{
"description": null,
"_filename": "DwComposition.StructureDefinition.json",
"package_name": "telus.dw.emr.extract",
"date": "2024-05-03T22:11:40.4165223+00:00",
"derivation": "constraint",
"publisher": null,
"fhirVersion": "4.0.1",
"name": "DwComposition",
"abstract": false,
"type": "Composition",
"experimental": null,
"resourceType": "StructureDefinition",
"title": null,
"package_version": "1.0.0",
"status": "draft",
"id": "8e8cbfe3-3c2a-4dbf-a980-c72424ba87bf",
"kind": "resource",
"url": "https://www.telus.com/health/fhir/dwemrextract/StructureDefinition/DwComposition",
"version": null,
"differential": {
"element": [ {
"id": "Composition.meta",
"path": "Composition.meta"
}, {
"id": "Composition.meta.lastUpdated",
"path": "Composition.meta.lastUpdated",
"mustSupport": true
}, {
"id": "Composition.meta.source",
"path": "Composition.meta.source",
"mustSupport": true
}, {
"id": "Composition.meta.security",
"path": "Composition.meta.security",
"mustSupport": true
}, {
"id": "Composition.text",
"path": "Composition.text",
"mustSupport": true
}, {
"id": "Composition.extension",
"path": "Composition.extension",
"mustSupport": false
}, {
"id": "Composition.extension:versionNumber",
"path": "Composition.extension",
"type": [ {
"code": "Extension",
"profile": [ "http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber" ]
} ],
"sliceName": "versionNumber",
"isModifier": false,
"mustSupport": true
}, {
"id": "Composition.identifier",
"path": "Composition.identifier",
"mustSupport": true
}, {
"id": "Composition.status",
"path": "Composition.status",
"mustSupport": true
}, {
"id": "Composition.type",
"path": "Composition.type",
"mustSupport": true
}, {
"id": "Composition.type.coding",
"path": "Composition.type.coding",
"binding": {
"strength": "preferred",
"valueSet": "http://loinc.org"
},
"fixedCoding": {
"code": "60591-5",
"system": "http://loinc.org",
"display": "Patient summary Document"
}
}, {
"id": "Composition.subject",
"path": "Composition.subject",
"mustSupport": true
}, {
"id": "Composition.date",
"path": "Composition.date",
"mustSupport": true
}, {
"id": "Composition.author",
"path": "Composition.author",
"comment": "Usage Note: Provide Reference to Organization\r\n\r\nReferences 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.",
"mustSupport": true
}, {
"id": "Composition.title",
"path": "Composition.title",
"comment": "Usage Note: CA Patient Summary\r\n\r\nFor 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.",
"mustSupport": true
}, {
"id": "Composition.attester",
"path": "Composition.attester",
"comment": "Usage Note: for future developent when the composition is manually reviewed/created by the patient/related person/provider/organization\r\n\r\nOnly list each attester once.",
"mustSupport": true
}, {
"id": "Composition.attester.mode",
"path": "Composition.attester.mode",
"fixedCode": "legal",
"mustSupport": true
}, {
"id": "Composition.custodian",
"path": "Composition.custodian",
"mustSupport": true
}, {
"id": "Composition.event",
"path": "Composition.event",
"label": "careProvisioningEvent",
"short": "The care provisioning being documented",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "$this",
"type": "type"
} ]
},
"definition": "The provision of healthcare over a period of time this PS is documented."
