Name Flags Card. Type Description & Constraints AuditEvent 0..* AuditEventRmdOperationFailed Event record kept for security purposes entity 2..* BackboneElement Data or objects used entity:patient 1..1 BackboneElement Data or objects used what 1..1 Reference(Patient) Specific instance of resource type 1..1 Coding Person Required Pattern: At least the following system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/audit-entity-type code 1..1 code Symbol in syntax defined by the system Fixed Value: 1 role 1..1 Coding Patient Required Pattern: At least the following system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/object-role code 1..1 code Symbol in syntax defined by the system Fixed Value: 1 Documentation for this format
ResMed Patient Operation Failed AuditEvent
Basic AuditEvent for a failed REST-ful operation with known Patient subject
A record of an event made for purposes of maintaining a security log. Typical uses include detection of intrusion attempts and monitoring for inappropriate usage.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
agent.who.identifier.exists(system = 'http://terminology.resmed.com/CodeSystem/resmed-system-identifier')
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifier for a family of the event. For example, a menu item, program, rule, policy, function code, application name or URL. It identifies the performed function.
This identifies the performed function. For "Execute" Event Action Code audit records, this identifies the application function performed.
.code (type, subtype and action are pre-coordinated or sent as translations)
This field enables queries of messages by implementation-defined event categories.
Type of action performed during the event
Indicator for type of action performed during the event that generated the audit.
This broadly indicates what kind of action was done on the AuditEvent.entity by the AuditEvent.agent.
Indicator for type of action performed during the event that generated the event.
The period during which the activity occurred.
The period can be a little arbitrary; where possible, the time should correspond to human assessment of the activity time.
In a distributed system, some sort of common time base (e.g. an NTP [RFC1305] server) is a good implementation tactic.
This ties an event to a specific date and time. Security audits typically require a consistent time base (e.g. UTC), to eliminate time-zone issues arising from geographical distribution.
Indicates whether the event succeeded or failed.
In some cases a "success" may be partial, for example, an incomplete or interrupted transfer of a radiological study. For the purpose of establishing accountability, these distinctions are not relevant.
A free text description of the outcome of the event.
The purposeOfUse (reason) that was used during the event being recorded.
Use AuditEvent.agent.purposeOfUse when you know that it is specific to the agent, otherwise use AuditEvent.purposeOfEvent. For example, during a machine-to-machine transfer it might not be obvious to the audit system who caused the event, but it does know why.
* .reasonCode [ControlActReason when Act.class = CACT Control Act] *.outboundRelationship[typeCode=RSON].target
An actor taking an active role in the event or activity that is logged.
Several agents may be associated (i.e. have some responsibility for an activity) with an event or activity. For example, an activity may be initiated by one user for other users or involve more than one user. However, only one user may be the initiator/requestor for the activity.
An agent can be a person, an organization, software, device, or other actors that may be ascribed responsibility.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Specification of the participation type the user plays when performing the event.
The Participation type of the agent to the event.
The security role that the user was acting under, that come from local codes defined by the access control security system (e.g. RBAC, ABAC) used in the local context.
Should be roles relevant to the event. Should not be an exhaustive list of roles.
This value ties an audited event to a user's role(s). It is an optional value that might be used to group events for analysis by user functional role categories.
What security role enabled the agent to participate in the event.
Reference to who this agent is that was involved in the event.
Where a User ID is available it will go into who.identifier.
This field ties an audit event to a specific resource or identifier.
Alternative agent Identifier. For a human, this should be a user identifier text string from authentication system. This identifier would be one known to a common authentication system (e.g. single sign-on), if available.
In some situations, a human user may authenticate with one identity but, to access a specific application system, may use a synonymous identify. For example, some "single sign on" implementations will do this. The alternative identifier would then be the original identify used for authentication, and the User ID is the one known to and used by the application.
The User ID and Authorization User ID may be internal or otherwise obscure values. This field assists the auditor in identifying the actual user.
Indicator that the user is or is not the requestor, or initiator, for the event being audited.
There can only be one initiator. If the initiator is not clear, then do not choose any one agent as the initiator.
This value is used to distinguish between requestor-users and recipient-users. For example, one person may initiate a report-output to be sent to another user.
If participation.typeCode was author, then true
* Role.Class =SDLOC *Role.Code = ServiceDeliveryLocationRoleType *Entity.Code = PlaceEntityType = df.Types of places for Entity.Class = PLC *EntityClass = PLC = df.A physical place or site with its containing structure. May be natural or man-made. The geographic position of a place might or might not be constant.
The policy or plan that authorized the activity being recorded. Typically, a single activity may have multiple applicable policies, such as patient consent, guarantor funding, etc. The policy would also indicate the security token used.
For example: Where an OAuth token authorizes, the unique identifier from the OAuth token is placed into the policy element Where a policy engine (e.g. XACML) holds policy logic, the unique policy identifier is placed into the policy element.
This value is used retrospectively to determine the authorization policies.
Type of media involved. Used when the event is about exporting/importing onto media.
Usually, this is used instead of specifying a network address. This field is not used for Media Id (i.e. the serial number of a CD).
Used when the event is about exporting/importing onto media.
Logical network location for application activity
Logical network location for application activity, if the activity has a network location.
Identifier for the network access point of the user device
An identifier for the network access point of the user device for the audit event.
This could be a device id, IP address or some other identifier associated with a device.
This datum identifies the user's network access point, which may be distinct from the server that performed the action. It is an optional value that may be used to group events recorded on separate servers for analysis of a specific network access point's data access across all servers.
An identifier for the type of network access point that originated the audit event.
