EHDS Logical Information Models
0.1.0 - ci-build

EHDS Logical Information Models, published by Xt-EHR. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Xt-EHR/xt-ehr-common/tree/stakeholder-consultation-D6-1 and changes regularly. See the Directory of published versions

## Logical Model: Patient summary model

Official URL: https://www.xt-ehr.eu/specifications/fhir/StructureDefinition/EHDSPatientSummary | Version: 0.1.0
Draft as of 2025-07-08 | Computable Name: EHDSPatientSummary

EHDS refined base model for Patient Summary

Patient summary consists of several sections of which some are suggested to be mandatory to support. For each mandatory section, implementers should as a minimum be able to produce a generated narrative text of the content, as well as certain structured elements. There are only few elements that are suggested as required to support at this point.

While the overall use cases for exchanging a full Patient Summary (PS) remain consistent—typically aiming to support patients access to its own data, transfer of data between systems and cross-border care (both emergency access, and continuity of care)—it is acknowledged that, in practice, implementers will need to support multiple variants of these use cases, depending on the context. In some cases, only a subset of the PS (e.g. just medications, allergies, or vaccinations) will be relevant or exchanged. As such, each section of the Patient Summary is described and handled independently, with clear guidance on both the narrative and structured data elements expected for that section.

The information elements and value sets suggested are mainly taken from eHN Guideline, MyHealth@EU and HL7 FHIR IPS. Some additions or adjustments have been made, based on input from the working group of this deliverable. These are described in each section.

Usages:

- This Logical Model is not used by any profiles in this Implementation Guide

### Views of Logical Model

Description of Differentials, Snapshots and how the different presentations work.