}, {
"id": "Composition.event:careProvisioningEvent",
"path": "Composition.event",
"label": "careProvisioningEvent",
"sliceName": "careProvisioningEvent",
"mustSupport": true
}, {
"id": "Composition.event:careProvisioningEvent.code",
"min": 1,
"path": "Composition.event.code",
"mustSupport": true
}, {
"id": "Composition.event:careProvisioningEvent.code.coding",
"code": [ {
"code": "PCPR",
"system": "http://terminology.hl7.org/CodeSystem/v3-ActClass",
"display": "care provision"
} ],
"path": "Composition.event.code.coding",
"mustSupport": true
}, {
"id": "Composition.event:careProvisioningEvent.code.coding.system",
"path": "Composition.event.code.coding.system",
"binding": {
"strength": "required",
"valueSet": "http://terminology.hl7.org/CodeSystem/v3-ActClass"
},
"mustSupport": true
}, {
"id": "Composition.event:careProvisioningEvent.code.coding.code",
"path": "Composition.event.code.coding.code",
"fixedCode": "PCPR",
"mustSupport": true
}, {
"id": "Composition.event:careProvisioningEvent.period",
"path": "Composition.event.period",
"mustSupport": true
}, {
"id": "Composition.event:careProvisioningEvent.period.start",
"path": "Composition.event.period.start",
"comment": "Earliest entry in the composition\r\n\r\nIf the low element is missing, the meaning is that the low boundary is not known."
}, {
"id": "Composition.event:careProvisioningEvent.period.end",
"path": "Composition.event.period.end",
"comment": "Latest entry in the composition. \r\nThe high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03."
}, {
"id": "Composition.section",
"path": "Composition.section",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "$this",
"type": "type"
} ]
}
}, {
"path": "Composition.section",
"min": 1,
"definition": "The medication summary section contains a description of the patient's medications relevant for the scope of the patient summary. The actual content could depend on the jurisdiction, it could report:\r\n\r\nthe currently active medications;\r\nthe current and past medications considered relevant by the authoring GP;\r\nthe patient prescriptions or dispensations automatically extracted by a regional or a national EHR.\r\nBecause This section has been expanded in the PS-CA to model a medicationRequest profile in addition to medicationStatement profile initially included in IPS-UV. This section requires either an entry indicating the subject is known not to be on any relevant medication; either an entry indicating that no information is available about medications; or entries summarizing the subject's relevant medications.",
"short": "Medication Summary Section",
"mustSupport": true,
"sliceName": "sectionMedications",
"max": "1",
"id": "Composition.section:sectionMedications",
"comment": "IPS-UV requires a minimum cardinality of 1 on this section to ensure it is always populated with some kind of entry. This constraint has been maintainted in the PS-CA. Systems that can support the clinical profiles in this section that do not have content for a given patient should use the absent/unknown pattern in the clinical profile. Systems that wholistically cannot produce the referenced profiles should use the new content not supported profile to communicate the system limitation. This pattern is considered a temporary measure to allow for patient summaries to be exchanged in Canada (and internationally) while some systems work to meet the expectations for the full set of patient summary sections."
}, {
"id": "Composition.section:sectionMedications.title",
"min": 1,
"path": "Composition.section.title",
"label": "Medication Summary",
"fixedString": "Medication",
"mustSupport": true
}, {
"id": "Composition.section:sectionMedications.code",
"min": 1,
"path": "Composition.section.code",
"binding": {
"strength": "preferred"
},
"mustSupport": true
}, {
"id": "Composition.section:sectionMedications.code.coding",
"code": [ {
"code": "10160-0",
"system": "http://loinc.org",
"display": "Hx of Medication use"
} ],
"path": "Composition.section.code.coding",
"mustSupport": true
}, {
"id": "Composition.section:sectionMedications.code.coding.system",
"path": "Composition.section.code.coding.system",
"binding": {
"strength": "required",
"valueSet": "http://loinc.org"
},
"mustSupport": true
}, {
"id": "Composition.section:sectionMedications.code.coding.code",
"code": [ {
"code": "10160-0",
"system": "http://loinc.org",
"display": "Hx of Medication Use"
} ],
"path": "Composition.section.code.coding.code",
"mustSupport": true
}, {
"id": "Composition.section:sectionMedications.code.coding.display",
"path": "Composition.section.code.coding.display",
"mustSupport": true
}, {
"id": "Composition.section:sectionMedications.text",
"min": 1,
"path": "Composition.section.text",
"mustSupport": true
}, {
"id": "Composition.section:sectionMedications.entry",
"min": 1,
"path": "Composition.section.entry",
"comment": "This entry requires a medicationStatement, a medicationRequest, or population of a resource according to the MedicationSectionNotSupported profile. If there are no entries in the list, an emptyReason SHOULD be provided.",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "$this",
"type": "type"
} ]
},
"mustSupport": true
}, {
"id": "Composition.section:sectionMedications.entry:medicationStatement",
"path": "Composition.section.entry",
"short": "Medication statements relevant for the scope of the patient summary",
"sliceName": "medicationStatement",
"definition": "This Medication Statements relevant for the scope of the patient summary or it is used to indicate that the subject is known not to be on any relevant medication; either that no information is available about medications."
