Merge branch 'instance-declaration-changes' into master

HL7 · Aug 14, 2024 · eb87fc2 · eb87fc2
2 parents 1dc3ca5 + cdb5c8e
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diff --git a/input/fsh/aliases.fsh b/input/fsh/aliases.fsh
@@ -18,6 +18,7 @@ Alias: $observation-category = http://terminology.hl7.org/CodeSystem/observation
 Alias: $v3-ObservationInterpretation = http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation
 Alias: $referencerange-meaning = http://terminology.hl7.org/CodeSystem/referencerange-meaning
 Alias: $condition-ver-status = http://terminology.hl7.org/CodeSystem/condition-ver-status
+Alias: $observation-status = http://hl7.org/fhir/observation-status
 Alias: $icd-10 = http://hl7.org/fhir/sid/icd-10
 Alias: $icd-o-3 = http://terminology.hl7.org/CodeSystem/icd-o-3
 Alias: $organization-type = http://terminology.hl7.org/CodeSystem/organization-type

diff --git a/input/fsh/instances/medication-39-07-1.fsh b/input/fsh/instances/medication-39-07-1.fsh
@@ -11,4 +11,4 @@ Usage: #example
 * form.coding[+] = $standardterms#10219000 "Tablet"
 * ingredient.itemCodeableConcept = $rxnorm#36567 "Simvastatin"
 * ingredient.strength.numerator = 40 'mg' "mcg"
-* ingredient.strength.denominator = 1 '{tablet}' "tablet"
+* ingredient.strength.denominator = 1 '1' "tablet"
diff --git a/input/fsh/instances/observation-alcoholuse-1.fsh b/input/fsh/instances/observation-alcoholuse-1.fsh
@@ -8,4 +8,4 @@ Usage: #example
 * subject = Reference(patient-example-female)
 * effectiveDateTime = "2019-07-15"
 * performer = Reference(eumfh-39-07)
-* valueQuantity = 2 '{wine glasses}/d' "wine glasses per day"
+* valueQuantity = 2 '/d' "wine glasses per day"
diff --git a/input/fsh/instances/observation-imaging-example-with-numeric-range-measurement.fsh b/input/fsh/instances/observation-imaging-example-with-numeric-range-measurement.fsh
@@ -0,0 +1,18 @@
+Instance: ips-example-imaging-5
+InstanceOf: Observation
+Title: "Observation: imaging Chest X-ray - PA and lateral, with additional sub-observation including numeric range"
+Description: "Observation: imaging Chest X-ray - PA and lateral, with additional sub-observation including numeric range"
+Usage: #example
+* partOf = Reference(TII-ImagingStudy-5-1)
+* status = #final
+* category = $observation-category#imaging "Imaging"
+* code = $loinc#42272-5 "XR Chest PA and Lateral"
+* code.text = "Chest X-ray - PA and lateral"
+* subject = Reference(Patient/eumfh-39-07)
+* effectiveDateTime = "1995-06-08"
+* performer[0] = Reference(Practitioner/eumfh-39-07)
+* performer[+] = Reference(TII-Organization1)
+* valueString = "FINDINGS: Normal cardiomediastinal silhouette. No focal parenchymal process. No pleural effusions. No pneumothorax. No acute osseous abnormalities. IMPRESSION: No acute cardiopulmonary findings."
+* component[0].code = $loinc#38181-4 "XR Chest Diameter.lateral"
+* component[=].valueRange.low = 27.8 'cm' "cm"
+* component[=].valueRange.high = 29.6 'cm' "cm"
diff --git a/input/fsh/invariants/ips-2.fsh b/input/fsh/invariants/ips-2.fsh
@@ -1,4 +1,4 @@
 Invariant: ips-2
-Description: "if no \"hasMember\" element is present then Observation must have a\" value\""
-* severity = #error
-* expression = "value.exists() or hasMember.exists()"
+Description: "At least one of these Observation elements shall be provided:  \"value\", \"dataAbsentReason\", \"hasMember\" or \"component\""
+Severity: #error
+Expression: "value.exists() or hasMember.exists() or component.exists() or dataAbsentReason.exists()"
diff --git a/input/fsh/invariants/ips-3.fsh b/input/fsh/invariants/ips-3.fsh
@@ -0,0 +1,4 @@
+Invariant: ips-3
+Description: "If observation has components, at least one of these Observation.component elements shall be provided:  \"value\" or \"dataAbsentReason\""
+Severity: #error
+Expression: "component.exists() implies (component.value.exists() or component.dataAbsentReason.exists())"
diff --git a/input/fsh/profiles/ObservationResultsLaboratoryPathologyUvIps.fsh b/input/fsh/profiles/ObservationResultsLaboratoryPathologyUvIps.fsh
@@ -16,10 +16,11 @@ This observation may represent the result of a simple laboratory test such as he
 * . ^short = "Laboratory (including Pathology) result for a simple test or for a panel/study"
 * . ^definition = "This observation may represent the result of a simple laboratory or pathology test such as hematocrit, or it may group the set of results produced by a multi-test study or panel such as a complete blood count, a dynamic function test, or a urine specimen study. In the latter case, the observation carries the overall conclusion of the study and references the atomic results of the study as \"has-member\" child observations"
 * . ^comment = "Represents either a lab simple observation or the group of observations produced by a laboratory study."
-* obeys ips-2
-* status = #final (exactly)
-* status ^extension[0].url = "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint"
-* status ^extension[=].valueString = "default: final"
+* obeys ips-2 and ips-3
+* status from ResultsStatusUvIps (required)
+* status ^label = "Observation 'complete' status codes"
+* status ^binding.extension[0].url = "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"
+* status ^binding.extension[=].valueString = "ObservationStatus"
 * category only CodeableConceptIPS
 * category ^slicing.discriminator.type = #pattern
 * category ^slicing.discriminator.path = "$this"

