Updating branch with master

source/adverseevent/adverseevent-introduction.xml

@@ -37,16 +37,15 @@
 		<p>
 			The AdverseEvent resource is designed to represent events that had a harmful impact on a subject, or had the potential to cause harm to a subject but were avoided.  In the course of medical care, there are many actions that may impact how a subject responds to a particular treatment impacting patient safety.  Therefore, the AdverseEvent resource may reference multiple other resources to represent the context or details of an adverse event such as Observation, Condition, MedicationAdministration, Immunization, Procedure, or ResearchStudy.  
 		</p>
-		<p>
-			A DetectedIssue reference is also related to the context of an AdverseEvent to the extent that a known risk for a potential issue, such as a drug-drug interaction, is documented. If, in the context of a known issue, an adverse event occurs, citing this relationship is important for preventing such an occurrence in the future.
-		</p>
 		<p>
 			The AdverseEvent resource should not be used when a more specific resource exists. 
 		</p>
 		<ul>
 			<li>The AllergyIntolerance resource is a case specific means of capturing the condition of an allergy or intolerance and the criticality (or potential for future harm) based on the response of a particular individual.</li>
 			<li>The Clinical Reasoning module provides resources and operations to enable the representation, distribution, and evaluation of clinical knowledge artifacts, such as clinical decision support rules, quality measures, order sets, and protocols.  The suite of resources within the clinical reasoning module should be used to capture clinical quality measures and clinical protocols that help drive clinical best practices.</li>
 			<li>The AdverseEvent resource is not intended to be used to capture potential subject risk in a prospective manner.  A more appropriate resource for this purpose would be RiskAssessment which captures predicted outcomes for a patient or population on the basis of source information. Examples include a prognosis statement for a particular condition, risk of health outcome (heart attack, particular type of cancer) on the basis of lifestyle factors and/or family history, or list of potential health risks based on a patient's genetic analysis.</li>
+			<li>A DetectedIssue reference is also related to the context of an AdverseEvent to the extent that a known risk for a potential issue, such as a drug-drug interaction, is documented. If, in the context of a known issue, an adverse event occurs, citing this relationship is important for preventing such an occurrence in the future. DetectedIssue only applies to documenting a risk associated with a specific planned or ongoing action, or the lack of an action which should be planned - not a general propensity to risk.</li>
+			<li>Flags highlight highly condensed view of information found in other resources, which may include AdverseEvent. The purpose of these other resources is to provide detailed clinical information. The purpose of a Flag is to alert practitioners to information that is important to influence their interaction with a Patient prior to detailed review of the record.</li>
 		</ul>
 	</div>
 

source/communication/bundle-Communication-search-params.xml

@@ -341,4 +341,23 @@
       </SearchParameter>
     </resource>
   </entry>
+  <entry>
+    <resource>
+      <SearchParameter>
+        <id value="Communication-in-response-to"/>
+        <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
+          <valueCode value="trial-use"/>
+        </extension>
+        <extension url="http://hl7.org/fhir/build/StructureDefinition/path">
+          <valueString value="Communication.inResponseTo"/>
+        </extension>
+        <url value="http://hl7.org/fhir/build/SearchParameter/Communication-in-response-to"/>
+        <description value="Reply to"/>
+        <code value="in-response-to"/>
+        <type value="reference"/>
+        <expression value="Communication.inResponseTo"/>
+        <processingMode value="normal"/>
+      </SearchParameter>
+    </resource>
+  </entry>
 </Bundle>

source/communication/communication-introduction.xml

@@ -34,7 +34,8 @@ Non-patient specific communication use cases may include:
 <a name="bnr"></a>
 <h2>Boundaries and Relationships</h2>
 <p>
-This resource is a record of a communication that has occurred or will occur. It does not represent the actual flow of communication.
+This resource is a record of a communication that has occurred or where the communication process has at least initiated. 
+It does not have to represent the actual flow of communication, but in some use cases could represent the actual flow of communication (for example secure messaging between provider and patient).
 While <a href="auditevent.html">AuditEvent</a> can track electronic disclosures of information, it cannot track conversations,
 phone calls, letters and other interactions that are not system-to-system.  And even for system-to-system communications, the
 specific end recipients might not be known.  Furthermore, <a href="auditevent.html">AuditEvents</a> are not considered to be "part"

