Brontekst bekijken van MedMij:Vprepub-2020.01/FHIR GGZ

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{{DISPLAYTITLE:MedMij FHIR Implementation Guide basic GGZ data {{VersieInfo|BgGGZ}}}}
{{MedMij:Vprepub/Issuebox_FHIR_IG}}

[[Bestand:MedMij2.png |link=https://www.medmij.nl/|rechts|Naar medmij.nl]]
[[Bestand:MedMij-GGZ-63.png |link=|links|80px|Use case GGZ|GGZ]] 
<imagemap>Bestand:Leeswijzer-technisch-banner 03 white.png|center|400px|alt=Afspraken-Functioneel-Technisch   
circle 241 216 211 [https://www.medmij.nl/afsprakenstelsel Afsprakenstelsel]                
circle 1013 224 212 [[MedMij:Vprepub/OntwerpGGZ|Functioneel]]                
circle 1787 230 212 [[MedMij:Vprepub/FHIR_IG|Technisch]]                
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=Introduction=
The page describes the FHIR requirements for exchanging GGZ information between the patients and healthcare providers in the context of MedMij.

'''Note''': This implementation guide builds on the general guidelines described in the [[MedMij:Vprepub/FHIR_IG#Use case overarching principles|use case overarching principles]].

=Actors involved=
{| class="wikitable"
! colspan="2" style="text-align:left;" | Actors
! colspan="2" style="text-align:left;" | Systems
! colspan="2" style="text-align:left;" | FHIR Capability Statements
|-
! style="text-align:left;" |Name
! style="text-align:left;" |Description
! style="text-align:left;" |Name
! style="text-align:left;" |Description
! style="text-align:left;" |Name
! style="text-align:left;" |Description
|-
| Patient
| The user of a personal healthcare environment.
| PHR
| Personal health record
|[[Bestand: Verwijzing.png| 20px]] {{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/ggz-clientcapabilities|nictiz.fhir.nl.stu3.zib2017|title=CapabilityStatement: Client}}
| FHIR Client requirements 
|-
| Healthcare professional
| The user of a XIS
| XIS
| Healthcare information system
|[[Bestand: Verwijzing.png| 20px]] {{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/ggz-servercapabilities|nictiz.fhir.nl.stu3.zib2017|title=CapabilityStatement: Server}}
| FHIR Server requirements 
|}

=Boundaries and Relationships=
The GGZ use case has similarities and differences with other use cases such as the BgZ, Medication Process, Vital Signs, GP Patient Data and Lab Results. These use cases use much of the same HCIM based FHIR profiles for exchanging information. Wherever possible every attempt is made to re-use the profiles as used in the BgZ. The GGZ use case also has unique profiles compared to the aforementioned use cases. In addition, it has a CareTeam profile without an underlying HCIM.
A second thing to note is that while the selection criteria of certain sections like procedure do not match with the BgZ or other use cases, this does not affect the profiles in use. For example, it is irrelevant for the response profile for procedures if you request ' surgical procedures' or 'every procedure'.

=Use case: retrieve GGZ information=
[[Bestand:Afsprakenstelsel-01.png|link=https://www.medmij.nl/afsprakenstelsel/|rechts |100px|Go to MedMij Afsprakenstelsel]]

{{FHIR-IG-Afsprakenstelsel-Note}}

===PHR: request message===
The PHR system requests the patients GGZ information using individual [https://www.hl7.org/fhir/stu3/search.html search] interactions. The BgGGZ consists of multiple FHIR resources with certain constraints. To obtain the patient's BgGGZ, the client can use multiple individual search operations based on specified search queries. The interactions are performed by an HTTP GET as shown:

<code>GET [base]/[type]{?[parameters]}</code>

The table below shows in the first three columns the HCIM name in Dutch, in English and what HCIM content is requested. The last column shows the FHIR search queries to obtain this information. These queries and expected responses are based on profiles listed in [[#List_of_profiles|this section]].