- Differential Table
- Snapshot Table

This structure is derived from EHDSDocument

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
EHDSPatientSummary |  | 0..* | EHDSDocument | Elements defined in Ancestors:header, presentedForm, header, knowledgeResources Patient summary model Instances of this logical model can be the target of a Reference
alerts |  | 1..1 | Base | Section: Alerts.
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
emptyReason |  | 0..1 | CodeableConcept | Reason for absence of data
medicalAlert |  | 0..* | EHDSAlert | Description of medical alerts in textual format: any clinical information that is imperative to know so that the life or health of the patient does not come under threat.
allergiesAndIntolerances |  | 1..1 | Base | Section: Allergies and intolerances
narrative |  | 1..1 | string | Text summary of the content in section
allergyIntolerance |  | 0..* | EHDSAllergyIntolerance | List of structured allergies and intolerances
emptyReason |  | 0..1 | CodeableConcept | Use if no Allergies are listed Binding Description: (preferred): 1.3.6.1.4.1.12559.11.10.1.3.1.42.47eHDSIAbsentOrUnknownAllergy; http://hl7.org/fhir/ValueSet/list-empty-reason
problems |  | 1..1 | Base | Medical problems.
narrative |  | 0..1 | string | Text summary of the content in the section
emptyReason |  | 0..1 | CodeableConcept | Use if no conditions are listed
problems |  | 0..* | EHDSCondition | !!Health conditions affecting the health of the patient.!!
medicationSummary |  | 1..1 | Base | Section: Medication Summary.
narrative |  | 0..1 | string | Text summary of the content in the section
emptyReason |  | 0..1 | CodeableConcept | Use if no medicines are listed
medicationTreatment |  | 0..* | EHDSMedicationStatement | Medication treatment/prescription relevant for this patient summary. Typically, medications whose period of time indicated for the treatment has not yet expired whether it has been dispensed or not.
medicalDevicesAndImplants |  | 1..1 | Base | Section: Medical devices and implants
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
emptyReason |  | 0..1 | CodeableConcept | Reason for absence of data
medicalDevice |  | 0..* | EHDSDeviceUse | Describes the patient's implanted and external medical devices and equipment that their health status depends on. Includes devices (such as cardiac pacemakers, implantable defibrillator, prothesis, ferromagnetic bone implants etc.) that are important to know by the HP.
procedures |  | 1..1 | Base | Section: Procedures
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
emptyReason |  | 0..1 | CodeableConcept | Reason for absence of data
procedure |  | 0..* | EHDSProcedure | List of procedures
vaccination |  | 0..1 | Base | Section: Vaccination/prophylaxis.
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
vaccination |  | 0..* | EHDSImmunisation | Immunisations given to the patient and their status at the point of care.
functionalStatus |  | 0..1 | Base | Section: Functional status
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
functionalStatusAssessment |  | 0..* | EHDSFunctionalStatus | An individual's ability to perform normal daily activities required to meet basic needs, fulfil usual roles and maintain health and well-being
socialHistory |  | 0..1 | Base | Section: Social history.
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
socialHistoryObservation |  | 0..* | EHDSSocialHistory | Social history observations related to health
pregnancyHistory |  | 0..1 | Base | Section: Pregnancy history
generatedNarrative |  | 0..1 | string | Generated text summary of the content in the section, for human interpretation
currentPregnancyStatus |  | 0..1 | EHDSCurrentPregnancy | Current pregnancy status
previousPregnanciesStatus |  | 0..1 | CodeableConcept | Overall status of previous pregnancies
previousPregnancies |  | 0..* | EHDSPregnancyHistory | History of previous pregnancies
travelHistory |  | 0..1 | Base | Relevant information about the patient's recent travel history
narrative |  | 0..1 | string | Text summary of the content in the section
travelHistory |  | 0..* | EHDSTravelHistory | Travel history for one country
patientStory |  | 0..1 | Base | What the patient believes to be important for the attending clinician to know.
narrative |  | 0..1 | string | Text summary of the content in the section
advanceDirectives |  | 0..1 | Base | Section: Advance Directives.
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
advanceDirective |  | 0..* | EHDSAdvanceDirective | Provision for healthcare decisions if, in the future, a person is unable to make those decisions
results |  | 0..1 | Base | Section: Observation results.
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
resultObservation[x] |  | 0..* |  | Observation results pertaining to the subject of care's health condition and which might have impact on future treatments
resultObservationEHDSObservation |  |  | EHDSObservation |
resultObservationEHDSLaboratoryObservation |  |  | EHDSLaboratoryObservation |
carePlan |  | 0..1 | Base | Section: Care plans.
narrative |  | 0..1 | string | Narrative containing the plan including proposals, goals, and order requests for monitoring, tracking, or improving the condition of the patient. In the future it is expected that this Section could be provided in a structured and coded format.
carePlanEntry |  | 0..* | EHDSCarePlan | Describes the intention of how one or more practitioners intend to deliver care for a particular patient for a period of time, possibly limited to care for a specific condition or set of conditions.
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
EHDSPatientSummary.allergiesAndIntolerances.emptyReason | preferred |