source/communicationrequest/bundle-CommunicationRequest-search-params.xml

@@ -307,4 +307,23 @@
       </SearchParameter>
     </resource>
   </entry>
+  <entry>
+    <resource>
+      <SearchParameter>
+        <id value="CommunicationRequest-about"/>
+        <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
+          <valueCode value="trial-use"/>
+        </extension>
+        <extension url="http://hl7.org/fhir/build/StructureDefinition/path">
+          <valueString value="CommunicationRequest.about"/>
+        </extension>
+        <url value="http://hl7.org/fhir/build/SearchParameter/CommunicationRequest-about"/>
+        <description value="Resources that pertain to this communication request"/>
+        <code value="about"/>
+        <type value="reference"/>
+        <expression value="CommunicationRequest.about"/>
+        <processingMode value="normal"/>
+      </SearchParameter>
+    </resource>
+  </entry>
 </Bundle>

source/goal/structuredefinition-Goal.xml

@@ -486,11 +486,11 @@
     </element>
     <element id="Goal.addresses">
       <extension url="http://hl7.org/fhir/build/StructureDefinition/committee-notes">
-        <valueString value="GF#19335, J#28213, J#37261"/>
+        <valueString value="GF#19335, J#28213, J#37261, J#40777"/>
       </extension>
       <path value="Goal.addresses"/>
       <short value="Issues addressed by this goal"/>
-      <definition value="The identified conditions and other health record elements that are intended to be addressed by the goal."/>
+      <definition value="The identified conditions and other resources that provide the context for why the goal exists."/>
       <requirements value="Allows specific goals to explicitly linked to the concerns they're dealing with - makes the goal more understandable."/>
       <min value="0"/>
       <max value="*"/>

