NCPI FHIR Implementation Guide v2
0.1.0 - ci-build

NCPI FHIR Implementation Guide v2 - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: NcpiResearchStudy - Detailed Descriptions

Draft as of 2024-03-21

Definitions for the ncpi-research-study resource profile.

Guidance on how to interpret the contents of this table can be found here

0. ResearchStudy
2. ResearchStudy.extension
SlicingThis element introduces a set of slices on ResearchStudy.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. ResearchStudy.extension:studyDesign
    Slice NamestudyDesign
    ShortStudy Design and Study Type
    Control0..*
    TypeExtension(Research Study Design) (Extension Type: CodeableConcept)
    6. ResearchStudy.extension:result
    Slice Nameresult
    ShortLink to results generated during the study.
    Control0..*
    TypeExtension(Research Study Result) (Extension Type: Reference)
    8. ResearchStudy.extension:associatedParty
    Slice NameassociatedParty
    Control0..*
    TypeExtension(Research Study Associated Party) (Complex Extension)
    10. ResearchStudy.extension:acknowledgement
    Slice Nameacknowledgement
    ShortURL describing the policy restrictions in detail.
    Control0..*
    TypeExtension(Research Study Acknowledgement) (Extension Type: markdown)
    12. ResearchStudy.identifier
    ShortExternal facing, globally unique identifiers. When providing more than one identifier, researchers should indicate the 'official' identifier by assigning 'official' to that identifier's use property.
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control1..?
    14. ResearchStudy.title
    ShortStudy's formal title.
    16. ResearchStudy.category
    18. ResearchStudy.category.coding
    ShortIndicate this is an NCPI Research Study
    Pattern Value{
      "system" : "https://nih-ncpi.github.io/ncpi-fhir-ig-2/CodeSystem/ncpi",
      "code" : "StudyCohort",
      "display" : "Study Cohort"
    }
    20. ResearchStudy.focus
    ShortThe primary, non-disease focus(es) of the study. This can include terms related to intervention, drug, device, or other focus.
    Comments

    Researcher specified foci that are not specific to disease/phenotype codes.

    22. ResearchStudy.condition
    ShortThe primary focus(es) of the study. This is specific to the disease. MeSH terms are preferred.
    Comments

    Disease and phenotype codes identified in the CDM study's 'focus'.

    24. ResearchStudy.relatedArtifact
    ShortAttribution, Study Weblinks, Citation, Study Documents, etc.
    26. ResearchStudy.description
    ShortStudy Description (Recommended)

    Guidance on how to interpret the contents of this table can be found here

    0. ResearchStudy
    Definition

    A process where a researcher or organization plans and then executes a series of steps intended to increase the field of healthcare-related knowledge. This includes studies of safety, efficacy, comparative effectiveness and other information about medications, devices, therapies and other interventional and investigative techniques. A ResearchStudy involves the gathering of information about human or animal subjects.

    ShortInvestigation to increase healthcare-related patient-independent knowledge
    Comments

    Need to make sure we encompass public health studies.

    Control0..*
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Alternate NamesClinical Trial, Study
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-4: 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())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    2. ResearchStudy.implicitRules
    Definition

    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.

    ShortA set of rules under which this content was created
    Comments

    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.

    Control0..1
    Typeuri
    Is Modifiertrue because 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
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. ResearchStudy.extension
    Definition

    An Extension


    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.

    ShortExtensionAdditional content defined by implementations
    Comments

    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.

    Control0..*
    TypeExtension
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on ResearchStudy.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 6. ResearchStudy.extension:studyDesign
      Slice NamestudyDesign
      Definition

      Codes categorizing the type of study such as investigational vs. observational, type of blinding, type of randomization, safety vs. efficacy, etc.

      ShortStudy Design and Study Type
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Research Study Design) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      8. ResearchStudy.extension:result
      Slice Nameresult
      Definition

      Link to citations associated with the study's publications.

      ShortLink to results generated during the study.
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Research Study Result) (Extension Type: Reference)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      10. ResearchStudy.extension:associatedParty
      Slice NameassociatedParty
      Definition

      Sponsors, collaborators, and other parties affiliated with a research study.