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
EHDSPatientSummary |  | 0..* | EHDSDocument | Elements defined in Ancestors:header, presentedForm, header, knowledgeResources Patient summary model Instances of this logical model can be the target of a Reference
header |  | 1..1 | Base | Document header elements
subject |  | 1..1 | EHDSPatient | Subject
identifier |  | 1..* | Identifier | Document ID
authorship |  | 1..* | Base | Authorship
author[x] |  | 1..1 |  | Author
authorEHDSHealthProfessional |  |  | EHDSHealthProfessional |
authorEHDSOrganisation |  |  | EHDSOrganisation |
authorEHDSDevice |  |  | EHDSDevice |
datetime |  | 1..1 | dateTime | Date and time of authoring/issuing
lastUpdate |  | 0..1 | dateTime | Date and time of the last update to the resource
status |  | 1..1 | CodeableConcept | Status of the resource
statusReason[x] |  | 0..1 |  | Reason for the current status of the resource.
statusReasonCodeableConcept |  |  | CodeableConcept |
statusReasonString |  |  | string |
language |  | 0..1 | CodeableConcept | Language Binding Description: (preferred): BCP 47
version |  | 0..1 | string | Version
documentType |  | 1..1 | CodeableConcept | Document type Binding Description: (preferred): LOINC
documentTitle |  | 1..1 | string | Document title
documentStatus |  | 1..1 | CodeableConcept | Document status Binding Description: (preferred): hl7:CompositionStatus
period |  | 0..1 | Period | Period
attestation |  | 0..* | Base | Attestation
attester |  | 1..1 | EHDSHealthProfessional | Attester
datetime |  | 1..1 | dateTime | DateTime
legalAuthentication |  | 0..1 | Base | Legal authentication
legalAuthenticator |  | 1..1 | EHDSHealthProfessional | Legal authenticator
datetime |  | 1..1 | dateTime | DateTime
eventType |  | 0..* | CodeableConcept | Event type Binding Description: (preferred): LOINC, SNOMED CT, dicom-cid-33-Modality
authorSpecialty |  | 0..* | CodeableConcept | Specialty Binding Description: (preferred): SNOMED CT
custodian |  | 1..1 | EHDSOrganisation | Document custodian
documentFormat |  | 0..1 | CodeableConcept | Document format Binding Description: (preferred): HL7 Document Format Codes
confidentiality |  | 0..1 | CodeableConcept | Confidentiality Binding Description: (preferred): hl7:Confidentiality
presentedForm |  | 0..* | EHDSAttachment | A narrative easy-to-read representation of the full data set, e.g. PDF-version of a document
knowledgeResources |  | 0..* | Base | Related documents and information sources
externalReference |  | 0..* | RelatedArtifact | Reference to external knowledge resource
relatedTo |  | 0..* | Reference() | Reference to part of the patient summary
alerts |  | 1..1 | Base | Section: Alerts.
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
emptyReason |  | 0..1 | CodeableConcept | Reason for absence of data
medicalAlert |  | 0..* | EHDSAlert | Description of medical alerts in textual format: any clinical information that is imperative to know so that the life or health of the patient does not come under threat.
allergiesAndIntolerances |  | 1..1 | Base | Section: Allergies and intolerances
narrative |  | 1..1 | string | Text summary of the content in section
allergyIntolerance |  | 0..* | EHDSAllergyIntolerance | List of structured allergies and intolerances
emptyReason |  | 0..1 | CodeableConcept | Use if no Allergies are listed Binding Description: (preferred): 1.3.6.1.4.1.12559.11.10.1.3.1.42.47eHDSIAbsentOrUnknownAllergy; http://hl7.org/fhir/ValueSet/list-empty-reason
problems |  | 1..1 | Base | Medical problems.
narrative |  | 0..1 | string | Text summary of the content in the section
emptyReason |  | 0..1 | CodeableConcept | Use if no conditions are listed
problems |  | 0..* | EHDSCondition | !!Health conditions affecting the health of the patient.!!
medicationSummary |  | 1..1 | Base | Section: Medication Summary.
narrative |  | 0..1 | string | Text summary of the content in the section
emptyReason |  | 0..1 | CodeableConcept | Use if no medicines are listed
medicationTreatment |  | 0..* | EHDSMedicationStatement | Medication treatment/prescription relevant for this patient summary. Typically, medications whose period of time indicated for the treatment has not yet expired whether it has been dispensed or not.
medicalDevicesAndImplants |  | 1..1 | Base | Section: Medical devices and implants
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
emptyReason |  | 0..1 | CodeableConcept | Reason for absence of data
medicalDevice |  | 0..* | EHDSDeviceUse | Describes the patient's implanted and external medical devices and equipment that their health status depends on. Includes devices (such as cardiac pacemakers, implantable defibrillator, prothesis, ferromagnetic bone implants etc.) that are important to know by the HP.
procedures |  | 1..1 | Base | Section: Procedures
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
emptyReason |  | 0..1 | CodeableConcept | Reason for absence of data
procedure |  | 0..* | EHDSProcedure | List of procedures
vaccination |  | 0..1 | Base | Section: Vaccination/prophylaxis.
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
vaccination |  | 0..* | EHDSImmunisation | Immunisations given to the patient and their status at the point of care.
functionalStatus |  | 0..1 | Base | Section: Functional status
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
functionalStatusAssessment |  | 0..* | EHDSFunctionalStatus | An individual's ability to perform normal daily activities required to meet basic needs, fulfil usual roles and maintain health and well-being
socialHistory |  | 0..1 | Base | Section: Social history.
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
socialHistoryObservation |  | 0..* | EHDSSocialHistory | Social history observations related to health
pregnancyHistory |  | 0..1 | Base | Section: Pregnancy history
generatedNarrative |  | 0..1 | string | Generated text summary of the content in the section, for human interpretation
currentPregnancyStatus |  | 0..1 | EHDSCurrentPregnancy | Current pregnancy status
previousPregnanciesStatus |  | 0..1 | CodeableConcept | Overall status of previous pregnancies
previousPregnancies |  | 0..* | EHDSPregnancyHistory | History of previous pregnancies
travelHistory |  | 0..1 | Base | Relevant information about the patient's recent travel history
narrative |  | 0..1 | string | Text summary of the content in the section
travelHistory |  | 0..* | EHDSTravelHistory | Travel history for one country
patientStory |  | 0..1 | Base | What the patient believes to be important for the attending clinician to know.
narrative |  | 0..1 | string | Text summary of the content in the section
advanceDirectives |  | 0..1 | Base | Section: Advance Directives.
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
advanceDirective |  | 0..* | EHDSAdvanceDirective | Provision for healthcare decisions if, in the future, a person is unable to make those decisions
results |  | 0..1 | Base | Section: Observation results.
narrative |  | 0..1 | string | Narrative, potentially formatted, content of the section
resultObservation[x] |  | 0..* |  | Observation results pertaining to the subject of care's health condition and which might have impact on future treatments
resultObservationEHDSObservation |  |  | EHDSObservation |
resultObservationEHDSLaboratoryObservation |  |  | EHDSLaboratoryObservation |
carePlan |  | 0..1 | Base | Section: Care plans.
narrative |  | 0..1 | string | Narrative containing the plan including proposals, goals, and order requests for monitoring, tracking, or improving the condition of the patient. In the future it is expected that this Section could be provided in a structured and coded format.
carePlanEntry |  | 0..* | EHDSCarePlan | Describes the intention of how one or more practitioners intend to deliver care for a particular patient for a period of time, possibly limited to care for a specific condition or set of conditions.
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
EHDSPatientSummary.header.language | preferred |
EHDSPatientSummary.header.documentType | preferred |
EHDSPatientSummary.header.documentStatus | preferred |
EHDSPatientSummary.header.eventType | preferred |
EHDSPatientSummary.header.authorSpecialty | preferred |
EHDSPatientSummary.header.documentFormat | preferred |
EHDSPatientSummary.header.confidentiality | preferred |
EHDSPatientSummary.allergiesAndIntolerances.emptyReason | preferred |

