type: resource-definitionsresource: Composition

Composition Definitions

Composition

A set of resources composed into a single coherent clinical statement with clinical attestation

Definition: A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and has traceability to the author who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).

Comments: While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.

Cardinality: 0..*

Mappings: workflow=Event; rim=Document[classCode="DOC" and moodCode="EVN" and isNormalAct()]; cda=ClinicalDocument; fhirdocumentreference=when described by DocumentReference; w5=infrastructure.documents

Composition.url

Canonical identifier for this Composition, represented as a URI (globally unique)

Definition: An absolute URI that is used to identify this Composition when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which an authoritative instance of this Composition is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the Composition is stored on different servers.

Comments: Can be a urn:uuid: or a urn:oid: but real http: addresses are preferred. Multiple instances may share the same URL if they have a distinct version.

Requirements: Allows the Composition to be referenced by a single globally unique identifier.

Cardinality: 0..1

Type: uri

Summary: true

Mappings: w5=FiveWs.identifier

Composition.identifier

Version-independent identifier for the Composition

Definition: A version-independent identifier for the Composition. This identifier stays constant as the composition is changed over time.

Comments: Similar to ClinicalDocument/setId in CDA. See discussion in resource definition for how these relate.

Cardinality: 0..*

Type: Identifier

Summary: true

Mappings: workflow=Event.identifier; w5=FiveWs.identifier; rim=Document.id / Document.setId; cda=.setId; fhirdocumentreference=DocumentReference.identifier

Composition.version

An explicitly assigned identifier of a variation of the content in the Composition

Comments: While each resource, including the composition itself, has its own version identifier, this is a formal identifier for the logical version of the Composition as a whole. It would remain constant if the resources were moved to a new server, and all got new individual resource versions, for example.

Cardinality: 0..1

Type: string

Summary: true

Mappings: cda=.versionNumber; w5=FiveWs.version; fhirdocumentreference=DocumentReference.version

Composition.consent

Represents informed consents and medico-legal transactions

Definition: References the consents associated with this document. Examples include a consent to perform the clinical service being documented (.event) or a consent for the information contained in the document to be released to a third party.

Cardinality: 0..*

Type: Reference(Consent)

Mappings: cda=.authorization.consent

Composition.basedOn

Fulfills plan, proposal or order

Definition: A plan, proposal or order that is fulfilled in whole or in part by this composition.

Requirements: Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

Aliases: fulfills

Cardinality: 0..*

Type: Reference(Appointment, AppointmentResponse, CarePlan, Claim, CommunicationRequest, CoverageEligibilityRequest, DeviceRequest, EnrollmentRequest, MedicationRequest, NutritionOrder, RequestOrchestration, ServiceRequest, Task, VisionPrescription)

Mappings: workflow=Event.basedOn; rim=.outboundRelationship[typeCode=FLFS].target; cda=.inFulfillmentOf

Composition.status

Definition: The workflow/clinical status of this composition. The status is a marker for the clinical standing of the document.

Comments: 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.

Requirements: Need to be able to mark interim, amended, or withdrawn compositions or documents.

Cardinality: 1..1

Type: code

Binding: required:composition-status

Summary: true

Is Modifier: true (Reason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)

Mappings: workflow=Event.status; w5=FiveWs.status; rim=interim: .completionCode="IN" & ./statusCode[isNormalDatatype()]="active"; final: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and not(./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct()]); amended: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and ./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct() and statusCode="completed"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]="obsolete"; cda=n/a; fhirdocumentreference=DocumentReference.docStatus

Composition.type

Kind of composition (LOINC if possible)

Definition: Specifies the particular kind of composition (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the composition.

Comments: For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.

Requirements: Key metadata element describing the composition, used in searching/filtering.

Cardinality: 1..1

Type: CodeableConcept

Binding: preferred:doc-typecodes

Summary: true

Mappings: workflow=Event.code; w5=FiveWs.class; rim=./code; cda=.code; fhirdocumentreference=DocumentReference.type

Composition.category

Categorization of Composition

Definition: A categorization for the type of the composition - helps for indexing and searching. This may be implied by or derived from the code specified in the Composition Type.

Requirements: Helps humans to assess whether the composition is of interest when viewing an index of compositions or documents.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:referenced-item-category

Summary: true

Mappings: w5=FiveWs.class; rim=.outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code; cda=n/a; fhirdocumentreference=DocumenttReference.category

Composition.subject

Who and/or what the composition is about

Definition: Who or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).

Comments: For clinical documents, this is usually the patient.

Requirements: Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about.

Cardinality: 0..*

Type: Reference(Resource)

Summary: true

Mappings: w5=FiveWs.subject; rim=.participation[typeCode="SBJ"].role[typeCode="PAT"]; cda=.recordTarget; workflow=Event.subject; fhirdocumentreference=DocumentReference.subject

Composition.encounter

Context of the Composition

Definition: Describes the clinical encounter or type of care this documentation is associated with.

