FHIR International Patient Summary
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## 3:XX FHIR International Patient Summary

# 3:5 IHE Namespaces, Concept Domains and Vocabularies

## 3:5.1 IHE Patient Care Coordination Namespaces

The Patient Care Coordination registry of OIDs is located here

# 3:6 PCC CDA Content Modules

This is not a CDA Profile

##### 3:6.3.1.X.1 Format Code

urn:ihe:pcc:fips:2025

## 3:6.2 LOINC Code

The LOINC code for this document is 60591-5 "Patient summary Document"

## 3:6.3 Standards

- International Patient Summary Implementation Guide 2.0.0 STU 2
- ISO 27269:2025: Health informatics — International Patient Summary
- LOINC
- SNOMED
- IHE FHIR Profile: Occupational Data for Health (ODH) - International
- International Labor Organization: International Standard Classification of Occupations (ISCO-08)
- International Labor Organization: International Standard Industrial Classification Codes Rev4 (ISIC Rev4)

## 3:6.6 FHIR Content Modules

### 3:6.6.1 HL7 FHIR Document Content Modules

#### 3:6.6.1.X FHIR IPS Document Content Modules

This Content Module Section defines the technical requirements for FHIR IPS Documents and Bundles

##### 3:6.6.1.X.1 FHIR IPS Bundle

###### 3:6.6.1.X.1.1 HL7 FHIR IPS Bundle Requirements

The HL7 FHIR IPS Bundle defines the constraints applied to the Bundle resource by the HL7 International Patient Summary (IPS) FHIR Implementation Guide.

IHE does not further constrain the base standard outside of the specified options defined below.

For a valid example of the HL7 FHIR IPS Bundle, review the Pandemic IPS Example Patient Patricia Jordana Bundle. This example patient has entries for all defined entries in the FHIR IPS bundle, including additional content that supports the ODH Option.

###### 3:6.6.1.X.1.2 FHIR IPS ODH Option Bundle Requirements

This Bundle defines the additional requirements of the Occupational Data For Health (ODH) Data Elements that may be incorporated into a patient's IPS Bundle. These data Elements utilize the International Labor Organization Codes for to Occupation and Industry.

In addition to the Entry requirements of IPS, this Bundle requires the support of at least 1 of the following ODH Data Elements:

- Past or Present Job
- Usual Work

It also allows optional support for the following ODH Data Elements:

- Employment Status
- Retirement Date
- CombatZone Period

The FHIR IPS ODH Option Bundle defines the constraints applied to the Bundle Resource for this option.

For a valid example of the FHIR IPS ODH Bundle review the ODH Patient Genny Works Example Bundle.

###### 3:6.6.1.X.1.3 FHIR IPS Complete Option Bundle Requirements

The FHiR IPS Complete Option Bundle Incorporates the Complete Testing option for IPS. This Structure definition binds the Complete Option Composition to the bundle, where all optional sections (e.g., Advanced Directives, Functional Status, History of Past Illnesses, History of Pregnancy, Plan of Care, Social History, and Vital Signs) are now Must Support sections.

For a valid example of the FHIR Complete IPS Bundle review the Pandemic IPS Example Patient Patricia Jordana Example Bundle.

##### 3:6.6.1.X.2 FHIR IPS Composition and Section Requirements

The following table shows the differences in the Composition Requirements for the Different Implementation Options.

Table 3:6.6.1.X.2-1: FHIR Composition Resource Optionality Requirements

Sections | HL7 IPS Optionality Cardinality | ODH Option Optionality Cardinality | Complete Option Optionality Cardinality | ISO IPS TC215 Section Optionality Cardinality
--- | --- | --- | --- | ---
Composition.section:sectionProblems | R [1..1] | R [1..1] | R [1..1] | M [1..1]
Composition.section:sectionAllergies | R [1..1] | R [1..1] | R [1..1] | M [1..1]
Composition.section:sectionMedications | R [1..1] | R [1..1] | R [1..1] | M [1..1]
Composition.section:sectionImmunizations | RE [0..1] | RE [0..1] | RE [0..1] | RE [0..1]
Composition.section:sectionResults | RE [0..1] | RE [0..1] | RE [0..1] | RE [0..1]
Composition.section:sectionProceduresHx | RE [0..1] | RE [0..1] | RE [0..1] | RE [0..1]
Composition.section:sectionMedicalDevices | RE [0..1] | RE [0..1] | RE [0..1] | RE [0..1]
Composition.section:sectionSocialHistory | O [0..1] | RE [0..1] | RE [0..1] | O [0..1]
Composition.section:sectionAdvanceDirectives | O [0..1] | O [0..1] | RE [0..1] | O [0..1]
Composition.section:sectionFunctionalStatus | O [0..1] | O [0..1] | RE [0..1] | O [0..1]
Composition.section:sectionPastProblems | O [0..1] | O [0..1] | RE [0..1] | O [0..1]
Composition.section:sectionPregnancyHx | O [0..1] | O [0..1] | RE [0..1] | O [0..1]
Composition.section:sectionPatientStory | O [0..1] | O [0..1] | RE [0..1] | O [0..1]
Composition.section:sectionPlanOfCare | O [0..1] | O [0..1] | RE [0..1] | O [0..1]
Composition.section:sectionVitalSigns | O [0..1] | O [0..1] | RE [0..1] | O [0..1]
Composition.section:sectionAlerts | O [0..1] | O [0..1] | RE [0..1] | O [0..1]
Composition.section:sectionPatientStory | O [0..1] | O [0..1] | RE [0..1] | O [0..1]

