Release R4B: May 28, 2022:

• Though the changes listed here seem quite extensive, they are limited to particular areas of the specification. See the explanation about R4B for further details
• Add CodeableReference and RatioRange types
• Add NutritionProduct Resource
• Add SubscriptionStatus and SubscriptionTopic Resources
• Add new Resources AdministrableProductDefinition, ClinicalUseDefinition, PackagedProductDefinition, ManufacturedItemDefinition and RegulatedAuthorization
• Rework MarketingStatus (relax cardinality constraints) and ProductShelfLife Types
• Rework & rename MedicinalProduct -> MedicinalProductDefinition
• Rework & rename MedicinalProductIngredient -> Ingredient
• Rework & rename SubstanceSpecification -> SubstanceDefinition
• Rework Evidence and EvidenceVariable Resources
• Add Citation and EvidenceReport Resources
• Remove EffectEvidenceSynthesis and RiskEvidenceSynthesis Resources
• Add canonical as an allowed type for subject[x] to ActivityDefinition and PlanDefinition
• Remove MedicinalProductAuthorization, MedicinalProductContraindication, MedicinalProductIndication, MedicinalProductInteraction, MedicinalproductManufactured, MedicinalproductPackaged, MedicinalproductPharmaceutical, MedicinalproductUndesirableEffect, SubstanceAmount, SubstanceNucleicAcid, SubstancePolymer, SubstanceProtein, SubstanceReferenceInformation and SubstanceSourceMaterial resources
• Refine some invariants that behaved erroneously with missing data (no new restrictions were introduced)

To help see and understand the differences between the specification releases, implementers can:

• review (or use) the R4/R4B difference analysis
• Use the "Compare To R4" link at the foot of every page

Technical Corrections to R4: Oct-30, 2019. Corrections to invariants & generated conformance resources, and add ANSI Normative Status Notes

This list of changes is farily long for a technical correction. The first set of changes should be reviewed for impact on implementations.

Corrections to the specification - resolving internal conflicts, or correcting definitional errors:

• Add Meta as a Special Type for Open Type Element list, allowing it to be used as a Parameter in Parameters.parameter, and in other places. The $meta operations required their use, but the design did not allow for this. [Task ]
• Change all code system OIDs to use the root 2.16.840.1.113883.4.642.4. instead of 2.16.840.1.113883.4.642.1. due to reassigning OID leaf values without updating the root in the past. This was causing problems for OID based terminology systems [Source ]
• Add new FHIRPath context variable %rootResource, and use it in ref-1 constraint - FHIRPath engines will need to support the new context variable [Task ]
• Fix genomics canonical URLS: http://www.ncbi.nlm.nih.gov/refseq/ -> http://www.ncbi.nlm.nih.gov/refseq, http://www.ncbi.nlm.nih.gov/clinvar/ -> http://www.ncbi.nlm.nih.gov/clinvar, and http://varnomen.hgvs.org/ -> http://varnomen.hgvs.org - these are now corrected back to what they had said in R3 [Task ]
• Fix Binding for FamilyMemberHistory.sex - it had a reference to the administrative gender value set, but it wrongly referred to the one on http://build.fhir.org; corrected to reference the one in the specification [Task ]

Changes to Constraints and generated definitions (fixing problems in validation, no impact on implementations, except for code generators):

• Fix expressions for Search parameters SubstanceSpecification-code and StructureDefinition-ext-context [Task ]
• Fix the definition of the Mother's Maiden name search parameter from extension(http://hl7.org/fhir/SearchParameter/patient-extensions-Patient-mothersMaidenName) to extension('http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName') [Task ]
• Fix the extension context for iso21090-nullFlavor and iso21090-preferred to any Element, not any Resource [Task ]
• Remove MultipleAnd/MultipleOr/Modifiers from generated Search Parameters [Task ]
• Add "ge" as a comparator to generated search parameters [Task ]
• Add extension operationdefinition-allowed-type, and use it to capture the definition of the property.value parameter is captured in the OperationDefinition that describes it [Task ]
• Fix how the type of Element.id and Extension.url is defined in the generated StructureDefinitions [Task ]
• Fix up the definition of ElementDefinition.type.code for special elements (Element.id, Extension.url, [Primitive].value) [Task ]
• Regenerate StructureDefinition snapshots to fix various snapshot and id issues [Task , Task ]

