PrescribeIT® Specification and Guide Version 5.0

A task to be performed.

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.

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.

The version specific identifier, as it appears in the version portion of the URL. This values changes when the resource is created, updated, or deleted.

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

When the resource last changed - e.g. when the version changed.

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant.

A list of profiles StructureDefinitions that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time.

• value @ value

A list of profiles StructureDefinitions that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

Fixed value: http://prescribeit.ca/fhir/StructureDefinition/task-e163-m

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

The security labels can be updated without changing the stated version of the resource The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

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

This is the common identifier that represents a paper order. It may be shared by multiple Task instances for various Medication Orders, reflecting multiple requests that are authorized simultaneously for a patient by a single prescriber

Usage Note: This business identifier is assigned by the sending application and is used to group tasks together that need to be processed and managed together. Refer to the PrescribeIT® Version 5.0 Jurisdictional Rules and Task Grouping Excel spreadsheet rules for a full set of scenarios.

Identifies a request, plan or proposal that drove the creation of this task

Usage Note: The URL for this extension does not refer to an existing web-page as is a pre-adoption extension. Refer to the Shared Health implementation Guide for more information.

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-Task.basedOn

The identifier of the request task that this task was created based on

Conformance Rule: The will be a URN (form urn:uuid:[guid]) containing the Task.id for the task being responded to

• 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).

Conformance Rule: The will be a URN (form urn:uuid:[guid]) containing the Task.id for the task being responded to

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

An Extension

• value @ url

If true, indicates that this renewal response is a subsequent response of an initial response that was sent as 'under review'.

Conformance Rules:

1) This must not be provided on any of the initial responses including when initial response is under review

2) This must only be provided and set to true on a subsequent response of Approve, Approve with change or Deny which follows on initial response of 'under review'

3) Subsequent responses of under review are not permitted

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 shall be the Task.id of the request task being responded to, expressed as a uri (i.e. urn:uuid:[original task 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.

An Extension

• value @ url

A modifier extension that, if true, indicates that a task that would normally be interpretted as seeking the immediate fulfillment of a request is not seeking fulfillment, but is merely sharing the authoritative order. The fulfillment request will arrive by other means

The business identifier for this task.

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

This will be a fixed code for each type of task. Review usage comments on child elements.

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.

A reference to a code defined by a terminology system.

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

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

• value @ system

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.

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

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

This is the URI that represents the coding system as defined within the binding.

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

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

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

Need to refer to a particular code in the system.

This is the code as defined within the binding.

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

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

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

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

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

A reference to a code defined by a terminology system.

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

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

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.

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

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

Fixed value: https://fhir.infoway-inforoute.ca/CodeSystem/prescriptiontasktype

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

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

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

Need to refer to a particular code in the system.

Fixed value: e163-m

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

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

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

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

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

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

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

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

A description of this task.

The type of participant that can execute the task.

Use to distinguish tasks on different activity queues.

The priority of the task among other tasks of the same type.

Used to identify the service level expected while performing a task.

This element does not apply to Tasks p170-m (Pharmacist Adapt), p200-m (RX Dispense Notification), and p210-m (RX Dispense Cancel Notification)

Conformance Rule: If one of the medications within a group is a high priority, the EMR should present the entire renewal request (based on Group Identifier) as a high priority item within the queue.

Conformance Rule: For Tasks p141-m (Cancel RX Request Denied) and p143-m (Cancel RX Remaining Fills Revoked) the priority must be set to high.

Usage Note: For Task e150-m (Discontinue RX Request) the priority should default to normal.

The current status of the task.

These states enable coordination of task status with off-the-shelf workflow solutions that support automation of tasks.

Fixed value: requested

An explaination as to why this task failed.

The subject of the task.

Used to identify the thing to be done (not the beneficiary -- see for below).

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.

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 is the reference to the Medication Order resource id. This is not a business identifier. Example: value='MedicationOrder/[guid].'