      ShortResearch Study Associated Party
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Research Study Associated Party) (Complex Extension)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      12. ResearchStudy.extension:acknowledgement
      Slice Nameacknowledgement
      Definition

      Provides an informative description of acknowledgement expectations for those using data from the research study.

      ShortURL describing the policy restrictions in detail.
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Research Study Acknowledgement) (Extension Type: markdown)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      14. ResearchStudy.modifierExtension
      Definition

      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).

      ShortExtensions that cannot be ignored
      Comments

      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.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Must Supportfalse
      Summaryfalse
      Requirements

      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.

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      16. ResearchStudy.identifier
      Definition

      Identifiers assigned to this research study by the sponsor or other systems.

      ShortExternal facing, globally unique identifiers. When providing more than one identifier, researchers should indicate the 'official' identifier by assigning 'official' to that identifier's use property.Business Identifier for study
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control10..*
      TypeIdentifier
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Allows identification of the research study as it is known by various participating systems and in a way that remains consistent across servers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. ResearchStudy.title
      Definition

      A short, descriptive user-friendly label for the study.

      ShortStudy's formal title.Name for this study
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. ResearchStudy.status
      Definition

      The current state of the study.

      Shortactive | administratively-completed | approved | closed-to-accrual | closed-to-accrual-and-intervention | completed | disapproved | in-review | temporarily-closed-to-accrual | temporarily-closed-to-accrual-and-intervention | withdrawn
      Control1..1
      BindingThe codes SHALL be taken from ResearchStudyStatushttp://hl7.org/fhir/ValueSet/research-study-status|4.3.0
      (required to http://hl7.org/fhir/ValueSet/research-study-status|4.3.0)

      Codes that convey the current status of the research study.

      Typecode
      Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. ResearchStudy.focus
      Definition

      The medication(s), food(s), therapy(ies), device(s) or other concerns or interventions that the study is seeking to gain more information about.

      ShortThe primary, non-disease focus(es) of the study. This can include terms related to intervention, drug, device, or other focus.Drugs, devices, etc. under study
      Comments

      Researcher specified foci that are not specific to disease/phenotype codes.

      Control0..*
      Binding

      Codes for medications, devices and other interventions.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. ResearchStudy.condition
      Definition

      The condition that is the focus of the study. For example, In a study to examine risk factors for Lupus, might have as an inclusion criterion "healthy volunteer", but the target condition code would be a Lupus SNOMED code.

      ShortThe primary focus(es) of the study. This is specific to the disease. MeSH terms are preferred.Condition being studied
      Comments

      Disease and phenotype codes identified in the CDM study's 'focus'.

      Control0..*
      BindingFor example codes, see Condition/Problem/DiagnosisCodeshttp://hl7.org/fhir/ValueSet/condition-code
      (example to http://hl7.org/fhir/ValueSet/condition-code)

      Identification of the condition or diagnosis.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. ResearchStudy.relatedArtifact
      Definition

      Citations, references and other related documents.

      ShortAttribution, Study Weblinks, Citation, Study Documents, etc.References and dependencies
      Control0..*
      TypeRelatedArtifact
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. ResearchStudy.description
      Definition

      A full description of how the study is being conducted.

      ShortStudy Description (Recommended)What this is study doing
      Control0..1
      Typemarkdown
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

      Guidance on how to interpret the contents of this table can be found here

      0. ResearchStudy
      Definition

      A process where a researcher or organization plans and then executes a series of steps intended to increase the field of healthcare-related knowledge. This includes studies of safety, efficacy, comparative effectiveness and other information about medications, devices, therapies and other interventional and investigative techniques. A ResearchStudy involves the gathering of information about human or animal subjects.

      ShortInvestigation to increase healthcare-related patient-independent knowledge
      Comments

      Need to make sure we encompass public health studies.

      Control0..*
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate NamesClinical Trial, Study
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: 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())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      2. ResearchStudy.id
      Definition

      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

      ShortLogical id of this artifact
      Comments

      The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

      Control0..1
      Typeid
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      4. ResearchStudy.meta
      Definition

      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.

