are signed and managed as a complete document • Types of documents are Constrained by specific PROFILES • ClinicalDocument (based on CDA) – documents related to provision of care. The subject is a patient.
- 17. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® FHIR the basics | Recording a consultation 12-year-old-boy First consultation Complaining of pain in the right ear for 3 days with an elevated temperature. On examination, temperature 38°C and an inflamed right eardrum with no perforation. Diagnosis Otitis Media, and prescribed Amoxicillin 250mg 3 times per day for 7 days. Follow up consultation 2 days later returned with an itchy skin rash. No breathing difficulties. On examination, urticarial rash on both arms. No evidence meningitis. Diagnosis of penicillin allergy. Antibiotics changes to Erythromycin 250mg 4 times per day for 10 days. Patient Encounter Condition Observation Medication Allergy Intolerance
- 18. Page 18 •HL7 New Zealand Scheduling patients • Appointment / AppointmentResponse • Availability • Slot • HealthCareService • Recalls (care plan) • Alerts
- 19. Page 19 •HL7 New Zealand Bundle Resource Bundles – grouping resources • Container resource • Types of Bundle • Searchset • Transaction • Document • Message • … Observation Resource Device Resource Condition Resource List Resource
- 20. Page 20 •HL7 New Zealand Messages – are bundles Observation Resource MessageHeader Resource source destination Device Resource Patient Resource <Bundle> <entry> <MessageHeader /> </entry> <entry> <Observation /> </entry> <entry> <Patient /> </entry> <entry> <Device /> </entry> </Bundle> event
- 21. Page 21 •HL7 New Zealand Document paradigm • Summary at a point in time • Part of record • Very common • CDA • CDA on FHIR
- 22. Page 22 •HL7 New Zealand Documents – are bundles 22 Observation Resource Composition Resource Section Device Resource Condition Resource List Resource <Bundle> <entry> <Composition /> </entry> <entry> <Observation /> </entry> <entry> <Device /> </entry> <entry> <List/> </entry> <entry> <Condition/> </entry> </Bundle> Attester Metadata Section Section
- 23. Page 23 •HL7 New Zealand Documents and Messages
- 24.
- 25. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Get to know the FHIR Home Page https://www.hl7.org/fhir/
- 26. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Diving into Resources Resource Identity & Metadata Human Readable Summary Extension with URL to definition Standard Data: • MRN • Name • Gender • Birth Date • Provider XML and JSON 1) Open Patient Resource 2) Scroll down to Resource Content 3) Open Detailed Descriptions
- 27. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Resource structure Resource Elements: • Name • Cardinality • Type • Description • Terminology binding • Other Patient
- 28. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Datatypes: Let’s look • Review datatypes in spec • Start from resource • Datatypes in resource definition • Backbone element • ‘choice’ data types • Identifiers • Review coded data • ValueSet binding https://www.hl7.org/fhir/datatypes.html
- 29. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Data types: Primitive Based on w3c schema and ISO data types • Stick to the “80% rule” – only expose what most will use • Simplified https://www.hl7.org/fhir/datatypes.html Open Mappings
- 30. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Data types: Complex Complex Data Type: • Composed of other data types • Can be “Profiled’ (constrained)
- 31. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Coded datatypes • Code: "status" : "confirmed" • Coding: { "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "C3214954", "display": "cashew nut allergenic extract Injectable" } • CodeableConcept: { "coding": [{ "system": "http://snomed.info/sct", "code": "39579001", "display": "Anaphylactic reaction“ }], "text" : "Anaphylaxis" }
- 32. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Terminology Sub-system • SNOMED CT / LOINC / RxNORM • ICPC, MIMS + 100s more • ICD-X+ • A drug formulary • Custom Code System: Defines a set of concepts with a coherent meaning Code Display Definition
- 33. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Terminology Sub-system Value Set: A selection of a set of codes for use in a particular context Code System: Defines a set of concepts with a coherent meaning Code Display Definition
- 34. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Terminology Sub-system Code System: Defines a set of concepts with a coherent meaning Code Display Definition Element Definition: Type and Value set reference Value Set: A selection of a set of codes for use in a particular context Binds
- 35. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Terminology Sub-system Code System: Defines a set of concepts with a coherent meaning Code Display Definition Element Definition: Type and Value set reference Value Set: A selection of a set of codes for use in a particular context Binds Element: code/ Coding/ CodeableConcept Conforms • SNOMED CT / LOINC / RxNORM • ICPC, MIMS + 100s more • ICD-X+ • A drug formulary • Custom https://www.hl7.org/fhir/terminologies.html https://www.hl7.org/fhir/terminology-service.html
- 36. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® ValueSet { "resourceType": "ValueSet", "id": "condition-code", "url": "http://hl7.org/fhir/ValueSet/condition-code", "compose": { "include": [ { "system": "http://snomed.info/sct", "filter": [ { "property": "concept", "op": "is-a", "value": "404684003" } ] }, { "system": "http://snomed.info/sct", "concept": [ { "code": "160245001", "display": "No current problems or disability" } ] } ] } } A context specific subset of one or more Code Systems Promotes consistency between applications Key component of Terminology Also CodeSystem Target of a number of services
- 37. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® ValueSet A subset of terms from a code system for a specific purpose or use case Promotes consistency between applications Key component of Terminology Also CodeSystem Skin Tones Pink Ruddish White Gray Yellow
- 38.