}, {
"id": "Composition.section:sectionMedications.entry:medicationRequest",
"path": "Composition.section.entry",
"sliceName": "medicationRequest",
"mustSupport": true
}, {
"id": "Composition.section:sectionMedications.emptyReason",
"max": "0",
"path": "Composition.section.emptyReason"
}, {
"id": "Composition.section:sectionMedications.section",
"max": "0",
"path": "Composition.section.section"
}, {
"path": "Composition.section",
"min": 1,
"definition": "This section documents the relevant allergies or intolerances (conditions) for that patient, describing the kind of reaction (e.g. rash, anaphylaxis,..); preferably the agents that cause it; and optionally the criticality and the certainty of the allergy. At a minimum, it should list currently active and any relevant historical allergies and adverse reactions. If no information about allergies is available, or if no allergies are known this should be clearly documented in the section.",
"short": "Allergies and Intolerances Section",
"mustSupport": true,
"sliceName": "sectionAllergies",
"max": "1",
"id": "Composition.section:sectionAllergies",
"comment": "IPS-UV requires a minimum cardinality of 1 on this section to ensure it is always populated with some kind of entry. This constraint has been maintainted in the PS-CA. Systems that can support the clinical profiles in this section that do not have content for a given patient should use the absent/unknown pattern in the clinical profile. Systems that wholistically cannot produce the referenced profiles should use the new content not supported profile to communicate the system limitation. This pattern is considered a temporary measure to allow for patient summaries to be exchanged in Canada (and internationally) while some systems work to meet the expectations for the full set of patient summary sections."
}, {
"id": "Composition.section:sectionAllergies.title",
"min": 1,
"path": "Composition.section.title",
"label": "Allergies and Intolerances",
"short": "Allergies and Intolerances",
"mustSupport": true
}, {
"id": "Composition.section:sectionAllergies.code",
"min": 1,
"code": [ {
"code": "48765-2",
"system": "http://loinc.org",
"display": "Allergy &or Adverse Reactions document"
} ],
"path": "Composition.section.code",
"binding": {
"strength": "preferred",
"valueSet": "http://loinc.org"
},
"mustSupport": true
}, {
"id": "Composition.section:sectionAllergies.code.coding",
"code": [ {
"code": "48765-2",
"system": "http://loinc.org",
"display": "Allergies and Adverse reactions Document"
} ],
"path": "Composition.section.code.coding",
"binding": {
"strength": "required",
"valueSet": "http://loinc.org"
},
"mustSupport": true
}, {
"id": "Composition.section:sectionAllergies.code.coding.system",
"path": "Composition.section.code.coding.system",
"binding": {
"strength": "required",
"valueSet": "http://loinc.org"
},
"mustSupport": true
}, {
"id": "Composition.section:sectionAllergies.code.coding.code",
"path": "Composition.section.code.coding.code",
"fixedCode": "48765-2",
"mustSupport": true
}, {
"id": "Composition.section:sectionAllergies.code.coding.display",
"path": "Composition.section.code.coding.display",
"fixedString": "Allergies and Adverse reactions Document",
"mustSupport": true
}, {
"id": "Composition.section:sectionAllergies.text",
"min": 1,
"path": "Composition.section.text",
"mustSupport": true
}, {
"id": "Composition.section:sectionAllergies.entry",
"min": 1,
"path": "Composition.section.entry",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "$this",
"type": "type"
} ]
}
}, {
"id": "Composition.section:sectionAllergies.entry:allergyOrIntolerance",
"path": "Composition.section.entry",
"sliceName": "allergyOrIntolerance",
"mustSupport": true
}, {
"id": "Composition.section:sectionAllergies.emptyReason",
"max": "0",
"path": "Composition.section.emptyReason"
}, {
