Practitioner

Introduction

Scope and Usage

Practitioner covers all individuals who are engaged in the healthcare process and healthcare-related services as part of their formal responsibilities and this Resource is used for attribution of activities and responsibilities to these individuals. Practitioners include (but are not limited to):

• physicians, dentists, pharmacists
• physician assistants, nurses, scribes
• midwives, dietitians, therapists, optometrists, paramedics
• medical technicians, laboratory scientists, prosthetic technicians, radiographers
• social workers, professional homecare providers, official volunteers
• receptionists handling patient registration
• IT personnel merging or unmerging patient records
• service animal (e.g., ward assigned dog capable of detecting cancer in patients)
• a bus driver for a community organization
• a lawyer acting for a hospital or a patient
• a person working for a supplier of a healthcare organization

The Practitioner resource is used for anyone involved in the provision of care or services to a Patient associated with an organization. The RelatedPerson resource is used for anyone involved in the care for a patient, typically having a personal *relationship *or non-healthcare-specific professional relationship to the patient.

Boundaries and Relationships

The Resource SHALL NOT be used for persons involved without a formal responsibility like individuals taking care for friends, relatives or neighbors. These can be registered as a Patient's Contact. If performing some action or being referenced by another resource, use the RelatedPerson resource.

The primary distinction between a Practitioner and a RelatedPerson is based on whether:

• The person/animal operates on behalf of the care delivery organization over multiple patients (Practitioner) or,
• Where the person/animal is not associated with the organization, and instead is allocated tasks specifically for the RelatedPerson's Patient (RelatedPerson).

A standard extension animalSpecies can be used to indicate the species of a service animal.

The PractitionerRole resource provides the details of roles that the practitioner is approved to perform for which organizations (and at which locations, and optionally what services too).

Practitioners are also often grouped into CareTeams independently of roles, where the CareTeam defines what specific role that they are fulfilling within the team, and might or might not have actual practitioner role resources created for the practitioner (and in the care team context, the organization the practitioner is representing)

When an autonomous system or machine is an actor or participant, the Device resource should be used to represent that system. This would include artificial intelligence or machine learning (AI/ML) systems, as well as other automated systems.

Background and Context

Practitioner performs different roles within the same or even different organizations. Depending on jurisdiction and custom, it may be necessary to maintain a specific Practitioner Resource for each such role or have a single Practitioner with multiple roles. The role can be limited to a specific period, after which authorization for this role ends. Note that the represented organization need not necessarily be the (direct) employer of a Practitioner.

Notes

Notes:

• The practitioner's Qualifications are acquired by the practitioner independent of any organization or role, and do not imply that they are allowed/authorized to perform roles relevant to the qualification at any specific Organization/Location.
• Business idenfitiers may be used in Practitioner.identifier and/or Practitioner.qualification.identifier based on local requirements.
  The Practitioner.identifier doesn't convey anything about the status of the license (other than period), if this or any additional details are available then the qualification.identifier should be used.
  E.g. a specific license includes its type, status, issuer and a local category extension for which specialties were included in the license.

StructureDefinition

Elements (Simplified)

• Practitioner [0..*]: - A person with a formal responsibility in the provisioning of healthcare or related services
• Practitioner.identifier [0..*]: Identifier An identifier for the person as this agent
• Practitioner.active [0..1]: boolean Whether this practitioner's record is in active use
• Practitioner.name [0..*]: HumanName The name(s) associated with the practitioner
• Practitioner.telecom [0..*]: ContactPoint A contact detail for the practitioner (that apply to all roles)
• Practitioner.gender [0..1]: code required:administrative-gender male | female | other | unknown
• Practitioner.birthDate [0..1]: date The date on which the practitioner was born
• Practitioner.deceased[x] [0..1]: boolean, dateTime Indicates if the practitioner is deceased or not
• Practitioner.address [0..*]: Address Address(es) of the practitioner that are not role specific (typically home address)
• Practitioner.photo [0..*]: Attachment Image of the person
• Practitioner.qualification [0..*]: BackboneElement Qualifications, certifications, accreditations, licenses, training, etc. pertaining to the provision of care
• Practitioner.qualification.identifier [0..*]: Identifier An identifier for this qualification for the practitioner
• Practitioner.qualification.code [1..1]: CodeableConcept example:v2-0360 Coded representation of the qualification
• Practitioner.qualification.status [0..1]: CodeableConcept preferred:qualification-status Status/progress of the qualification
• Practitioner.qualification.period [0..1]: Period Period during which the qualification is valid
• Practitioner.qualification.issuer [0..1]: Reference(Organization) Organization that regulates and issues the qualification
• Practitioner.communication [0..*]: BackboneElement A language which may be used to communicate with the practitioner
• Practitioner.communication.language [1..1]: CodeableConcept required:all-languages The language code used to communicate with the practitioner
• Practitioner.communication.preferred [0..1]: boolean Language preference indicator