Documentation Corrections and Clarifications (no implementer impact):

• Add ANSI notes
• Fix FMM levels for Device (0 to 2), DeviceRequest (0 to 1), ResearchStudy (0 to 1), and ResearchSubject (0 to 1) [Task ]
• Fix up search parameter table [Task , Task ]
• Fix definition of IssueType.exception [Task ]
• Remove Erroneous Normative Marker on message-events value set [Task ]
• Fix various broken internal links & R3 Comparison links + JSON Schema link in downloads [Task , Task , Task ]
• Add note about markdown and XML signatures (to both XML and Signature pages) [Task ]
• Update language about specification status in summary page [Task ]
• Clarify copyright statement for NUBC derived codes (here and here)
• Remove spurious paragraph about R3 version status [Task ]
• Add note about FHIRPath Quantity usage [Task ]
• Fix profiling examples [Task ]
• Fix the FHIRPath expressions for the following invariants: sdf-8, sdf-8a, sdf-9, sdf-15, sdf-17, sdf-16, con-3, eld-4, eld-18, ait-1, ait-2, obs-7, bnd-10 and vs-2 + fix the description for eld-8 [Task , Task , Task , Task , Task , Task , Task , Task , Task , Task ]
• Fix the XPath invariant for dom-3 [Source ]
• Fix the definition for entered-in-error for Event, Request and SupplyDelivery [Source ]
• Fix the short descriptions for the following code elements: ActivityDefinition.intent, AppointmentResponse.participantStatus, CarePlan.status, CarePlan.activity.detail.kind, ClinicalImpression.status, CodeSystem.filter.operator, Communication.status, Communication.priority, CommunicationRequest.status, CommunicationRequest.priority, Contract.status, Contract.contentDefinition.publicationStatus, DeviceRequest.status, DeviceRequest.intent, DeviceRequest.priority, DocumentReference.docStatus, GraphDefinition.link.target.compartment.code, Media.status, MedicationDispense.status, MedicationRequest.intent, NutritionOrder.status, NutritionOrder.intent, Procedure.status, RequestGroup.status, RequestGroup.intent, ServiceRequest.status and ServiceRequest.intent - they had been listing the wrong codes [Source ]
• Fix Implicit SNOMED CT Value sets in example concept maps [Task ]

This technical correction also includes earlier changes made without releasing a new version:

• Fix external links for the Implementation Guide Registry and the FHIR Registry [Task ]

R4: Dec 27, 2018. First Normative content, with many significant changes

Note that between R3 and R4, nearly 3000 change proposals were applied to the specification, including >1000 substantive changes, of which 339 were labeled 'non-compatible'. As such, providing a comprehensive list of changes between specifications is not appropriate. To help see and understand the differences between the specification releases, implementers can review (or use) the R3/R4 transforms

To help implementers, the more significant changes are listed here:

