[%settitle Version History%] [%file newheader%] [%file newnavbar%]

Version History since DSTU #1

For background to this version history, see FHIR Version Management Policy.

Major Milestones:

• Move a set of definitions out to be Additional Resources
• Dosage Types: Rework to handle complex dosing regimes
• Signatures: Rework the way signing works
• Extensive minor changes across the entire specification
• Change the status of everything to normative now, except for explicitly marked informative pages

| | 6.0.0-ballot3 |

R6 3rd Draft Ballot. Significant changes:

• Additional Resources: Allowing for development of FHIR Resources in other specifications
• Group: Allowing for groups to act collectively, or receive care collectively - change made based on feedback from LMICs countries, and also for social care
• New data types: RelativeTime
• New Resources: DeviceAlert, InsuranceProduct, MolecularDefinition, PersonalRelationship
• Removed Resources: EvidenceReport
• Significant changes have been made to the Vital Signs Profiles, and the profile Medical Product of Human Origin profile has been added
• The following resources have been updated: ResearchStudy, ResearchSubject, Measure, MeasureReport, ServiceRequest, Task, Specimen, Observation, DiagnosticReport, Device, DeviceAssociation, DeviceDefinition, DeviceMetric, DeviceAlert, NutritionProduct, NutritionIntake, NutritionOrder, BiologicallyDerivedProduct, BiologicallyDerivedProductDispense, SupplyDelivery, SupplyRequest, DocumentReference
• The following Module Pages have been added or updated: Diagnostics, Device, Nutrition, BDP

| | 6.0.0-ballot2 | Version Information was not generated for this release | | 6.0.0-ballot1 | Version Information was not generated for this release | | 5.0.0 |

R5 Milestone. This version has cumulatively made 1000s of changes from the R4+R4B milestones (3969 change requests, including 1840 substantive changes). Most of the changes are in response to implementation feedback. There is no comprehensive list, but here is a list of the more significant changes:

• Complete Rework Subscriptions framework
• Rework the abstract datatypes (new types Base, DataType, BackboneType), and introduce CanonicalResource and MetadataResource interfaces
• All the extensions have been moved to a new package hl7.fhir.uv.extensions published at http://hl7.org/fhir/extensions. They are still published as part of this specification, but they will be released more often
• A number of clarifications have been made on the RESTful API and Search pages, that have resulted in the introduction of new SHALL and SHOULD conformance statements. Though the new SHALL statements are believed to be clarifications, implementers should review these pages carefully and particularly should note the clarifications around the use of GET/POST on search, and the new SHOULD requirement for clients about timezones
• New resources: ActorDefinition, ArtifactAssessment, BiologicallyDerivedProductDispense, ConditionDefinition, DeviceAssociation, DeviceDispense, EncounterHistory, FormularyItem, GenomicStudy, ImagingSelection, InventoryItem, InventoryReport, NutritionIntake, NutritionProduct, Permission, TestPlan and Transport + New types: integer64, Availability and ExtendedContactDetail
• Renamed resources DeviceUseStatement -> DeviceUsage and RequestGroup -> RequestOrchestration
• Removed resources CatalogEntry (R4B), DocumentManifest (R4B) (use [[%List%]]), Media (R4B) (use [[%DocumentReference%]] or [[%Observation%]]), EffectEvidenceSynthesis (R4), ResearchDefinition (R4B), ResearchElementDefinition (R4B), RiskEvidenceSynthesis (R4), and the type Contributor (R4B)
• For the Medication Definition resources, the changes are more complicated:
  • Renamed in R4B: MedicinalProduct -> [[%MedicinalProductDefinition%]], MedicinalProductAuthorization -> [[%RegulatedAuthorization%]], MedicinalProductIngredient -> [[%Ingredient%]], MedicinalProductManufactured -> [[%ManufacturedItemDefinition%]], MedicinalProductPackaged -> [[%PackagedProductDefinition%]], MedicinalProductPharmaceutical -> [[%AdministrableProductDefinition%]], SubstanceSpecification -> [[%SubstanceDefinition%]]
  • Collapsed into [[%ClinicalUseDefinition%]] in R4B: MedicinalProductContraindication, MedicinalProductIndication, MedicinalProductInteraction, MedicinalProductUndesirableEffect
  • Removed in R4B: types ProdCharacteristic and SubstanceAmount
  • Omitted from R4B due to limited scope: SubstanceNucleicAcid, SubstancePolymer, SubstanceProtein, SubstanceReferenceInformation, SubstanceSourceMaterial
• Moved many code systems and value sets to terminology.hl7.org
• Added Operations for Large Resources
• Added the ability to define additional bindings on elements
• Documented FHIR NPM Packages
• Changes to reliable messaging (which identifier elements are used)