Mappings

• Practitioner Mappings — 51 mapping entries

Implementation Guide

implementationguide-Practitioner-core.xml

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

<ImplementationGuide xmlns="http://hl7.org/fhir">
  <id value="Practitioner-core"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.30.9"/>
  </identifier>
  <version value="0.01"/>
  <name value="PractitionerHL7Extensions"/>
  <title value="Practitioner  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 Practitioner resource"/>
</ImplementationGuide>

Resource Packs

list-Practitioner-packs.xml

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

<List xmlns="http://hl7.org/fhir">
  <id value="Practitioner-packs"/>
  <status value="current"/>
  <mode value="working"/>
  <entry>
    <item>
      <reference value="ImplementationGuide/Practitioner-core"/>
    </item>
  </entry>
</List>

Search Parameters

• active — token — Whether the practitioner record is active — Practitioner.active
• address — string — A server defined search that may match any of the string fields in the Address, including line, city, district, state, country, postalCode, and/or text — Practitioner.address
• address-city — string — A city specified in an address — Practitioner.address.city
• address-country — string — A country specified in an address — Practitioner.address.country
• address-postalcode — string — A postalCode specified in an address — Practitioner.address.postalCode
• address-state — string — A state specified in an address — Practitioner.address.state
• address-use — token — A use code specified in an address — Practitioner.address.use
• communication — token — A language to communicate with the practitioner — Practitioner.communication.language
• email — token — A value in an email contact — Practitioner.telecom.where(system='email')
• family — string — A portion of the family name — Practitioner.name.family
• gender — token — Gender of the practitioner — Practitioner.gender
• given — string — A portion of the given name — Practitioner.name.given
• identifier — token — A practitioner's Identifier — Practitioner.identifier | Practitioner.qualification.identifier
• qualification-code — token — The type of qualification — Practitioner.qualification.code
• qualification-period — date — The date(s) a qualification is valid for — Practitioner.qualification.period
• qual-code-period — composite — The practitioner has a qualification during a specific period — Practitioner.qualification
• name — string — A server defined search that may match any of the string fields in the HumanName, including family, give, prefix, suffix, suffix, and/or text — Practitioner.name
• phone — token — A value in a phone contact — Practitioner.telecom.where(system='phone')
• phonetic — string — A portion of either family or given name using some kind of phonetic matching algorithm — Practitioner.name
• telecom — token — The value in any kind of contact — Practitioner.telecom
• death-date — date — The date of death has been provided and satisfies this search value — (Practitioner.deceased.ofType(dateTime))
• deceased — token — This Practitioner has been marked as deceased, or has a death date entered — Practitioner.deceased.exists() and Practitioner.deceased != false

Full Search Parameters

Examples

• 3ad0687e-f477-468c-afd5-fcc2bf897809 — practitioner-examples-general — HL7 Defined Practitioner Examples
• example — practitioner-example — General Person Example
• f001 — practitioner-example-f001-evdb — Fictive KNO-physician
• f002 — practitioner-example-f002-pv — Fictive Cardiothoracal surgeon
• f003 — practitioner-example-f003-mv — Fictive Cardiothoracal surgeon
• f004 — practitioner-example-f004-rb — Fictive KNO-physician
• f005 — practitioner-example-f005-al — Fictive KNO-physician
• f006 — practitioner-example-f006-rvdb — Fictive Pharmacist
• f007 — practitioner-example-f007-sh — Fictive physician
• f201 — practitioner-example-f201-ab — Fictive Oncologist/Pulmonologist
• f202 — practitioner-example-f202-lm — Fictive Lab worker
• f203 — practitioner-example-f203-jvg — Fictive Physiotherapist
• f204 — practitioner-example-f204-ce — Fictive Nurse
• prac4 — practitioner-example-prac4 — Deceased Practitioner (details also in person)
• practitioner-example — practitioner-example
• practitioner-example-f001-evdb — practitioner-example-f001-evdb
• practitioner-example-f002-pv — practitioner-example-f002-pv
• practitioner-example-f003-mv — practitioner-example-f003-mv
• practitioner-example-f004-rb — practitioner-example-f004-rb
• practitioner-example-f005-al — practitioner-example-f005-al
• practitioner-example-f006-rvdb — practitioner-example-f006-rvdb
• practitioner-example-f007-sh — practitioner-example-f007-sh
• practitioner-example-f201-ab — practitioner-example-f201-ab
• practitioner-example-f202-lm — practitioner-example-f202-lm
• practitioner-example-f203-jvg — practitioner-example-f203-jvg
• practitioner-example-f204-ce — practitioner-example-f204-ce
• practitioner-example-prac4 — practitioner-example-prac4
• practitioner-example-xcda-author — practitioner-example-xcda-author
• practitioner-example-xcda1 — practitioner-example-xcda1
• practitioner-examples-general — practitioner-examples-general
• practitioner-examples-header — practitioner-examples-header
• xcda-author — practitioner-example-xcda-author — CDA Example Author
• xcda1 — practitioner-example-xcda1 — 2nd CDA Example Author

