Media — Removed in R5

Media existed in FHIR R4 to carry clinical multimedia content. It was removed in R5: its role is split among DocumentReference, Observation and ImagingStudy depending on usage.

Status in R5

The HL7 Orders & Observations work group found that Media was largely used for cases more precisely covered by DocumentReference (documents, clinical photographs) or Observation (image-derived measures, snapshots). Removal avoids fragmentation and standardizes queries: a client searching for "all patient content" now queries DocumentReference and Observation uniformly.

Replacements by use case

• Clinical photograph (skin lesion, wound) — DocumentReference with category=clinical-photo and a content[].attachment carrying the image or its URL.
• Imaging screen capture — Observation with valueAttachment or ImagingStudy if DICOM-compliant.
• Audio (auscultation, voice memo) — DocumentReference, contentType=audio/mp3.
• Video (endoscopy, ultrasound) — DocumentReference, contentType=video/mp4, or ImagingStudy if PACS-attached.
• ID photo (patient face) — Patient.photo (inline Attachment).

Migration path from R4

1. Identify R4 Media by type: image, video, audio.
2. For each, determine the clinical context: linked to an ImagingStudy (DICOM), to a report (DocumentReference), to a measure (Observation).
3. Create the target resources with the R4 Media identifier as identifier for traceability.
4. Update the resources that referenced R4 Media (basedOn, derivedFrom, etc.).
5. Keep R4 Media read-only (versioned) during transition; marking them status=entered-in-error is incorrect because they were valid in R4.

Related resources

• DocumentReference — main replacement for binary content.
• Observation — for content tied to a measure.
• ImagingStudy — for DICOM imaging.