Conformance Rule: The Medication Order reference must be for the Medication Order that is being Approved or Approved with Changes by the prescriber.

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 who benefits from the performance of the service specified in the task (e.g., the patient).

Used to track tasks outstanding for a beneficiary. Do not use to track the task owner or creator (see owner and creator respectively).

Identifies the patient tied to the task. (FHIR prohibits inheritance of context, so this must be explicitly declared rather than inferred from the presence of the Patient resource in the message)

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.

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.

This is a reference to the Patient associated with the task. It will be a URN pointing to the id of the patient record in the message

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.

A reference to a formal or informal definition of the task.

Enables a formal definition of how he task is to be performed (e.g. using BPMN, BPEL, XPDL or other formal notation) to be associated with a task, enabling automation.

The date and time this task was created.

Most often used along with lastUpdated to track duration of task to supporting monitoring and management.

This indicates when the request was created. This will generally be the same as the date of message construction.

Conformance Rule: Date-Time must be specified down to the day. Time is optional and may be ignored.

Usage Note: If time is present, FHIR requires the UTC offset and for time to be specified down to the seconds. If seconds aren't available, they may be filled with '00'

The date and time of last modification to this task.

Used along with history to track task activity and time in a particular task state. This enables monitoring and management.

This is required by FHIR but is not needed. It should generally be set to the same value as Task.created. This is the date of the most recent transaction as recorded in the EMR.

Usage Note: If time is present, FHIR requires the UTC offset and for time to be specified down to the seconds. If seconds aren't available, they may be filled with '00'.

Conformance Rule: PMS is not expected to display this date as it is irrelevant to the Pharmacist or to the processing of the discontinue notification.

The creator of the task.

Identifies who created this task. May be used by access control mechanisms (e.g., to ensure that only the creator can cancel a task).

This is who is submitting the task and asking for it be done.

In the context of all EMR message this will be the PrescribeIT® Prescriber that responsible for initiating or overseeing the clinical event in the message.

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.

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.

This is a reference to the originating prescriber Practitioner. This value will be returned from the Provider Registry Practitioner query. Example: value='https://{environmentSpecificHost}/{environmentAndContextSpecificPath}/Practitioner/{CPRID}'

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 owner of this task. The participant who can execute this task.

Identifies who is expected to perform this task.

This is who is intended to receive/act on the task

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.

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.

This is a reference to the pharmacy Organization being responded to. This value should echo the Task.creator from the request task being responded to. Example: value='https://{environmentSpecificHost}/{environmentAndContextSpecificPath}/Organization/{CPRID}'

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.

Task that this particular task is part of.

Allows tasks to be broken down into sub-steps (and this division can occur independent of the original task).

Inputs to the task.

Resources and data used to perform the task. This data is used in the business logic of task execution, and is stored separately because it varies between workflows.

• value @ name

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.

The name of the input parameter.

Inputs are named to enable task automation to bind data and pass it from one task to the next.

The value of the input parameter as a basic type.

Task inputs can take any form.

Inputs to the task.

Resources and data used to perform the task. This data is used in the business logic of task execution, and is stored separately because it varies between workflows.

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.

The name of the input parameter.

Inputs are named to enable task automation to bind data and pass it from one task to the next.

Fixed value: change

This is a textual description of the changes, eg change. This would be a substantive change such as a change in dose, frequency or patient instructions, or a change of classification of drugs. This will be specified as needed and if included in the message, this should be displayed to the Pharmacist/Pharmacy Technician

Task inputs can take any form.

Conformance Rule: EMR expected to call out a difference in dosing, if they notice a difference in the request, versus what is in the EMR. A difference in the quantity or number of refills does not constitute changes

Outputs produced by the Task.

Resources and data produced during the execution the task. This data is generated by the business logic of task execution, and is stored separately because it varies between workflows.

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.

The name of the Output parameter.

Outputs are named to enable task automation to bind data and pass it from one task to the next.

The value of the Output parameter as a basic type.

Task outputs can take any form.