Full Examples

Mapping Exceptions

practitioner-fivews-mapping-exceptions.xml

Unmapped Elements

• FiveWs.what — Unknown
• FiveWs.recorded — Unknown
• FiveWs.author — Unknown
• FiveWs.actor — Unknown
• FiveWs.cause — Unknown
• FiveWs.version — Unknown
• FiveWs.witness — Unknown
• FiveWs.class — Unknown
• FiveWs.where — Unknown
• FiveWs.context — Unknown
• FiveWs.init — Unknown
• FiveWs.why — Unknown
• FiveWs.source — Unknown
• FiveWs.who — Unknown
• FiveWs.grade — Unknown
• FiveWs.planned — Unknown
• FiveWs.done — Unknown
• FiveWs.subject — Unknown

practitioner-participant-mapping-exceptions.xml

Divergent Elements

• Participant.identifier → Practitioner.identifier
  • shortUnmatched | reason=Unknown | pattern=Business Identifier for practitioner | resource=An identifier for the person as this agent
  • definitionUnmatched | reason=Unknown | pattern=Business identifiers assigned to this practitioner by one of the applications involved. These identifiers remain constant as the resource is updated and propagates from server to server. | resource=An identifier that applies to this person in this role.
  • commentsUnmatched | reason=Unknown | pattern=Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
  • requirementsUnmatched | reason=Unknown | pattern=Allows identification of the practitioner as it is known by various participating systems and in a way that remains consistent across servers. | resource=Often, specific identities are assigned for the agent.
• Participant.active → Practitioner.active
  • shortUnmatched | reason=Unknown | pattern=Whether the practitioner is currently active | resource=Whether this practitioner's record is in active use
  • definitionUnmatched | reason=Unknown | pattern=Whether this practitioner record is in active use. | resource=Whether this practitioner's record is in active use.
• Participant.name → Practitioner.name
  • missingTypes | reason=Unknown | pattern=string
  • extraTypes | reason=Unknown
  • shortUnmatched | reason=Unknown | pattern=A name for the practitioner | resource=The name(s) associated with the practitioner
  • definitionUnmatched | reason=Unknown | pattern=Description of the practitioner as presented to a consumer while searching. | resource=The name(s) associated with the practitioner.

practitioner-participantcontactable-mapping-exceptions.xml

Divergent Elements

• ParticipantContactable.telecom → Practitioner.telecom
  • definitionUnmatched | reason=Unknown | pattern=A contact detail (e.g. a telephone number or an email address) by which the practitioner may be contacted. | resource=A contact detail for the practitioner, e.g. a telephone number or an email address.
  • requirementsUnmatched | reason=Unknown | pattern=Participants have (primary) ways to contact them in some way such as phone, email. | resource=Need to know how to reach a practitioner independent to any roles the practitioner may have.
• ParticipantContactable.address → Practitioner.address
  • shortUnmatched | reason=Unknown | pattern=An address for the practitioner | resource=Address(es) of the practitioner that are not role specific (typically home address)
  • definitionUnmatched | reason=Unknown | pattern=An address where the practitioner can be reached. | resource=Address(es) of the practitioner that are not role specific (typically home address). Work addresses are not typically entered in this property as they are usually role dependent.
  • requirementsUnmatched | reason=Unknown | pattern=May need to keep track of practitioner addresses for contacting, billing or reporting requirements and also to help with identification. | resource=The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.

Unmapped Elements

• Participant.identifier — Unknown
• Participant.name — Unknown
• Participant.active — Unknown

practitioner-participantliving-mapping-exceptions.xml

Divergent Elements

• ParticipantLiving.birthDate → Practitioner.birthDate
  • summary | reason=Unknown | pattern=false
  • shortUnmatched | reason=Unknown | pattern=The date of birth for the practitioner | resource=The date on which the practitioner was born
  • definitionUnmatched | reason=Unknown | pattern=The date when the practitioner was born. | resource=The date of birth for the practitioner.
  • requirementsUnmatched | reason=Unknown | pattern=Used for identity verification and may drive other business processes. | resource=Needed for identification.
• ParticipantLiving.gender → Practitioner.gender
  • summary | reason=Unknown | pattern=false
  • definitionUnmatched | reason=Unknown | pattern=Administrative Gender - the gender that the practitioner is considered to have for administration and record keeping purposes. | resource=Administrative Gender - the gender that the person is considered to have for administration and record keeping purposes.
  • requirementsUnmatched | reason=Unknown | pattern=Needed for identification of the individual, in combination with (at least) name and birth date. | resource=Needed to address the person correctly.
• ParticipantLiving.photo → Practitioner.photo
  • shortUnmatched | reason=Unknown | pattern=Image of the {{title} | resource=Image of the person
  • definitionUnmatched | reason=Unknown | pattern=A facial image of the practitioner. | resource=Image of the person.
  • requirementsUnmatched | reason=Unknown | pattern=Many EHR systems have the capability to capture an image of the participant. Fits with newer social media usage too. | resource=Many EHR systems have the capability to capture an image of patients and personnel. Fits with newer social media usage too.

Unmapped Elements

• Participant.identifier — Unknown
• Participant.name — Unknown
• Participant.active — Unknown
• ParticipantContactable.address — Unknown
• ParticipantLiving.communication — Unknown
• ParticipantContactable.telecom — Unknown