Practitioner (Resource) or Reference by Practitioner Identity

In message paradigms, especially HL7 v2 laboratory order (OML_O21/ORM_O01) and unsolicitied observations (ORU_R01) it is common to use the XCN (Extended Composite Id Number And Name For Persons). The FHIR equivalent to this datatype is FHIR Reference

For example:

HL7 v2 XCN

C3456789^Darwin^Samuel^^^Dr^^^GMC

HL7 FHIR Reference

{
    "reference" : "Practitioner/1234",
    "type" : "Practitioner",
    "identifier" : {
      "system" : "https://fhir.hl7.org.uk/Id/gmc-number",
      "value" : "C3456789"
    },
    "display" : "Dr Darwin, Samuel"
}

FHIR Reference introduces a reference to a detailed version of Practitioner which includes fields such as telecom and gender.

It is not clear in Enterprise/Regional use of FHIR which approach Resource or Reference should be taken, both HL7 v2 and FHIR support Reference aggregate or entities by identity from Dommain Driven Design (DDD) and this appears to also be followed by IHE XDS and DICOM. In addition, NHS England Data Dictionary and NHS England HL7 v2 ADT Message Specification favour Reference NHS England FHIR STU3/R4 specifications around Messaging, tend to favour Resource.

It is likely that the reference may be able to point to Care Service Directory services provided by NHS England Healthcare Worker - FHIR API in the near future,(or alternatively downloaded from NHS England Organisation Data Service - CSV Downloads. Therefore: it is proposed:

Reference by Practitioner Identity only

and so continuing conventions used in HL7 v2, i.e. no Practitioner resources will be present in FHIR Messaging.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from UKCorePractitioner

Name	Flags	Card.	Type	Description & Constraints
Practitioner			UKCorePractitioner
Slices for identifier		1..*	Identifier	An identifier that applies to this person in this role. Slice: Unordered, Open by value:type
identifier:All Slices				Content/Rules for all slices
system		1..1	uri	The namespace for the identifier value
value		1..1	string	The value that is unique
identifier:EnglandPractitionerIdentifier	S	1..1	EnglandPractitionerIdentifier	An identifier that applies to this person in this role.
name		0..1	HumanName	The name(s) associated with the practitioner.
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Practitioner		0..*	UKCorePractitioner	A person with a formal responsibility in the provisioning of healthcare or related services dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-6: A resource should have narrative for robust management dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!N	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier	SΣ	1..*	Identifier	An identifier that applies to this person in this role. Slice: Unordered, Open by value:type ele-1: All FHIR elements must have a @value or children
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
identifier:EnglandPractitionerIdentifier	SΣ	1..1	EnglandPractitionerIdentifier	An identifier that applies to this person in this role. ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	The namespace for the identifier value Binding: Practitioner Identifiers (required) ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
name	SΣ	0..1	HumanName	The name(s) associated with the practitioner. ele-1: All FHIR elements must have a @value or children
telecom	SΣC	0..*	ContactPoint	A contact detail for the practitioner (that apply to all roles). ele-1: All FHIR elements must have a @value or children cpt-2: A system is required if a value is provided.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Practitioner.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Practitioner.identifier:EnglandPractitionerIdentifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Practitioner.identifier:EnglandPractitionerIdentifier.system	required	PractitionerIdentifiers (a valid code from UK Professional License) https://hl7.mft.nhs.uk/ValueSet/PractitionerIdentifiers from this IG

Name	Flags	Card.	Type	Description & Constraints
Practitioner		0..*	UKCorePractitioner	A person with a formal responsibility in the provisioning of healthcare or related services
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!N	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url
Slices for identifier	SΣ	1..*	Identifier	An identifier that applies to this person in this role. Slice: Unordered, Open by value:type
identifier:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:EnglandPractitionerIdentifier	SΣ	1..1	EnglandPractitionerIdentifier	An identifier that applies to this person in this role.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system Fixed Value: As shown (License number)
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..0	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: LN
display		0..0	string	Representation defined by the system
userSelected		0..0	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
system	Σ	1..1	uri	The namespace for the identifier value Binding: Practitioner Identifiers (required) Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
active	Σ	0..1	boolean	Whether this practitioner's record is in active use
name	SΣ	0..1	HumanName	The name(s) associated with the practitioner.
telecom	SΣC	0..*	ContactPoint	A contact detail for the practitioner (that apply to all roles). cpt-2: A system is required if a value is provided.
address	Σ	0..*	Address	Address(es) of the practitioner that are not role specific (typically home address)
gender	Σ	0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
birthDate	Σ	0..1	date	The date on which the practitioner was born
photo	C	0..*	Attachment	Image of the person att-1: If the Attachment has data, it SHALL have a contentType
qualification		0..*	BackboneElement	Certification, licenses, or training pertaining to the provision of care
id		0..1	string	Unique id for inter-element referencing
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
identifier		0..*	Identifier	An identifier for this qualification for the practitioner
code		1..1	CodeableConcept	Coded representation of the qualification Binding: v2 table 0360, Version 2.7 (example): Specific qualification the practitioner has to provide a service.
period	C	0..1	Period	Period during which the qualification is valid per-1: If present, start SHALL have a lower value than end
issuer	C	0..1	Reference(Organization)	Organization that regulates and issues the qualification ref-1: SHALL have a contained resource if a local reference is provided
communication		0..*	CodeableConcept	A language the practitioner can use in patient communication Binding: AllLanguages (required): A ValueSet that identifies the language used by a person. Additional Bindings Purpose AllLanguages Max Binding
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Practitioner.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Practitioner.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Practitioner.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Practitioner.identifier:EnglandPractitionerIdentifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Practitioner.identifier:EnglandPractitionerIdentifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Practitioner.identifier:EnglandPractitionerIdentifier.system	required	PractitionerIdentifiers (a valid code from UK Professional License) https://hl7.mft.nhs.uk/ValueSet/PractitionerIdentifiers from this IG
Practitioner.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1 from the FHIR Standard
Practitioner.qualification.code	example	v2.0360.2.7 (a valid code from http://terminology.hl7.org/CodeSystem/v2-0360|2.7) http://terminology.hl7.org/ValueSet/v2-2.7-0360 from the FHIR Standard
Practitioner.communication	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding

Differential View

This structure is derived from UKCorePractitioner

Name	Flags	Card.	Type	Description & Constraints
Practitioner			UKCorePractitioner
Slices for identifier		1..*	Identifier	An identifier that applies to this person in this role. Slice: Unordered, Open by value:type
identifier:All Slices				Content/Rules for all slices
system		1..1	uri	The namespace for the identifier value
value		1..1	string	The value that is unique
identifier:EnglandPractitionerIdentifier	S	1..1	EnglandPractitionerIdentifier	An identifier that applies to this person in this role.
name		0..1	HumanName	The name(s) associated with the practitioner.
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Practitioner		0..*	UKCorePractitioner	A person with a formal responsibility in the provisioning of healthcare or related services dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-6: A resource should have narrative for robust management dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!N	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier	SΣ	1..*	Identifier	An identifier that applies to this person in this role. Slice: Unordered, Open by value:type ele-1: All FHIR elements must have a @value or children
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
identifier:EnglandPractitionerIdentifier	SΣ	1..1	EnglandPractitionerIdentifier	An identifier that applies to this person in this role. ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	uri	The namespace for the identifier value Binding: Practitioner Identifiers (required) ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
name	SΣ	0..1	HumanName	The name(s) associated with the practitioner. ele-1: All FHIR elements must have a @value or children
telecom	SΣC	0..*	ContactPoint	A contact detail for the practitioner (that apply to all roles). ele-1: All FHIR elements must have a @value or children cpt-2: A system is required if a value is provided.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Practitioner.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Practitioner.identifier:EnglandPractitionerIdentifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Practitioner.identifier:EnglandPractitionerIdentifier.system	required	PractitionerIdentifiers (a valid code from UK Professional License) https://hl7.mft.nhs.uk/ValueSet/PractitionerIdentifiers from this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Practitioner		0..*	UKCorePractitioner	A person with a formal responsibility in the provisioning of healthcare or related services
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!N	0..*	Extension	Extensions that cannot be ignored Slice: Unordered, Open by value:url
Slices for identifier	SΣ	1..*	Identifier	An identifier that applies to this person in this role. Slice: Unordered, Open by value:type
identifier:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:EnglandPractitionerIdentifier	SΣ	1..1	EnglandPractitionerIdentifier	An identifier that applies to this person in this role.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system Fixed Value: As shown (License number)
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..0	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: LN
display		0..0	string	Representation defined by the system
userSelected		0..0	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
system	Σ	1..1	uri	The namespace for the identifier value Binding: Practitioner Identifiers (required) Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
active	Σ	0..1	boolean	Whether this practitioner's record is in active use
name	SΣ	0..1	HumanName	The name(s) associated with the practitioner.
telecom	SΣC	0..*	ContactPoint	A contact detail for the practitioner (that apply to all roles). cpt-2: A system is required if a value is provided.
address	Σ	0..*	Address	Address(es) of the practitioner that are not role specific (typically home address)
gender	Σ	0..1	code	male | female | other | unknown Binding: AdministrativeGender (required): The gender of a person used for administrative purposes.
birthDate	Σ	0..1	date	The date on which the practitioner was born
photo	C	0..*	Attachment	Image of the person att-1: If the Attachment has data, it SHALL have a contentType
qualification		0..*	BackboneElement	Certification, licenses, or training pertaining to the provision of care
id		0..1	string	Unique id for inter-element referencing
extension	N	0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
identifier		0..*	Identifier	An identifier for this qualification for the practitioner
code		1..1	CodeableConcept	Coded representation of the qualification Binding: v2 table 0360, Version 2.7 (example): Specific qualification the practitioner has to provide a service.
period	C	0..1	Period	Period during which the qualification is valid per-1: If present, start SHALL have a lower value than end
issuer	C	0..1	Reference(Organization)	Organization that regulates and issues the qualification ref-1: SHALL have a contained resource if a local reference is provided
communication		0..*	CodeableConcept	A language the practitioner can use in patient communication Binding: AllLanguages (required): A ValueSet that identifies the language used by a person. Additional Bindings Purpose AllLanguages Max Binding
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Practitioner.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Practitioner.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Practitioner.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Practitioner.identifier:EnglandPractitionerIdentifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Practitioner.identifier:EnglandPractitionerIdentifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Practitioner.identifier:EnglandPractitionerIdentifier.system	required	PractitionerIdentifiers (a valid code from UK Professional License) https://hl7.mft.nhs.uk/ValueSet/PractitionerIdentifiers from this IG
Practitioner.gender	required	AdministrativeGender http://hl7.org/fhir/ValueSet/administrative-gender|4.0.1 from the FHIR Standard
Practitioner.qualification.code	example	v2.0360.2.7 (a valid code from http://terminology.hl7.org/CodeSystem/v2-0360|2.7) http://terminology.hl7.org/ValueSet/v2-2.7-0360 from the FHIR Standard
Practitioner.communication	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding

This structure is derived from UKCorePractitioner

Summary

Mandatory: 4 elements
Must-Support: 1 element

Structures

This structure refers to these other structures:

• England Practitioner Identifier (https://hl7.mft.nhs.uk/StructureDefinition/EnglandPractitionerIdentifier)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Practitioner.identifier