About Normative content in the R5 release

The 5th Major release of the FHIR specification is labeled as 'trial-use' because the entire ballot cycle that led to this release was performed under the HL7 STU (Standard for Trial Use). None of the content in this specification is considered "Normative", but the content that was previously normative in Release 4 is still labelled as Normative to preserve the status through the publication and implementation of this release.

A few new artifacts (such as CanonicalResource) are labelled as Normative because they were created by moving existing normative content to a new type.

| | 5.0.0-draft-final | R5 Draft: Final QA Version (for internal review by HL7). | | 5.0.0-snapshot3 | R5 Snapshot 3 - Connectathon 32 Base. This stable version for the connectathon and final publication preparation has many changes since the ballot. Some particularly significant changes:

• Add Obligations and Additional Bindings for finer grained control over application behavior

| | 5.0.0-ballot | R5 Ballot - Sept/Oct 2022 Ballot. This ballot has 1000s of changes. Some particularly significant changes:

• Change the way version numbering works
• New Resources: Transport, NutritionIntake, ActorDefinition, Requirements, GenomicStudy and FormularyItem
• New Data Types: Availability, ExtendedContactDetail, MonetaryComponent and VirtualServiceDetail
• Complete Rework Subscriptions framework
• Hundreds of clarifications, technical corrections etc.
• 3157 change requests were applied to R5, of which 1486 changes were considered substantive.

| | 4.6.0 | Draft Ballot for R5 - May 2021 Ballot (Apr 14-20 2021). Significant changes:

• Add RatioRange datatype
• Rename DeviceUseStatement to DeviceUsage
• New resources InventoryReport, Citation, EvidenceReport, and ClinicalUseIssue
• Updates for subscriptions, medication definitions, and evidence based medicine
• Ongoing development of other resources

| | 4.5.0 | 3rd Milestone for R5 - September 2020 Virtual Connectathon Stable Version (Aug-20 2020). Significant changes:

• Ongoing development of less mature resources
• Finish removing content moved to http://terminology.hl7.org

| | 4.4.0 | 2nd Milestone for R5 - May 2020 Virtual Connectathon Stable Version. Significant changes:

• Further Development of the Subscription framework (SubjectStatus, rename Topic to SubscriptionTopic)
• Add new Resources Permission, NutritionProduct, Citation, and EvidenceReport

| | 4.3.0 |

Release R4B: May 28, 2022:

• Though the changes listed here seem quite extensive, they are limited to particular areas of the specification. See the explanation about R4B for further details
• Add CodeableReference and RatioRange types
• Add NutritionProduct Resource
• Add SubscriptionStatus and SubscriptionTopic Resources
• Add new Resources AdministrableProductDefinition, ClinicalUseDefinition, PackagedProductDefinition, ManufacturedItemDefinition and RegulatedAuthorization
• Rework MarketingStatus (relax cardinality constraints) and ProductShelfLife Types
• Rework & rename MedicinalProduct -> MedicinalProductDefinition
• Rework & rename MedicinalProductIngredient -> Ingredient
• Rework & rename SubstanceSpecification -> SubstanceDefinition
• Rework Evidence and EvidenceVariable Resources
• Add Citation and EvidenceReport Resources
• Remove EffectEvidenceSynthesis and RiskEvidenceSynthesis Resources
• Add canonical as an allowed type for subject[x] to ActivityDefinition and PlanDefinition
• Remove MedicinalProductAuthorization, MedicinalProductContraindication, MedicinalProductIndication, MedicinalProductInteraction, MedicinalproductManufactured, MedicinalproductPackaged, MedicinalproductPharmaceutical, MedicinalproductUndesirableEffect, SubstanceAmount, SubstanceNucleicAcid, SubstancePolymer, SubstanceProtein, SubstanceReferenceInformation and SubstanceSourceMaterial resources
• Refine some invariants that behaved erroneously with missing data (no new restrictions were introduced)

