PrescribeIT® Specification and Guide Version 5.0

An occurrence of information being transmitted; e.g. an alert that was sent to a responsible provider, a public health agency was notified about a reportable condition.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Usage Note: This will usually be a GUID and is assigned by the sending application.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

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 as much as possible.

The 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-readable narrative that contains a summary of the resource, and may 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.

These 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.

An Extension

• value @ url

A string describing the 'subject' of the communication. Equvalent to 'subject' in an email.

Usage Note: This will be the subject line. Though not mandatory, the vendors may choose to auto-fill a subject using the category + patient name or whatever is deemed to be important for the recipient to see. Out of Office may also be considered as part of the subject line. (Note: it is currently an extension, but will be forthcoming in future FHIR releases).

Allows a communication to reference the individual Medication Order

Usage Note: This is used to identify the medication order that the communication is related too. Only the Prescription business identifier is included, the entire medication order resource will not be included. This is used to associate and link communications to the proper medication order to facilitate having a complete view of communication in context of the medication order that it is referring too.

Conformance Rule:

(1) When creating a communication that is linked to a medication order, the medication order identifier must be in the same format and have the same value as it was sent or received in the original task's MedicationOrder.identifier(EMR-id).

(2) When receiving a communication and this element is populated, the system must use this value to find the corresponding medication order record in the receiving system to associate and link that incoming communication with in order to facilitate having that complete view of the context involved.

(3) When replying to a communication and this element is populated, the system must resend the data as it was received.

(4) Communication.extension(topic) and Communication.extension(topicGroup) must never be populated together, only one or the other extension can be populated depending on what needs to be referenced.

unique id for the element within a resource (for internal references).

An Extension

Source of the definition for the extension code - a logical name or a URL.

Fixed value: http://hl7.org/fhir/StructureDefinition/extension-Communication.topic

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

• type @ $this

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

unique id for the element within a resource (for internal references).

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity 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.

unique id for the element within a resource (for internal references).

An Extension

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition should be version specific. This will ideally be the URI for the Resource Profile defining the extension, with the code for the extension after a #.

A technical identifier - identifies some entity uniquely and unambiguously.

• type @ $this

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

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

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.

Plain 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.

Allows a communication to reference the group of Medication Orders found in the bundle

Usage Note: This is used to identify the bundle that the communication is related too (e.g. Communications pertains to an entire Prescription i.e. multiple medication orders). Only the Group business identifier is included, the entire message bundle is not included. This is used to associate and link communications to the proper bundle in order to facilitate having a complete view of communication in context of the entire bundle that it is referring to.

Conformance Rule:

(1) When creating a communication that is linked to an entire message bundle (e.g. prescription), the group identifier must be in the same format and have the same value as it was sent or received in the original bundle's Task.extension(groupIdentifier).

(2) When receiving a communication and this element is populated, the system must use this value to find the corresponding bundle or all the tasks related to that bundle (e.g. multiple medication orders) in the receiving system to associate and link that incoming communication with in order to facilitate having that complete view of the context involved.

(3) When replying to a communication and this element is populated, the system must resend the data as it was received.

(4) Communication.extension(topic) and Communication.extension(topicGroup) must never be populated together, only one or the other extension can be populated depending on what needs to be referenced.

The individual responsible for recording the communication in an electronic system.

Usage Note: When communication is initiated within a prescriber’s clinic, this is optionally used to identify the Medical Office Assistant who is sending the message on behalf of a licenced professional. This profile contains only a name and a title.

Usage Note: For 'communication enterer' The title of the data enterer must be conveyed as text; codes will not be used.

Conformance Rule: This is mandatory when the communication sender is the Pharmacy

Indicates the relative urgent of this communication in comparison with others

Conformance Rule: set value = 'high' when Urgent. The default is normal and flag is not set. Recipients must queue appropriately (urgent first) or display when this flag is set to urgent.

