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type: resourceresource: Composition

Composition

Introduction

Scope and Usage

A Composition is the basic structure from which FHIR Documents - immutable bundles with attested narrative - are built. A single logical composition may be associated with a series of derived documents, each of which is a frozen copy of the composition.

Note: EN 13606 uses the term "Composition" to refer to a single commit to an EHR system, and offers some common examples: a composition containing a consultation note, a progress note, a report or a letter, an investigation report, a prescription form or a set of bedside nursing observations. Using Composition for an attested EHR commit is a valid use of the Composition resource, but for FHIR purposes, it would be usual to make more granular updates with individual provenance statements.

The Clinical Document profile constrains Composition to specify a clinical document (matching CDA). See also the comparison with CDA.

Boundaries and Relationships

Composition is a structure for grouping information for purposes of persistence and attestability. The Composition resource defines a set of healthcare-related information that is assembled together into a single logical document that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. The Composition resource provides the basic structure of a FHIR document. The full content of the document is expressed using a Bundle containing the Composition and its entries.

There are several other grouping structures in FHIR with distinct purposes:

The Composition resource organizes clinical and administrative content into sections, each of which contains a narrative, and references other resources for supporting data. The narrative content of the various sections in a Composition are supported by the resources referenced in the section entries. The complete set of content to make up a document includes the Composition resource together with various resources pointed to or indirectly connected to the Composition. See the FHIR Documents documentation for guidance on how a Composition is used when creating a document bundle.

Background and Context

Composition Status Codes

Every composition has a status element, which describes the status of the content of the composition, taken from this list of codes:

<%codelist http://hl7.org/fhir/composition-status%>

Composition status generally only moves down through this list - it moves from registered or preliminary to final and then it may progress to amended. Note that in many workflows, only final compositions are made available and the preliminary status is not used.

Diagram showing typical transitions of clinical status for the Composition resource

A very few compositions are created entirely in error in the workflow - usually the composition concerns the wrong patient or is written by the wrong author, and the error is only detected after the composition has been used or documents have been derived from it. To support resolution of this case, the composition is updated to be marked as entered-in-error and a new derived document can be created. This means that the entire series of derived documents is now considered to be created in error and systems receiving derived documents based on retracted compositions SHOULD remove data taken from earlier documents from routine use and/or take other appropriate actions. Systems are not required to provide this workflow or support documents derived from retracted compositions, but they SHALL NOT ignore a status of entered-in-error. Note that systems that handle compositions or derived documents and don't support the error status need to define some other way of handling compositions that are created in error; while this is not a common occurrence, some clinical systems have no provision for removing erroneous information from a patient's record, and there is no way for a user to know that it is not fit for use - this is not safe.

Note for CDA aware readers

Many users of this specification are familiar with the Clinical Document Architecture (CDA) and related specifications. CDA is a primary design input to the Composition resource (other principal inputs are other HL7 document specifications and EN13606). There are three important structural differences between CDA and the Composition resource:

In addition, note that both the code lists (e.g., Composition.status) and the Composition resource are mapped to HL7 v3 and/or CDA.

Notes

Notes:

Compositions about multiple entities

Typically, a composition is made about the subject - e.g. a patient, or group of patients, location, or device - and the distinction between the subject and the composition describes the subject. Some kinds of documents contain data about other parties or entities that are relevant to the subject of the document. Some examples:

In all these cases, the subject of the document is a single patient, but some of the details are actually related to other persons or entities. When this happens, these other entities are detailed in the Composition.section.focus element. In the absence of a focus, it is assumed that the subject of the composition is the focus.

If a focus is specified, then the resources referred to from the section SHALL either:

A few compositions genuinely cover multiple subjects - different sections are about different subjects. In such case, Composition.subject is omitted, and the extension section-subject is used on each section to indicate the subject.

[%stu-note dstu%] Feedback is welcome on two issues related to Composition:

Feedback here. [%end-note%]

StructureDefinition

Elements (Simplified)

Mappings

Implementation Guide

implementationguide-Composition-core.xml

<?xml version="1.0" encoding="UTF-8"?>

<ImplementationGuide xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../publish/ImplementationGuide.xsd">
  <id value="Composition-core"/>
  <version value="0.01"/>
  <name value="CompositionHL7Extensions"/>
  <title value="Composition  H L7  Extensions"/>
  <status value="draft"/>
  <date value="1970-01-01T10:00:00+10:00"/>
  <publisher value="HL7"/>
  <description value="Defines common extensions used with or related to the Composition resource"/>
  <definition>
    <resource>
      <reference>
        <reference value="StructureDefinition/catalog"/>
      </reference>
    </resource>
  </definition>
</ImplementationGuide>

Operations

Full Operations

Resource Packs

list-Composition-packs.xml

<?xml version="1.0" encoding="UTF-8"?>

<List xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../publish/List.xsd">
  <id value="Composition-packs"/>
  <status value="current"/>
  <mode value="working"/>
  <entry>
    <item>
      <reference value="ImplementationGuide/Composition-core"/>
    </item>
  </entry>
</List>

Search Parameters

Full Search Parameters

Examples

Full Examples

Mapping Exceptions

composition-event-mapping-exceptions.xml

Divergent Elements

Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is. | resource=If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "entered-in-error" is why this element is labeled as a modifier of other elements.

Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required.

Unmapped Elements

composition-fivews-mapping-exceptions.xml

Unmapped Elements