Communication

An occurrence of information being transmitted; e.g. an alert that was sent to a responsible provider, a public health agency that was notified about a reportable condition.

Schema

Elements

Name	Required	Type	Description
identifier		Identifier[]	Unique identifier Details Business identifiers assigned to this communication by the performer or other systems which remain constant as the resource is updated and propagates from server to server. This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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.
instantiatesCanonical		canonical[]	Instantiates FHIR protocol or definition Details The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication.
instantiatesUri		uri[]	Instantiates external protocol or definition Details The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication. This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
basedOn		Reference<Resource>[]	Request fulfilled by this communication Details An order, proposal or plan fulfilled in whole or in part by this Communication. This must point to some sort of a 'Request' resource, such as CarePlan, CommunicationRequest, ServiceRequest, MedicationRequest, etc.
partOf		Reference<Resource>[]	Part of this action Details Part of this action.
inResponseTo		Reference<Communication>[]	Reply to Details Prior communication that this communication is in response to.
status	✓	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Details The status of the transmission. This element is labeled as a modifier because the status contains the codes aborted and entered-in-error that mark the communication as not currently valid.
statusReason		CodeableConcept	Reason for current status Details Captures the reason for the current state of the Communication. This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.
category		CodeableConcept[]	Message category Details The type of message conveyed such as alert, notification, reminder, instruction, etc. There may be multiple axes of categorization and one communication may serve multiple purposes.
priority		code	routine | urgent | asap | stat Details Characterizes how quickly the planned or in progress communication must be addressed. Includes concepts such as stat, urgent, routine. Used to prioritize workflow (such as which communication to read first) when the communication is planned or in progress.
medium		CodeableConcept[]	A channel of communication Details A channel that was used for this communication (e.g. email, fax).
subject		Reference<Patient | Group>	Focus of message Details The patient or group that was the focus of this communication.
topic		CodeableConcept	Description of the purpose/content Details Description of the purpose/content, similar to a subject line in an email. Communication.topic.text can be used without any codings.
about		Reference<Resource>[]	Resources that pertain to this communication Details Other resources that pertain to this communication and to which this communication should be associated. Don't use Communication.about element when a more specific element exists, such as basedOn or reasonReference.
encounter		Reference<Encounter>	Encounter created as part of Details The Encounter during which this Communication was created or to which the creation of this record is tightly associated. This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.
sent		dateTime	When sent Details The time when this communication was sent.
received		dateTime	When received Details The time when this communication arrived at the destination.
recipient		Reference< Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Group | CareTeam | HealthcareService >[]	Message recipient Details The entity (e.g. person, organization, clinical information system, care team or device) which was the target of the communication. If receipts need to be tracked by an individual, a separate resource instance will need to be created for each recipient. Multiple recipient communications are intended where either receipts are not tracked (e.g. a mass mail-out) or a receipt is captured in aggregate (all emails confirmed received by a particular time).
sender		Reference< Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService >	Message sender Details The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication.
reasonCode		CodeableConcept[]	Indication for message Details The reason or justification for the communication. Textual reasons can be captured using reasonCode.text.
reasonReference		Reference< Condition | Observation | DiagnosticReport | DocumentReference >[]	Why was communication done? Details Indicates another resource whose existence justifies this communication.
payload		CommunicationPayload[]	Message payload Details Text, attachment(s), or resource(s) that was communicated to the recipient.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
content[x]	✓	string, Attachment, Reference<Resource>	Message part content Details A communicated content (or for multi-part communications, one portion of the communication).
note		Annotation[]	Comments made about the communication Details Additional notes or commentary about the communication by the sender, receiver or other interested parties.

Search Parameters

Name	Type	Description	Expression
based-on	reference	Request fulfilled by this communication	Communication.basedOn
category	token	Message category	Communication.category
encounter	reference	Encounter created as part of	Communication.encounter
identifier	token	Unique identifier	Communication.identifier
instantiates-canonical	reference	Instantiates FHIR protocol or definition	Communication.instantiatesCanonical
instantiates-uri	uri	Instantiates external protocol or definition	Communication.instantiatesUri
medium	token	A channel of communication	Communication.medium
part-of	reference	Part of this action	Communication.partOf
patient	reference	Focus of message	Communication.subject.where(resolve() is Patient)
received	date	When received	Communication.received
recipient	reference	Message recipient	Communication.recipient
sender	reference	Message sender	Communication.sender
sent	date	When sent	Communication.sent
status	token	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown	Communication.status
subject	reference	Focus of message	Communication.subject

Inherited Elements

Name	Required	Type	Description
id		string	Logical id of this artifact Details The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
meta		Meta	Metadata about the resource Details The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRules		uri	A set of rules under which this content was created Details A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
language		code	Language of the resource content Details The base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
text		Narrative	Text summary of the resource, for human interpretation Details A human-readable narrative that contains a summary of the resource and can be 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. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
contained		Resource[]	Contained, inline Resources Details These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored Details May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Usage

Communication is one of the event resources in the FHIR workflow specification.

This resource is a record of a communication even if it is planned or has failed. A communication is a conveyance of information from one entity, a sender, to another entity, a receiver. The sender and receivers may be patients, practitioners, related persons, organizations, or devices. Communication use cases include:

• A reminder or alert delivered to a responsible provider
• A recorded notification from the nurse to the on-call physician (or any other specified person) that a patient's temperature exceeds a value
• A notification to a public health agency of a patient presenting with a communicable disease reportable to the public health agency
• Patient educational material sent by a provider to a patient
• Unable to deliver lab results to ordering physician

Non-patient specific communication use cases may include:

• A nurse call from a hall bathroom
• Advisory for battery service from a pump

Relationships

This resource is a record of a communication that has occurred. It does not represent the actual flow of communication. While AuditEvent can track electronic disclosures of information, it cannot track conversations, phone calls, letters and other interactions that are not system-to-system. And even for system-to-system communications, the specific end recipients might not be known. Furthermore, AuditEvents are not considered to be "part" of the patient record, while Communication instances are. The Communication resource is not used as a general audit mechanism to track every disclosure of every record. Rather, it is used when a clinician or other user wants to ensure a record of a particular communication is itself maintained as part of the reviewable health record.

Flag resources represent a continuous ongoing "communication" alerting anyone dealing with the patient of certain precautions to take or issues to be aware of. The flags are continuously present as an ongoing reminder. This is distinct from Communication where there is a specific intended sender and receiver and the information is delivered only once.

Communication and Encounter

The Communication is about the transfer of information (which might or might not occur as part of an encounter), while Encounter is about the coming together (in person or virtually) of a Patient with a Practitioner. Communication does not deal with the duration of a call, it represents the fact that information was transferred at a particular point in time.

The phone calls involving the Patient should be handled using Encounter. Phone calls not involving the patient (e.g. between practitioners or practitioner to relative) that are tracked for billing or other purposes can use Communication to represent the information transferred but are not ideal to represent the call itself. A better mechanism for handling such calls will be explored in a future release.