Note that Release 4B was a derivative of Release 4. Release 5 is a direct development from Release 4, with many of the changes found in Release 4B incorporated and further developed.

| | 4.2.0 | 1st Milestone for R5 - Sydney Connectathon Stable Version. Significant changes:

• Rework the abstact datatypes (new types Base, DataType, BackboneType), and introduce CanonicalResource and MetadataResource interfaces
• Major upgrade to Subscription resource and the pub/sub patterns

| | 4.1.0 | Current build after 4.1.0 release | | 4.0.1 |

Release 4: Dec 27, 2018. First Normative content, with many significant changes

Note that between R3 and R4, nearly 3000 change proposals were applied to the specification, including >1000 substantive changes, of which 339 were labeled 'non-compatible'. As such, providing a comprehensive list of changes between specifications is not appropriate. To help see and understand the differences between the specification releases, implementers can:

• consult the R3/R4 difference analysis
• review (or use) the R3/R4 transforms
• Use the link at the foot of every page

To help implementers, the more significant changes are listed here:

• Some content marked Normative using N - see Documentation and Resource indexes. The meaning of normative is described at length in the Rules for Inter-version change.
• New Resources:
  • BiologicallyDerivedProduct
  • ChargeItemDefinition
  • DeviceDefinition
  • EffectEvidenceSynthesis
  • EventDefinition
  • Evidence
  • EvidenceVariable
  • ExampleScenario
  • ImmunizationEvaluation
  • InsurancePlan
  • Invoice
  • MedicationKnowledge
  • MedicinalProduct
  • MedicinalProductAuthorization
  • MedicinalProductContraindication
  • MedicinalProductIndication
  • MedicinalProductIngredient
  • MedicinalProductInteraction
  • MedicinalProductManufactured
  • MedicinalProductPackaged
  • MedicinalProductPharmaceutical
  • MedicinalProductUndesirableEffect
  • ObservationDefinition
  • OrganizationAffiliation
  • ResearchDefinition
  • ResearchElementDefinition
  • RiskEvidenceSynthesis
  • SpecimenDefinition
  • SubstancePolymer
  • SubstanceReferenceInformation
  • SubstanceSpecification
  • TerminologyCapabilities
  • VerificationResult
• Renamed Resources:
  • BodySite -> BodyStructure
  • EligibilityRequest -> CoverageEligibilityRequest
  • EligibilityResponse -> CoverageEligibilityResponse
  • Sequence -> MolecularSequence
  • ReferralRequest & ProcedureRequest -> ServiceRequest
• Deleted Resources:
  • DeviceComponent
  • ImagingManifest
• Clarification of the meaning and use of IsModifier
• Considerable development of the Version Management Policy, and support for multiple FHIR versions (specifically, the FHIR Version parameter)
• Datatypes: Rework Money (no longer a constraint on Quantity), and add Expression

| | 3.6.0 | Current build after 3.5.0 release | | 3.5.0 |

Release R4 Ballot #1: Sept 20, 2018. R4 ballot #2

Major changes from R4 Ballot 1 (3.3.0):

This is only the major changes. More comprehensive lists can be found in the ballot introduction (later removed).

Major changes in the other parts of the specification:

• New Resources: MedicationKnowledge, DeviceDefinition, ChargeItemDefinition
• Renamed Resources: OrgnizationRole to OrganizationAffiliation, EligibilityRequest to CoverageEligibilityRequest, EligibilityResponse to CoverageEligibilityResponse, and ProductPlan to InsurancePlan
• Significant rework around devices - in the Device resource, remove DeviceComponent + new resource DeviceDefinition
• Update maps/diffs to R3 (see note above)
• New page listing best practices
• A sweeping change to code system and value set URLs to align with new terminology infrastructure
• Add information and operations related to supporting multiple versions of FHIR
• Rewrite Asynchronous Pattern Operation
• New security notes about suggested best practices, and new safety notes about deleting records
• Lots of changes to Financial Resources (especially Contract)

| | 3.4.0 | Current build after 3.3.0 release | | 3.3.0 |

Release R4 Ballot #1: Apr 3, 2018. R4 ballot #1. Major changes from R3:

• Mark all content with a standards status - Normative, Trial use, Draft, or external
• Many minor & major changes to datatypes, resources, operations
• New Resources: BiologicallyDerivedProduct, EventDefinition, ExampleScenario, ImmunizationEvaluation, Invoice, ItemInstance, ObservationDefinition, OccupationalData, OrganizationAffiliation, SpecimenDefinition, TerminologyCapabilities, UserSession and VerificationResult, and a new set of resources for medication knowledge management: MedicinalProduct, MedicinalProductAuthorization, MedicinalProductClinicals, MedicinalProductDeviceSpec, MedicinalProductIngredient, MedicinalProductPackaged, MedicinalProductPharmaceutical, InsurancePlan, SubstancePolymer, SubstanceReferenceInformation and SubstanceSpecification.
• Renamed Resources: ProcedureRequest to ServiceRequest & BodySite to BodyStructure
• Removed Resources: DataElement, ImagingManifest and ServiceDefinition
• New Pages: Asynchronous Use, Persistence/Data bases, FiveWs Pattern and Multi-language support

| | 3.2.0 |

Release R4 Draft: Dec 21, 2017. R4 draft ballot. Major changes:

• Ensure that all pages have a standards status, and enforce standards status throughout. Add dependency analysis
• Many minor changes to datatypes, resources, operations
• New Resources: SpecimenDefinition, ObservationDefinition, ExampleScenario, TerminologyCapabilities, UserSession, Invoice, InsurancePlan, OccupationalData, OrganizationAffiliation, VerificationResult, MedicinalProduct, MedicinalProductAuthorization, MedicinalProductClinicals, MedicinalProductIngredient, MedicinalProductPackaged, MedicinalProductPharmaceutical, MedicinalProductDeviceSpec, SubstanceSpecification, SubstancePolymer, SubstanceReferenceInformation, BiologicallyDerivedProduct, ItemInstance
• Add draft support for bulk data (Asynchronous API + nd-json format)

| | 3.1.0 | R4 development begins | | 3.0.0 |

Release 3: Mar 21, 2017. STU3

This is the full FHIR Release 3 (R3). R3 is a complete overhaul of the specification from R2, with over 2400 change proposals process, and applied in R3. Of those changes, 380+ are labeled as a breaking change. Given this level of change, there is no useful way to present a single change list. Users can use the R2/R3 difference comparison, the R2 <-> R3 transforms, or the "Compare to R2" link at the foot of every page to help visualise the differences between R2 and R3.

Many of the changes made in this release (since 1.8.0) are in response to Quality Assurance processes in HL7, with a goal of readying the specification for Normative processes in R4:

• Reorder many resources and improve their definitions and bindings (Quality Assurance work)
• Add draft resources AdverseEvent and GraphDefinition
• Change to the way discriminators work in profiles (for profile/tooling authors)
• Finalization of the Turtle (RDF) format, along with JSON-LD (later removed)
• Consolidation of Version management issues into a single Version Policy page, and update to current policy
• Add rules about how missing data in search

Roll up: Of all the many changes (thousands) between R2 and R3, these are the most significant:

• Change the FHIR mime type to application/fhir+xml|json instead of application/xml|json+fhir (breaking change, for conformance to W3C+IETF rules)
• Rename the "Conformance" resource to "CapabilityStatement" and Deprecate use of the OPTIONS command to retrieve the CapabilityStatement
• Search Changes around errors in search parameters, missing data, sorting
• Change HumanName.family from 0..* to 0..1
• CodeSystem now separated out from ValueSet

| | 1.9.0 |

FHIR Rolling Build, 2016 Dec onwards

| | 1.8.0 |

FHIR QA Release, Dec 6, 2016

STU 3 Candidate, and also the basis for several implementation guide ballots and the San Antonio Jan 2017 Connectathon

Breaking Changes Summary:

• Change HumanName.family from 0..* to 0..1
• Rename MedicationOrder and DiagnosticOrder to MedicationRequest and DiagnosticRequest and make a series of changes to align with the Request Pattern
• Add cross resource search + rework composite parameter expressions
• Harmonize resource metadata across the Terminology, Conformance, and Knowledge resources
• Change the way versioned references to canonical URLs are handled
• REST - servers must return a location header on a create
• Condition status elements reworked

These are only the more significant changes, there were many 100s of changes made in response to ballot comments and ongoing implementation experience. These include breaking changes to may resources. Structural changes are summarized here, and Transforms between DSTU 2 and STU 3 are provided for many resources.

| | 1.6.0 |

FHIR STU3 ballot, Aug 11, 2016

STU 3 ballot version, and also the basis for the Baltimore Sept 2016 Connectathon