diff --git a/input/fsh/profiles/ObservationResultsRadiologyUvIps.fsh b/input/fsh/profiles/ObservationResultsRadiologyUvIps.fsh
@@ -6,7 +6,7 @@ Description: """This profile represents the constraints applied to the Observati
 
 This observation may represent the conclusions of a diagnostic procedure such a Chest RX, or it may group the set of results produced by that single or multi-modality procedure. 
 
-In the latter case, the main observation (this one) carries the overall conclusion of the study and/or a global interpretation by the observer of the study as value of this observation; and may references the atomic results of the study as "child observations".
+In the latter case, the main observation (this one) carries the overall conclusion of the study and/or a global interpretation by the observer of the study as value of this observation; and may reference the atomic results of the study as "child observations".
 
 It allows also providing details about the related study using the partOf element referring to an ImagingStudy resource.
 """
@@ -18,10 +18,10 @@ It allows also providing details about the related study using the partOf elemen
 * ^jurisdiction = $m49.htm#001
 * obeys hasMemberOrComponent
 * partOf only Reference(ImagingStudyUvIps)
-* status = #final (exactly)
-* status ^extension.url = "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint"
-* status ^extension.valueString = "default: final"
-* status ^definition = "The status of the result value. Only final results feed patient summaries."
+* status from ResultsStatusUvIps (required)
+* status ^label = "Observation 'complete' status codes"
+* status ^binding.extension[0].url = "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"
+* status ^binding.extension[=].valueString = "ObservationStatus"
 * category only CodeableConceptIPS
 * category ^slicing.discriminator.type = #pattern
 * category ^slicing.discriminator.path = "$this"