An identifier kept in common by all communications forming a single discussion thread

Conformance Rule: For a new communication, this must be created by the sender. This value must be created as a GUID to ensure it is unique across the network so that different conversation threads do not get mixed together by mistake.

Usage Note: A conversation is made up of an initial communication plus all linked communications (e.g. replies). This thread identifier is used by systems to pull together the complete conversation.

Indicates the practitioner or organization to which responses should be directed as the primary recipient

Conformance Rule: This must be populated with a Practitioner that is responsible for the communication. This should be the same identfier as the Sender when the Sender is the registered PrescribeIT® Practitioner. If the sender is a LOCUM, the replyTO must contain the Provider Registry ID of the registered PrescribeIT® Practitioner the Locum is acting on behalf of.

Conformance Rule: This value must be identical to the sender for communications are initiated by the Pharmacy

unique id for the element within a resource (for internal references).

An Extension

Source of the definition for the extension code - a logical name or a URL.

Fixed value: http://sharedhealth.exchange/fhir/StructureDefinition/ext-communication-reply-to

A reference from one resource to another.

unique id for the element within a resource (for internal references).

An Extension

• value @ url

Describes an Organization that a referenced practitioner is acting on-behalf-of

Usage Note: This contains the Provider Registry Organization Identifier associated with the Responsible Practitioner (ReplyTo) of this communication. This should contain the same value as MessageHeader.source.endpoint and represents the organization that is sending the communication.

Conformance Rule: This is mandatory if the 'replyTo' is a Practitioner. It is not permitted if the 'replyTo' is an organization.

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

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.

Plain 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.

May 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. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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.

A technical identifier - identifies some entity uniquely and unambiguously.

Conformance Rule: This business identifier must be created by the sending application and must be unique for each communiciation.

This is used to described the category type of clinical communication message.

​Usage Note: For vendors implementing v5.0 the binding to use is CommunicationCategory (20190415) (required) which contains only the value of 'general'.

For vendors implementing v5.2 or higher the binding to use is the one that is declared above which contains additional values.

The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication.

This is a choice of sender types. The sender may either be a registered PrescribeIT® Practitioner or a locum or a Pharmacy.

Usage Note: If a Locum is sending a communication and acting on behalf of a Practitioner, the Locum Profile is used. A Locum does not have to be in the Provider Registry as a registered participant of PrescribeIT®. The Sender will otherwise be the Practitioner (organization or practitioner) who is registered for PrescribeIT® service in the Provider Registry.

Conformance Rule: The locum only applies to communications initiated by Prescribers.

• exists @ extension('http://sharedhealth.exchange/fhir/StructureDefinition/ext-communication-sender-locum')

The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication.

Conformance Rule: This set of constraints applies when the sender is either a Practitioner or Organization

unique id for the element within a resource (for internal references).

An Extension

• value @ url

If set to true, indicates that the sender with this extension is a locum

Describes an Organization that a referenced practitioner is acting on-behalf-of

Conformance Rule: This extension must be present when the Communication.sender(PR).reference points to a Practitioner.

Usage Rule: This is NOT used for communications that are initiated by the Pharmacy

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

Conformance Rule: This must point to either the Practitioner or Organization Provider Registry ID.

Plain 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.

The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication.

Conformance Rule: This set of constraints applies when the sender is a Locum.

unique id for the element within a resource (for internal references).

An Extension

• value @ url

If set to true, indicates that the sender with this extension is a locum

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

Conformance Rule: This must point to the Locum Practitioner.

Plain 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.

The entity (e.g. practitioner, organization) which is the target of the communication. There can only be one recipient of a communication either a practitioner/clinic combination (NOTE: clinic is sent as the onBehalfOf organization) if a pharmacy is sending or a pharmacy if a practitioner is sending.

unique id for the element within a resource (for internal references).

An Extension

• value @ url

Describes an Organization that a referenced practitioner is acting on-behalf-of

Conformance Rule: This is used to specify the organization that the recipient is associated with. This will be the Provider Registry identifier for the organization. Note: This will be the same identifier as specified in the destination list in the 305 message header.

