PACIO Advance Directive Interoperability Implementation Guide
0.1.0 - STU 1 Ballot

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## FHIR Artifacts

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

### Behavior: Capability Statements

The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.

PADI CapabilityStatement | This Section describes the expected capabilities of the PACIO Advance Directive Interoperability (ADI) Server actor which is responsible for providing responses to the queries submitted by the ADI Requestors. There are two primary vehicles in which Advance Directive Information can be conveyed: DocumentReference and Bundle. Through a DocumentReference, the ADI may be encoded inside directly as content data or referred to through a content reference (pointing to the ADI included in a resource like Binary) or reference a Bundle with the type=document for FHIR encoded data. The resources referred to by the Composition in the document bundle include Patient, Observation,Goal, ServiceRequest, Organization, RelatedPerson, Consent, List, and Provenance.

### Structures: Abstract Profiles

These are profiles on resources or data types that describe patterns used by other profiles, but cannot be instantiated directly. I.e. instances can conform to profiles based on these abstract profiles, but do not declare conformance to the abstract profiles themselves.

ADI Goal | This profile defines the base requirements for all ADI Goals.
PACIO ADI Header | This abstract profile defines constraints that represent common administrative and demographic concepts for advance directives information used in US Realm clinical documents.

### Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide

ADI Autopsy Observation | This profile is used to represent the author’s thoughts about autopsy.
ADI Care Experience Preference | Care Experience Preference is a clinical statement that presents the author’s personal thoughts about something a person feels is relevant to their care experience and may be pertinent when planning their care.
PACIO ADI Document Reference | This profile defines constraints that represent the information needed to register an advance directive information document on a FHIR server.
ADI Documentation Observation | This profile is used to indicate if additional advance directive documents, such as physician order for life sustaining treatment (MOLST or POLST) or Do Not Resuscitate Order (DNR) exist and a reference to the document.
ADI Organ Donation | This profile is used to represent the author’s thoughts about organ donation.
ADI Personal Advance Care Plan Composition | This profile encompasses information that makes up the author’s advance care information plan.
ADI Participant | This profile represents a person participating in a persons advance directives in some capacity such as healthcare agent or healthcare agent advisor.
ADI Participant Consent | This profile is used to represent a consent for an advance directive participant such as a healthcare agent or advisor and power or limitation granted to such persons.
ADI Personal Goal | This profile is a statement that presents the author’s personal health and treatment goals that are pertinent when planning their care.
Personal Intervention Preference | This profile is used to represent a personal preference for a type of medical intervention (treatment) request under certain conditions.
ADI Personal Priorities Organizer | Personal Priorities Organizer is used to represent a set of personal goals, preferences or care experiences in a preferred ranked order.
ADI Preference Care Plan | The Preference Care Plan is a means for an individual to express their goals and preferences under certain circumstances that may be pertinent when planning his or her care.
PACIO ADI Provenance | Advance Directive Interoperability Provenance based on US Core to capture, search and fetch provenance information associated with advance directive interoperability data.

### Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide

Attestation Information | The Attestation Information Extension allows for the capture of information relevant to the attestation.
Authorization | The Advance Directive Information Authorization Extension contains the ADI Consent profile which represents information about a patient’s consents.
Clause | A clause or set of clauses relevant to the resource or element being extended
Contextual Value | The Contextual Value Extension represents one or more values with a singular context.
Data Enterer | Data Enterer Extension represents the person who transferred the content, written or dictated, into the Advance Directive document. To clarify, an author provides the content, subject to their own interpretation; a dataEnterer adds an author’s information to the electronic system.
Effective Date | The Advance Directive document effective dates.
Goal Order by Descending Priority | Indicates if the goals are ordered in descending priority (Y) or no specific order (N).
Informant | The Advance Directive Information Informant Extension describes an information source for any content within the Advance Directive document. This informant is constrained for use when the source of information is an assigned health care provider for the patient.
Information Recipient | The Information Recipient Extension records the intended recipient of the advance directive information at the time the document was created.
Jurisdiction | Jurisdiction for which content is applicable.
Participant | The Advance Directive Information Participant Extension identifies supporting entities, including parents, relatives, caregivers, insurance policyholders, guarantors, and others related in some way to the patient. A supporting person or organization is an individual or an organization with a relationship to the patient. A supporting person who is playing multiple roles would be recorded in multiple participants (e.g., emergency contact and next-of-kin).
Performer | The Advance Directive Information Performer Extension represents clinicians who actually and principally carry out the clinical services being documented. In a transfer of care this represents the healthcare providers involved in the current or pertinent historical care of the patient. Preferably, the patients key healthcare care team members would be listed, particularly their primary physician and any active consulting physicians, therapists, and counselors.
Version Number | Advance Directive Information VersionNumber Extension represents a numeric value used to version successive replacement documents.

### Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide

Advance Directive Categories | Kinds of Advance Directives This ValueSet is managed at the US National Library of Medicine (NLM) Value Set Authority Center (VSAC): https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.11.20.9.69.4/expansion
Attester Role | Codes indicating a role of an attester.
Care Experience Preferences | This value set includes concepts representing an individual’s care experience preferences at end of life which can be expressed by the individual in his or her advance care plan),(Data Element Scope: The intent of this value set is to identify personal care experience preferences that may be relevant and could be considered by clinicians when making a treatment/care plan for the person. This ValueSet is managed at the US National Library of Medicine (NLM) Value Set Authority Center (VSAC): https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1115.11/expansion
Type of clause | Type of clause
ADI Consent Actor Role | This value set identifies the role the advance directive participant has, which could include: healthcare agent, proxy, or advisor roles that individuals commonly designate to empower surrogates to make medical treatment and care decisions when the individual is unable to effectively communicate with medical personnel or requires assistance with decision making. This ValueSet is managed at the US National Library of Medicine (NLM) Value Set Authority Center (VSAC): https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1046.35/expansion
Consent Type | Codes indicating type of advance directive consents.
Documentation Types | Types of Documents
Healthcare Agent Decisions | Codes indicating decisions a healthcare agent may or may not make on behalf of an individual.
Health Goals | Clinical Focus: This value set includes concepts representing an individual’s goals at end of life which can be expressed by the individual in his or her advance care plan.),(Data Element Scope: The intent of this value set is to identify personal goals that may be relevant and could be considered by clinicians when making a treatment/care plan for the person.),(Inclusion Criteria: Include member value sets for Health Goals at end of life for LOINC and SNOMED CT.),(Exclusion Criteria: None. This ValueSet is managed at the US National Library of Medicine (NLM) Value Set Authority Center (VSAC): https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1115.7/expansion
Intervention Preferences - Narrative | Clinical Focus: This value set includes concepts representing an individual’s intervention preferences which can be expressed by the individual in his or her advance care plan.),(Data Element Scope: The intent of this value set is to identify personal intervention preferences that may be relevant and could be considered by clinicians or any person or organization that is providing care, treatment, or performing any other type of act to or on behalf of the individual.)
Intervention Preferences - Ordinal | Clinical Focus: This value set includes concepts representing an individual’s intervention preferences which can be expressed by the individual in his or her advance care plan.),(Data Element Scope: The intent of this value set is to identify personal intervention preferences that may be relevant and could be considered by clinicians or any person or organization that is providing care, treatment, or performing any other type of act to or on behalf of the individual.)
Intervention Preferences | Clinical Focus: This value set includes concepts representing an individual’s intervention preferences which can be expressed by the individual in his or her advance care plan.),(Data Element Scope: The intent of this value set is to identify personal intervention preferences that may be relevant and could be considered by clinicians or any person or organization that is providing care, treatment, or performing any other type of act to or on behalf of the individual.)
No Healthcare Agent Included Reason | Includes data absent reason concepts to express why a Healthcare Agent is not included.
Participant Relationships | This value set identifies the relationship an advance directive participant has with the person the advance directive is about.
Personal And Legal Relationship Role Type | Clinical Focus: A personal or legal relationship records the role of a person in relation to another person, or a person to himself or herself. This value set is to be used when recording relationships based on personal or family ties or through legal assignment of responsibility.
Presence Indicator | Codes specifying whether the presence of something exists or is unknown to exist.
Upon Death Preferences | This value set includes concepts representing an individual’s preferences of treatment.

### Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide

ADI Goal Category Code System | Advance Directive Goal Categories
Healthcare Agent Decision Codes | Codes indicating decisions a healthcare agent may or may not make on behalf of an individual.

### Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like

Example-McBee-AutopsyObservation1 | Example Patient McBee Autopsy Observation (Thoughts Regarding Autopsy)
Example-McBee-Bundle1 | Example Patient McBee ADI Document Bundle McBee 1
Example-McBee-CareExperiencePreference1 | Example Patient McBee Care Experience Preference (My Joys)
Example-McBee-CareExperiencePreference2 | Example Patient McBee Care Experience Preference (How to care for me)
Example-McBee-CareExperiencePreference3 | Example Patient McBee Care Experience Preference (Religious affiliation contact)
Example-McBee-CareExperiencePreference4 | Example Patient McBee Care Experience Preference (My unfinished business)
Example-McBee-HealthcareAgent1 | Example Patient McBee Healthcare Agent (Sally Bobbins)
Example-McBee-HealthcareAgent2 | Example Patient McBee Healthcare Agent (S. Leonard Susskind)
Example-McBee-HealthcareAgentConsent | Example Patient McBee Healthcare Agent Consent
Example-McBee-OrganDonationObservation1 | Example Patient McBee Organ Donation Observation 1
Example-McBee-OrganizationAssembler1 | Example Patient McBee Assembler Organization
Example-McBee-OrganizationCustodian1 | Example Patient McBee Custodian Organization
Example-McBee-PACPComposition1 | Example Patient McBee Personal Advance Care Plan Composition Example 1
Example-McBee-PACPProvenance1 | Example Patient McBee Provenance
Example-McBee-Patient1 | Example Patient McBee Patient Example 1
Example-McBee-PersonalGoal1 | Example Patient McBee Personal Goal 1
Example-McBee-PersonalGoal2 | Example Patient McBee Personal Goal 2
Example-McBee-PersonalGoal3 | Example Patient McBee Personal Goal 3
Example-McBee-PersonalGoal4 | Example Patient McBee Personal Goal 4
Example-McBee-PersonalGoal5 | Example Patient McBee Personal Goal 5
Example-McBee-PersonalGoal6 | Example Patient McBee Personal Goal 6
Example-McBee-PersonalGoal7 | Example Patient McBee Personal Goal 7
Example-McBee-PersonalInterventionPreference1 | Example Patient McBee Personal Intervention Preference (Palliative Care)
Example-McBee-PersonalInterventionPreference2 | Example Patient McBee Personal Intervention Preference (Terminal Illness Health Deterioration)
Example-McBee-PersonalInterventionPreference3 | Example Patient McBee Personal Intervention Preference (Artificial Nutrition and Hydration)
Example-McBee-PersonalInterventionPreference4 | Example Patient McBee Personal Intervention Preference (Severe Illness or Injury)
Example-McBee-PersonalInterventionPreference5 | Example Patient McBee Personal Intervention Preference (Thoughts on CPR 1)
Example-McBee-PersonalInterventionPreference6 | Example Patient McBee Personal Intervention Preference (THoughts on CPR 2)
Example-McBee-PersonalInterventionPreference7 | Example Patient McBee Personal Intervention Preference (Preferred Location for Last Days)
Example-McBee-PersonalInterventionPreference8 | Example Patient McBee Personal Intervention Preference (Death arrangements)
Example-McBee-PersonalPrioritiesOrganizer1 | Example Patient McBee Personal Priorities Organizer
Example-McBee-PreferenceCarePlan1 | Example Patient McBee Preference Care Plan 1
Example-Smith-Johnson-AutopsyObservation1 | Example Patient Smith-Johnson Autopsy Observation (Thoughts Regarding Autopsy)