      ShortMetadata about the resource
      Control0..1
      TypeMeta
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. ResearchStudy.implicitRules
      Definition

      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.

      ShortA set of rules under which this content was created
      Comments

      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.

      Control0..1
      Typeuri
      Is Modifiertrue because 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
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. ResearchStudy.language
      Definition

      The base language in which the resource is written.

      ShortLanguage of the resource content
      Comments

      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).

      Control0..1
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      IETF language tag

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. ResearchStudy.text
      Definition

      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.

      ShortText summary of the resource, for human interpretation
      Comments

      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.

      Control0..1
      TypeNarrative
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. ResearchStudy.contained
      Definition

      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.

      ShortContained, inline Resources
      Comments

      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.

      Control0..*
      TypeResource
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      Invariantsdom-r4b: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems (($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic))
      14. ResearchStudy.extension
      Definition

      An Extension

      ShortExtension
      Control0..*
      TypeExtension
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on ResearchStudy.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. ResearchStudy.extension:studyDesign
        Slice NamestudyDesign
        Definition

        Codes categorizing the type of study such as investigational vs. observational, type of blinding, type of randomization, safety vs. efficacy, etc.

        ShortStudy Design and Study Type
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Research Study Design) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        18. ResearchStudy.extension:result
        Slice Nameresult
        Definition

        Link to citations associated with the study's publications.

        ShortLink to results generated during the study.
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Research Study Result) (Extension Type: Reference)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        20. ResearchStudy.extension:associatedParty
        Slice NameassociatedParty
        Definition

        Sponsors, collaborators, and other parties affiliated with a research study.

        ShortResearch Study Associated Party
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Research Study Associated Party) (Complex Extension)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        22. ResearchStudy.extension:acknowledgement
        Slice Nameacknowledgement
        Definition

        Provides an informative description of acknowledgement expectations for those using data from the research study.

        ShortURL describing the policy restrictions in detail.
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Research Study Acknowledgement) (Extension Type: markdown)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        24. ResearchStudy.modifierExtension
        Definition

        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).

        ShortExtensions that cannot be ignored
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Must Supportfalse
        Summaryfalse
        Requirements

        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.

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        26. ResearchStudy.identifier
        Definition

        Identifiers assigned to this research study by the sponsor or other systems.

        ShortExternal facing, globally unique identifiers. When providing more than one identifier, researchers should indicate the 'official' identifier by assigning 'official' to that identifier's use property.
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control1..*
        TypeIdentifier
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Allows identification of the research study as it is known by various participating systems and in a way that remains consistent across servers.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. ResearchStudy.title
        Definition

        A short, descriptive user-friendly label for the study.

        ShortStudy's formal title.
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. ResearchStudy.protocol
        Definition

        The set of steps expected to be performed as part of the execution of the study.

        ShortSteps followed in executing study
        Control0..*
        TypeReference(PlanDefinition)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. ResearchStudy.partOf
        Definition

        A larger research study of which this particular study is a component or step.

        ShortPart of larger study
        Control0..*
        TypeReference(ResearchStudy)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Allows breaking a study into components (e.g. by study site) each with their own PI, status, enrollment, etc.

        Alternate Namescontainer
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. ResearchStudy.status
        Definition

        The current state of the study.

        Shortactive | administratively-completed | approved | closed-to-accrual | closed-to-accrual-and-intervention | completed | disapproved | in-review | temporarily-closed-to-accrual | temporarily-closed-to-accrual-and-intervention | withdrawn
        Control1..1
        BindingThe codes SHALL be taken from ResearchStudyStatus
        (required to http://hl7.org/fhir/ValueSet/research-study-status|4.3.0)

        Codes that convey the current status of the research study.

        Typecode
        Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. ResearchStudy.primaryPurposeType
        Definition

        The type of study based upon the intent of the study's activities. A classification of the intent of the study.