###### 3:6.6.1.X.2.1 HL7 FHIR IPS Composition and Section Requirements

The HL7 FHIR IPS Composition defines the constraints applied to the Composition resource by the HL7 International Patient Summary (IPS) FHIR Implementation Guide.

IHE does not further constrain the base HL7 Implementation Guide requirements outside of the specified options defined below.

IHE has added further clarification on the expected behavior for implementation with regards to missing data and provides guidance on incorporating additional standard content within the IPS Section Requirements below.

For a valid example of the FHIR IPS OHH Composition, review the Genny Works ODH IPS Example Bundle.

###### 3:6.6.1.X.2.1.1 Immunization Section Requirements

In order to support the meanings of Absent Data described by ISO 27269:2025: Health informatics — International Patient Summary Standard Immunization Section 17.2.4 Missing: "These two situations should be explicitly documented in the IPS section: — known absence of vaccinations; — no information available about vaccinations", the emptyReason data element SHOULD Be supported for this section. Open issue FIPS_023 documents the misalignment between the HL7 and ISO Standard.

If the Immunization data is not available or supported by the Content Creator system, then the IPS Immunizations Section SHALL have an appropriate emptyReason.

If there is a known absence of Immunization data, then this SHOULD be represented in the IPS Immunizations Section with an Immunization Entry as a vaccineCode of 787482006 "No known immunizations".

###### 3:6.6.1.X.2.1.2 History Of Procedures Section Requirements

In order to support the meanings of Absent Data described by ISO 27269:2025: Health informatics — International Patient Summary Standard History of Procedures Section 16.2.4 Missing - "Required if available, if not, then a reason shall be given.", the emptyReason data element SHOULD Be supported for this section. Open issue FIPS_023 documents the misalignment between the HL7 and ISO Standard.

If the History of Procedures data is not available or supported by the Content Creator system, then the IPS History of Procedures Section SHALL have an appropriate emptyReason.

If there is a known absence of Procedure data, then this MAY be represented in the IPS History of Procedures Section with an emptyReason of data-absent-reason of not-applicable, OR Represented in the Procedure Entry as a Procedure Code of 787480003 "No known procedures". A Content Creator SHALL support at least one of these approaches.

###### 3:6.6.1.X.2.1.3 Medical Devices Section Requirements

In order to support the meanings of Absent Data described by ISO 27269:2025: Health informatics — International Patient Summary Standard Medical Devices Section 18.2.4 Missing - "If missing, then the reason should be declared", the emptyReason data element SHOULD Be supported for this section. Open issue FIPS_023 documents the misalignment between the HL7 and ISO Standard.

If the Medical Devices data is not available or supported by the Content Creator system, then the IPS Medical Devices Section SHALL have an appropriate emptyReason.

If there is a known absence of Device data, then this MAY be represented in the IPS Medical Devices Section with a data-absent-reason of not-applicable, OR Represented in the Procedure Entry as Medical Devices Code of 787483001 "No known device use". A Content Creator SHALL support at least one of these approaches.

###### 3:6.6.1.X.2.1.4 Lab Results Section Requirements

In order to support the meanings of Absent Data described by ISO 27269:2025: Health informatics — International Patient Summary Standard Lab Results Section 2.2.2.4 Missing "The implication is that no findings or results have been observed that are relevant to the present summary.", the emptyReason data element SHOULD Be supported for this section. Open issue FIPS_023 documents the misalignment between the HL7 and ISO Standard.

If the Lab Results data is not available or supported by the Content Creator system, then the IPS Results Section SHALL have an appropriate emptyReason.