- 39. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Adapting FHIR to your needs: Profiling “the FHIR specification is a "platform specification" - it creates a common platform or foundation on which a variety of different solutions are implemented” • Many different contexts in healthcare, but want a single set of Resources • Need to be able to describe ‘usage of FHIR’ based on context • Allow for these usage statements to: • Authored in a structured manner • Published in a registry & Discoverable • Used as the basis for validation, code, report and UI generation. http://hl7.org/fhir/profiling.html
- 40. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Profiling 3 main aspects to profiling: • Constraining a resource - remove element, change multiplicity fix values • Change coded element binding • Adding a new element (an extension) Typical Adaptions in Profiles. • Rules about which resource elements are or are not used, and what additional elements are added that are not part of the base specification • Rules about which API features are used, and how • Rules about which terminologies are used in particular elements • Descriptions of how the Resource elements and API features map to local requirements and/or implementations
- 41. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® For example… Note: Limited mandatory elements in the core spec Require that the identifier uses the NHS number – and is required Limit names to just 1 (instead of 0..*) Change maritalStatus to another set of codes that extends the one from HL7 international Add an extension to support ethnicity Doesn’t support photo
- 42. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® The ‘profile’ • Defines each element • Path • Name • dataType • Binding • Multiplicity • Mapping & much more • Including allowable extension points • http://hl7.org/fhir/profiling.html Select resource, open Profiles & Extensions
- 43. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Extension Definitions • Simple or Complex • Definition: • Available on the web • Canonical Url • Resolvable or Registry • In resource instance: • Reference to Url • Extension or ModifierExtension • Example: US Core – Patient Resource – Extended to include race and ethnicity. • https://www.hl7.org/fhir/extensibility.html> “extensibility is a fundamental part of the design of this specification. Every element in a resource can have extension child elements to represent additional information that is not part of the basic definition of the resource.”
- 44. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Implementation Guides: Pulling it All Together Example • HL7 FHIR® US Core Implementation Guide • https://www.hl7.org/fhir/us/core/
- 45.
- 46. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® An ecosystem A digital ecosystem is a distributed, adaptive, open socio-technical system with properties of self-organisation, scalability and sustainability inspired from natural ecosystems. Wikipedia
- 47. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Components
- 48. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® FHIR Operations • When more complex server logic required than simple CRUD • Midway between REST & SOAP • Some defined in spec. e.g.: • Get all data for a patient • Expand/filter terminology • CDS services • Can define custom services • Still using FHIR resources • Resources to define / inputs
- 49. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Regardless of paradigm, the content is the same FHIR Repository
- 50. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® REST (API) • “Representational State Transfer” – an architecture for how to connect systems in real time • Uses HTTP/S • Simple to use • Very commonly used outside of healthcare – especially mobile • For simple interactions • Create • Read (& Query) • Update • Delete • A lot of tooling / experience available
- 51. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Security • FHIR is not a security standard • Leverages existing standards – for example • TLS • OAuth2 • Support in the specification • Security tags (metadata) • Specialized resources • Provenance • AuditEvent • More detail • http://hl7.org/fhir/security.html
- 52. © 2012 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Freely available Unencumbered – free for use, no membership required http://hl7.org/fhir 52
- 53. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Benefits to Clinicians • Clinicians can get involved in system design • Tooling available • Improved access to more complete, higher quality patient information incl. genomics • Greater choice and variety of applications and devices to support clinical workflow • Increased IT development speed – solving business problems faster in innovative ways • Improving Decision Support - E.g. Immunization protocol • Saving time