Publication Changes:

• Move the US Realm implementation guides out of the specification (see http://www.fhir.org/guides/registry)
• Rework the home page, and introduce modules as a way to navigate the specification + add significant new implementer advice (e.g., "Getting Started")
• Change the Navigation menu to focus on indexes to the content in the specification
• Move FHIRPath expression language to its long term home

Technical Changes:

• RESTful API
  • Change the FHIR mime type to application/fhir+xml|json instead of application/xml|json+fhir (breaking change, for conformance to W3C+IETF rules)
  • Add new uses for the Prefer header (return OperationOutcome, and manage behavior related to unknown / unsupported search parameters
  • Deprecate use of the OPTIONS command to retrieve the CapabilityStatement
  • Add support for conditional references to the transaction interaction
  • Add reverse chaining
• Formats: No change to XML + JSON formats. Add Turtle Format, and related validation tools
• For Datatypes and Resources, there is formal difference analysis from DSTU2 (also found throughout the specification), and transforms between DSTU 2 and STU 3 are provided for many resources

| | 1.5.0 |

FHIR Current Build Update, July 8 2016

Update current version to 1.5 to prevent confusion with implementations still running the May 2016 version.

• There are many changes in this version from 1.4.0, but no formal list is provided. A formal list will be provided for 1.6 (as a diff to 1.4)

| | 1.4.0 |

FHIR Connectathon 12 Snapshot, Mar 30 2016

Frozen base for Connectathon 12 & For Comment ballots:

• FHIR API and Serialization Format Enhancement

  • The _sort parameter has been reworked
  • New or extended search parameters for read, search or history: _type, _at, _summary, _elements
  • Change Turtle representation - now ready for trial

• Conformance resources with significant breaking changes and behavior:

  • StructureDefinition - Type Handling: Changes to how the structure definition types work: baseType replaces constrainedType (now type) & baseDefinition replaces base
  • CodeSystem now separated out from ValueSet: CodeSystem is now a first class resource type in order to support use throughout the FHIR eco-system, such as to support value set expansion and validation. It is intended to be used for distributing the smaller ad-hoc code systems that are ubiquitously encountered throughout the healthcare process.

• Other resources with significant breaking changes and behavior:

  • AllergyIntolerance
  • Appointment
  • AuditEvent
  • Claim
  • ClaimResponse
  • Device
  • ConceptMap
  • Conformance (now CapabilityStatement)
  • Contract
  • CoverageEligibilityRequest
  • CoverageEligibilityResponse
  • Device
  • DiagnosticRequest
  • ExplanationOfBenefit
  • Library
  • Measure
  • Medication
  • MedicationAdministration
  • MedicationStatement
  • Observation: the introduction of the Vital Signs Profile (proposed to be mandatory)
  • OperationDefinition
  • Patient
  • PaymentNotice
  • PaymentReconciliation
  • Practitioner
  • Provenance
  • ReferralRequest
  • Schedule
  • Slot
  • StructureDefinition
  • TestScript
  • ValueSet

• Add new draft resources:

  • CareTeam
  • CodeSystem
  • CompartmentDefinition
  • Linkage
  • MeasureReport
  • PractitionerRole
  • Protocol
  • StructureMap
  • Task

| | 1.2.0 |

FHIR Connectathon 11 Snapshot, Dec 11 2015

Frozen base for Connectathon 11:

• Remove GuidanceRequest
• Add new draft resource: ExpansionProfile
• Modifications to Financial Resource & TestScript resource

Note: this version is temporary, and was removed after Connectathon 11 was complete

| | 1.1.0 |

GAO Ballot + technical corrections, Dec 2 2015

A ballot publication for the GAO Ballot that also includes:

• Various technical corrections to the generated snapshots
• Populate FHIRPath expressions in extensions for all search parameters and invariants
• Add new draft resources: GuidanceRequest, GuidanceResponse, ModuleMetadata, ModuleDefinition, Library, DecisionSupportServiceModule, DecisionSupportRule, OrderSet, Measure
• Major restructure of Questionnaire

| | 1.0.2 |

Technical Correction 1, Oct 24 2015

A series of technical corrections to the specification following extensive review:

• Corrections to Extension cardinalities in implementation guides
• Corrections in the conformance resources that support the specifications
• Correct several erroneous invariants
• Various typos, broken links, and fixes in examples
• For a comprehensive list of corrections, see the Task list for FHIR DSTU2 Technical Correction 1

| | 1.0.1 |

DSTU 2, Sept 23 2015

Changes of significance during the QA process:

• Remove the Clinical Quality Improvement Framework (CQIF) from this published version
• made fixes to generated schematrons
• updated generated conformance resources (StructureDefinitions and SearchParameters) so they were consistent with the specification
• Many spelling / grammar / broken link fixes

| | 1.0.0 |

DSTU 2 QA Preview, Aug 31 2015

This version had extensive change as a result of the May 2015 DSTU ballot, ongoing testing, and the open change proposals (1317 tasks). The extent of the changes is best illustrated by the number of the list of changes labeled 'breaking change' - 158 changes of 1317 total tasks. Below is a list of the most important changes:

• General: introduced the maturity framework
• RESTful API: add batch, several clarifications around versioning & transactional integrity, changed Bundle URL resolution rules
• Search: changed the way <> etc.works, added _list parameter, changed rules around contained and included resources
• Formats: added a note about whitespace in XML, added code generation schemas
• Datatypes:
  • New datatypes: markdown, Annotation,
  • changed datatypes: Coding, Quantity, Signature, Timing, Address, ContactPoint
  • changes to ElementDefinition: add base, make type.profile repeat, remove invariant.name and replace with invariant.requirements, remove binding.name, add min/max value
• Resources:
  • New resources: Account, ImplementationGuide, TestScript
  • renamed: Contraindication -> DetectedIssue, MedicationPrescription -> MedicationRequest, QuestionnaireAnswers -> QuestionnaireResponse
  • removed: Supply
  • changed: almost all resources - too many to list (1317 tasks worth of changes) - add, remove elements, change types, references, definitions & value sets, re-order elements, provide much more documentation and new examples
• Implementation Guide:
  • Move Argonaut content out

| | 0.5.0 |

DSTU Ballot, May 2015

This version had extensive change as a result of the January 2015 Draft ballot, ongoing testing, and the open change proposals (over 800 tasks). The list below is a summary of the major changes to resource content. It shows only a limited number of the overall changes.

Enumerations

• All spaces removed
• Extensive content changes not noted here

New Datatypes

• unsignedInt
• positiveInt
• Signature
• Meta

Changed Datatypes

• Coding - remove valueSet property
• Attachment - add creation
• Identifier - replace label with type
• Timing - major rework of content
• ElementDefinition - add label, code, rename 'formal' to definition, rename synonym to alias, add language to mapping, remove conformance and isExtensible and replace with strength

New Resources

• BodySite
• Claim

Removed Resources

• CarePlan2 -> collapsed into CarePlan
• FamilyHistory -> broken up into FamilyMemberHistory
• InstitutionalClaim, OralHealthClaim, PharmacyClaim, ProfessionalClaim, VisionClaim -> collapsed into Claim
• Other - use Basic instead
• PendedRequest,Readjudicate, Reversal, StatusRequest, StatusResponse - use ProcessRequest/Response instead
• SupportingDocumentation - use DocumentReference instead
• ProcessRequest, ProcessResponse - use Task instead

Renamed Resources

• Alert -> Flag: 'alert' made people think it was an action like an alarm
• SecurityEvent -> AuditEvent: it wasn't just for security purposes
• ClinicalAssessment -> ClinicalImpression: people got confused with 'assessment' tools like APGAR score
• Profile -> StructureDefinition: 'Profile' is the process, a package of statements