        Shorttreatment | prevention | diagnostic | supportive-care | screening | health-services-research | basic-science | device-feasibility
        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from ResearchStudyPrimaryPurposeType
        (extensible to http://hl7.org/fhir/ValueSet/research-study-prim-purp-type)

        Codes for the main intent of the study.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. ResearchStudy.phase
        Definition

        The stage in the progression of a therapy from initial experimental use in humans in clinical trials to post-market evaluation.

        Shortn-a | early-phase-1 | phase-1 | phase-1-phase-2 | phase-2 | phase-2-phase-3 | phase-3 | phase-4
        Control0..1
        BindingFor example codes, see ResearchStudyPhase
        (example to http://hl7.org/fhir/ValueSet/research-study-phase)

        Codes for the stage in the progression of a therapy from initial experimental use in humans in clinical trials to post-market evaluation.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. ResearchStudy.category
        Definition

        Codes categorizing the type of study such as investigational vs. observational, type of blinding, type of randomization, safety vs. efficacy, etc.

        ShortClassifications for the study
        Control0..*
        Binding

        Codes that describe the type of research study. E.g. Study phase, Interventional/Observational, blinding type, etc.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. ResearchStudy.category.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        Typeid
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        44. ResearchStudy.category.extension
        Definition

        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.

        ShortAdditional content defined by implementations
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on ResearchStudy.category.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 46. ResearchStudy.category.coding
          Definition

          A reference to a code defined by a terminology system.

          ShortIndicate this is an NCPI Research Study
          Comments

          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control0..*
          TypeCoding
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Pattern Value{
            "system" : "https://nih-ncpi.github.io/ncpi-fhir-ig-2/CodeSystem/ncpi",
            "code" : "StudyCohort",
            "display" : "Study Cohort"
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          48. ResearchStudy.category.text
          Definition

          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

          ShortPlain text representation of the concept
          Comments

          Very often the text is the same as a displayName of one of the codings.

          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          50. ResearchStudy.focus
          Definition

          The medication(s), food(s), therapy(ies), device(s) or other concerns or interventions that the study is seeking to gain more information about.

          ShortThe primary, non-disease focus(es) of the study. This can include terms related to intervention, drug, device, or other focus.
          Comments

          Researcher specified foci that are not specific to disease/phenotype codes.

          Control0..*
          Binding

          Codes for medications, devices and other interventions.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. ResearchStudy.condition
          Definition

          The condition that is the focus of the study. For example, In a study to examine risk factors for Lupus, might have as an inclusion criterion "healthy volunteer", but the target condition code would be a Lupus SNOMED code.

          ShortThe primary focus(es) of the study. This is specific to the disease. MeSH terms are preferred.
          Comments

          Disease and phenotype codes identified in the CDM study's 'focus'.

          Control0..*
          BindingFor example codes, see Condition/Problem/DiagnosisCodes
          (example to http://hl7.org/fhir/ValueSet/condition-code)

          Identification of the condition or diagnosis.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          54. ResearchStudy.contact
          Definition

          Contact details to assist a user in learning more about or engaging with the study.

          ShortContact details for the study
          Control0..*
          TypeContactDetail
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          56. ResearchStudy.relatedArtifact
          Definition

          Citations, references and other related documents.

          ShortAttribution, Study Weblinks, Citation, Study Documents, etc.
          Control0..*
          TypeRelatedArtifact
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          58. ResearchStudy.keyword
          Definition

          Key terms to aid in searching for or filtering the study.

          ShortUsed to search for the study
          Control0..*
          Binding

          Words associated with the study that may be useful in discovery.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          60. ResearchStudy.location
          Definition

          Indicates a country, state or other region where the study is taking place.

          ShortGeographic region(s) for study
          Control0..*
          BindingUnless not suitable, these codes SHALL be taken from Jurisdiction ValueSet
          (extensible to http://hl7.org/fhir/ValueSet/jurisdiction)

          Countries and regions within which this artifact is targeted for use.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          62. ResearchStudy.description
          Definition

          A full description of how the study is being conducted.