diff --git a/input/fsh/valuesets/ResultsStatusUvIps.fsh b/input/fsh/valuesets/ResultsStatusUvIps.fsh
@@ -0,0 +1,21 @@
+ValueSet: ResultsStatusUvIps
+Id: results-status-uv-ips
+Title: "Results Status Codes - IPS"
+Description: """
+IPS Observation status codes allowable for results.  This value set includes the subset of \"complete\" (results available, with no further actions needed or anticipated) status codes from http://hl7.org/fhir/observation-status.
+"""
+* ^meta.profile = "http://hl7.org/fhir/StructureDefinition/shareablevalueset"
+* ^status = #active
+* ^experimental = false
+* ^publisher = "HL7 International / Patient Care"
+* ^contact.telecom.system = #url
+* ^contact.telecom.value = "http://www.hl7.org/Special/committees/patientcare"
+* ^jurisdiction = $m49.htm#001
+* ^immutable = false
+* ^copyright = "Produced by HL7 under the terms of HL7® Governance and Operations Manual relating to Intellectual Property (Section 16), specifically its copyright, trademark and patent provisions."
+* include codes from system $observation-status
+    where concept is-a #final "Final"
+* include codes from system $observation-status
+    where concept is-a #amended "Amended"
+* include codes from system $observation-status
+    where concept is-a #corrected "Corrected"
diff --git a/input/ignoreWarnings.txt b/input/ignoreWarnings.txt
@@ -13,11 +13,3 @@ INFORMATION: Immunization/75680: Immunization.vaccineCode.coding[2].system: A de
 
 # The EDQM codesystem has properties not known to FHIR publication tooling
 %No definition can be found for the system http://standardterms.edqm.eu, and the property%
-
-# UCUM coding has been reviewed and decision to retain information inside curly brackets
-WARNING: Medication/eumfh-39-07-1: Medication.ingredient[0].strength.denominator: UCUM Codes that contain human readable annotations like {tablet} can be misleading (e.g. they are ignored when comparing units). Best Practice is not to depend on annotations in the UCUM code, so this usage should be checked
-WARNING: Observation/alcohol-use-example: Observation.value.ofType(Quantity): UCUM Codes that contain human readable annotations like {wine glasses} can be misleading (e.g. they are ignored when comparing units). Best Practice is not to depend on annotations in the UCUM code, so this usage should be checked
-
-# It is not possible to include examples on datatypes (oddly this error does not arise on other datatypes which lack examples)
-WARNING: StructureDefinition.where(url = 'http://hl7.org/fhir/uv/ips/StructureDefinition/Range-uv-ips'): The Implementation Guide contains no examples for this data type profile
-WARNING: StructureDefinition.where(url = 'http://hl7.org/fhir/uv/ips/StructureDefinition/SimpleQuantity-uv-ips'): The Implementation Guide contains no examples for this data type profile
diff --git a/input/pagecontent/Structure-of-the-International-Patient-Summary.md b/input/pagecontent/Structure-of-the-International-Patient-Summary.md
@@ -133,7 +133,7 @@ Following are the profiles that have been defined for each section. (R) denotes
     <a href="StructureDefinition-Device-observer-uv-ips.html">Device (performer, observer)</a> |
     <a href="StructureDefinition-ImagingStudy-uv-ips.html">Imaging Study (IPS)</a> ]
 - Vital Signs
-  [ <a href="{{site.data.fhir.path}}vitalsigns.html">Vital Signs</a> ]
+  [ <a href="{{site.data.fhir.path}}observation-vitalsigns.html">Vital Signs Profiles</a> ]
 - Past history of illnesses
   [ <a href="StructureDefinition-Condition-uv-ips.html">Condition (IPS)</a> ]
 - Pregnancy (status and history summary)

diff --git a/input/pagecontent/changes.md b/input/pagecontent/changes.md
@@ -1,15 +1,70 @@
-### STU 2.0 Update
+### STU 2.0.0-ballot Update
 
-This change list provides an overview and detail of changes in STU 2.0.  The major categories of revision include:
+This change list provides an overview and detail of changes in STU 2.0 Ballot.  The major categories of revision include:
 
-Detailed change list for 2.0.0 since 1.1.0 includes: 
+- Sending "empty" sections allowed (no section.entry with use of emptyReason)
+- Add Alerts Section
+- Add Patient Story Section
+- Clarifications on the $summary operation
+- Rework of Observation profiles
+- Updates for IPS-IPA Alignment
+- Transition to SNOMED IPS Terminology and Terminology Consolidation
 
-- **Compatible, Substantive Changes**
+Detailed change list for 2.0.0-ballot since 1.1.0 includes: 
 