• Some content marked Normative using N - see Documentation and Resource indexes. The meaning of normative is described at length in the Rules for Inter-version change.
• New Resources:
  • BiologicallyDerivedProduct
  • CatalogEntry
  • ChargeItemDefinition
  • DeviceDefinition
  • EffectEvidenceSynthesis
  • EventDefinition
  • Evidence
  • EvidenceVariable
  • ExampleScenario
  • ImmunizationEvaluation
  • InsurancePlan
  • Invoice
  • MedicationKnowledge
  • MedicinalProduct
  • MedicinalProductAuthorization
  • MedicinalProductContraindication
  • MedicinalProductIndication
  • MedicinalProductIngredient
  • MedicinalProductInteraction
  • MedicinalProductManufactured
  • MedicinalProductPackaged
  • MedicinalProductPharmaceutical
  • MedicinalProductUndesirableEffect
  • ObservationDefinition
  • OrganizationAffiliation
  • ResearchDefinition
  • ResearchElementDefinition
  • RiskEvidenceSynthesis
  • SpecimenDefinition
  • SubstancePolymer
  • SubstanceReferenceInformation
  • SubstanceSpecification
  • TerminologyCapabilities
  • VerificationResult
• Renamed Resources:
  • BodySite -> BodyStructure
  • EligibilityRequest -> CoverageEligibilityRequest
  • EligibilityResponse -> CoverageEligibilityResponse
  • Sequence -> MolecularSequence
  • ReferralRequest & ProcedureRequest -> ServiceRequest
• Deleted Resources:
  • DeviceComponent
  • ImagingManifest
• Clarification of the meaning and use of IsModifier
• Considerable development of the Version Management Policy, and support for multiple FHIR versions (specifically, the FHIR Version parameter)
• Datatypes: Rework Money (no longer a constraint on Quantity), and add Expression

Release R4 Ballot #1: Sept 20, 2018. R4 ballot #2

Major changes from R4 Ballot 1 (3.3.0):

This is only the major changes. More comprehensive lists can be found in the ballot introduction (later removed).

Major changes in the other parts of the specification:

• New Resources: MedicationKnowledge, DeviceDefinition, ChargeItemDefinition
• Renamed Resources: OrgnizationRole to OrganizationAffiliation, EligibilityRequest to CoverageEligibilityRequest, EligibilityResponse to CoverageEligibilityResponse, and ProductPlan to InsurancePlan
• Significant rework around devices - in the Device resource, remove DeviceComponent + new resource DeviceDefinition
• Update maps/diffs to R3 (see note above)
• New page listing best practices
• A sweeping change to code system and value set URLs to align with new terminology infrastructure
• Add information and operations related to supporting multiple versions of FHIR
• Rewrite Asynchronous Pattern Operation
• New security notes about suggested best practices, and new safety notes about deleting records
• Lots of changes to Financial Resources (especially Contract)

Release R4 Ballot #1: Apr 3, 2018. R4 ballot #1. Major changes from R3:

• Mark all content with a standards status - Normative, Trial use, Draft, or external
• Many minor & major changes to data types, resources, operations
• New Resources: BiologicallyDerivedProduct, CatalogEntry, EventDefinition, ExampleScenario, ImmunizationEvaluation, Invoice, ItemInstance, ObservationDefinition, OccupationalData, OrganizationAffiliation, SpecimenDefinition, TerminologyCapabilities, UserSession and VerificationResult, and a new set of resources for medication knowledge management: MedicinalProduct, MedicinalProductAuthorization, MedicinalProductClinicals, MedicinalProductDeviceSpec, MedicinalProductIngredient, MedicinalProductPackaged, MedicinalProductPharmaceutical , InsurancePlan, SubstancePolymer, SubstanceReferenceInformation and SubstanceSpecification.
• Renamed Resources: ProcedureRequest to ServiceRequest & BodySite to BodyStructure
• Removed Resources: DataElement, ImagingManifest and ServiceDefinition
• New Pages: Asynchronous Use, Persistence/Data bases, FiveWs Pattern and Multi-language support

Release R4 Draft: Dec 21, 2017. R4 draft ballot. Major changes:

• Ensure that all pages have a standards status, and enforce standards status throughout. Add dependency analysis
• Many minor changes to data types, resources, operations
• New Resources: CatalogEntry, SpecimenDefinition, ObservationDefinition, ExampleScenario, TerminologyCapabilities, UserSession, Invoice, InsurancePlan, OccupationalData, OrganizationAffiliation, VerificationResult, MedicinalProduct, MedicinalProductAuthorization MedicinalProductClinicals , MedicinalProductIngredient, MedicinalProductPackaged, MedicinalProductPharmaceutical MedicinalProductDeviceSpec , SubstanceSpecification, SubstancePolymer, SubstanceReferenceInformation, BiologicallyDerivedProduct, ItemInstance
• Add draft support for bulk data (Asynchronous API + nd-json format)

Release 3: Mar 21, 2017. STU3

This is the full FHIR Release 3 (R3). R3 is a complete overhaul of the specification from R2, with over 2400 change proposals process, and applied in R3. Of those changes, 380+ are labeled as a breaking change. Given this level of change, there is no useful way to present a single change list. Users can use the R2/R3 difference comparison, the R2 <-> R3 transforms, or the "Compare to R2" link at the foot of every page to help visualise the differences between R2 and R3.