Changes Inside Resources

• Parameters - allow parameter.part to contain a resource
• AllergyIntolerance - rename subject to patient
• Appointment - remove lastModifiedBy/lastModified, add location
• AppointmentResponse - remove lastModifiedBy/lastModified, add rename individual to actor
• AuditEvent - add .event.purposeOfEvent, participant.location, .policy, and .purposeOfUse
• Bundle - major reorganization
• CarePlan - pull goal out + other reorganization
• ClinicalImpression - add status, replace careplan & referral with trigger, rename diagnosis to finding, make plan 0..*,
• Composition - change .section.content to refer to List only, not any
• ConceptMap - change identifier to url, add useContext, change telecom to contact,
• Condition - rename subject to patient, rename status to clinicalStatus, change to bodySite = code or Reference(BodySite), rename .codeableConcept to .code
• Conformance (now CapabilityStatement) - change identifier to url, add useContext, change telecom to contact, add requirements and copyright, add support for conditional operations,
• Contract - extensive rewrite
• Coverage - add bin, subscriberId
• DataElement (now StructureDefinition) - total rewrite to use ElementDefinition
• Device - add status, manufactureDate
• DeviceMetric - rename operationalState to operationalStatus, add measurementMode, rename calibrationInfo to calibration, change color to an enumerations
• DeviceRequest/DeviceUsage - change to bodySite = code or Reference(BodySite)
• DiagnosticRequest- change to bodySite = code or Reference(BodySite)
• DiagnosticReport - add encounter
• DocumentReference - add format, remove policyManager, make content : Attachment, and remove several related attributes, remove service reference and add context.practiceSetting, sourcePatientInfo, and related
• Encounter - add incomingReferralRequest, allow reason to repeat, rename diet to dietPreference
• EpisodeOfCare - rename currentStatus to status, allow referralRequest to repeat,
• Flag - rename subject to patient, change from note to code
• Goal - add targetDate, statusDate, author, priority
• HealthcareService - extensive rewrite
• ImagingObjectSelection - remove retrieveAETitle, rename retrieveUrl to url, add frames
• ImagingStudy - add laterality, change url to attachment
• Immunization - add encounter, rename subject to patient, rename refusedIndicator to wasNotGiven, rename refusalReason to reasonNotGiven
• List - add title, status, change ordered to orderedBy, add note
• Location - remove status
• Medication - add batch
• MedicationAdministration - add reasonGiven, note, text. remove timing & maxDosePerPeriod
• MedicationDispense - collapse to a single dispense, add daysSupply, note and substitution, change quantity to allow range
• MedicationRequest - add note, change quantity to allow range,
• MedicationStatement - add informationSource, status, dateAsserted, replace whenGiven with effective[x], remove device, add dosage.text
• NamingSystem - add date, publisher,
• NutritionOrder - extensive rewrite
• Observation - change name to code, allow more types of value[x], change type of dataAbsentReason, change to bodySite = code or Reference(BodySite), allow identifier to repeat, add device,
• OperationDefinition - change identifier to url, add useContext, change telecom to contact, change name to title, add reuqirements, idempotent,
• OperationOutcome - change type of .issue.type
• OrderResponse - rename code to orderStatus
• Organization - remove location and contact.gender
• Patient - communication to allow 'preferred'
• Person - rename other to target
• Practitioner - change type of birthDate, allow multiple roles per practitioner
• Procedure - add status and category, change to bodySite = code or Reference(BodySite), allow date to be period too, add location, change followUp to code 0..*, add device tracking
• ServiceRequest - change to bodySite = code or Reference(BodySite)
• Provenance - change integritySignature to signature & make it a type, allow reference by Reference as well as URI
• Questionnaire - add telecom
• Schedule - move lastModified
• SearchParameter - change telecom to contact, add status, experimental, date,
• Slot - move lastModified
• Specimen - change source to parent, change to bodySite = code or Reference(BodySite)
• StructureDefinition - complete rewrite
• Subscription - change type of tag, reanme url to endPoint,
• ValueSet - change identifier to url, add useContext, change telecom to contact, replace purpose with useContext, add requirements, rename stableDate to lockedDate, change type of expansion.identifier, add expansion parameters

| | 0.4.0 |

Draft For Comment, January 2015 Ballot

Breaking Changes (full list):