Example-Smith-Johnson-Bundle1 | Example Patient Smith-Johnson ADI Document Bundle Smith-Johnson 1
Example-Smith-Johnson-CareExperiencePreference1 | Example Patient Smith-Johnson Care Experience Preference (Role of Religion)
Example-Smith-Johnson-CareExperiencePreference2 | Example Patient Smith-Johnson Care Experience Preference (My Likes and Joys)
Example-Smith-Johnson-CareExperiencePreference3 | Example Patient Smith-Johnson Care Experience Preference (My Dislikes and Fears)
Example-Smith-Johnson-CareExperiencePreference4 | Example Patient Smith-Johnson Care Experience Preference (How to Care for Me)
Example-Smith-Johnson-CareExperiencePreference5 | Example Patient Smith-Johnson Care Experience Preference (My Religion)
Example-Smith-Johnson-CareExperiencePreference6 | Example Patient Smith-Johnson Care Experience Preference (Religious Contact)
Example-Smith-Johnson-CareExperiencePreference7 | Example Patient Smith-Johnson Care Experience Preference (Religious Contact)
Example-Smith-Johnson-CareExperiencePreference8 | Example Patient Smith-Johnson Care Experience Preference (Religious Contact)
Example-Smith-Johnson-DocRef-Binary1 | Example Patient Smith-Johnson DocumentReference Binary Data Attachment
Example-Smith-Johnson-DocRef-Bundle | Example Patient Smith-Johnson DocumentReference Bundle
Example-Smith-Johnson-DocRef-Device1 | Example Patient Smith-Johnson DocumentReference Device
Example-Smith-Johnson-DocRef-DocumentReference | Example Patient Smith-Johnson DocumentReference
Example-Smith-Johnson-DocumentationObservation1 | Example Patient Smith-Johnson PMOLST Documentation Observation
Example-Smith-Johnson-HealthcareAgent1 | Example Patient Smith-Johnson Healthcare Agent (Charles Johnson)
Example-Smith-Johnson-HealthcareAgent2 | Example Patient Smith-Johnson Healthcare Agent (Debra Johnson)
Example-Smith-Johnson-HealthcareAgentConsent | Example Patient Smith-Johnson Healthcare Agent Consent
Example-Smith-Johnson-Notary1 | Example Patient Smith-Johnson Notary
Example-Smith-Johnson-OrganDonationObservation1 | Example Patient Smith-Johnson Organ Donation Observation 1
Example-Smith-Johnson-OrganizationAssembler1 | Example Patient Smith-Johnson Assembler Organization
Example-Smith-Johnson-OrganizationCustodian1 | Example Patient Smith-Johnson Custodian Organization
Example-Smith-Johnson-PACPComposition1 | Example Patient Smith-Johnson Personal Advance Care Plan Composition Example 1
Example-Smith-Johnson-PACPProvenance1 | Example Patient Smith-Johnson Provenance
Example-Smith-Johnson-Patient1 | Example Patient Smith-Johnson Patient Example 1
Example-Smith-Johnson-PersonalGoal1 | Example Patient Smith-Johnson Personal Goal 1
Example-Smith-Johnson-PersonalInterventionPreference1 | Example Patient Smith-Johnson Personal Intervention Preference (Significant Pain or Suffering)
Example-Smith-Johnson-PersonalInterventionPreference3 | Example Patient Smith-Johnson Personal Intervention Preference (Mental Illness Deterioration)
Example-Smith-Johnson-PersonalInterventionPreference5 | Example Patient Smith-Johnson Personal Intervention Preference (Final Days Location)
Example-Smith-Johnson-PersonalInterventionPreference6 | Example Patient Smith-Johnson Personal Intervention Preference (Death Arrangements)
Example-Smith-Johnson-PreferenceCarePlan1 | Example Patient Smith-Johnson Preference Care Plan 1
Example-Smith-Johnson-PreferenceCarePlan2 | Example Patient Smith-Johnson Preference Care Plan 2
Example-Smith-Johnson-PreferenceCarePlan3 | Example Patient Smith-Johnson Preference Care Plan 3