-  - Reinstate revised ResultsSpecimenCollectionMethodUvIps value set (https://jira.hl7.org/browse/FHIR-46500)
-  - Remove "Target Site - IPS" value set (as per [FHIR-32809](https://jira.hl7.org/browse/FHIR-32809))
+- **Non-compatible**
+  - AllergyIntolerance.code should have min cardinality of 1.. ([FHIR-39530](https://jira.hl7.org/browse/FHIR-39530) )
+  - Allow sections with emptyReason and no entries ([FHIR-41529](https://jira.hl7.org/browse/FHIR-41529) )
+  - Relax cardinality on composition.section.entries to allow for section.text to be used in isolate ([FHIR-42872](https://jira.hl7.org/browse/FHIR-42872) )
+  - Revision to absent-unknown valueset setup in IPS ([FHIR-45004](https://jira.hl7.org/browse/FHIR-45004) )
+  - Combine lab/path profiles and remove base results observation profile ([FHIR-45294](https://jira.hl7.org/browse/FHIR-45294) )
 
+- **Compatible, Substantive Changes**
+  - Remove "Target Site - IPS" value set ([FHIR-32809](https://jira.hl7.org/browse/FHIR-32809))
+  - Modification profile input definition of $summary  ([FHIR-40240](https://jira.hl7.org/browse/FHIR-40240) )
+  - Transition the absent-unknown codesystem to SNOMED valueset ([FHIR-40456](https://jira.hl7.org/browse/FHIR-40456) )
+  - Add a section for Patient commentary / Patient Story ([FHIR-41260](https://jira.hl7.org/browse/FHIR-41260) )
+  - Revise invariant ips-2 for Lab Observation ([FHIR-41554](https://jira.hl7.org/browse/FHIR-41554) )
+  - Remove old constraint for radiology Observation that requires valueString or component ([FHIR-42870](https://jira.hl7.org/browse/FHIR-42870) )
+  - Remove all required LOINC bindings on observation value[x] elements ([FHIR-42972](https://jira.hl7.org/browse/FHIR-42972) )
+  - Relax cardinality on Condition.clinicalStatus - exception given Required ValueSet deficiency ([FHIR-43299](https://jira.hl7.org/browse/FHIR-43299) )
+  remove invariant pat-cnt-2or3-char (Patient country code) ([FHIR-43370](https://jira.hl7.org/browse/FHIR-43370) )
+  - Remove Allergy Abatement Extension and use base extension ([FHIR-44847](https://jira.hl7.org/browse/FHIR-44847) )
+  - Resolve SNOMED Version challenge with value set ([FHIR-44904](https://jira.hl7.org/browse/FHIR-44904) )
+  - Remove IPS Bundle.link 0..0 constraint ([FHIR-45973](https://jira.hl7.org/browse/FHIR-45973) )
+  - Add Alerts section to IPS based on ISO 27269 ([FHIR-46289](https://jira.hl7.org/browse/FHIR-46289) )
+  - Consolidate SNOMED terminology valuesets and make definitions consistent ([FHIR-46365](https://jira.hl7.org/browse/FHIR-46365) )
+  - Remove Media profile ([FHIR-46401](https://jira.hl7.org/browse/FHIR-46401) )
+  - Add reference to new FHIR Clinical Documents profile ([FHIR-46458](https://jira.hl7.org/browse/FHIR-46458) )
+  - Reinstate revised ResultsSpecimenCollectionMethodUvIps value set ([FHIR-46500](https://jira.hl7.org/browse/FHIR-46500) )
+  - Reinstate revised ResultsSpecimenCollectionMethodUvIps value set ([FHIR-46500](https://jira.hl7.org/browse/FHIR-46500))
+  - Add additional status codes to Result Observation ([FHIR-46502](https://jira.hl7.org/browse/FHIR-46502) )
+
 - **Non-substantive Changes**
+  - Composition-uv-ips profile, changes to clinicaldocument profile reference ([FHIR-15995](https://jira.hl7.org/browse/FHIR-15995) )
+  - Distinct tabs for Differential View, Snapshot View and Examples ([FHIR-16149](https://jira.hl7.org/browse/FHIR-16149) )