This datum identifies the type of network access point identifier of the user device for the audit event. It is an optional value that may be used to group events recorded on separate servers for analysis of access according to a network access point's type.
The type of network access point of this agent in the audit event.
The reason (purpose of use), specific to this agent, that was used during the event being recorded.
Use AuditEvent.agent.purposeOfUse when you know that is specific to the agent, otherwise use AuditEvent.purposeOfEvent. For example, during a machine-to-machine transfer it might not be obvious to the audit system who caused the event, but it does know why.
*.reasonCode [ActHealthInformationPurposeOfUseReason codes/v:PurposeOfUse (2.16.840.1.113883.1.11.20448) * .outboundRelationship[typeCode=RSON or SUBJ].target
A user agent profile that (sort of) follows the IHE.BasicAudit.OAUTHaccessTokenUse.Minimal profile.
Extensions are always sliced by (at least) url
Literal reference, Relative, internal or absolute URL
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Type the reference refers to (e.g. "Patient")
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
usual | official | temp | secondary | old (If known)
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Identifies the purpose for this identifier, if known .
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Allows users to make use of identifiers when the identifier system is not known.
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Identifier.system is always case sensitive.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
Time period when id is/was valid for use
Time period during which identifier is/was valid for use.
Role.effectiveTime or implied by context
Organization that issued id (may be just text)
Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Since multi-tier, distributed, or composite applications make source identification ambiguous, this collection of fields may repeat for each application or process actively involved in the event. For example, multiple value-sets can identify participating web servers, application processes, and database server threads in an n-tier distributed application. Passive event participants (e.g. low-level network transports) need not be identified.
.participation[typeCode=INF].role[classCode=ASSIGN].player[classCode=DEV, determinerCode=INSTANCE]
The fully qualified domain name of the ResMed system authoring these events.
Logical source location within the healthcare enterprise network. For example, a hospital or other provider location within a multi-entity provider group.
This value differentiates among the sites in a multi-site enterprise health information system.
Identifier of the source where the event was detected.
This field ties the event to a specific source system. It may be used to group events for analysis according to where the event was detected.
The type of source where event originated
Code specifying the type of source where event originated.
This field indicates which type of source is identified by the Audit Source ID. It is an optional value that may be used to group events for analysis according to the type of source where the event occurred.
Code specifying the type of system that detected and recorded the event.
Specific instances of data or objects that have been accessed.
Required unless the values for event identification, agent identification, and audit source identification are sufficient to document the entire auditable event. Because events may have more than one entity, this group can be a repeating set of values.
The event may have other entities involved.
not(exists(f:name)) or not(exists(f:query))
.outboundRelationship[typeCode=SUBJ].target or .participation[typeCode=SBJ].role
Identifies a specific instance of the entity. The reference should be version specific.
ParticipantObjectID and ParticipantObjectIDTypeCode
Provenance.target, Provenance.entity.what
The type of the object that was involved in this audit event.
This value is distinct from the user's role or any user relationship to the entity.
To describe the object being acted upon. In addition to queries on the subject of the action in an auditable event, it is also important to be able to query on the object type for the action.
Code for the entity type involved in the audit event.
Code representing the role the entity played in the event being audited.
For some detailed audit analysis it may be necessary to indicate a more granular type of entity, based on the application role it serves.
Code representing the role the entity played in the audit event.
role.code (not sure what this would mean for an Act)
Identifier for the data life-cycle stage for the entity.
This can be used to provide an audit trail for data, over time, as it passes through the system.
Institutional policies for privacy and security may optionally fall under different accountability rules based on data life cycle. This provides a differentiating value for those cases.
target of ObservationEvent[code="lifecycle"].value
Security labels for the identified entity.
This field identifies the security labels for a specific instance of an object, such as a patient, to detect/track privacy and security issues.
Security Labels from the Healthcare Privacy and Security Classification System.
A name of the entity in the audit event.
This field may be used in a query/report to identify audit events for a specific person. For example, where multiple synonymous entity identifiers (patient number, medical record number, encounter number, etc.) have been used.
Use only where entity can't be identified with an identifier.
Text that describes the entity in more detail.
The query parameters for a query-type entities.
The meaning and secondary-encoding of the content of base64 encoded blob is specific to the AuditEvent.type, AuditEvent.subtype, AuditEvent.entity.type, and AuditEvent.entity.role. The base64 is a general-use and safe container for event specific data blobs regardless of the encoding used by the transaction being recorded. An AuditEvent consuming application must understand the event it is consuming and the formats used by the event. For example, if auditing an Oracle network database access, the Oracle formats must be understood as they will be simply encoded in the base64binary blob.
For query events, it may be necessary to capture the actual query input to the query process in order to identify the specific event. Because of differences among query implementations and data encoding for them, this is a base 64 encoded data blob. It may be subsequently decoded or interpreted by downstream audit analysis processing.
Tagged value pairs for conveying additional information about the entity.
Implementation-defined data about specific details of the object accessed or used.
.inboundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN]
The type of extra detail provided in the value.
The value can be string when known to be a string, else base64 encoding should be used to protect binary or undefined content. The meaning and secondary-encoding of the content of base64 encoded blob is specific to the AuditEvent.type, AuditEvent.subtype, AuditEvent.entity.type, and AuditEvent.entity.role. The base64 is a general-use and safe container for event specific data blobs regardless of the encoding used by the transaction being recorded. An AuditEvent consuming application must understand the event it is consuming and the formats used by the event. For example if auditing an Oracle network database access, the Oracle formats must be understood as they will be simply encoded in the base64binary blob.
Should not duplicate the entity value unless absolutely necessary.
An entity representing the client request ID. This is a replication of the same entity found in the IHE BALP profiles.