Requirements: Provides context for the composition and supports searching.

Cardinality: 0..1

Type: Reference(Encounter)

Summary: true

Mappings: workflow=Event.encounter; w5=FiveWs.context; rim=unique(highest(./outboundRelationship[typeCode="SUBJ" and isNormalActRelationship()], priorityNumber)/target[moodCode="EVN" and classCode=("ENC", "PCPR") and isNormalAct]); cda=.componentOf.encompassingEncounter; fhirdocumentreference=DocumentReference.context

Composition.date

Composition editing time

Definition: The composition editing time, when the composition was last logically changed by the author.

Comments: The Last Modified Date on the composition may be after the date of the document was attested without being changed. This means that the date on an amended document is the date of the amendment, not the date of original authorship.

Requirements: dateTime is used for tracking, organizing versions and searching. Note that this is the time of authoring this version of the Composition. When packaged in a document, Bundle.timestamp is the date of packaging.

Cardinality: 1..1

Type: dateTime

Summary: true

Mappings: workflow=Event.occurrence[x]; w5=FiveWs.done[x]; rim=.effectiveTime[type="TS"]; cda=.effectiveTime; fhirdocumentreference=DocumentReference.content.attachment.date, DocumentReference.date

Composition.useContext

The context that the content is intended to support

Definition: The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate Composition instances.

Comments: When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.

Requirements: Assist in searching for appropriate content.

Cardinality: 0..*

Type: UsageContext

Summary: true

Composition.author

Who and/or what authored the composition

Definition: Identifies who is responsible for the information in the composition, not necessarily who typed it in.

Comments: When the Composition is software-generated, a Device can be referenced. When a software-generated Composition is verified by a human (but not authored by that human), use the attester element to identify the human(s) who performed the verification.

Requirements: Identifies who is responsible for the content.

Cardinality: 0..*

Type: Reference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)

Summary: true

Mappings: workflow=Event.performer; w5=FiveWs.author; rim=.participation[typeCode="AUT"].role[classCode="ASSIGNED"]; cda=.author.assignedAuthor; fhirdocumentreference=DocumentReference.author

Composition.participant

Identifies supporting entities, including parents, relatives, caregivers, insurance policyholders, guarantors, and others related in some way to the patient

Definition: Identifies supporting entities, including parents, relatives, caregivers, insurance policyholders, guarantors, and others related in some way to the patient. A supporting person or organization is an individual or an organization with a relationship to the patient. A supporting person who is playing multiple roles would be recorded in multiple participants (e.g., emergency contact and next-of-kin).

Cardinality: 0..*

Type: BackboneElement

Composition.participant.type

AUT | AUTHEN | CST | LA | RCT | SBJ

Definition: Meaning and purpose of participation, in creation of the clinical document. The list includes: data entry person, informant, primary information recipient, and tracker. Other types are allowed.

Cardinality: 1..*

Type: CodeableConcept

Binding: preferred:fhir-clinical-doc-participant

Composition.participant.function

Definition: Exact function of the participant in the creation of the clinical document. This is more granular than type.

Cardinality: 0..*

Type: CodeableConcept

Binding: preferred:v3-ParticipationFunction

Composition.participant.time

Time period of participation

Cardinality: 0..1

Type: Period

Composition.participant.party

Who the participant is

Cardinality: 1..1

Type: Reference(Practitioner, PractitionerRole, Patient, RelatedPerson, Device, Organization)

Composition.name

Name for this Composition (computer friendly)

Definition: A natural language name identifying the {{title}}. This name should be usable as an identifier for the module by machine processing applications such as code generation.

Comments: The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.

Requirements: Support human navigation and code generation.

Cardinality: 0..1

Type: string

Summary: true

Composition.title

Human Readable name/title

Definition: Official human-readable label for the composition.

Comments: For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.

Cardinality: 0..1

Type: string

Summary: true

Mappings: rim=./title; cda=.title; fhirdocumentreference=DocumentReference.description, DocumentReference.content.attachment.title

Composition.note

For any additional notes

Comments: A comment, general note or annotation not coded elsewhere.

Cardinality: 0..*

Type: Annotation

Composition.attester

Attests to accuracy of composition

Definition: A participant who has attested to the accuracy of the composition/document.

Comments: Only list each attester once.

Requirements: Identifies responsibility for the accuracy of the composition content.

Conditions: cmp-3

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=.participation[typeCode="AUTHEN"].role[classCode="ASSIGNED"]; cda=.authenticator/.legalAuthenticator; fhirdocumentreference=DocumentReference.attester

Composition.attester.mode

personal | professional | legal | official

Definition: The type of attestation the authenticator offers.