Other representations of model: CSV, Excel

### Notes:

### Differences and relationship to eHN

The main proposed changes of the proposed EEHRxF logical model, compared with the eHN Guideline are:

- The structure has been flattened to facilitate implementation of only parts of the Patient summary and better support a data centric approach. The result is that all sections are at the same level, not having the grouper-sections "Alerts", "Medical problems", "Medical history", and "Patient provided data" that the eHN GL does.

- All content sections are kept the same as in the Guideline. However, we do suggest that the two problem sections are combined into one. This is to better support different use cases and current available data. See under the section "Problems" for more information.

- In line with the International Patient Summary and MyHealth@EU specifications, there is an empty list reason elements for all sections that are suggested to be mandatory

- Each section has a Generated narrative text element. This is in line with the FHIR International Patient Summary implementation guide, and supports the right for natural persons to get the content in an easily readable format (Article 3 in the EHDS regulation).

- Instead of top level preferred code systems, which in many cases are not meant to be implemented in full, we have added value sets that are in use in the MyHealth@EU and HL7 Europe specifications as examples. We also include some value sets based on suggestions from participating Member states.

- The logical models have cardinality, and repeatable elements are split into their own models, which is often reused between different priority categories (e.g. problems, procedures). The individual information elements in these reusable models are based on the eHN Guideline, unless otherwise stated.