• Replace atom and taglist with a native Bundle format (3728, 3558, 2889) (and also Binary)
• JSON: change how extensions are represented (3471)
• RESTful API: change how version specific upgrades work (3451)
• DataTypes:
• Rename Schedule to Timing (3536, 3236)
• Rename Contact to ContactPoint (3533) and swap order of elements (3108))
• Address - change zip to postCode (2888)
• Quantity: Correct schema spelling for "QuantityCompararator" (3531)
• Change allowable values for the id type to include capital letters, and allow up to 64 chars (3750)
• Restructure Profile - only one structure, and pull ExtensionDefinition out of Profile (3647, 3498), and pull SearchParameter out (3626)
• Profile: allow 0..* discriminator (3131), and change the way discriminators work across resource boundaries (3124) + generate multiple types properly (2856)
• remove _validate interaction, and replace with $validate operation (3686)
• Patient: separate birth time from birthDate (3731), Change Administrative Gender from a CodableConcept to a Code. Also fixed the values as male|female|other|unknown with mappings to v2 and v3 (3070)
• DocumentReference: change encoding of Hash to Base64 (3291)
• Group: rename header to title (3126)
• Condition: split relatedItem into two (3111)
• Questionnaire: drop questionnaire.group.question.remarks (3255) and move omitReason from extension to base resource (3260)
• QuestionnaireResponse: allow multiple answers (3146)
• ValueSet: replace ValueSet.compose.include.code with ValueSet.compose.include.concept (3258), added new rules about expansion content (3138)
• Remove DeviceObservationReport and Query
• Collapse AdverseReaction into AllergyIntolerance
• Appointment changes - individual field renamed to actor, and added mappings to HL7 V2 and HL7 v3
• FamilyMemberHistory combined with List replaces FamilyHistory (with corresponding updates to related profiles)
• Flag replaces Alert including improved clarification of how it is used and replacement of "note" with "code"
• CarePlan significantly refactored including splitting Goal out as a distinct resource, moving elements between activity and detail, introduction of several new elements and supported relationship types

New Resources:

• Appointment
• AppointmentResponse
• Basic
• ClaimResponse
• ClinicalImpression
• Communication
• CommunicationRequest
• Contract
• Contraindication
• Coverage
• CoverageEligibilityRequest
• CoverageEligibilityResponse
• DataElement (now StructureDefinition)
• DeviceMetric
• DeviceRequest
• DeviceUsage
• EnrollmentRequest
• EnrollmentResponse
• EpisodeOfCare
• ExplanationOfBenefit
• StructureDefinition
• Goal
• HealthcareService
• ImagingObjectSelection
• InstitutionalClaim
• NamingSystem
• NutritionOrder
• OperationDefinition
• OralHealthClaim
• PaymentNotice
• PaymentReconciliation
• Person
• PharmacyClaim
• ServiceRequest
• ProfessionalClaim
• QuestionnaireResponse
• ReferralRequest
• RiskAssessment
• SearchParameter
• Schedule
• Slot
• Subscription
• SupportingDocumentation
• VisionClaim
• VisionPrescription

New Implementation Guides (see discussion of status)

• Argonaut Project
• Data Access Framework
• Structured Data Capture & Structured Data Capture - Data Element Exchange
• US Laboratory Order, Report & Report to Public Health

| | 0.3.0 |

• Renamed Namespace to NamingSystem
• Split QuestionnaireResponse from Questionnaire and significantly revamped the Questionnaire in response to feedback from the Connectathon.
• Added DataElement (now StructureDefinition) resource (has been previously discussed as ObservationDefinition)
• Defined Subscription resource for evaluation
• Add time datatype
• Define RPC-type operations on the RESTful interface, and add Operation Definition
• Defined operations on several resources including ConceptMap, Questionnaire and ValueSet
• Conformance (now CapabilityStatement): Change Conformance.rest.operation to Conformance.rest.interaction and Conformance.rest.resource.operation to Conformance.rest.resource.interaction, and add Conformance.rest.operation to point to Operation Definition
• Profile: add Profile.url, Profile.structure.snapshot and Profile.structure.differential, and remove query definition (now in OperationDefinition)
• Add pages for LOINC, RxNorm, and SNOMED CT
• Significant rework for ConceptMap so it can be used to map between structures as well as value sets
• Add Contraindication and Risk Assessment and added examples to other resources in support of these
• Add Referral Request
• Add supportingInformation to DiagnosticRequest
• Add fulfills to Encounter
• Add date and age[x] to FamilyHistory
• Change cardinality of Location.identifier to 0..*
• Change cardinality of Practitioner.address to 0..*
• Add Observation.encounter to 0..*
• Temporarily added content for the Structured Data Capture implementation guide, including profiles on several resources, conformance instances, etc. This content will be moved to an external specification once the necessary tooling is in place to support that form of publication.

| | 0.2.1 |

• Minor new optional elements on value set for metadata, new extensions for all the rest of the VSD project metadata, formal profile to express basic minimum metadata for value set

| | 0.2.0 |

• Namespace: adjustments based on Grahame's feedback

| | 0.1.0 |

• Add Appointment, Appointment Response, Schedule and Slot
• Add Namespace

|

Note: a useful tool for displaying the differences between pages is the W3C HTML Diff engine.

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