{| class="wikitable" style="horizontal-align: right" 

!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:10px" | HCIM NL
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:10px" | HCIM EN
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:10px" | Content
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:10px" | Search URL<ref>See [[MedMij:Vprepub/FHIR_IG#Search_URLs_and_search_parameters|Search URLs and search parameters]] for the interpretation of these search URLs</ref>
|-
| Patient
| Patient
| Identification, birthdate, gender, deceasedindicator, contact details, marital status, legal status, and general practitioner (practitioner or organization)
| <pre>GET [base]/Patient?_include=Patient:general-practitioner</pre>
|-
| BurgerlijkeStaat
| MaritalStatus
| Known marital status
| style="font-style:italic;" | see Patient
|-
| Betaler
| Payer
| Insurance information
| <pre>GET [base]/Coverage?_include=Coverage:payor:Patient&_include=Coverage:payor:Organization</pre>
|-
| BehandelAanwijzing
| TreatmentDirective
| All known treatment directives
| <pre>GET [base]/Consent?category=http://snomed.info/sct|11291000146105</pre>
|-
| Wilsverklaring
| AdvanceDirective
| All known advance directives
| <pre>GET [base]/Consent?category=http://snomed.info/sct|11341000146107</pre>
|-
| JuridischeStatus
| LegalStatus
| Known legal status
| style="font-style:italic;" | see Patient and FreedomRestrictingMeasures procedure
|-
| VrijheidbeperkendeMaatregelen
| FreedomRestrictingMeasures
| All known freedom restricting measures
| ''see Procedure''
<span id="FunctionalOrMentalStatusRemark">{{IssueBox|Due to legislation (the 'Wet verplichte ggz' (Wvggz)) HCIM FreedomRestrictingMeasures-v3.1 (release 2017) has become obsolete. Therefore, this version of the BgGGZ will not require the use and exchange of this HCIM.
}}</span>
|-
| Contactpersoon
| Contact
| First relation/contact
| style="font-style:italic;" | see Patient.contact
|-
| FunctioneleOfMentaleStatus
| FunctionalOrMentalStatus
| All known functional / mental status
| <pre>GET [base]/Observation?category=http://snomed.info/sct|118228005,http://snomed.info/sct|384821006</pre>
<span id="FunctionalOrMentalStatusRemark"></span>{{NoteBox|The NL-CM:4.26.6 StatusDate concept is incorrectly mapped on the <code>effective[x]:effectivePeriod.start</code> element in the HCIM FunctionalOrMentalStatus profile, it is a date rather than a period. Presumed solution will come from a future HCIM release. See [https://bits.nictiz.nl/browse/MM-1570 MM-1570] for more information.}}
|-
| Probleem
| Problem
| All known problems 
| <pre>GET [base]/Condition</pre>
|-
| Druggebruik
| DrugUse
| All known drug use
| <pre>GET [base]/Observation?code=http://snomed.info/sct|228366006</pre>
|-
| Alcoholgebruik
| AlcoholUse
| All known alcohol use
| <pre>GET [base]/Observation?code=http://snomed.info/sct|228273003</pre>
|-
| Tabakgebruik
| TobaccoUse
| All known tobacco use
| <pre>GET [base]/Observation?code=http://snomed.info/sct|365980008</pre>
|-
| Woonsituatie
| LivingSituation
| Last known living situation
| <pre>GET [base]/Observation/$lastn?code=http://snomed.info/sct|365508006</pre>
|-
| Gezinssituatie
| FamilySituation
| All known family situations
| <pre>GET [base]/Observation?code=http://snomed.info/sct|365470003</pre>
|-
| GezinssituatieKind
| FamilySituationChild
| All known family situations of child patient
| <pre>GET [base]/Observation?code=http://snomed.info/sct|55801000146105</pre>
|-
| Taalvaardigheid
| LanguageProficiency
| Known language proficiency 
| style="font-style:italic;" | see Patient
|-
| ParticipatieInMaatschappij
| ParticipationInSociety
| All known participation in society status
| <pre>GET [base]/Observation?code=http://snomed.info/sct|314845004</pre>
|-
| HulpVanAnderen
| HelpFromOthers
| All known help from others
| <pre>GET [base]/CarePlan?category=http://snomed.info/sct|243114000</pre>
|-
| LaboratoriumUitslag
| LaboratoryTestResult
| Last known laboratory results per type (incl. medication levels like lithium)
| <pre>GET [base]/Observation/$lastn?category=http://snomed.info/sct|275711006&_include=Observation:related-target&_include=Observation:specimen</pre>
|-
| AlgemeneMeting
| GeneralMeasurement
| All known questionaire (for example HONOS, OQ-45, CQ index, 4DKL) outcome scores.
| <pre>GET [base]/Observation?category=http://hl7.org/fhir/observation-category|survey</pre>
|-
| Verrichting
| Procedure
| All known GGZ procedures (includes all known freedom restricting measures)
| <pre>GET [base]/Procedure</pre>
|-
| TekstUitslag
| TextResult
| All known text results of GGZ procedures
| <pre>GET [base]/DiagnosticReport</pre>
|-
| -
| -
| CareTeam: primary healthprofessional and other relevant healthprofessionals including the healthcare provider. 
| <pre>GET [base]/CareTeam?_include=CareTeam:participant</pre>
|-
| Zorgverlener
| HealthProfessional
| General Practitioner of the patient
| style="font-style:italic;" | see Patient, CareTeam
|-
| Zorgaanbieder
| HealthProvider
| General Practitioner's organization of the patient
| style="font-style:italic;" | see Patient, CareTeam
|}
<references/>