Many of the changes made in this release (since 1.8.0) are in response to Quality Assurance processes in HL7, with a goal of readying the specification for Normative processes in R4:

• Reorder many resources and improve their definitions and bindings (Quality Assurance work)
• Add draft resources AdverseEvent and GraphDefinition
• Change to the way discriminators work in profiles (for profile/tooling authors)
• Finalization of the Turtle (RDF) format, along with JSON-LD (later removed)
• Consolidation of Vresion management issues into a single Version Policy page, and update to current policy
• Add rules about how missing data in search

Roll up: Of all the many changes (thousands) between R2 and R3, these are the most significant:

• Change the FHIR mime type to application/fhir+xml|json instead of application/xml|json+fhir (breaking change, for conformance to W3C+IETF rules)
• Rename the "Conformance" resource to "CapabilityStatement" and Deprecate use of the OPTIONS command to retrieve the CapabilityStatement
• Search Changes around errors in search parameters, missing data, sorting
• Change HumanName.family from 0..* to 0..1
• CodeSystem now separated out from ValueSet

FHIR Rolling Build, 2016 Dec onwards

FHIR QA Release, Dec 6, 2016

STU 3 Candidate, and also the basis for several implementation guide ballots and the San Antonio Jan 2017 Connectathon

Breaking Changes Summary:

• Change HumanName.family from 0..* to 0..1
• Rename MedicationOrder and DiagnosticOrder to MedicationRequest and DiagnosticRequest and make a series of changes to align with the Request Pattern
• Add cross resource search + rework composite parameter expressions
• Harmonise resource metadata across the Terminology, Conformance, and Knowledge resources
• Change the way versioned references to canonical URLs are handled
• REST - servers must return a location header on a create
• Condition status elements reworked

These are only the more significant changes, there were many 100s of changes made in response to ballot comments and ongoing implementation experience. These include breaking changes to may resources. Structural changes are summarized here, and Transforms between DSTU 2 and STU 3 are provided for many resources.

FHIR STU3 ballot, Aug 11, 2016

STU 3 ballot version, and also the basis for the Baltimore Sept 2016 Connectathon

Publication Changes:

• Move the US Realm implementation guides out of the specification (see http://www.fhir.org/guides/registry )
• Rework the home page, and introduce modules as a way to navigate the specification + add significant new implementer advice (e.g. "Getting Started")
• Change the Navigation menu to focus on indexes to the content in the specification
• Move FHIRPath expression language to its long term home

Technical Changes:

• RESTful API
  • Change the FHIR mime type to application/fhir+xml|json instead of application/xml|json+fhir (breaking change, for conformance to W3C+IETF rules)
  • Add new uses for the Prefer header (return OperationOutcome, and manage behavior related to unknown / unsupported search parameters
  • Deprecate use of the OPTIONS command to retrieve the CapabilityStatement
  • Add support for conditional references to the transaction interaction
  • Add reverse chaining
• Formats: No change to XML + JSON formats. Add Turtle Format, and related validation tools
• For Data Types and Resources, there is formal difference analysis from DSTU2 (also found throughout the specification), and transforms between DSTU 2 and STU 3 are provided for many resources

FHIR Current Build Update, July 8 2016

Update current version to 1.5 to prevent confusion with implementations still running the May 2016 version.