+  - Profiles used in the entries are not always made explicit ([FHIR-16159](https://jira.hl7.org/browse/FHIR-16159) )
+  - Add links for downloading this guide and the specified resources ([FHIR-16160](https://jira.hl7.org/browse/FHIR-16160) )
+  - Rename the observation-uv-ips profile ([FHIR-16281](https://jira.hl7.org/browse/FHIR-16281) )
+  - Clarify intended use of vital signs ([FHIR-37837](https://jira.hl7.org/browse/FHIR-37837) )
+  - Addition of change log to IG ([FHIR-39449](https://jira.hl7.org/browse/FHIR-39449) )
+  - Improve details of IPS Generation and Data Inclusion ([FHIR-39598](https://jira.hl7.org/browse/FHIR-39598) )
+  - Remove graph parameter from $summary operation ([FHIR-40223](https://jira.hl7.org/browse/FHIR-40223) )
+  - Text for 6.2.1 Medication Summary is no longer correct ([FHIR-41556](https://jira.hl7.org/browse/FHIR-41556) )
+  - Update $summary to update identifier param/provide guidance on supply of system ([FHIR-43029](https://jira.hl7.org/browse/FHIR-43029) )
+  - Display mismatch between value set and code system ([FHIR-44806](https://jira.hl7.org/browse/FHIR-44806) )
+  - Composition profile restrictions on codes can be improved ([FHIR-45197](https://jira.hl7.org/browse/FHIR-45197) )
+  - Modify Patient/$summary identifier definition to allow as a query param ([FHIR-45441](https://jira.hl7.org/browse/FHIR-45441) )
+  - Add guidance for minimal expectations of Composition.text ([FHIR-45975](https://jira.hl7.org/browse/FHIR-45975) )
+  - Fix example bundle reference errors ( [FHIR-45979](https://jira.hl7.org/browse/FHIR-45975) )
+  - Add pointer to note extension at Composition.section ([FHIR-46084](https://jira.hl7.org/browse/FHIR-46084) )
+  - Relax the valueset code binding in Radiology profile ([FHIR-46286](https://jira.hl7.org/browse/FHIR-46286) )
+  - Add section/narrative on data redaction/confidentiality/security ([FHIR-46457](https://jira.hl7.org/browse/FHIR-46457) )
+  - Remove ordinalValue extension from the current-smoking-status-uv-ips value set ([FHIR-46471](https://jira.hl7.org/browse/FHIR-46471) )
+  - Remove IPS ConceptMap instances ([FHIR-46474](https://jira.hl7.org/browse/FHIR-46474) )
+  - Narrative updates - update STU notes, update images, update authors, design and other narrative updates ([FHIR-46488](https://jira.hl7.org/browse/FHIR-46488) )
+  - Consider changing example instances to follow best practice for UCUM and avoid using curly braces ([FHIR-46501](https://jira.hl7.org/browse/FHIR-46501) )
+
 
 ### STU 1.1.0 Update
 

diff --git a/input/pagecontent/index.md b/input/pagecontent/index.md
@@ -65,7 +65,7 @@ This Implementation Guide has been balloted as STU with the intention to go norm
 | **Contributor** | François Macary | Phast | francois.macary@phast.fr |
 | **Contributor** | Gary Dickinson | CentriHealth | gary.dickinson@ehr-standards.com |
 | **Contributor** | George Dixon | Allscripts | george.dixon@allscripts.com |
-| **Contributor** | John Moerhke | By Light Professional IT Services | John.Moehrke@bylight.com
+| **Contributor** | John Moehrke | By Light Professional IT Services | John.Moehrke@bylight.com
 | **Contributor** | Dr Kai U. Heitmann | Heitmann Consulting and Services, ART-DECOR Open Tools GmbH, HL7 Germany | info@kheitmann.de |
 | **Contributor** | Kenneth Sinn  | Ontario Health Digital Services | ken.sinn@ontariohealth.ca |
 | **Contributor** | Sheridan Cook | Accenture | sheridan.cook@accenture.com |