Requirements: Indicates the level of authority of the attestation.

Cardinality: 1..1

Type: CodeableConcept

Binding: preferred:composition-attestation-mode

Mappings: rim=unique(./modeCode); cda=implied by .authenticator/.legalAuthenticator; fhirdocumentreference=DocumentReference.attester.mode

Composition.attester.time

When the composition was attested

Definition: When the composition was attested by the party.

Requirements: Identifies when the information in the composition was deemed accurate. (Things may have changed since then.).

Cardinality: 0..1

Type: dateTime

Mappings: rim=./time[type="TS" and isNormalDatatype()]; cda=.authenticator.time; fhirdocumentreference=DocumentReference.attester.time

Composition.attester.party

Who attested the composition

Definition: Who attested the composition in the specified way.

Requirements: Identifies who has taken on the responsibility for accuracy of the composition content.

Cardinality: 0..1

Type: Reference(Patient, RelatedPerson, Practitioner, PractitionerRole, Organization, Group)

Mappings: w5=FiveWs.witness; rim=./role[classCode="ASSIGNED" and isNormalRole]/player[determinerCode="INST" and classCode=("DEV", "PSN") and isNormalEntity()] or ./role[classCode="ASSIGNED" and isNormalRole and not(player)]/scoper[determinerCode="INST" and classCode="ORG" and isNormalEntity()]; cda=.authenticator.assignedEnttty; fhirdocumentreference=DocumentReference.attester.party

Composition.custodian

Organization which maintains the composition

Definition: Identifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information.

Comments: This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However, it is important that this information be known when working with a derived document, so providing a custodian is encouraged.

Requirements: Identifies where to go to find the current version, where to report issues, etc.

Cardinality: 0..1

Type: Reference(Organization, Patient, Group)

Summary: true

Mappings: rim=.participation[typeCode="RCV"].role[classCode="CUST"].scoper[classCode="ORG" and determinerCode="INST"]; cda=.custodian.assignedCustodian; fhirdocumentreference=DocumentReference.custodian

Composition.relatesTo

Relationships to other compositions/documents

Definition: Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

Comments: To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a targetReference with an identifier.
When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

"relatesTo": [{
  "type": "replaces",
  "targetReference": {
    "identifier": { 
      "system": "...", 
      "value": "..."
    }
  } 
}]

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=.outboundRelationship; cda=.relatedDocument; fhirdocumentreference=DocumentReference.relatesTo

Composition.relatesTo.type

Definition: The type of relationship to the related artifact.

Cardinality: 1..1

Type: CodeableConcept

Binding: extensible:artifact-relationship-type

Composition.relatesTo.target[x]

The artifact that is related to this Composition

Definition: The artifact that is related to this Composition Resource.

Cardinality: 1..1

Type: uri, Attachment, canonical, Reference(Resource), markdown

Composition.event

The clinical service(s) being documented

Definition: The clinical service, such as a colonoscopy or an appendectomy, being documented.

Comments: The event needs to be consistent with the type element, though can provide further information if desired.

Requirements: Provides context for the composition and creates a linkage between a resource describing an event and the composition created describing the event.

Cardinality: 0..*

Type: BackboneElement

Summary: true

Mappings: rim=outboundRelationship[typeCode="SUBJ"].target[classCode<'ACT']; cda=.documentationOf.serviceEvent

Composition.event.period

The period covered by the documentation

Definition: The period of time covered by the documentation. There is no assertion that the documentation is a complete representation for this period, only that it documents events during this time.

Cardinality: 0..1

Type: Period

Summary: true

Mappings: rim=.effectiveTime; cda=.effectiveTime; fhirdocumentreference=DocumentReference.period

Composition.event.detail

The event(s) being documented, as code(s), reference(s), or both

Definition: Represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the typeCode, such as a "History and Physical Report" in which case the procedure being documented is necessarily a "History and Physical" act. The events may be included as a code or as a reference to an other resource.

Comments: An event can further specialize the act inherent in Composition.type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more events are included, they SHALL NOT conflict with the values inherent in Composition.type as such a conflict would create an ambiguous situation. This short list of codes is provided to be used as key words for certain types of queries.

Cardinality: 0..*

Type: CodeableReference

Binding: example:v3-ActCode

Summary: true

Mappings: rim=.outboundRelationship[typeCode="SUBJ"].target; cda=n/a; fhirdocumentreference=DocumentReference.event

Composition.section

Composition is broken into sections

Definition: The root of the sections that make up the composition.

