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As described in https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/538935313/Behind+the+Scenes#Overview-of-Communication-produced-by-the-Infrastructure, the eHealth Infrastructure automatically creates FHIR Communication (of profile https://docs.ehealth.sundhed.dk/latest-releasedfhir/ig/StructureDefinition-ehealth-message.html ) in various situations.

It is possible to control if and how these FHIR Communication are created through use of FHIR CommunicationRequest (https://docs.ehealth.sundhed.dk/latest-released/igfhir/StructureDefinition-ehealth-communication-request.html ).

Info

In the descriptions below, the terms opt-in and opt-out are used with the following meaning:

  • Opt-in: Use of CommunicationRequest by a Patient or CareTeam to get a copy of a Communication (profile ehealth-message) where the Patient or CareTeam is not recipient of the default Communication.

  • Opt-out: Use of CommunicationRequest by a Patient or CareTeam to suppress creation of the default Communication to the said Patient or CareTeam.

A CareTeam must be involved in an EpisodeOfCare or CarePlan in order to opt-in for Communication referring the EpisodeOfCare and/or CarePlan and/or ServiceRequest.

...

  • subject = Patient reference

  • occurrencePeriod.start = start of period for which the control applies

  • occurrencePeriod.end = end of period for which the control applies, if known. Otherwise it can be left empty.

  • status = active when control is in effect. Can be set to other values as appropriate (one of draft | active | on-hold | revoked | completed).

  • doNotPerform = false (or unset) for opt-in or override of medium/payload, true in order to opt-out (that is, to suppress creation)

Info

For eHealth Infrastructure up to Release 13, doNotPerform set to true shall be accompanied by setting status = on-hold. From Release 14 and onward, the status is used for controlling the CommunicationRequest lifecycle and is not used for suppressing message creation.

...

The paragraph below reflects behavior as of eHealth Infrastructure Release 14.

CommunicationRequest subject shall not be set for control of message creation regarding:

  • Automated creation of medium nemsms Communication when Communication with category message and Patient as recipient created

  • Reminder about appointment

How to set remaining elements of the CommunicationRequest vary with situation, see below.

Info

The Communication.category is set depending on the intended use and involved recipients. See the section Introduction on https://docs.ehealth.sundhed.dk/latest-released/ig/StructureDefinition-ehealth-message.html for details. When a Communication with category=message is created to do human-human communication, it can be controlled whether to also send a mobile text message (NemSMS) to a Patient recipient as described on https://docs.ehealth.sundhed.dk/latest-released/ig/StructureDefinition-ehealth-message.html#automatic-nemsms-notifications. This requires opt-in as it is not the default behavior.

Controlling Message Creation with Patient as Recipient

...

  • recipient = Patient reference

  • category = <depending on situation>

  • reasonCode = <depending on situation>

  • episodeOfCare = <depending on situation>

  • basedOn = <depending on situation>

  • priority = <depending on situation>

Situation

Created by Default

Opt-in Supported

Opt-out Supported

Payload and Medium Overridable

Element category

Element reasonCode

Element episodeOfCare

Element basedOn

Element priority

Unexpected measurement submitted

No

Yes

No

Yes

notification

UnexpectedMeasuringResolving

ServiceRequest reference

Missing measurement determined

No

Yes

No

Yes

notification

MissingMeasurementResolving

ServiceRequest reference

Reminder to submit measurement (about to be created)

Yes

No

Yes

Yes

advice

ReminderSubmitMeasurement

EpisodeOfCare reference

Communication created by triage (or other infrastructure rules)

No

Yes

No

Yes

notification

Depends on rule

ServiceRequest reference

Depends on rule

EpisodeOfCare created

No

Yes

No

Yes

notification

EpisodeOfCareCreated

EpisodeOfCare changed (in team, status, scheduledStatus or scheduledTeam)

No

Yes

No

Yes

notification

EpisodeOfCareCareTeamChange , EpisodeOfCareScheduledCareTeamChange , EpisodeOfCareStatusChange or EpisodeOfCareScheduledStatusChange

EpisodeOfCare reference

CarePlan created/changed (in careTeam, status, scheduledStatus or scheduledTeam)

No

Yes

No

Yes

notification

CarePlanCreated,CarePlanCareTeamChange , CarePlanScheduledCareTeamChange , CarePlanStatusChange orCarePlanScheduledStatusChange

EpisodeOfCare reference

Reminder about appointment

Yes

No

Yes

Yes

advice

AppointmentNotification or VideoAppointmentNotificationdepending on appointment type

EpisodeOfCare reference (optional)

If specified, the CommunicationRequest is specific to Appointment referencing the EpisodeOfCare. See section on scope of message creation control below.

Automated creation of medium nemsms Communication when Communication with category message and Patient as recipient created

No

Yes

No

Only medium=nemsms possible

message

Same as ehealth-message (

or left empty

optional)

When omitted, it corresponds to match on all ehealth-message reasonCodes. See section on scope of message creation control below.

EpisodeOfCare reference (optional)

EpisodeOfCare reference

If specified, the CommunicationRequest is specific to Communication resources referencing the EpisodeOfCare. See section on scope of message creation control below.

Info

Currently, no infrastructure rules (see Library Resources) cause creation of Communication. Neither with Patient or CareTeam as recipient.

...

  • recipient = CareTeam reference

  • category = <depending on situation>

  • reasonCode = <depending on situation>

  • episodeOfCare = <depending on situation>

  • basedOn = <depending on situation>

  • priority = <depending on situation>

Situation

Created by Default

Opt-in Supported

Opt-out Supported

Payload and Medium Overridable

Element category

Element reasonCode

Element episodeOfCare

Element basedOn

Element priority

Unexpected measurement submitted

No

Yes

No

No

notification

UnexpectedMeasuringResolving

ServiceRequest reference

Missing measurement determined

Yes

No

Yes

No

notification

MissingMeasurementResolving

ServiceRequest reference

Communication created by triage (or other infrastructure rules)

Yes

No

Yes

No

depends on rule

depends on rule

ServiceRequest reference

depends on rule

EpisodeOfCare created

Yes

No

Yes

No

notification

EpisodeOfCareCreated

EpisodeOfCare changed (in team, status, scheduledStatus or scheduledTeam)

Yes

No

Yes

No

notification

EpisodeOfCareCareTeamChange , EpisodeOfCareScheduledCareTeamChange , EpisodeOfCareStatusChange or EpisodeOfCareScheduledStatusChange

EpisodeOfCare reference

CarePlan created/changed (in careTeam, status, scheduledStatus or scheduledTeam)

Yes

No

Yes

No

notification

CarePlanCreated,CarePlanCareTeamChange , CarePlanScheduledCareTeamChange , CarePlanStatusChange orCarePlanScheduledStatusChange

EpisodeOfCare reference

Reminder about appointment

No

Yes

No

Only payload

advice

AppointmentNotification or VideoAppointmentNotificationdepending on appointment type

EpisodeOfCare reference (optional)

If specified, the CommunicationRequest is specific to Appointment referencing the EpisodeOfCare. See section on scope of message creation control below.

Scope of the Message Creation Control

...