"id": "Composition.section:sectionAllergies.section",
"max": "0",
"path": "Composition.section.section"
}, {
"path": "Composition.section",
"min": 1,
"definition": "The PS problem section lists and describes clinical problems or conditions currently being monitored for the patient.",
"short": "Problems section",
"mustSupport": true,
"sliceName": "sectionProblems",
"max": "1",
"id": "Composition.section:sectionProblems",
"comment": "IPS-UV requires a minimum cardinality of 1 on this section to ensure it is always populated with some kind of entry. This constraint has been maintainted in the PS-CA. Systems that can support the clinical profiles in this section that do not have content for a given patient should use the absent/unknown pattern in the clinical profile. Systems that wholistically cannot produce the referenced profiles should use the new content not supported profile to communicate the system limitation. This pattern is considered a temporary measure to allow for patient summaries to be exchanged in Canada (and internationally) while some systems work to meet the expectations for the full set of patient summary sections."
}, {
"id": "Composition.section:sectionProblems.title",
"min": 1,
"path": "Composition.section.title",
"label": "Problems List",
"fixedString": "Active Problems",
"mustSupport": true
}, {
"id": "Composition.section:sectionProblems.code",
"min": 1,
"code": [ {
"code": "11450-4",
"system": "http://loinc.org",
"display": "Problem List - Reported"
} ],
"path": "Composition.section.code",
"binding": {
"strength": "required",
"valueSet": "http://loinc.org"
},
"mustSupport": true
}, {
"id": "Composition.section:sectionProblems.code.coding",
"code": [ {
"code": "11450-4",
"system": "http://loinc.org",
"display": "Problem List - Reported"
} ],
"path": "Composition.section.code.coding",
"mustSupport": true
}, {
"id": "Composition.section:sectionProblems.code.coding.system",
"path": "Composition.section.code.coding.system",
"binding": {
"strength": "required",
"valueSet": "http://loinc.org"
},
"mustSupport": true
}, {
"id": "Composition.section:sectionProblems.code.coding.code",
"path": "Composition.section.code.coding.code",
"fixedCode": "11450-4",
"mustSupport": true
}, {
"id": "Composition.section:sectionProblems.code.coding.display",
"path": "Composition.section.code.coding.display",
"fixedString": "Problem List - Reported",
"mustSupport": true
}, {
"id": "Composition.section:sectionProblems.text",
"min": 1,
"path": "Composition.section.text",
"mustSupport": true
}, {
"id": "Composition.section:sectionProblems.entry",
"min": 1,
"path": "Composition.section.entry",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "$this",
"type": "type"
} ]
}
}, {
"id": "Composition.section:sectionProblems.entry:problem",
"path": "Composition.section.entry",
"sliceName": "problem"
}, {
"id": "Composition.section:sectionProblems.emptyReason",
"max": "0",
"path": "Composition.section.emptyReason"
}, {
"id": "Composition.section:sectionProblems.section",
"max": "0",
"path": "Composition.section.section"
}, {
"id": "Composition.section:sectionProceduresHx",
"max": "1",
"path": "Composition.section",
"short": "History of Procedures Section",
"comment": "IPS-UV considers this a Must Support section. This constraint has been relaxed in the PS-CA to allow for jurisdictions who will not be including this domain/section in their initial implementation of patient summaries. Participating jurisdictions are expected to be able to receive this section in a patient summary without flagging an error. Additionally vendors should expect that some jurisdictions may further constrain support of this section within the context of their own jurisdictional content",
"sliceName": "sectionProceduresHx",