Conditions: cmp-3

Cardinality: 0..*

Type: BackboneElement

Constraints: cmp-1 | error | A section must contain at least one of text, entries, or sub-sections | text.exists() or entry.exists() or section.exists(); cmp-2 | error | A section can only have an emptyReason if no entries are included | emptyReason.empty() or entry.empty(); cmp-3 | warning | If attester exists then the Composition either needs a text or a section | %resource.attester.exists() implies(text.exists() or section.exists())

Mappings: rim=./outboundRelationship[typeCode="COMP" and isNormalActRelationship()]/target[moodCode="EVN" and classCode="DOCSECT" and isNormalAct]; cda=.component.structuredBody.component.section

Composition.section.title

Label for section (e.g. for ToC)

Definition: The label for this particular section. This will be part of the rendered content for the document, and is often used to build a table of contents.

Comments: The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.

Requirements: Section headings are often standardized for different types of documents. They give guidance to humans on how the document is organized.

Aliases: header, label, caption

Cardinality: 0..1

Type: string

Mappings: rim=./title; cda=.title

Composition.section.code

Classification of section (recommended)

Definition: A code identifying the kind of content contained within the section. This must be consistent with the section title.

Comments: The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document.

If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.

Requirements: Provides computable standardized labels to topics within the document.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:doc-section-codes

Mappings: rim=./code; cda=.code

Composition.section.author

Who and/or what authored the section, when the section is authored by someone other than the composition.author

Definition: Identifies who is responsible for the information in this section, not necessarily who typed it in.

The actual author of the section when it is not the author of the composition. If author is not specified, the author is assumed to be the author of the parent section or the author of the composition.

Requirements: Identifies who is responsible for the content.

Cardinality: 0..*

Type: Reference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)

Mappings: w5=FiveWs.author; rim=.participation[typeCode="AUT"].role[classCode="ASSIGNED"]; cda=.author.assignedAuthor

Composition.section.focus

Who/what the section is about, when it is not about the subject of composition

Definition: The actual focus of the section when it is not the subject of the composition, but instead represents something or someone associated with the subject such as (for a patient subject) a spouse, parent, fetus, or donor. If not focus is specified, the focus is assumed to be focus of the parent section, or, for a section in the Composition itself, the subject of the composition. Sections with a focus SHALL only include resources where the logical subject (patient, subject, focus, etc.) matches the section focus, or the resources have no logical subject (few resources).

Comments: Typically, sections in a doument are about the subject of the document, whether that is a patient, or group of patients, location, or device, or whatever. For some kind of documents, some sections actually contain data about related entities. Typical examples are a section in a newborn discharge summary concerning the mother, or family history documents, with a section about each family member, though there are many other examples.

Cardinality: 0..1

Type: Reference(Resource)

Mappings: cda=.subject? (CDA did not differentiate between subject and focus)

Composition.section.text

Text summary of the section, for human interpretation

Definition: A human-readable narrative that contains the attested content of the section, 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.

Comments: Document profiles may define what content should be represented in the narrative to ensure clinical safety.

Conditions: cmp-1

Cardinality: 0..1

Type: Narrative

Mappings: rim=.text; cda=.text

Composition.section.note

Information about the section contents that is not represented by any of the section entries

Comments: A comment, general note or annotation not coded elsewhere in the section.

Cardinality: 0..*

Type: Annotation

Composition.section.orderedBy

Order of section entries

Definition: Specifies the order applied to the items in the section entries.

Comments: Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.

Requirements: Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries.

Cardinality: 0..1

Type: CodeableConcept

Binding: preferred:list-order

Mappings: rim=.outboundRelationship[typeCode=COMP].sequenceNumber > 1; cda=n/a

Composition.section.entry

A reference to data that supports this section

Definition: A reference to the actual resource from which the narrative in the section is derived.

Comments: If there are no entries in the list, an emptyReason SHOULD be provided.

Conditions: cmp-1, cmp-2

Cardinality: 0..*

Type: Reference(Resource)

Mappings: rim=.outboundRelationship[typeCode=COMP] or .participation[typeCode=SBJ]; cda=.entry

Composition.section.emptyReason

Why the section is empty

Definition: If the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason.

Comments: The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.

Requirements: Allows capturing things like "none exist" or "not asked" which can be important for most lists.

Conditions: cmp-2

Cardinality: 0..1

Type: CodeableConcept

Binding: preferred:list-empty-reason

Mappings: rim=.inboundRelationship[typeCode=SUBJ,code<ListEmptyReason].value[type=CD]; cda=n/a

Composition.section.section

Nested Section

Definition: A nested sub-section within this section.

Comments: Nested sections are primarily used to help human readers navigate to particular portions of the document.

Cardinality: 0..*

Mappings: rim=./outboundRelationship[typeCode="COMP" and isNormalActRelationship()]/target[moodCode="EVN" and classCode="DOCSECT" and isNormalAct]; cda=.component.section