The messages are represented by FHIR Communication resources and can be created either by the infrastructure itself—often as part of automated processing workflows—or by User Systems, depending on the context of the interaction or the operational requirements.

Introduction

In the infrastructure messages are represented by FHIR Communication resources. These can be created both by the infrastructure itself, as part of some of its automated processing, and by the User Systems. The technical constraints and definitions of the Communication resources can be found here:

http://ehealth-documentation.s3-website-eu-west-1.amazonaws.com/latest-released/ig/StructureDefinition-ehealth-message.html

Depending on how the medium-variable is set in the Communication a message can be sent to the recipient in different ways. One example of a possible way is an SMS through the NemSMS system.

Message Medium

The medium in the Communication, if set, indicates the manner in which the message should be delivered to the recipient.

When a Communication is created with medium=nemsms it is automatically also passed on to the external NemSMS-system and delivered to the recipient as an SMS. This is also further explained in the NemSMS Notifications segment in http://ehealth-documentation.s3-website-eu-west-1.amazonaws.com/latest-released/ig/StructureDefinition-ehealth-message.html.

When Communication is created without a medium there is no automatic delivery. It is in that case up to the User Systems themselves to deliver the message to the user.

Messages Generated By the Infrastructure

On multiple occasions the infrastructure has the possibility of automatically generating messages, however, whether it actually does so by default is dependent on the situation and the recipient. In some cases, the Communications have medium=nemsms as the default medium and will therefore be delivered as an SMS, in other cases the medium is not set and it is therefore solely represented by the Communication resource created in the infrastructure.

If a Communication is created by default and by default has medium=nemsms an SMS will be sent to the recipient when the situation/trigger happens. If a Communication is not created by default, nothing happens. Nothing is created in the infrastructure, nothing is passed to the external NemSMS system and nothing is sent to the recipient.

While the table below shows a complete list of the situations of automated messages, there is more information to be found on the content of the created Communications created by automated processing.

Situation/Trigger	Created by Default	Default medium	Recipient	Payload

Situation/Trigger	Created by Default	Default medium	Recipient	Payload
Measurement submitted at an unexpected time	No	Not set	One Communication will be created for each CareTeam associated with the CarePlan.	“Uventet måling“
Measurement submitted at an unexpected time	No	Not set	Patient	“Uventet måling“
Automated processing rule requests Communication(s) to be made.	Yes	Not set	One Communication will be created for each CareTeam associated with the CarePlan.	Dependent on the output from the specific rule.
	No	Not set	Patient	Dependent on the output from the specific rule.
Missing measurement	Yes	Not set	One Communication will be created for each CareTeam associated with the CarePlan.	“Afklaring af årsag til manglende målinger“
Missing measurement	No	Not set	Patient	“Afklaring af årsag til manglende målinger“
Creation of EpisodeOfCare	Yes	Not set	One Communication will be created for each CareTeam associated with the CarePlan.	“Der er oprettet nyt forløb den %s. Se det i din telemedicinske løsning.“
Creation of EpisodeOfCare	No	Not set	Patient
Creation of CarePlan ($apply)	Yes	Not set	One Communication will be created for each CareTeam associated with the CarePlan.	“Der er oprettet ny plan den %s. Se den i din telemedicinske løsning.“
Creation of CarePlan ($apply)	No	Not set	Patient
Change in CarePlan of CareTeam, scheduled CareTeam, status or scheduled status	Yes	Not set	One Communication will be created for each CareTeam associated with the CarePlan.	“Der er sket ændringer i din plan den %s. Se i din telemedicinske løsning.“
	No	Not set	Patient
Change in EpisodeOfCare of CareTeam, scheduled CareTeam, status or scheduled status	Yes	Not set	One Communication will be created for each CareTeam associated with the CarePlan.	“Der er sket ændringer i dit forløb den %s. Se i din telemedicinske løsning.“
	No	Not set	Patient
Reminder to submit measurement	Yes	`nemsms`	Patient	“Du har en opgave. Se den i din telemedicinske løsning.”
If a contract has a reminder days setup and a matching order/orderline have an agreedDateFrom – reminder days = current day	Yes	`nemsms` when Nem SMS is enabled for the Patient at the time of sending the Communication, otherwise no medium is set.	Patient	“Der kommer en leverance af telemedicinsk udstyr mellem %s og %s.“
Reminder about appointment	Yes	`nemsms`	Patient	“Husk din aftale den %. Se den i din telemedicinske løsning.“
Reminder about the video appointment	Yes	`nemsms`	Patient	“Husk din videoaftale den %. Åbn din telemedicinske løsning for at deltage i videomødet.“
Automated creation of Communication with `medium=nemsms` when a Communication with `category=message` and Patient as `recipient` created	No	`nemsms`	Patient	"Du har modtaget en ny besked. Se den i din telemedicinske løsning.“

If a situation’s default creation and medium is not as wanted, one can override it by use of a CommunicationRequest to opt in/out of creation, or to override the medium.

Overriding default Communications

Overriding the default settings for the automated Communication creations is done using the CommunicationRequest resource.

The table below outlines the override possibilities with respect to default creation and default medium. However, more control is possible and is described in Controlling Creation of Messages.

Situation/Trigger	Recipient	Default Creation Overridable	Default Medium Overridable

Situation/Trigger	Recipient	Default Creation Overridable	Default Medium Overridable
Measurement submitted at unexpected time	CareTeam	Yes	No
Measurement submitted at unexpected time	Patient	Yes	Yes
Automated processing rule requests Communication(s) to be made.	CareTeam	Yes	No
	Patient	Yes	Yes
Missing measurement	CareTeam	Yes	No
Missing measurement	Patient	Yes	Yes
Creation of EpisodeOfCare	CareTeam	Yes	No
Creation of EpisodeOfCare	Patient	Yes	Yes
Creation of CarePlan ($apply)	CareTeam	Yes	No
Creation of CarePlan ($apply)	Patient	Yes	Yes
Change in CarePlan of CareTeam, scheduled CareTeam, status or scheduled status	CareTeam	Yes	No
	Patient	Yes	Yes
Change in EpisodeOfCare of CareTeam, scheduled CareTeam, status or scheduled status	CareTeam	Yes	No
	Patient	Yes	Yes
Reminder to submit measurement	Patient	Yes	Yes
If a contract has a reminder days setup and a matching order/Orderline has an agreedDateFrom – reminder days = current day	Patient	Yes	Yes
Reminder about appointment	Patient	Yes	Yes
Reminder about the video appointment	Patient	Yes	Yes
Automated creation of Communication with `medium=nemsms` when a Communication with `category=message` and Patient as `recipient` created	Patient	Yes	No

Overriding whether a Communication is made by default is done by use of the doNotPerform-field which can be set to either true or false. If a Communication is by default not created for a situation, one can set doNotPerform=false to opt in and actually have Communications created, additionally, if a Communication is created by default for a situation, it can be opted out of by setting doNotPerform=true.

Overriding the medium is done setting the medium-field of the CommunicationRequest. For example, if one wants to change the medium to nemsms when it is by default not set, one will set medium=nemsms as described in Controlling Creation of Messages | Overriding the Payload and/or Medium. Additionally, If the medium is by default nemsms but one overrides it to be not set, an SMS will no longer be sent, however, a Communication will still be created in the infrastructure.

eHealth Infrastructure Wiki

Generation and Control of Infrastructure Communication (Messages and NemSMS)

Contents

Introduction

Message Medium

Messages Generated By the Infrastructure

Overriding default Communications

Related documentation