"definition": "The History of Procedures Section contains a description of the patient past procedures that are pertinent to the scope of this document. Procedures may refer for example to:\r\n\r\nInvasive Diagnostic procedure:e.g. Cardiac catheterization; (the results of these procedure are documented in the results section)\r\nTherapeutic procedure: e.g. dialysis;\r\nSurgical procedure: e.g. appendectomy",
"mustSupport": true
}, {
"id": "Composition.section:sectionProceduresHx.title",
"min": 1,
"path": "Composition.section.title",
"label": "History of Procedures",
"fixedString": "History of Procedures",
"mustSupport": true
}, {
"id": "Composition.section:sectionProceduresHx.code",
"min": 1,
"code": [ {
"code": "47519-4",
"system": "http://loinc.org",
"display": "History of Procedures document"
} ],
"path": "Composition.section.code",
"binding": {
"strength": "preferred",
"valueSet": "http://loinc.org"
},
"mustSupport": true
}, {
"id": "Composition.section:sectionProceduresHx.code.coding",
"code": [ {
"code": "47519-4",
"system": "http://loinc.org",
"display": "History of Procedures document"
} ],
"path": "Composition.section.code.coding",
"mustSupport": true
}, {
"id": "Composition.section:sectionProceduresHx.code.coding.system",
"code": [ {
"code": "47519-4",
"system": "http://loinc.org",
"display": "History of Procedures Document"
} ],
"path": "Composition.section.code.coding.system",
"fixedUri": "http://loinc.org",
"mustSupport": true
}, {
"id": "Composition.section:sectionProceduresHx.code.coding.code",
"path": "Composition.section.code.coding.code",
"fixedCode": "47519-4",
"mustSupport": true
}, {
"id": "Composition.section:sectionProceduresHx.code.coding.display",
"path": "Composition.section.code.coding.display",
"fixedString": "History of Procedures Document",
"mustSupport": true
}, {
"id": "Composition.section:sectionProceduresHx.text",
"min": 1,
"path": "Composition.section.text",
"mustSupport": true
}, {
"id": "Composition.section:sectionProceduresHx.entry",
"min": 1,
"path": "Composition.section.entry",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "$this",
"type": "type"
} ]
},
"mustSupport": true
}, {
"id": "Composition.section:sectionProceduresHx.entry:procedure",
"max": "1",
"min": 1,
"path": "Composition.section.entry",
"sliceName": "procedure",
"mustSupport": true
}, {
"id": "Composition.section:sectionProceduresHx.emptyReason",
"max": "0",
"path": "Composition.section.emptyReason"
}, {
"id": "Composition.section:sectionProceduresHx.section",
"max": "0",
"path": "Composition.section.section"
}, {
"id": "Composition.section:sectionImmunizations",
"max": "1",
"path": "Composition.section",
"short": "Immunizations Section",
"comment": "IPS-UV considers this a Must Support section. This constraint has been relaxed in the PS-CA to allow for jurisdictions who will not be including this domain/section in their initial implementation of patient summaries. Participating jurisdictions are expected to be able to receive this section in a patient summary without flagging an error. Additionally vendors should expect that some jurisdictions may further constrain support of this section within the context of their own jurisdictional content",
"sliceName": "sectionImmunizations",
"definition": "The Immunizations Section defines a patient's current immunization status and pertinent immunization history. The primary use case for the Immunization Section is to enable communication of a patient's immunization status. The section includes the current immunization status, and may contain the entire immunization history that is relevant to the period of time being summarized.",
"mustSupport": true
}, {
"id": "Composition.section:sectionImmunizations.title",
"min": 1,
"path": "Composition.section.title",
"label": "History of Immunization",
"fixedString": "History of Immunization",
"mustSupport": true
}, {
"id": "Composition.section:sectionImmunizations.code",
"min": 1,