          ShortStudy Description (Recommended)
          Control0..1
          Typemarkdown
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          64. ResearchStudy.enrollment
          Definition

          Reference to a Group that defines the criteria for and quantity of subjects participating in the study. E.g. " 200 female Europeans between the ages of 20 and 45 with early onset diabetes".

          ShortInclusion & exclusion criteria
          Comments

          The Group referenced should not generally enumerate specific subjects. Subjects will be linked to the study using the ResearchSubject resource.

          Control0..*
          TypeReference(Group)
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Alternate Namespatient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          66. ResearchStudy.period
          Definition

          Identifies the start date and the expected (or actual, depending on status) end date for the study.

          ShortWhen the study began and ended
          Control0..1
          TypePeriod
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Alternate Namestiming
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          68. ResearchStudy.sponsor
          Definition

          An organization that initiates the investigation and is legally responsible for the study.

          ShortOrganization that initiates and is legally responsible for the study
          Control0..1
          TypeReference(Organization)
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          70. ResearchStudy.principalInvestigator
          Definition

          A researcher in a study who oversees multiple aspects of the study, such as concept development, protocol writing, protocol submission for IRB approval, participant recruitment, informed consent, data collection, analysis, interpretation and presentation.

          ShortResearcher who oversees multiple aspects of the study
          Control0..1
          TypeReference(Practitioner, PractitionerRole)
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          72. ResearchStudy.site
          Definition

          A facility in which study activities are conducted.

          ShortFacility where study activities are conducted
          Control0..*
          TypeReference(Location)
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          74. ResearchStudy.reasonStopped
          Definition

          A description and/or code explaining the premature termination of the study.

          Shortaccrual-goal-met | closed-due-to-toxicity | closed-due-to-lack-of-study-progress | temporarily-closed-per-study-design
          Control0..1
          BindingFor example codes, see ResearchStudyReasonStopped
          (example to http://hl7.org/fhir/ValueSet/research-study-reason-stopped)

          Codes for why the study ended prematurely.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          76. ResearchStudy.note
          Definition

          Comments made about the study by the performer, subject or other participants.

          ShortComments made about the study
          Control0..*
          TypeAnnotation
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          78. ResearchStudy.arm
          Definition

          Describes an expected sequence of events for one of the participants of a study. E.g. Exposure to drug A, wash-out, exposure to drug B, wash-out, follow-up.

          ShortDefined path through the study for a subject
          Control0..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
          80. ResearchStudy.arm.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          82. ResearchStudy.arm.extension
          Definition

          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.

          ShortAdditional content defined by implementations
          Comments

          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.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          84. ResearchStudy.arm.modifierExtension
          Definition

          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).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          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.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          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.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          86. ResearchStudy.arm.name
          Definition

          Unique, human-readable label for this arm of the study.

          ShortLabel for study arm
          Control1..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          88. ResearchStudy.arm.type
          Definition

          Categorization of study arm, e.g. experimental, active comparator, placebo comparater.

          ShortCategorization of study arm
          Control0..1
          TypeCodeableConcept
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          90. ResearchStudy.arm.description
          Definition

          A succinct description of the path through the study that would be followed by a subject adhering to this arm.

          ShortShort explanation of study path
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          92. ResearchStudy.objective
          Definition

          A goal that the study is aiming to achieve in terms of a scientific question to be answered by the analysis of data collected during the study.

          ShortA goal for the study
          Control0..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
          94. ResearchStudy.objective.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          96. ResearchStudy.objective.extension
          Definition

          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.

          ShortAdditional content defined by implementations
          Comments

          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.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          98. ResearchStudy.objective.modifierExtension
          Definition

          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).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          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.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          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.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          100. ResearchStudy.objective.name
          Definition

          Unique, human-readable label for this objective of the study.

          ShortLabel for the objective
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          102. ResearchStudy.objective.type
          Definition

          The kind of study objective.

          Shortprimary | secondary | exploratory
          Control0..1
          BindingThe codes SHOULD be taken from ResearchStudyObjectiveType
          (preferred to http://hl7.org/fhir/ValueSet/research-study-objective-type)

          Codes for the kind of study objective.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))