Relationship Between FHIR Models

Linkages

Relationship Between FHIR Models

The model currently covers Consultations, Problems, Medications and Medical Devices, Allergies, Immunisations, Uncategorised Data, Referrals, Investigations, and Diary Entries. Other clinical areas will be added as they are developed.

The relationships between two FHIR profiles are recorded in only one of the linked FHIR profiles (similar to in a relational database management system). This is shown by the direction of the arrow in the FHIR model. For example, the MedicationStatement profile contains a field that can be used to look up the linked Medication. There is no field in the Medication profile that can be used to look up the linked MedicationStatement.

Consultations and Problems

Consultations

When a consultation is extracted, it will supply the metadata of the consultation and all the clinical data that was recorded during the consultation.

The response to the query includes:

• A List profile containing references to Encounter for every Consultation that met the search criteria

• A List profile for each clinical area that data exists in the bundle

For each Encounter referenced in the List profile:

• The Encounter profile of the Consultation

• The List profiles that describe the structure of the Consultation

• The ProblemHeader (Condition) profile of any directly linked Problems

• The MedicationRequest, MedicationStatement and Medication profiles of any linked Medications or Medical Devices

  • Always include the MedicationStatement, MedicationRequest (intent = plan) and Medication profiles

  • Only include MedicationRequest (intent = order) for directly linked issues

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Medications and Medical Devices

• The AllergyIntolerance profile of any linked Allergies, including resolved allergies

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Allergies

• The Immunization profile of any linked Immunisations

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Immunisations

• The Observation profile of any linked Uncategorised Data

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Uncategorised Data

• The ReferralRequest profile of any linked Referrals

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Referrals

• The DiagnosticReport, ProcedureRequest, Observation, and Specimenprofiles of any linked Investigations

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Investigation

• The ProcedureRequestprofile of any linked Diary Entries

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Diary Entries

• All administrative profiles referenced directly (or via another administrative profile) by any of the clinical profiles included above

  • Include Patient, Organization, PractitionerRole, Practitioner and Location.

Clinical items within the Consultation are always included in the response regardless of their inclusion/exclusion in other parts of the query. So, for example, if a consumer requests consultations then any medications that are contained in the consultations extracted will be present in the bundle, regardless of the medications parameter being absent or set to false in the request.

Problems

When Medicus returns a problem it will supply the metadata and description of the problem and all the clinical data that has been linked to the problem.

The response to the query includes:

• A List profile containing references to ProblemHeader (Condition) for every Problem that met the search criteria

• A List profile containing references to ProblemHeader (Condition) for every Problem not meeting the search critieria but directly linked to a Problem which does meet the search criteria

• A List profile for each clinical area that data exists in the bundle

For each ProblemHeader (Condition) referenced in the List profile:

• The ProblemHeader (Condition) profile of the Problem

• The ProblemHeader (Condition) profiles of any directly linked Problems

• The Encounter profiles of any linked Consultations

• The MedicationRequest, MedicationStatement and Medication profiles of any linked Medications or Medical Devices

  • Always include the MedicationStatement, MedicationRequest (intent = plan) and Medication profiles

  • Only include MedicationRequest (intent = order) for directly linked issues

• The AllergyIntolerance profile of any linked Allergies

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Allergies

• The Immunization profile of any linked Immunisations

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Immunisations

• The Observation profile of any linked Uncategorised Data

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Uncategorised Data

• The ReferralRequest profile of any linked Referrals

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Referrals

• The DiagnosticReport, ProcedureRequest, Observation, and Specimen profiles of any linked Investigations

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Investigation

  • Where an observation that represents a test or test group header has been made the actual problem then the ‘diagnosticReport’ it is from MUST be linked to the problem in the relatedClinicalContent extension.

• The ProcedureRequestprofile of any linked Diary Entries

  • Include the ProblemHeader (Condition) profile of any Problems linked to the extracted Diary Entries

• All administrative profiles referenced directly (or via another administrative profile) by any of the clinical profiles included above

  • Include Patient, Organization, PractitionerRole, Practitioner and Location

Clinical items linked to the Problem are always included in the response regardless of their inclusion/exclusion in other parts of the query.

Medications and Medical Devices

When Medicus returns a medication or medical device it will supply the prescription plan information.

The response to the query includes:

• A List profile containing references to MedicationStatement for every Medication and Medical Device that met the search criteria

• A List profile containing references to each ProblemHeader that is contained in the bundle

For each MedicationStatement referenced in the List profile:

• The MedicationStatement profile of the Medication or Medical Device

• The MedicationRequest (intent = plan) profile of the Medication or Medical Device

• The Medication profile of the Medication and Medical Device

• Where requested, the MedicationRequest (intent = order) profile for every issue

• The ProblemHeader (Condition) profiles of any directly linked Problems

• All administrative profiles referenced directly (or via another administrative profile) by any of the clinical profiles included above

  • Include Patient, Organization, PractitionerRole, Practitioner and Location

Allergies

When Medicus returns an allergy it will supply all the allergy data.