"path": "Composition.section.code",
"mustSupport": true
}, {
"id": "Composition.section:sectionImmunizations.code.coding",
"code": [ {
"code": "11369-6",
"system": "http://loinc.org",
"display": "History of Immunization Narrative"
} ],
"path": "Composition.section.code.coding",
"binding": {
"strength": "preferred",
"valueSet": "http://loinc.org"
},
"mustSupport": true
}, {
"id": "Composition.section:sectionImmunizations.code.coding.system",
"path": "Composition.section.code.coding.system",
"mustSupport": true
}, {
"id": "Composition.section:sectionImmunizations.code.coding.code",
"code": [ {
"code": "11369-6",
"system": "http://loinc.org",
"display": "History of Immunization Narrative"
} ],
"path": "Composition.section.code.coding.code",
"fixedCode": "11369-6",
"mustSupport": true
}, {
"id": "Composition.section:sectionImmunizations.code.coding.display",
"path": "Composition.section.code.coding.display",
"mustSupport": true
}, {
"id": "Composition.section:sectionImmunizations.code.text",
"path": "Composition.section.code.text",
"mustSupport": false
}, {
"id": "Composition.section:sectionImmunizations.text",
"min": 1,
"path": "Composition.section.text",
"mustSupport": true
}, {
"id": "Composition.section:sectionImmunizations.entry",
"min": 1,
"path": "Composition.section.entry",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "$this",
"type": "type"
} ]
},
"mustSupport": true
}, {
"id": "Composition.section:sectionImmunizations.entry:immunization",
"path": "Composition.section.entry",
"sliceName": "immunization",
"mustSupport": true
}, {
"id": "Composition.section:sectionImmunizations.emptyReason",
"max": "0",
"path": "Composition.section.emptyReason"
}, {
"id": "Composition.section:sectionImmunizations.section",
"max": "0",
"path": "Composition.section.section"
}, {
"id": "Composition.section:sectionResults",
"max": "1",
"path": "Composition.section",
"short": "Results Section",
"comment": "IPS-UV considers this a Must Support section. This constraint has been relaxed in the PS-CA to allow for jurisdictions who will not be including this domain/section in their initial implementation of patient summaries. Participating jurisdictions are expected to be able to receive this section in a patient summary without flagging an error. Additionally vendors should expect that some jurisdictions may further constrain support of this section within the context of their own jurisdictional content",
"sliceName": "sectionResults",
"definition": "This section assembles relevant observation results collected on the patient or produced on in-vitro biologic specimens collected from the patient. Some of these results may be laboratory results, others may be anatomic pathology results, others, radiology results, and others, clinical results",
"mustSupport": true
}, {
"id": "Composition.section:sectionResults.title",
"min": 1,
"path": "Composition.section.title",
"label": "Diagnostic tests/laboratory data",
"fixedString": "Diagnostic tests/laboratory data",
"mustSupport": true
}, {
"id": "Composition.section:sectionResults.code",
"min": 1,
"code": [ {
"code": "30954-2",
"system": "http://loinc.org",
"display": "Relevant diagnostic tests/laboratory data Narrative"
} ],
"path": "Composition.section.code",
"mustSupport": true
}, {
"id": "Composition.section:sectionResults.code.coding",
"code": [ {
"code": "30954-2",
"system": "http://loinc.org",
"display": "Relevant diagnostic tests/laboratory data Narrative"
} ],
"path": "Composition.section.code.coding",
"mustSupport": true
}, {
"id": "Composition.section:sectionResults.code.coding.system",
"path": "Composition.section.code.coding.system",
"fixedUri": "http://loinc.org",
"mustSupport": true
}, {
"id": "Composition.section:sectionResults.code.coding.code",
"path": "Composition.section.code.coding.code",
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