Element Identifiers in FHIR

In this article, we’ll take a closer look at element identifiers in FHIR, the relevant changes introduced by STU3 and the reasons that motivated that change.

FHIR has supported element identifiers since DSTU1. They are intended to specify unique identifiers for the elements within an individual resource. The official definition from the STU3 specification states: “The id property of the element is defined to allow implementers to build implementation functionality that makes use of internal references inside the resource. This specification does not use the internal id on the element in any way.

Element ids are particularly convenient to identify the individual ElementDefinitions inside of a StructureDefinition. In a basic StructureDefinition without slicing, each element definition has a unique path. However when a profile introduces slicing constraints, element paths are no longer unique, as the following example demonstrates:

Element name Slice name Element path
Patient Patient
identifier Patient.identifier
identifier ssn Patient.identifier
system Patient.identifier.system
identifier ehr Patient.identifier
system Patient.identifier.system

Clearly, the element path itself is not sufficient to uniquely identify individual element definitions, as we also require information about slice name(s). But if we would also include the slice name(s) in the expression, then the resulting value is no longer ambiguous and becomes a unique identifier:

Element name Slice name Element identifier
Patient Patient
identifier Patient.identifier
identifier ssn Patient.identifier:ssn
system Patient.identifier:ssn.system
identifier ehr Patient.identifier:ehr
system Patient.identifier:ehr.system

In order to support this, FHIR STU3 introduces some changes in the definition of element ids. The following table compares the specification of element ids in different FHIR versions:

FHIR version data type max length
DSTU 1 id 36 characters
DSTU 2 id 64 characters
STU 3 string 1MB

In STU3, the element identifier datatype has changed from id to string, effectively removing the maximum length constraint. Also, STU3 allows any string value that does not contain spaces, whereas in earlier versions, the set of valid characters was limited to A-Z | a-z| 0-9 | - | .

FHIR does not specify a mandatory format for element identifiers. In STU3, any unique non-empty string value without spaces is considered to be a valid identifier. However STU3 does introduce a preferred format for the identifiers of ElementDefinitions in a StructureDefinition resource:


Similar to the element path, the preferred identifier format specifies a number of path segments, separated by a dot “.” character. Each segment represents an individual element in the hierarchy and starts with the element name, optionally followed by a semicolon “:” character and the associated slice name (if not empty).

The preferred element identifier value only depends on the position of the element in the element tree. Different available representations of a specific ElementDefinition in both the differential and the snapshot component share the exact same identifier value. As the astute reader may have already noticed, this implies that element identifiers in the preferred format are actually not fully unique within the context of the containing StructureDefinition resource. Also, if we include multiple StructureDefinitions in a Bundle resource, then ElementDefinition identifiers of are not guaranteed to be unique within the context of the containing Bundle resource.

Note: When a FHIR resource is serialized to the XML representation, FHIR element identifiers are expressed as xml:id attributes. According to the W3C specification, “the [identifier] value is unique within the XML document”. So in fact, the FHIR specification violates the W3C XML specification… However in practical situations, this idiosyncrasy of FHIR shouldn’t pose an issue.

In general, software cannot assume that FHIR element identifiers follow the preferred format. The FHIR specification itself does not use the internal id on the element in any way (1). For ElementDefinitions contained in a StructureDefinition resource, the element name and the slice name remain to be the leading identifying attributes for processing logic to act on. This also implies that a sparse differential component should always include parent elements with a non-empty slice name, even if they are unconstrained. In theory, processing logic could reconstruct the parent element hierarchy by parsing the element identifiers in the differential component, provided that all identifiers are specified in the preferred format. However as the preferred identifier format is not required, generic logic cannot rely on this information.

Nonetheless, the standard open source Java and the .NET libraries for FHIR STU3 both provide implementations of a snapshot generator that can generate element ids in the preferred format. So within a clearly defined use context that guarantees standardized element identifiers to be present, e.g. because all snapshots are always (re-)generated by a standard FHIR library, it becomes possible to implement processing logic that acts on the standard identifiers.

Forge, the FHIR profile editor, introduced preliminary support for element identifiers as part of the initial STU3 release from May 2017. Initially, Forge allowed users to specify custom identifiers, however this feature has been deprecated since. As of release 16.4 for STU3, Forge will automatically generate element identifiers in the preferred format on all ElementDefinitions in both the differential and snapshot components. Users can not manually edit the generated identifiers.

1. ^ As Grahame points out in his comment, the FHIR standard actually does use element id’s as the target of content references. However these references do not rely on the format of the identifier.


One thought on “Element Identifiers in FHIR

  1. Grahame Grieve

    We should update the comment ‘FHIR doesn’t use the element id in any way’ since we now do use it in StructureDefinition.*.element. Note that we don’t use xml:id in the schemas for the .id because of the violation that this would create


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