Pointer FHIR Resource (DocumentReference)

Technical guidance for pointer FHIR resource population.

References

NHS Digital Profile:
NRL-DocumentReference-1

HL7 FHIR STU3 Resource(s):
DocumentReference

User Stories:
-

The NRL-DocumentReference-1 resource is the data model used for the pointers held on the NRL. This page outlines the population guidance for the pointer data model, referencing the associated FHIR resources and ValueSets.

Identifiers

Logical Identifier

Uniquely identifies the pointer within the NRL. Used by providers to supersede, update or delete pointers.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Pointer identifier	`id`	id	0..1	Assigned by the NRL at creation time.

Additional Guidance

The format of the pointer identifier (ID) is under the control of the NRL service and the client should not make assumptions about the structure of the identifier.

If the pointer was ever to be migrated to a different NRL service instance then it is possible that its ID might change to avoid clashes with pointers on the target NRL service.

Master Identifier

The master identifier is an optional identifier generated by the provider; it can be thought of as a business identifier but must be unique within the boundary of the NRL.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Master identifier	`masterIdentifier`	Identifier	0..1	See below.
	`masterIdentifier.system`	uri	1..1	The namespace for the identifier. This element is mandatory if `masterIdentifier` is included.
	`masterIdentifier.value`	string	1..1	The unique value of the identifier. This element is mandatory if `masterIdentifier` is included.

A unique master identifier MUST be used for each pointer:

Once a master identifier has been used in the creation of a pointer, the same master identifier value MUST NOT be re-used with another pointer.
‘Superseding’ a pointer requires a new unique master identifier value to be used.
Master identifiers from deleted pointers MUST NOT be used again for new or superseding pointers.

It is recommended that the scope of the master identifier’s uniqueness extends beyond the NRL service, ideally as a globally unique business identifier using an OID or UUID; this is helpful in scenarios where provider merge, or where a migration of the NRL is required. In this case, the values for system and value should match the following pattern (see the FHIR identifier registry for more details and the FHIR specification for some examples):

masterIdentifier.system	masterIdentifier.value
urn:ietf:rfc:3986	OID: urn:oid:[oidValue] UUID: urn:uuid:[uuidValue]

The NRL guarantees that no two pointers for the same patient (identified by NHS number) will have the same master identifier. It is the responsibility of the provider to ensure the master identifiers it creates are unique across all pointers for a patient (ideally all patients). Should a provider attempt to create a pointer with an identical master identifier to an existing pointer for the same patient, the request will be blocked.

Patient

The patent’s NHS Number to which the pointer relates.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Patient	`subject.reference`	string	1..1	The NHS Number reference MUST follow the structure: `https://demographics.spineservices.nhs.uk/STU3/Patient/[nhsNumber]`.

Pointer Metadata

FHIR Profile

The URI of the FHIR profile the resource conforms to, indicating the version of the pointer model.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Profile	`meta.profile`	uri	1..1	The value MUST be `https://fhir.nhs.uk/STU3/StructureDefinition/NRL-DocumentReference-1`.

Additional Guidance

The FHIR profile which the pointer conforms to will be indicated in this metadata attribute to enable consumers to support the different versions of the pointer model. Major changes to the pointer model will be reflected in the NRL DocumentReference FHIR profile, using the naming convention NRL-DocumentReference-[major_version].

Note: Pointers conforming to the NRLS-DocumentReference-1 profile will not have this attribute populated.

Pointer Owner

ODS code for the pointer’s owner organization.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Pointer owner	`custodian.reference`	string	1..1	The organization reference MUST follow the structure: `https://directory.spineservices.nhs.uk/STU3/Organization/[ODS Code]`.

Pointer Status

The status of the pointer.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Pointer status	`status`	code	1..1	All pointers created MUST have the status `current`. Pointers which have been superseded via the `supersede` interaction will have the `superseded` status. Pointers which have been marked as erroneous via the `update` interaction will have the `entered-in-error` status.

Additional Guidance

Only pointers with the current status will be available to consumers.

Pointer Versioning

Metadata used to track the current version of a pointer.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Version	`meta.versionId`	id	0..1	Auto-populated by the NRL. Pointer version number.
Pointer indexed datetime	`indexed`	instant	0..1	Auto-populated by the NRL. The date and time the pointer was created.
Pointer last updated datetime	`meta.lastUpdated`	instant	0..1	Auto-populated by the NRL. The date and time the pointer was last updated.

Relationship referencing the previous version of a pointer, which has been superseded.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Related Pointer	`relatesTo`	BackboneElement	0..1
	`relatesTo.code`	code	1..1	The type of relationship between the documents (pointers). This element is mandatory if `relatesTo` is included and the value MUST be `replaces`.
	`relatesTo.target.reference` `relatesTo.target.identifier`	string Identifier	1..1	The target of the relationship, denoted by a literal reference or logical identifier to the target `DocumentReference` held within the NRL. Only one of these values should be populated.

Additional Guidance

For further detail on superseding a pointer, see the Supersede interaction page.