• There are many changes in this version from 1.4.0, but no formal list is provided. A formal list will be provided for 1.6 (as a diff to 1.4)

FHIR Connectathon 12 Snapshot, Mar 30 2016

Frozen base for Connectathon 12 & For Comment ballots:

• FHIR API and Serialization Format Enhancement
  • The _sort parameter has been reworked
  • New or extended search parameters for read, search or history: _type, _at, _summary, _elements
  • Change Turtle representation - now ready for trial
• Conformance resources with significant breaking changes and behavior:
  • StructureDefinition - Type Handling: Changes to how the structure definition types work: baseType replaces constrainedType (now type) & baseDefinition replaces base
  • CodeSystem now separated out from ValueSet: CodeSystem is now a first class resource type in order to support use throughout the FHIR eco-system, such as to support value set expansion and validation. It is intended to be used for distributing the smaller ad-hoc code systems that are ubiquitously encountered throughout the healthcare process.
• Other resources with significant breaking changes and behavior:
  • AllergyIntolerance
  • Appointment
  • AuditEvent
  • Claim
  • ClaimResponse
  • Device
  • ConceptMap
  • Conformance (now CapabilityStatement)
  • Contract
  • CoverageEligibilityRequest
  • CoverageEligibilityResponse
  • Device
  • DiagnosticRequest
  • ExplanationOfBenefit
  • Library
  • Measure
  • Medication
  • MedicationAdministration
  • MedicationStatement
  • Observation: the introduction of the Vital Signs Profile (proposed to be mandatory)
  • OperationDefinition
  • Patient
  • PaymentNotice
  • PaymentReconciliation
  • Practitioner
  • Provenance
  • ReferralRequest
  • Schedule
  • MolecularSequence
  • Slot
  • StructureDefinition
  • TestScript
  • ValueSet
• Add new draft resources:
  • CareTeam
  • CodeSystem
  • CompartmentDefinition
  • Linkage
  • MeasureReport
  • PractitionerRole
  • Protocol
  • StructureMap
  • Task

FHIR Connectathon 11 Snapshot, Dec 11 2015

Frozen base for Connectathon 11:

• Remove GuidanceRequest
• Add new draft resources: MolecularSequence, ExpansionProfile
• Modifications to Financial Resource & TestScript resource

Note: this version is temporary, and was removed after Connectathon 11 was complete

GAO Ballot + technical corrections, Dec 2 2015

A ballot publication for the GAO Ballot that also includes:

• Various technical corrections to the generated snapshots
• Populate FHIRPath expressions in extensions for all search parameters and invariants
• Add new draft resources: GuidanceRequest, GuidanceResponse, ModuleMetadata, ModuleDefinition, Library, DecisionSupportServiceModule, DecisionSupportRule, OrderSet, Measure
• Major restructure of Questionnaire

Technical Correction 1, Oct 24 2015

A series of technical corrections to the specification following extensive review:

• Corrections to Extension cardinalities in implementation guides
• Corrections in the conformance resources that support the specifications
• Correct several erroneous invariants
• Various typos, broken links, and fixes in examples
• For a comprehensive list of corrections, see the Task list for FHIR DSTU2 Technical Correction 1

DSTU 2, Sept 23 2015

Changes of significance during the QA process:

• Remove the Clinical Quality Improvement Framework (CQIF) from this published version
• made fixes to generated schematrons
• updated generated comformance resources (StructureDefinitions and SearchParameters) so they were consistent with the specification
• Many spelling / grammar / broken link fixes

DSTU 2 QA Preview, Aug 31 2015

This version had extensive change as a result of the May 2015 DSTU ballot, ongoing testing, and the open change proposals (1317 tasks). The extent of the changes is best illustrated by the number of the list of changes labeled 'breaking change' - 158 changes of 1317 total tasks. Below is a list of the most important changes:

• General: introduced the maturity framework
• RESTful API: add batch, several clarifications around versioning & transactional integrity, changed Bundle URL resolution rules
• Search: changed the way <> etc.works, added _list parameter, changed rules around contained and included resources
• Formats: added a note about whitespace in XML, added code generation schemas
• Data Types:
  • New data types: markdown, Annotation,
  • changed data types: Coding, Quantity, Signature, Timing, Address, ContactPoint
  • changes to ElementDefinition: add base, make type.profile repeat, remove invariant.name and replace with invariant.requirements, remove binding.name, add min/max value
• Resources:
  • New resources: Account, ImplementationGuide, TestScript
  • renamed: Contraindication -> DetectedIssue, MedicationPrescription -> MedicationRequest, QuestionnaireAnswers -> QuestionnaireResponse
  • removed: Supply
  • changed: almost all resources - too many to list (1317 tasks worth of changes) - add, remove elements, change types, references, definitions & value sets, re-order elements, provide much more documentation and new examples
• Implementation Guide:
  • Move Argonaut content out

DSTU Ballot, May 2015

This version had extensive change as a result of the January 2015 Draft ballot, ongoing testing, and the open change proposals (over 800 tasks). The list below is a summary of the major changes to resource content. It shows only a limited number of the overall changes.

Enumerations

• All spaces removed
• Extensive content changes not noted here

New Data Types

• unsignedInt
• positiveInt
• Signature
• Meta

Changed Data Types

• Coding - remove valueSet property
• Attachment - add creation
• Identifier - replace label with type
• Timing - major rework of content
• ElementDefinition - add label, code, rename 'formal' to definition, rename synonym to alias, add language to mapping, remove conformance and isExtensible and replace with strength

New Resources

• BodySite
• Claim

Removed Resources

• CarePlan2 -> collapsed into CarePlan
• FamilyHistory -> broken up into FamilyMemberHistory
• InstitutionalClaim, OralHealthClaim, PharmacyClaim, ProfessionalClaim, VisionClaim -> collapsed into Claim
• Other - use Basic instead
• PendedRequest,Readjudicate, Reversal, StatusRequest, StatusResponse - use ProcessRequest/Response instead
• SupportingDocumentation - use DocumentManifest instead
• ProcessRequest, ProcessResponse - use Task instead

Renamed Resources

• Alert -> Flag: 'alert' made people think it was an action like an alarm
• SecurityEvent -> AuditEvent: it wasn't just for security purposes
• ClinicalAssessment -> ClinicalImpression: people got confused with 'assessment' tools like APGAR score
• Profile -> StructureDefinition: 'Profile' is the process, a package of statements

