IE (Ireland) Core Implementation Guide - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

General Guidance

Representing "Not Present" and "Unknown" Data

If information is not available or not applicable, IE Core profiles provide the following mechanisms:

Missing Data for Non-Coded Elements

For non-coded elements (string, date, numeric, etc.):

• If the element has minimum cardinality of 0, omit the element
• If the element has minimum cardinality ≥ 1, use the Data Absent Reason extension

Missing Data for Coded Elements

For coded elements:

• If the element has a required binding and the data is not available, use the null flavor code from the bound value set if available
• If no null flavor is available, use the Data Absent Reason extension

Contained Resources

In some cases, the content referred to in a resource reference does not have an independent existence apart from the referencing resource. In these cases, the content is included as a contained resource.

IE Core profiles SHOULD use contained resources when:

• The referenced resource only exists in the context of the referencing resource
• The server does not support the referenced resource type as a standalone resource

Provenance

IE Core defines a Provenance profile that SHOULD be used to track the origin and history of clinical data. See the Basic Provenance page for detailed guidance.

Irish Address Format

IE Core uses the standard FHIR Address datatype with the following Irish-specific guidance:

• address.line: Street address (e.g., "51 Bracken Road")
• address.city: City/town name (e.g., "Sandyford")
• address.state: Irish county (bound to Ireland Counties ValueSet)
• address.postalCode: Eircode (e.g., "D18 CV48")
• address.country: "IE" or "Ireland"

Language Support

Ireland has two official languages: English (en) and Irish/Gaeilge (ga). IE Core implementations:

• SHALL support English language content
• SHOULD support Irish language content where available
• SHOULD use BCP 47 language tags: en-IE for Irish English and ga-IE for Irish/Gaeilge

Timezone

All datetime values in IE Core SHOULD include timezone information. Ireland observes:

• Greenwich Mean Time (GMT/UTC+0) during standard time
• Irish Standard Time (IST/UTC+1) during summer time

Clinical Terminology Standards (HIQA)

In accordance with HIQA's Guidance on Terminology Standards for Ireland, IE Core adopts the following terminology standards:

Domain	Primary Standard	Secondary / Supplementary
Clinical terms (diagnoses, procedures, findings)	SNOMED CT	ICD-10-AM/ACHI (aggregation)
Medications	NMPC	SNOMED CT Irish Edition, ATC (WHO international classification)
Laboratory observations	LOINC	SNOMED CT (for result values)
Allergies & adverse reactions	SNOMED CT	—
Immunizations	SNOMED CT, CVX	ATC (J07 vaccines)

SNOMED CT is Ireland's nationally adopted reference terminology, maintained through the SNOMED CT Irish Extension by eHealth Ireland's National Release Centre. Ireland is a member of SNOMED International.

For medications, IE Core adopts the National Medicinal Product Catalogue (NMPC) as the preferred primary code wherever available. SNOMED CT Irish Edition SHOULD be carried as a secondary coding wherever available to support clinical interoperability, terminology services, and cross-border mapping.

LOINC is the recommended standard for laboratory observation identifiers, in line with international best practice and EU cross-border laboratory result exchange.

ATC (WHO) is used as a supplementary classification for medications, particularly for EU cross-border interoperability under EHDS and MyHealth@EU.

See the Medication List page for detailed medication terminology guidance.

XT-EHR Obligations Framework

XT-EHR v1.0.0 introduced a formal Obligations Framework as a new layer on top of the EHDS logical models. This framework is separate from and additive to the logical model definitions, and defines normative obligations (SHALL/SHOULD/MAY) for each actor type — Creator, Repository, and Consumer — for each element in each model.

What this means for IE Core implementers

Actor	Obligations
Creator (system that creates the document/resource)	SHALL populate all elements marked as SHALL for Creator in the XT-EHR Obligations model. IE Core MS flags identify these elements.
Repository (system that stores and retrieves the document/resource)	SHALL store and return all elements received; SHALL NOT remove or modify mandatory elements
Consumer (system that receives and displays/processes the document/resource)	SHALL process (display or use) all elements marked as SHALL for Consumer; SHOULD render human narrative where available

IE Core Must Support and Obligations

In IE Core, elements marked as Must Support (MS) correspond to elements that carry a SHALL obligation in the XT-EHR Obligations model for at least one actor. Where an element is present in XT-EHR with a SHOULD obligation, IE Core typically marks it as MS but does not add minimum cardinality.

Implementers building systems for cross-border exchange via MyHealth@EU SHOULD consult the XT-EHR Obligations models to verify that their system satisfies all obligations for the relevant actor type.

Obligations coverage in IE Core (since v0.1.1)

• Patient Summary (EHDSPatientSummaryObligations): Partial — all mandatory sections implemented, with remaining dependency on partial MedicationUse and Alert coverage
• Discharge Report (EHDSDischargeReportObligations): Partial — all mandatory sections implemented, with remaining dependency on partial MedicationUse and Alert coverage
• ePrescription (EHDSMedicationPrescriptionObligations): out of scope for IE Core; profiled in IE Medication Events (ADR-009)
• MedicationStatement (EHDSMedicationUseObligations): Partial — adherence element obligation deferred (FHIR R4 limitation)
• Flag/Alert (EHDSAlertObligations): Partial — alertType binding to be finalised
• DeviceUseStatement (EHDSDeviceUseObligations): Not yet covered — profile planned