Information Metadata

Information Category

A high-level category of the information, from a set of supported categories.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Information category	`class`	CodeableConcept	1..1	`class.coding` is bound to the NRL-RecordClass-1 ValueSet.
	`class.coding.system`	uri	1..1	Identity of the terminology system.
	`class.coding.code`	code	1..1	Symbol in syntax defined by the system.
	`class.coding.display`	string	1..1	Representation defined by the system. Display values MUST be as listed in the value set and are case sensitive.

Information Type

The clinical type of the information. Used to support searching to allow consumers to make sense of search results containing many pointers.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Information type	`type`	CodeableConcept	1..1	`type.coding` is bound to the NRL-RecordType-1 ValueSet.
	`type.coding.system`	uri	1..1	Identity of the terminology system. Example value: `http://snomed.info/sct`.
	`type.coding.code`	code	1..1	Symbol in syntax defined by the system. Example value: `736253002`.
	`type.coding.display`	string	1..1	Representation defined by the system. Display values MUST be as listed in the value set and are case sensitive.

For further information on which types are supported, see the Supported Pointer Types page.

Clinical Setting

Describes the clinical setting in which the information was recorded.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Clinical setting	`context.practiceSetting`	CodeableConcept	1..1	`context.practiceSetting.coding` is bound to the NRL-PracticeSetting-1 ValueSet. Note that this ValueSet refers to a SNOMED CT reference set and all SNOMED CT concepts that are members of this reference set are valid clinical setting codes.
	`context.practiceSetting.coding.system`	uri	1..1	Identity of the terminology system.
	`context.practiceSetting.coding.code`	code	1..1	Symbol in syntax defined by the system.
	`context.practiceSetting.coding.display`	string	1..1	Representation defined by the system. The display value MUST be the preferred term and one of the synonyms for the concept, not the Fully Specified Name, as described in the FHIR guidance for usage of SNOMED CT. Display values are case sensitive and MUST only have the first word capitalised.

Information Owner

ODS code for the information owner organization.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Information owner	`author.reference`	string	1..1	The organization reference MUST follow the structure: `https://directory.spineservices.nhs.uk/STU3/Organization/[ODS Code]`.

Period

Optional information detailing the period the record is/was active.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Period of care	`context.period`	Period	0..1	Where this property is included, the start date MUST be populated.
	`context.period.start`	dateTime	1..1	Starting time with inclusive boundary.
	`context.period.end`	dateTime	0..1	End time with inclusive boundary, if not ongoing.

Information Creation Date

The date and time (on the provider’s system) that the information was created, for static records.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Information creation datetime	`content.attachment.creation`	dateTime	0..1	The date and time (on the provider’s system) that the information was created, for static records.

Additional Guidance

The information creation date is specific to each format of the record that is referenced on the pointer. Where the creation date is included and multiple formats are referenced, the creation date must be set for each individual format.

Retrieval Information

Retrieval URL

Absolute URL for the location of the information on the provider’s system and/or a service that allows you to look up information based on the provider url, e.g. a web page with service contact details.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Retrieval URL	`content.attachment.url`	uri	1..1	Where retrieval of the record is facilitated by the SSP, the record URL on the pointer MUST NOT include the SSP base URL.

Retrieval Format

Describes the technical structure and rules of the information such that the consumer can pick an appropriate mechanism to handle the retrieved information.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Retrieval format	`content.format`	Coding	1..1	Bound to the NRL-FormatCode-1 ValueSet.
	`content.format.system`	uri	1..1	Identity of the terminology system.
	`content.format.code`	code	1..1	Symbol in syntax defined by the system.
	`content.format.display`	string	1..1	Representation defined by the system.

For further information on which formats are supported, see the Supported Formats on the Information Retrieval Overview page.

Retrieval MIME Type

Describes the type of data such that the consumer can pick an appropriate mechanism to handle the information.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Retrieval MIME type	`content.attachment.contentType`	code	1..1	The MIME type of the content available at the `content.attachment.url` (e.g. unstructured document supported MIME types.) Where more than one data format is available for the content, there will be multiple `content` entries, one for each MIME type (which may share the same URL).

Information Stability

Describes whether the information content at the time of the request is dynamically generated or is static.

Data Item	FHIRPath	Data Type	Cardinality	Population Guidance
Information Stability	`content.extension:contentStability`	Extension	1..1	Information stability extension.
	`content.extension:contentStability` `.url`	uri	1..1	Identifies the meaning of the extension. The value MUST be `https://fhir.nhs.uk/STU3/StructureDefinition/Extension-NRL-ContentStability-1`.
	`content.extension:contentStability` `.valueCodeableConcept`	CodeableConcept	1..1	`content.extension:contentStability.valueCodeableConcept.coding` is bound to the NRL-ContentStability-1 ValueSet.
	`content.extension:contentStability` `.valueCodeableConcept.coding.system`	uri	1..1	Identity of the terminology system.
	`content.extension:contentStability` `.valueCodeableConcept.coding.code`	code	1..1	Symbol in syntax defined by the system.
	`content.extension:contentStability` `.valueCodeableConcept.coding.display`	string	1..1	Representation defined by the system.