Changes Inside Resources

• Parameters - allow parameter.part to contain a resource
• AllergyIntolerance - rename subject to patient
• Appointment - remove lastModifiedBy/lastModified, add location
• AppointmentResponse - remove lastModifiedBy/lastModified, add rename individual to actor
• AuditEvent - add .event.purposeOfEvent, participant.location, .policy, and .purposeOfUse
• Bundle - major reorganization
• CarePlan - pull goal out + other reorganization
• ClinicalImpression - add status, replace careplan & referral with trigger, rename diagnosis to finding, make plan 0..*,
• Composition - change .section.content to refer to List only, not any
• ConceptMap - change identifier to url, add useContext, change telecom to contact,
• Condition - rename subject to patient, rename status to clinicalStatus, change to bodySite = code or Reference(BodySite), rename .codeableConcept to .code
• Conformance (now CapabilityStatement) - change identifier to url, add useContext, change telecom to contact, add requirements and copyright, add support for conditional operations,
• Contract - extensive rewrite
• Coverage - add bin, subscriberId
• DataElement (now StructureDefinition) - total rewrite to use ElementDefinition
• Device - add status, manufactureDate
• DeviceMetric - rename operationalState to operationalStatus, add measurementMode, rename calibrationInfo to calibration, change color to an enumerations
• DeviceRequest/DeviceUseStatement - change to bodySite = code or Reference(BodySite)
• DiagnosticRequest- change to bodySite = code or Reference(BodySite)
• DiagnosticReport - add encounter
• DocumentManifest - add options for how content is referred to
• DocumentReference - add format, remove policyManager, make content : Attachment, and remove several related attributes, remove service reference and add context.practiceSetting, sourcePatientInfo, and related
• Encounter - add incomingReferralRequest, allow reason to repeat, rename diet to dietPreference
• EpisodeOfCare - rename currentStatus to status, allow referralRequest to repeat,
• Flag - rename subject to patient, change from note to code
• Goal - add targetDate, statusDate, author, priority
• HealthcareService - extensive rewrite
• ImagingObjectSelection - remove retrieveAETitle, rename retrieveUrl to url, add frames
• ImagingStudy - add laterality, change url to attachment
• Immunization - add encounter, rename subject to patient, rename refusedIndicator to wasNotGiven, rename refusalReason to reasonNotGiven
• ImmunizationRecommendation - rename subject to patient
• List - add title, status, change ordered to orderedBy, add note
• Location - remove status
• Media - remove created (-> Attachment)
• Medication - add batch
• MedicationAdministration - add reasonGiven, note, text. remove timing & maxDosePerPeriod
• MedicationDispense - collapse to a single dispense, add daysSupply, note and substitution, change quantity to allow range
• MedicationRequest - add note, change quantity to allow range,
• MedicationStatement - add informationSource, status, dateAsserted, replace whenGiven with effective[x], remove device, add dosage.text
• NamingSystem - add date, publisher,
• NutritionOrder - extensive rewrite
• Observation - change name to code, allow more types of value[x], change type of dataAbsentReason, change to bodySite = code or Reference(BodySite), allow identifier to repeat, add device,
• OperationDefinition - change identifier to url, add useContext, change telecom to contact, change name to title, add reuqirements, idempotent,
• OperationOutcome - change type of .issue.type
• OrderResponse - rename code to orderStatus
• Organization - remove location and contact.gender
• Patient - communication to allow 'preferred'
• Person - rename other to target
• Practitioner - change type of birthDate, allow multiple roles per practitioner
• Procedure - add status and category, change to bodySite = code or Reference(BodySite), allow date to be period too, add location, change followUp to code 0..*, add device tracking
• ServiceRequest - change to bodySite = code or Reference(BodySite)
• Provenance - change integritySignature to signature & make it a type, allow reference by Reference as well as URI
• Questionnaire - add telecom
• Schedule - move lastModified
• SearchParameter - change telecom to contact, add status, experimental, date,
• Slot - move lastModified
• Specimen - change source to parent, change to bodySite = code or Reference(BodySite)
• StructureDefinition - complete rewrite
• Subscription - change type of tag, reanme url to endPoint,
• ValueSet - change identifier to url, add useContext, change telecom to contact, replace purpose with useContext, add requirements, rename stableDate to lockedDate, change type of expansion.identifier, add expansion parameters

Draft For Comment, January 2015 Ballot

Breaking Changes (full list):

• Replace atom and taglist with a native Bundle format (3728 , 3558 , 2889 ) (and also Binary)
• JSON: change how extensions are represented (3471 )
• RESTful API: change how version specific upgrades work (3451 )
• DataTypes:
• Rename Schedule to Timing (3536 , 3236 )
• Rename Contact to ContactPoint (3533 ) and swap order of elements (3108 ))
• Address - change zip to postCode (2888 )
• Quantity: Correct schema spelling for "QuantityCompararator" (3531 )
• Change allowable values for the id type to include capital letters, and allow up to 64 chars (3750 )
• Restructure Profile - only one structure, and pull ExtensionDefinition out of Profile (3647, 3498), and pull SearchParameter out (3626 )
• Profile: allow 0..* discriminator (3131 ), and change the way discriminators work across resource boundaries (3124 ) + generate multiple types properly (2856 )
• remove _validate interaction, and replace with $validate operation (3686 )
• Patient: separate birth time from birthDate (3731 ), Change Administrative Gender from a CodableConcept to a Code. Also fixed the values as male|female|other|unknown with mappings to v2 and v3 (3070 )
• DocumentReference: change encoding of Hash to Base64 (3291 )
• Group: rename header to title (3126 )
• Condition: split relatedItem into two (3111 )
• Questionnaire: drop questionnaire.group.question.remarks (3255 ) and move omitReason from extension to base resource (3260 )
• QuestionnaireResponse: allow multiple answers (3146 )
• ValueSet: replace ValueSet.compose.include.code with ValueSet.compose.include.concept (3258 ), added new rules about expansion content (3138 )
• Media: Rename element 'dateTime' to 'created' (3174 ) and length to duration (2866 )
• Remove DeviceObservationReport and Query
• Collapse AdverseReaction into AllergyIntolerance
• Appointment changes - individual field renamed to actor, and added mappings to HL7 v2 and HL7 v3
• FamilyMemberHistory combined with List replaces FamilyHistory (with corresponding updates to related profiles)
• Flag replaces Alert including improved clarification of how it is used and replacement of "note" with "code"
• CarePlan significantly refactored including splitting Goal out as a distinct resource, moving elements between activity and detail, introduction of several new elements and supported relationship types

