Media

A photo, video, or audio recording acquired or used in healthcare. The actual content may be inline or provided by direct reference.

Schema

Elements

Name	Required	Type	Description
identifier		Identifier[]	Identifier(s) for the image Details Identifiers associated with the image - these may include identifiers for the image itself, identifiers for the context of its collection (e.g. series ids) and context ids such as accession numbers or other workflow identifiers. The identifier label and use can be used to determine what kind of identifier it is.
basedOn		Reference<ServiceRequest | CarePlan>[]	Procedure that caused this media to be created Details A procedure that is fulfilled in whole or in part by the creation of this media.
partOf		Reference<Resource>[]	Part of referenced event Details A larger event of which this particular event is a component or step. Not to be used to link an event to an Encounter - use Media.encounter for that. [The allowed reference resources may be adjusted as appropriate for the event resource].
status	✓	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Details The current state of the {{title}}. A nominal state-transition diagram can be found in the [[event.html#statemachine | Event pattern]] documentation Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.
type		CodeableConcept	Classification of media as image, video, or audio Details A code that classifies whether the media is an image, video or audio recording or some other media category.
modality		CodeableConcept	The type of acquisition equipment/process Details Details of the type of the media - usually, how it was acquired (what type of device). If images sourced from a DICOM system, are wrapped in a Media resource, then this is the modality.
view		CodeableConcept	Imaging view, e.g. Lateral or Antero-posterior Details The name of the imaging view e.g. Lateral or Antero-posterior (AP).
subject		Reference< Patient | Practitioner | PractitionerRole | Group | Device | Specimen | Location >	Who/What this Media is a record of Details Who/What this Media is a record of.
encounter		Reference<Encounter>	Encounter associated with media Details The encounter that establishes the context for this media. This will typically be the encounter the media occurred within.
created[x]		dateTime, Period	When Media was collected Details The date and time(s) at which the media was collected.
issued		instant	Date/Time this version was made available Details The date and time this version of the media was made available to providers, typically after having been reviewed. It may be the same as the [`lastUpdated` ](resource-definitions.html#Meta.lastUpdated) time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the `lastUpdated` time of the resource itself due to a non-clinically significant update that does not require the new version to be reviewed and verified again.
operator		Reference< Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson >	The person who generated the image Details The person who administered the collection of the image.
reasonCode		CodeableConcept[]	Why was event performed? Details Describes why the event occurred in coded or textual form. Textual reasons can be captured using reasonCode.text.
bodySite		CodeableConcept	Observed body part Details Indicates the site on the subject's body where the observation was made (i.e. the target site). Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension[ bodySite](extension-bodysite.html).
deviceName		string	Name of the device/manufacturer Details The name of the device / manufacturer of the device that was used to make the recording.
device		Reference< Device | DeviceMetric | Device >	Observing Device Details The device used to collect the media. An extension should be used if further typing of the device is needed. Secondary devices used to support collecting a media can be represented using either extension or through the Observation.related element.
height		positiveInt	Height of the image in pixels (photo/video) Details Height of the image in pixels (photo/video).
width		positiveInt	Width of the image in pixels (photo/video) Details Width of the image in pixels (photo/video).
frames		positiveInt	Number of frames if > 1 (photo) Details The number of frames in a photo. This is used with a multi-page fax, or an imaging acquisition context that takes multiple slices in a single image, or an animated gif. If there is more than one frame, this SHALL have a value in order to alert interface software that a multi-frame capable rendering widget is required. if the number of frames is not supplied, the value may be unknown. Applications should not assume that there is only one frame unless it is explicitly stated.
duration		decimal	Length in seconds (audio / video) Details The duration of the recording in seconds - for audio and video. The duration might differ from occurrencePeriod if recording was paused.
content	✓	Attachment	Actual Media - reference or data Details The actual content of the media - inline or by direct reference to the media source file. Recommended content types: image/jpeg, image/png, image/tiff, video/mpeg, audio/mp4, application/dicom. Application/dicom can contain the transfer syntax as a parameter. For media that covers a period of time (video/sound), the content.creationTime is the end time. Creation time is used for tracking, organizing versions and searching.
note		Annotation[]	Comments made about the media Details Comments made about the media by the performer, subject or other participants. Not to be used for observations, conclusions, etc. Instead use an [Observation](observation.html) based on the Media/ImagingStudy resource.

Search Parameters

Name	Type	Description	Expression
based-on	reference	Procedure that caused this media to be created	Media.basedOn
created	date	When Media was collected	Media.created
device	reference	Observing Device	Media.device
encounter	reference	Encounter associated with media	Media.encounter
identifier	token	Identifier(s) for the image	Media.identifier
modality	token	The type of acquisition equipment/process	Media.modality
operator	reference	The person who generated the image	Media.operator
patient	reference	Who/What this Media is a record of	Media.subject.where(resolve() is Patient)
site	token	Observed body part	Media.bodySite
status	token	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown	Media.status
subject	reference	Who/What this Media is a record of	Media.subject
type	token	Classification of media as image, video, or audio	Media.type
view	token	Imaging view, e.g. Lateral or Antero-posterior	Media.view

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

Trial-Use Note: The Orders and Observations workgroups wants to make the balloter aware than observations that require the attachment data types are represented by the Media resource instead of Observation. There have been several significant changes to the Media resource in order to align it with Observation and the workflow event pattern including:

1. The addition of the partOf and issued elements.
2. The required type was changed an optional category and the subtype element was renamed to modality.
3. Additional reference targets added to the subject,operator, and basedOn elements
4. The additions of several standard event extensions.

The Media resource contains photos, videos, and audio recordings. It is used with media acquired or used as part of the healthcare process. Here are some typical usages:

• Photos and videos of diagnostic or care provision procedures for recording purposes
• Images contained in diagnostic reports

Relationships

This resource captures a specific type of Observation - an Observation whose value is audio, video or image data. This resource is the preferred representation of such forms of information as it exposes the metadata relevant for interpreting the information. However, in some legacy environments, media information may occasionally appear in Observation instead. Systems should be aware of this possibility.

The Media resource is able to contain medical images in a DICOM format. These images may also be made accessible through an ImagingStudy resource, which provides a direct reference to the image to a WADO-RS server.

For such images, the WADO-RS framework is a preferred method for representing the images - the WADO-RS service may include rendering the image with annotations and display parameters from an associated DICOM presentation state, for instance.

On the other hand, the media resource allows for a robust transfer of an image across boundaries where the WADO-RS service is not available. For this reason, medical images can also be represented in a Media resource, but the Media.content.url should provide a reference to a source WADO-RS service for the image.

Referenced By

• AdverseEvent
• ClinicalImpression
• DeviceUseStatement
• DiagnosticReport
• ImagingStudy
• MedicationKnowledge
• Observation