If there is a known absence of Results data, then this MAY be represented in the IPS Results Section with a data-absent-reason of not-applicable, OR Represented by the omission of the section. A Content Creator SHALL support at least one of these approaches.

###### 3:6.6.1.X.2.1.5 Social History Section Requirements

While the Structure definition does not slice the entry specifically for this, the IPS Social History Section does allow for a large variety of Social history Observations to be documented in this section.

These Observations include:

- Occupational Data for Health (ODH) Entries:
  - Usual Work
  - Past or present Job
  - Employment Status
  - Retirement Date
  - Combat Zone Period

The following concepts have not been profiled in FHIR, but are defined in the IHE Patient Care Coordination Technical Framework, Volume 2 Section 6.3.4.24 Social History Observation 1.3.6.1.4.1.19376.1.5.3.1.4.13.4. These can be modeled using the FHIR Observation Resource.

SNOMED-CT Code | Description | Data Type | Units
--- | --- | --- | ---
229819007 | Smoking | PQ (valueQuantity) | {pack}/d or {pack}/wk or {pack}/a
256235009 | Exercise | PQ (valueQuantity) | {times}/wk
160573003 | ETOH (Alcohol) Use | PQ (valueQuantity) | {drink}/d or {drink}/wk
364393001 | Diet | CD (valueCodeableConcept) | N/A
364703007 | Employment | CD (valueCodeableConcept) | N/A
425400000 | Toxic Exposure | CD (valueCodeableConcept) | N/A
363908000 | Drug Use | CD (valueCodeableConcept) | N/A
228272008 | Other Social History | Any | N/A

Additional Concepts Include:

Observation Code | Description | Data Type
--- | --- | ---
98978-0 (LOINC) | Homelessness | CD (valueCodeableConcept)
713458007 (SNOMED-CT) | Lack of access to transportation | CD (valueCodeableConcept)
707087005 (SNOMED-CT) | Domestic Violence Risk | CD (valueCodeableConcept)

For a valid example of the FHIR IPS ODH Section, review the Genny Works ODH IPS Example Bundle.

###### 3:6.6.1.X.2.1.6 Pregnancy History Section Requirements

While the Structure definition does not slice the entry specifically for this, the IPS Pregnancy History Section does allow for a large variety of Pregnancy Observations to be documented in this section.

###### 3:6.6.1.X.2.1.7 FHIR IPS Advanced Directives Section Requirements

If the Advanced Directive data is not available or supported by the Content Creator system, then the IPS Advanced Directives Section SHOULD have an appropriate emptyReason.

If there is a known absence of Advanced Directives, then this MAY be represented in the IPS Advanced Directives Section with a data-absent-reason of not-applicable, OR Represented by the omission of the section. A Content Creator SHALL support at least one of these approaches.

- If the person authorizing the Advanced Directive is the patient, then the Person Authorizing Directive element should be found in: Composition.section:sectionAdvanceDirectives.entry:advanceDirectivesConsent.performer:Patient

- If the person authorizing the Advanced directive is a patient representative, then the Person Authorizing Directive element should be found in: Composition.section:sectionAdvanceDirectives.entry:advanceDirectivesConsent.performer:RelatedPerson

###### 3:6.6.1.X.2.1.8 IPS History of Past Problems Section Requirements

- Problem Type ConditionUvIps.category: In addition to the HL7 Problem Type extensible value set the following additional problem types may also be documented:
  - 148006 Preliminary diagnosis (SNOMED-CT)
  - 5558000 Working diagnosis (SNOMED-CT)
  - 30207005 Risk of (SNOMED-CT) Open issue FIPS_011

###### 3:6.6.1.X.2.2 FHIR IPS ODH Option Composition and Section Requirements

The FHIR IPS ODH Option Composition defines the constraints applied to the Bundle Resource for this bundle.

For a valid example of the HL7 FHIR IPS Bundle with all Required and Must support sections documented review the Genny Works ODH IPS Example Bundle.

###### 3:6.6.1.X.2.2.1 FHIR IPS ODH Social History Section Requirements

For the FHIR IPS ODH Option, this is now a Must Support section. The Patient's Occupation and Industry Data Elements SHALL Be Documented in the IPS if it is known.

This Section SHALL support either the ODH Past or Present Job or the Usual Work Data Elements to document the patient's Occupation and Industry.

###### 3:6.6.1.X.2.3 FHIR IPS Complete Option Composition and Section Requirements

This option defines a testing option for the HL7 FHIR International Patient Summary, where all of the optional sections(e.g., Advanced Directives, Functional Status, History of Past Illnesses, History of Pregnancy, Plan of Care, Social History, and Vital Signs) will become Must Support sections.