source/observation/structuredefinition-profile-vitalsigns.xml

@@ -7,7 +7,7 @@
     <div xmlns="http://www.w3.org/1999/xhtml">to do</div>
   </text>
   <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-summary">
-    <valueMarkdown value="&quot;#### Complete Summary of the Mandatory Requirements&#xA;&#xA;1.  One status in `Observation.status` which has a [required](terminologies.html#extensible) binding to:&#xA;    -    [ObservationStatus] value set.&#xA;1.  A category in `Observation.category` which must have:&#xA;    -   a fixed `Observation.category.coding.system`=&quot;http://terminology.hl7.org/CodeSystem/observation-category&quot;&#xA;    -   a fixed `Observation.category.coding.code`= &quot;vital-signs&quot;&#xA;&#xA;1.  A code in `Observation.code`&#xA;    -   a fixed `Observation.code.coding.system`= &quot;http://loinc.org&quot;&quot;&#xA;    -   a LOINC code in `Observation.code.coding.code` which has an [extensible](terminologies.html#extensible) binding to:&#xA;         -   [Vital Signs] value set.&#xA;                &#xA;1.  One patient in `Observation.subject`&#xA;1.  A date and time in `effectiveDateTime` or `effectivePeriod`&#xA;1.  Either one `Observation.value[x]` or, if there is no value, one code in `Observation.DataAbsentReason`&#xA;    -   if a vital sign measure then:&#xA;        -  One numeric value in Observation.valueQuantity.value&#xA;        - a fixed Observation.valueQuantity.system=&quot;http://unitsofmeasure.org&quot;&#xA;        - a UCUM unit code in Observation.valueQuantity.code which has a required binding to the [Vital Signs Units] value set.&#xA;    -   Observation.DataAbsentReason is bound to [Observation Value&#xA;        Absent Reason] value set.&#xA;&#xA;1.  When using a panel code to group component observations (Note: See&#xA;    the comments regarding blood pressure in the table above), one or&#xA;    more `Observation.component.code` each of which must have:&#xA;    -   a fixed&#xA;        `Observation.component.code.coding.system` =&quot;&quot;http://loinc.org&quot;&quot;&#xA;         -   a LOINC code in `Observation.code.coding.code` which has an [extensible] binding to:&#xA;             -   [Vital Signs Units] value set.&#xA;&#xA;1.  Either one `Observation.component.valueQuantity` or, if there is&#xA;    no value, one code in `Observation.component.DataAbsentReason`&#xA;    -   Observation.component.DataAbsentReason is bound to [Observation&#xA;        Value Absent Reason] value set.&#xA;&#xA;1.  When using a panel code to group observations, one or more reference&#xA;    to Vitals Signs Observations in `Observation.related.target`&#xA;    -   a fixed `Observation.related.type`= &quot;has-member&quot;&quot;&#xA;&#xA; [Vital Signs]: valueset-observation-vitalsignresult.html&#xA;  [Vital Signs Units]: valueset-ucum-vitals-common.html&#xA;  [extensible]: terminologies.html#extensible&#xA;  [ObservationStatus]: valueset-observation-status.html&#xA; [Observation Value Absent Reason]: valueset-data-absent-reason.html&#xA;[required]: terminologies.html#required&quot;"/>
+    <valueMarkdown value="#### Complete Summary of the Mandatory Requirements&#xA;&#xA;1.  One status in `Observation.status` which has a [required](terminologies.html#extensible) binding to:&#xA;    -    [ObservationStatus] value set.&#xA;1.  A category in `Observation.category` which must have:&#xA;    -   a fixed `Observation.category.coding.system`=&quot;http://terminology.hl7.org/CodeSystem/observation-category&quot;&#xA;    -   a fixed `Observation.category.coding.code`= &quot;vital-signs&quot;&#xA;&#xA;1.  A code in `Observation.code`&#xA;    -   a fixed `Observation.code.coding.system`= &quot;http://loinc.org&quot;&quot;&#xA;    -   a LOINC code in `Observation.code.coding.code` which has an [extensible](terminologies.html#extensible) binding to:&#xA;         -   [Vital Signs] value set.&#xA;                &#xA;1.  One patient in `Observation.subject`&#xA;1.  A date and time in `effectiveDateTime` or `effectivePeriod`&#xA;1.  Either one `Observation.value[x]` or a populated component (with `component.code` and `component.value[x]`), if there is no value, one code in `Observation.DataAbsentReason`&#xA;    -   if a vital sign measure then:&#xA;        -  One numeric value in Observation.valueQuantity.value&#xA;        - a fixed Observation.valueQuantity.system=&quot;http://unitsofmeasure.org&quot;&#xA;        - a UCUM unit code in Observation.valueQuantity.code which has a required binding to the [Vital Signs Units] value set.&#xA;    -   Observation.DataAbsentReason is bound to [Observation Value&#xA;        Absent Reason] value set.&#xA;&#xA;1.  When using a panel code to group component observations (Note: See&#xA;    the comments regarding blood pressure in the table above), one or&#xA;    more `Observation.component.code` each of which must have:&#xA;    -   a fixed&#xA;        `Observation.component.code.coding.system` =&quot;&quot;http://loinc.org&quot;&quot;&#xA;         -   a LOINC code in `Observation.code.coding.code` which has an [extensible] binding to:&#xA;             -   [Vital Signs Units] value set.&#xA;&#xA;1.  Either one `Observation.component.valueQuantity` or, if there is&#xA;    no value, one code in `Observation.component.DataAbsentReason`&#xA;    -   Observation.component.DataAbsentReason is bound to [Observation&#xA;        Value Absent Reason] value set.&#xA;&#xA;1.  When using a panel code to group observations, one or more reference&#xA;    to Vitals Signs Observations in `Observation.related.target`&#xA;    -   a fixed `Observation.related.type`= &quot;has-member&quot;&quot;&#xA;&#xA; [Vital Signs]: valueset-observation-vitalsignresult.html&#xA;  [Vital Signs Units]: valueset-ucum-vitals-common.html&#xA;  [extensible]: terminologies.html#extensible&#xA;  [ObservationStatus]: valueset-observation-status.html&#xA; [Observation Value Absent Reason]: valueset-data-absent-reason.html&#xA;[required]: terminologies.html#required&quot;"/>
   </extension>
   <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
     <valueInteger value="5"/>
@@ -341,4 +341,4 @@
       <mustSupport value="true"/>
     </element>
   </differential>
-</StructureDefinition>
+</StructureDefinition>