The response to the query includes:

• A List profile containing references to AllergyIntolerance for every active Allergy

• Where requested, a List profile containing references to AllergyIntolerance for every ended Allergy

• A List profile containing references to each ProblemHeader that is contained in the bundle

For each AllergyIntolerance referenced in either of the List profiles:

• The AllergyIntolerance profile of the Allergy

• The ProblemHeader (Condition) profiles of any directly linked Problems

• All administrative profiles referenced directly (or via another administrative profile) by any of the clinical profiles included above

  • Include Patient, Organization, PractitionerRole, Practitioner and Location

Immunisations

When Medicus returns an immunisation it will supply all the immunisation data.

The response to the query includes:

• A List profile containing references to Immunization for every Immunisation and Observation for every consent / dissent to immunisation (referred to below as query response List profile)

• A List profile containing references to each ProblemHeader that is contained in the bundle

For each Immunization referenced in the query response List profile:

• The Immunization profile of the Immunisation

• The ProblemHeader (Condition) profiles of any directly linked Problems

For each Observation referenced in the query response List profile:

• The Observation profile of the consent / dissent for immunisation

• The ProblemHeader (Condition) profiles of any directly linked Problems

For each Immunization and Observation referenced in the query response List profile:

• All administrative profiles referenced directly (or via another administrative profile) by any of the clinical profiles included above

  • Include Patient, Organization, PractitionerRole, Practitioner and Location

Uncategorised Data

When Medicus returns uncategorised data it will supply all the data about the uncategorised data.

The response to the query includes:

• A List profile containing references to Observation for every Uncategorised Data that met the search criteria

• A List profile containing references to each ProblemHeader that is contained in the bundle

For each Observation referenced in the List profile:

• The Observation profile of the Uncategorised Data

• The ProblemHeader (Condition) profiles of any directly linked Problems

• All administrative profiles referenced directly (or via another administrative profile) by any of the clinical profiles included above

  • Include Patient, Organization, PractitionerRole, Practitioner and Location

Referrals

When Medicus returns a referral it will supply all the referral data.

The response to the query includes:

• A List profile containing references to ReferralRequest for every Referral that met the search criteria

• A List profile containing references to each ProblemHeader that is contained in the bundle

For each ReferralRequest referenced in the List profile:

• The ReferralRequest profile of the Referral

• The ProblemHeader (Condition) profiles of any directly linked Problems

• All administrative profiles referenced directly (or via another administrative profile) by any of the clinical profiles included above

  • Include Patient, Organization, PractitionerRole, Practitioner and Location

Investigations

When Medicus returns an investigation it will supply all the investigation information.

The response to the query includes:

• A List profile containing references to DiagnosticReport for every Investigation that met the search criteria

• A List profile containing references to each ProblemHeader that is contained in the bundle

For each DiagnosticReport referenced in the List profile:

• The DiagnosticReport profile of the Investigation

• The ProcedureRequest profile of the Investigation

• The Specimen profiles of the Investigation

• The Observation profiles of the Investigation

• The ProblemHeader (Condition) profiles of any directly linked Problems

• All administrative profiles referenced directly (or via another administrative profile) by any of the clinical profiles included above

  • Include Patient, Organization, PractitionerRole, Practitioner and Location

Diary Entries

When Medicus returns a diary entry it will supply all the diary entry data.

The response to the query includes:

• A List profile containing references to ProcedureRequest for every Diary Entry that met the search criteria

• A List profile containing references to each ProblemHeader that is contained in the bundle

For each ProcedureRequest referenced in the List profile:

• The ProcedureRequest profile of the Diary Entry

• The ProblemHeader (Condition) profiles of any directly linked Problems

• All administrative profiles referenced directly (or via another administrative profile) by any of the clinical profiles included above

  • Include Patient, Organization, PractitionerRole, Practitioner and Location

Problem and Consultation Linkages

The sections above show general details of the linkages for problems or consultations responses. This section looks at the representation of problem and consultation linkages, when consultations have been requested.

The example below represents a simple case of a consultation and its content which all relates to a single, new problem.

• The problem header references to the consultation, the consultation topic, the actual problem and any other content of the consultation

• The consultation topic references the problem header

• The actual problem is included as a resource (an uncategorised data observation in this case) and references the consultation

• All other content of the consultation references the consultation and is referenced by the problem header

This further example represents a subsequent consultation which includes further information related to the problem above and other information related to a new problem recorded in the same consultation. The consultation content relating to the existing and new problem is represented as described above, except the existing problem is shown with a new instance of a clinical item which is the same term.

Multiple Clinical Areas Requests

The details above have described the response a request for a single clinical area. The consumer may include more than one clinical area in a request.

This model is an example of a request for medications and allergies. It is included to show how related problem references are consolidated into a single List profile where more than one clinical area has been requested. This applies regardles of which clincial areas or how many clinical areas are included in the request.

This model is an example of a request for consultations, problems, medications and allergies. It also includes a consolidated related problems List profile, but is included to show the multiple List profiles extracted due to the inclusion of

• a primary list for each of the requested clinical areas

• secondary lists for all clinical areas contained in consultations or linked to problems, regardless of inclusion in the request

Duplicate Extracted Profiles

Where the same instance of a profile is extracted from multiple query responses (for example a medication is extracted as part of the medication search and the consultation search), it will only be included once in the response message.