For a valid example of the FHIR IPS Option Composition, review the Patricia Jordana Pandemic IPS Example Composition.

###### 3:6.6.1.X.2.3.1 FHIR IPS Complete IPS Advance Directives Section Requirements

If the Advanced Directive data is not available or unsupported by the Content Creator system, then the IPS Advance Directives SHALL have an appropriate emptyReason.

If there is a known absence of Advanced Directives, then this SHOULD be represented in the IPS Advanced Directives Section with a data-absent-reason of not-applicable, OR Represented by the omission of the section. A Content Creator SHALL support at least one of these approaches.

###### 3:6.6.1.X.2.3.2 FHIR IPS Complete IPS Functional Status Section Requirements

If the Functional Status information is not available or unsupported by the Content Creator system, then the IPS Functional Status Section SHALL have an appropriate emptyReason.

If there is a known absence of Functional Status information, then this SHOULD be represented in the IPS Functional Status Section with a data-absent-reason of not-applicable, OR Represented by the omission of the section. A Content Creator SHALL support at least one of these approaches.

###### 3:6.6.1.X.2.3.3 FHIR IPS Complete IPS History of Past Illness Section Requirements

If the past problems are not available or unsupported by the Content Creator system, then the IPS History of Past Illness Section SHALL have an appropriate emptyReason.

If there is a known absence of relevant past problems, then this SHOULD be represented in the IPS History of Past Illness Section with a data-absent-reason of not-applicable, OR Represented by the omission of the section. A Content Creator SHALL support at least one of these approaches.

###### 3:6.6.1.X.2.3.4 FHIR IPS Complete IPS History of Pregnancy Section Requirements

If the pregnancy data is not available or unsupported by the Content Creator system, then the IPS History of Pregnancy Section SHALL have an appropriate emptyReason.

If there is a known absence of pregnancy information, then this SHOULD be represented in the IPS History of Pregnancy Section with a data-absent-reason of not-applicable, OR Represented by the omission of the section. A Content Creator SHALL support at least one of these approaches.

###### 3:6.6.1.X.2.3.5 FHIR IPS Complete IPS Plan of Care Section Requirements

If the Care plan and Goals information is not available or unsupported by the Content Creator system, then the IPS Plan of Care Section SHALL have an appropriate emptyReason.

If there is a known absence of Advanced Directives, then this SHOULD be represented in the IPS Advanced Directives Section with a data-absent-reason of not-applicable, OR Represented by the omission of the section. A Content Creator SHALL support at least one of these approaches.

###### 3:6.6.1.X.2.3.6 FHIR IPS Complete IPS Social History Section Requirements

If the Social History information is not available or unsupported by the Content Creator system, then the IPS Functional Status Section SHALL have an appropriate emptyReason.

If there is a known absence of Social History, then this SHOULD be represented in the IPS Social History Section with a data-absent-reason of not-applicable, OR Represented by the omission of the section. A Content Creator SHALL support at least one of these approaches.

###### 3:6.6.1.X.2.3.7 FHIR IPS Complete IPS Vital Signs Section Requirements

If the Vital Signs information is not available or unsupported by the Content Creator system, then the IPS Vital Signs Section SHALL have an appropriate emptyReason.

If there is a known absence of Vital Signs, then this SHOULD be represented in the IPS Vital Signs Section with a data-absent-reason of not-applicable, OR Represented by the omission of the section. A Content Creator SHALL support at least one of these approaches.

###### 3:6.6.1.X.2.3.8 FHIR IPS Complete IPS Alerts Section Requirements

If the Alert data is not available or unsupported by the Content Creator system, then the IPS Alerts Section SHALL have an appropriate emptyReason.

If there is a known absence of Alerts, then this SHOULD be represented in the IPS Alerts Section with a data-absent-reason of not-applicable, OR Represented by the omission of the section. A Content Creator SHALL support at least one of these approaches.

###### 3:6.6.1.X.2.3.9 FHIR IPS Complete IPS Patient Story Section Requirements

If the Patient Story information is not available or unsupported by the Content Creator system, then the IPS Patient Story Section SHALL have an appropriate emptyReason.

If there is a known absence of Patient Story information, then this SHOULD be represented in the IPS Patient Story Section with a data-absent-reason of not-applicable, OR Represented by the omission of the section. A Content Creator SHALL support at least one of these approaches.

##### 3:6.6.1.X.3 FHIR IPS Entry Resource Requirements

There are No Additional Entry Resource requirements at this time.

##### 3:6.6.1.X.4 FHIR IPS Value Sets

There are No Additional value set requirements at this time.