- 54. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® ▸ From HL7 http://hl7.org/fhir/index.html wiki.hl7.org/index.php?title=FHIR http://www.fhir.org/ ▸ Community https://chat.fhir.org/ List server (fhir@lists.hl7.org ) Stack Overflow (tag FHIR) ▸ Blogs www.healthintersections.com.au/ https://fhirblog.com/ https://thefhirplace.com/ https://brianpos.com ▸ Libraries Java (http://hapifhir.io/) C# (NuGet HL7.FHIR) ▸ Tooling Forge (http://fhir.furore.com/Forge) http://clinfhir.com/ ▸ Test servers http://wiki.hl7.org/index.php?title=P ublicly_Available_FHIR_Servers_fo r_testing https://fhirblog.com/2016/10/19/sett ing-up-your-own-fhir-server-for- profiling/ More information
- 55. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Benefits to Consumers • Prospect of improved patient engagement apps, enabled through FHIR APIs to clinical systems • Can engage more deeply • Clinician has access to a more complete patient record and improved decision making tools, leading to: • Better decision making • More efficient diagnosis and treatment • Higher quality care • Overall improved patient experience – reducing wasted time
- 56. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Benefits to Health Care Organisations • Most vendors are committed to FHIR • Should lead to: • faster deployments • lower cost interoperability • reduced vendor lock in as FHIR is adopted by source systems • Standards based APIs to support internal application development • Capture data for • Analytics and Decision Support • Population Management
- 57. © 2015 HL7® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR® Next Session Hands On
Editor's Notes
- #6 vs FHIR REST paradigm - treat data as independently , retrievable resource using http - think of browsing on the web FHIR RESTful API endpoints on a server and the stuff you can do to get them back 3) FHIR documents/ document paradigm = type of bundle vs CDA Document architecture using FHIR - Clinical document practice - profile on FHIR for CDA on top of that a ccda profile that expresses the dataelements in
- #8 vs FHIR REST paradigm - treat data as independently , retrievable resource using http - think of browsing on the web FHIR RESTful API endpoints on a server and the stuff you can do to get them back 3) FHIR documents/ document paradigm = type of bundle vs CDA Document architecture using FHIR - Clinical document practice - profile on FHIR for CDA on top of that a ccda profile that expresses the dataelements in
- #9 Maturity model Goto the spec – resource list
- #16 In general, FHIR is based on resources and extensions. Since extensions represent the local variations in the system we are very concerned about refining this boundary. One of the areas where there is healthy discussion is around the concept of lists. Clinicians see many types of lists, problems, diagnosis, patient concerns, allergies, meds, etc. From a developer standpoint they are all flavors of a list. So a discussion ensued over how to refine them.
- #17 “All documents have the same structure: a Bundle of resources of type "document" that has a Composition resource as the first resource in the bundle, followed by a series of other resources, referenced from the Composition resource, that provide supporting evidence for the document. The bundle gathers all the content of the document into a single XML or JSON document which may be signed and managed as required.
- #21 A Message is similar, refers (amongst others) to its author, and contains information about the source, destination and the event that triggered it. A message contains 1 “data” resource, which is the root of the payload of the message. This is just a normal resource, which in its turn can refer to other related resources.
- #23 A Document, no matter how nested, is flattened to a list of entries, the Document’s header being the first. The document header (and any other the other resources) refer to each other using normal references to reflect the document’s nesting. Of course, there may be a digital signature (on the whole Bundle) to attest to the content of the document.
- #26 Open the FHIR Home Page and point out the following: Top Menu – Getting Started – Better than I can do Documentation – the canonical documents
- #28 Each Resource is composed of about 20-40 resource “elements” Each resource element is defined by: Name Cardinality Type (Data type or structural resource) Description Terminology Binding Other stuff (Comments, Constraints, Summary Flags, mappings, etc)
- #31 Complex meaning composed of other datatypes - example identifer, codeableConcept
- #34 Eg condition with different specialties
- #44 There are some cases where the information provided in an extension modifies the meaning of the element that contains it. Such extensions are known as "modifier extensions". Implementers SHOULD avoid the use of modifier extensions where possible. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
- #53 Was a bigger deal before HL7 decided to open up all IP full legal text towards bottom of FHIR home page The FHIR specification is openly and freely available including a sandbox for exploring the concepts