Examples

JSON Example

A JSON example of a DocumentReference resource is displayed below:

{
  "resourceType": "DocumentReference",
  "id": "c037a0cb-0c77-4976-83a1-a5d2703e6aa3-23325861873450086113",
  "meta": {
    "profile": [
      "https://fhir.nhs.uk/STU3/StructureDefinition/NRL-DocumentReference-1"
    ]
  },
  "status": "current",
  "type": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "736253002",
        "display": "Mental health crisis plan"
      }
    ]
  },
  "class": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "734163000",
        "display": "Care plan"
      }
    ]
  },
  "subject": {
    "reference": "https://demographics.spineservices.nhs.uk/STU3/Patient/9876543210"
  },
  "indexed": "2016-03-08T15:26:01+01:00",
  "author": [
    {
      "reference": "https://directory.spineservices.nhs.uk/STU3/Organization/RGD"
    }
  ],
  "custodian": {
    "reference": "https://directory.spineservices.nhs.uk/STU3/Organization/RR8"
  },
  "content": [
    {
      "attachment": {
        "contentType": "application/pdf",
        "url": "https://p1.nhs.uk/MentalhealthCrisisPlanReport.pdf",
        "creation": "2016-03-08T15:26:00+01:00"
      },
      "format": {
        "system": "https://fhir.nhs.uk/STU3/CodeSystem/NRL-FormatCode-1",
        "code": "urn:nhs-ic:unstructured",
        "display": "Unstructured Document"
      },
      "extension": [
        {
          "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-NRL-ContentStability-1",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "https://fhir.nhs.uk/STU3/CodeSystem/NRL-ContentStability-1",
                "code": "static",
                "display": "Static"
              }
            ]
          }
        }
      ]
    }
  ],
  "context": {
    "period": {
      "start": "2016-03-07T13:34:00+01:00"
    },
    "practiceSetting": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "708168004",
          "display": "Mental health service"
        }
      ]
    }
  }
}

XML Example

An XML example of a DocumentReference resource is displayed below:

<DocumentReference xmlns="http://hl7.org/fhir">
  <id value="c037a0cb-0c77-4976-83a1-a5d2703e6aa3-23325861873450086113" />
  <meta>
    <profile value="https://fhir.nhs.uk/STU3/StructureDefinition/NRL-DocumentReference-1" />
  </meta>
  <status value="current" />
  <type>
    <coding>
      <system value="http://snomed.info/sct" />
      <code value="736253002" />
      <display value="Mental health crisis plan" />
    </coding>
  </type>
  <class>
    <coding>
      <system value="http://snomed.info/sct" />
      <code value="734163000" />
      <display value="Care plan" />
    </coding>
  </class>
  <subject>
    <reference value="https://demographics.spineservices.nhs.uk/STU3/Patient/9876543210" />
  </subject>
  <indexed value="2016-03-08T15:26:01+01:00" />
  <author>
    <reference value="https://directory.spineservices.nhs.uk/STU3/Organization/RGD" />
  </author>
  <custodian>
    <reference value="https://directory.spineservices.nhs.uk/STU3/Organization/RR8" />
  </custodian>
  <content>
    <attachment>
      <contentType value="application/pdf" />
      <url value="https://p1.nhs.uk/MentalhealthCrisisPlanReport.pdf" />
      <creation value="2016-03-08T15:26:00+01:00" />
    </attachment>
    <format>
      <system value="https://fhir.nhs.uk/STU3/CodeSystem/NRL-FormatCode-1" />
      <code value="urn:nhs-ic:unstructured" />
      <display value="Unstructured Document" />
    </format>
    <extension url="https://fhir.nhs.uk/STU3/StructureDefinition/Extension-NRL-ContentStability-1">
      <valueCodeableConcept>
        <coding>
          <system value="https://fhir.nhs.uk/STU3/CodeSystem/NRL-ContentStability-1" />
          <code value="static" />
          <display value="Static" />
        </coding>
      </valueCodeableConcept>
    </extension>
  </content>
  <context>
    <period>
      <start value="2016-03-07T13:34:00+01:00" />
    </period>
    <practiceSetting>
      <coding>
        <system value="http://snomed.info/sct" />
        <code value="708168004" />
        <display value="Mental health service" />
      </coding>
    </practiceSetting>
  </context>
</DocumentReference>

Tags:

Pointer FHIR Resource (DocumentReference)

References

Identifiers

Logical Identifier

Master Identifier

Patient

Pointer Metadata

FHIR Profile

Pointer Owner

Pointer Status

Pointer Versioning

Related Pointer

Information Metadata

Information Category

Information Type

Clinical Setting

Information Owner

Period

Information Creation Date

Retrieval Information

Retrieval URL

Retrieval Format

Retrieval MIME Type

Information Stability

Examples

JSON Example

XML Example