This is only specified and must be specified if the recipient is a Practitioner

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

Conformance Rule: The recipient should be either an organization (in the case of the pharmacy being the recipient) or a person (in the case of a prescriber being the recipient). If the recipient is an organization, the CPRID of the organization should be provided in the form of a URL. If the recipient is a prescriber, the prescriber’s CPRID should be provided in the form of a URL. If the recipient is a prescriber, then the “On-Behalf-Of” should be provided in order to identify the location where the prescriber should receive the communication in question. The “On-Behalf-Of” should not be included if the recipient is an organization as this would be redundant.

Plain 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.

Text, attachment(s), or resource(s) that was communicated to the recipient.

This is used to convey the message to the recipient.

• type @ content

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

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.

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

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.

A communicated content (or for multi-part communications, one portion of the communication).

Text, attachment(s), or resource(s) that was communicated to the recipient.

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

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.

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

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.

A communicated content (or for multi-part communications, one portion of the communication).

Usage Note: This is the Message Body; restrictedto 1MB; string will allow LF, CR, Horizontal TAB.

Usage Note: Tabs should be avoided where possible due to various interpretation which could result in the original formatting being lost.

Text, attachment(s), or resource(s) that was communicated to the recipient.

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

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.

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

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.

For referring to data content defined in other formats.

Conformance Rule: A maximum of 20 attachments. The combined maximum size for all attachments may not exceed 50 MB. Anything larger will be rejected.

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

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.

Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.

Processors of the data need to be able to know how to interpret the data.

Identifies the mime type the binary content is expressed in.

Conformance Rule: The charset will be UTF-8 only.

The human language of the content. The value can be any valid value according to BCP 47.

Users need to be able to choose between the languages in a set of attachments.

The actual data of the attachment - a sequence of bytes. In XML, represented using base64.

The data needs to able to be transmitted inline.

The base64-encoded data SHALL be expressed in the same character set as the base resource XML or JSON.

Location where the attachment is uploaded too or downloaded from, using the unique identifier of the attachment.

The data needs to be transmitted by reference.

Conformance Rule: This will be expressed as a URL on the server - https://EnvironmentSpecificHost/EnvironmentSpecificPathInbox/Binary/[guid or uuid or unique identifier]. The attachment content SHALL be PUT to the same URL immediately after posting the 305 message containing this attachment. It cannot be PUT prior to the 305 message otherwise an error will be returned.

The number of bytes of data that make up this attachment.

Representing the size allows applications to determine whether they should fetch the content automatically in advance, or refuse to fetch it at all.

Conformance Rule: The combined size of all attachments cannot exceed 50 MB.

The calculated hash of the data using SHA-1. Represented using base64.

Included so that applications can verify that the contents of a location have not changed and so that a signature of the content can implicitly sign the content of an image without having to include the data in the instance or reference the url in the signature.

A label or set of text to display in place of the data.

Applications need a label to display to a human user in place of the actual data if the data cannot be rendered or perceived by the viewer.

The date that the attachment was first created.

This is often tracked as an integrity issue for use of the attachment.

A channel that was used for this communication (e.g. email, fax).

The status of the transmission.

Usage Note: The sending system should set this to 'in-progress'. There are no expectations on the receiving system to consider this value.

The encounter within which the communication was sent.

The time when this communication was sent.

The time when this communication arrived at the destination.

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Codes for describing reasons for the occurrence of a communication.

FUTURE USE ONLY

Usage Note: This will be used for 'textual' description of the reason. Example: Request consultation or Patient Seen at Walkin Clinic.

The patient who was the focus of this communication.

Conformance Rule: If the communication relates to a patient, this will be populated.

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

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.

-

Conformance Rule: This must point to the patient associated with the message. No external references should be used.

Plain 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.

The communication request that was responsible for producing this communication.