New Resources:

• Appointment
• AppointmentResponse
• Basic
• ClaimResponse
• ClinicalImpression
• Communication
• CommunicationRequest
• Contract
• Contraindication
• Coverage
• CoverageEligibilityRequest
• CoverageEligibilityResponse
• DataElement (now StructureDefinition)
• DeviceMetric
• DeviceRequest
• DeviceUseStatement
• EnrollmentRequest
• EnrollmentResponse
• EpisodeOfCare
• ExplanationOfBenefit
• StructureDefinition
• Goal
• HealthcareService
• ImagingObjectSelection
• InstitutionalClaim
• NamingSystem
• NutritionOrder
• OperationDefinition
• OralHealthClaim
• PaymentNotice
• PaymentReconciliation
• Person
• PharmacyClaim
• ServiceRequest
• ProfessionalClaim
• QuestionnaireResponse
• ReferralRequest
• RiskAssessment
• SearchParameter
• Schedule
• Slot
• Subscription
• SupportingDocumentation
• VisionClaim
• VisionPrescription

New Implementation Guides (see discussion of status)

• Argonaut Project
• Data Access Framework
• Structured Data Capture & Structured Data Capture - Data Element Exchange
• US Laboratory Order, Report & Report to Public Health
• EHRS Functional model - Record Lifecycle Events

• Renamed Namespace to NamingSystem
• Split QuestionnaireResponse from Questionnaire and significantly revamped the Questionnaire in response to feedback from the Connectathon.
• Added DataElement (now StructureDefinition) resource (has been previously discussed as ObservationDefinition)
• Defined Subscription resource for evaluation
• Add time data type
• Define RPC-type operations on the RESTful interface, and add Operation Definition
• Defined operations on several resources including ConceptMap, Questionnaire and ValueSet
• Conformance (now CapabilityStatement): Change Conformance.rest.operation to Conformance.rest.interaction and Conformance.rest.resource.operation to Conformance.rest.resource.interaction, and add Conformance.rest.operation to point to Operation Definition
• Profile: add Profile.url, Profile.structure.snapshot and Profile.structure.differential, and remove query definition (now in OperationDefinition)
• Add pages for LOINC, RxNorm, and SNOMED CT
• Significant rework for ConceptMap so it can be used to map between structures as well as value sets
• Add Contraindication and Risk Assessment and added examples to other resources in support of these
• Add Referral Request
• Add supportingInformation to DiagnosticRequest
• Add fulfills to Encounter
• Add date and age[x] to FamilyHistory
• Change cardinality of Location.identifier to 0..*
• Change cardinality of Practitioner.address to 0..*
• Add Observation.encounter to 0..*
• Temporarily added content for the Structured Data Capture implementation guide , including profiles on several resources, conformance instances, etc. This content will be moved to an external specification once the necessary tooling is in place to support that form of publication.

• Minor new optional elements on value set for metadata, new extensions for all the rest of the VSD project metadata, formal profile to express basic minimum metadata for value set

• Namespace: adjustments based on Grahame's feedback

• Add Appointment, Appointment Response, Schedule and Slot
• Add Namespace