performer is a Participation Element
The performer XML element in CDA documents, is one of several “participation” elements that connect roles/entities to clinical act statements. The following articles overview the relevant concepts:

  • The article “Entity” XML elements and “role” XML elements introduces the concept of an “entity” (person, place or thing and its permanent characteristics) and “role” (temporary context-sensitive characteristics of an entity, such as “role of a person entity being a patient”), in CDA. It also outlines the XML syntax used in CDA to represent entities in roles.
  • The article Clinical act statements, presents an overview of the clinical act statement that is the core of the CDA document structured body.
  • The article Participation elements focuses on the participation elements that connect a “role/entity combination” to a clinical act statement.
  • The article Scoping of entities in roles introduces the concept of “scoping” entities in roles, and the XML syntax for doing so.

The performer element is one of eight participation elements that are commonly used in CDA documents (they are listed in the article noted above on clinical act statements). Of those, the subject, specimen, performer, author, informant, and participant participation elements are common to all clinical act statements in the CDA structured body.

Two Similar, But Different performer Sub-Elements
The performer element appears (as just noted, along with many other participation elements) in the clinical statements of the CDA structured body. In addition, the performer element appears in the CDA Header as a sub-element of the serviceEvent element.

This article focuses on the performer element as it is used broadly in clinical act statements in the CDA Body. There is a dedicated article, The serviceEvent/performer sub-element, that focuses on the other use of the performer element, in the CDA Header.

The Attributes of the performer Element
When the performer element appears in the clinical statements of the CDA structured body, its typeCode attribute has a fixed and default value of “PRF”. Commonly in XML syntax, when there is a fixed, default value for an attribute, that attribute is left out of the element in the XML document.

The performer element can optionally take the nullFlavor attribute – refer to the article The nullFlavor attribute, for additional information.

The assignedEntity Sub-Element of the performer Element
The main sub-element of the performer element is the sub-element named assignedEntity. This is the role element that the performer element links (to the clinical act statement that is the parent element of performer).

This is the case for all participation elements, as the primary function of participation elements is to connect a clinical act statement to role/entity elements.

Typically nested within the assignedEntity sub-element of the performer element, is the XML element representing the entity in that role (as well as any scoping entity).

Here is an example of the use of the performer element, highlighting the full use of its assignedEntity sub-element, with a corresponding entity (in the assignedPerson sub-element) and scoping entity (in the representedOrganization sub-element):

   <time nullFlavor="UNK"/>
      <id root="2.16.840.1.113883.19.5.9999.456" extension="2981823"/>
         <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
      <telecom nullFlavor="UNK"/>
         <id root="2.16.840.1.113883.19.5.9999.1393"/>
         <name>Community Health and Hospitals</name>
         <telecom nullFlavor="UNK"/>
         <addr nullFlavor="UNK"/>

Note that in some cases, the assignedEntity role element alone is sufficient (for example, when the specific person acting in that role is not known). Here is an example of the use of the performer element without an assignedPerson or representedOrganization sub-element of assignedEntity:

      <id root="2a620155-9d11-439e-92a3-5d9815ff4de8"
      <code code="59058001" codeSystem="2.16.840.1.113883.6.96"
         codeSystemName="SNOMED CT" displayName="General Physician"/>

Other Sub-Element of the performer Element
In addition to the assignedEntity sub-element, the performer element has a time sub-element that represents the time interval when the performer performed the clinical act.

A very rarely used sub-element of the performer element is named modeCode. It is a code element that indicates the nature of the interaction between the performer and the clinical act statement (e.g. “face to face” or “remote presence”). Refer to The modeCode element, for additional information.

Other CDA PRO Know Articles Referenced In This Article