===Server - XIS===
The returned data to the PHR should conform to the profiles listed in [[#List_of_profiles]].

===The <code>lastn</code> operation===
The following [http://hl7.org/fhir/STU3/operations.html operation] is needed for this use case.
* [http://hl7.org/fhir/STU3/observation-operations.html#lastn Last N Observations Query]

The <code>lastn</code> query meets the common need for searching for the most recent or last n=number of observations for a subject. For example, retrieving the last 5 temperatures for a patient to view trends or fetching the most recent laboratory results or vital signs. The link will provide more detailed information and examples regarding this operation.

The FHIR STU3 specification is vague regarding the sorting mechanism of <code>lastn</code>. In FHIR R4 however, this has been clarified and can be read as follows: when using <code>lastn</code>, the <code>effective[x]</code> element is used for sorting of Observations, sorted from most recent to the oldest.

==List of profiles==
The profiles represent their entire respective HCIM and are applicable in a broader context than the exchange of GGZ information. 

{{MedMij:Vprepub/NoteBoxPackage|p1=nictiz.fhir.nl.stu3.zib2017}}

{| class="wikitable" style="horizontal-align: right" 
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:50px" | HCIM NL
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:50px" | HCIM EN
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:50px" | FHIR Resource
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:400px" | FHIR Profile
|-
| Patient
| Patient
| Patient
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017}}
|-
| Betaler
| Payer
| Coverage
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Payer|nictiz.fhir.nl.stu3.zib2017}}
|-
| BehandelAanwijzing
| TreatmentDirective
| Consent
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective|nictiz.fhir.nl.stu3.zib2017}}
|-
| Wilsverklaring
| AdvanceDirective
| Consent
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AdvanceDirective|nictiz.fhir.nl.stu3.zib2017}}
|-
|-
| JuridischeStatus*
| LegalStatus* 
| Extension
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017|see Patient}} or {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-FreedomRestrictingMeasures|nictiz.fhir.nl.stu3.zib2017|see FreedomRestrictingMeasures}}
|-
| VrijheidbeperkendeMaatregelen
| FreedomRestrictingMeasures
| Procedure
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-FreedomRestrictingMeasures|nictiz.fhir.nl.stu3.zib2017}}
|-
| FunctioneleOfMentaleStatus
| FunctionalOrMentalStatus
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-FunctionalOrMentalStatus|nictiz.fhir.nl.stu3.zib2017}}
|-
| Probleem
| Problem
| Condition
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Problem|nictiz.fhir.nl.stu3.zib2017}}
|-
| Woonsituatie
| LivingSituation
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-LivingSituation|nictiz.fhir.nl.stu3.zib2017}}
|-
| Druggebruik
| DrugUse
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-DrugUse|nictiz.fhir.nl.stu3.zib2017}}
|-
| Alcoholgebruik
| AlcoholUse
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AlcoholUse|nictiz.fhir.nl.stu3.zib2017}}
|-
| Tabakgebruik
| TobaccoUse
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-TobaccoUse|nictiz.fhir.nl.stu3.zib2017}}
|-
| Gezinssituatie
| FamilySituation
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-FamilySituation|nictiz.fhir.nl.stu3.zib2017}}
|-
| GezinssituatieKind
| FamilySituationChild
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-FamilySituationChild|nictiz.fhir.nl.stu3.zib2017}}
|-
| Taalvaardigheid
| LanguageProficiency
| Patient
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017|see Patient}}
|-
| ParticipatieInMaatschappij
| ParticipationInSociety
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-ParticipationInSociety|nictiz.fhir.nl.stu3.zib2017}}
|-
| HulpVanAnderen
| HelpFromOthers
| CarePlan
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-HelpFromOthers|nictiz.fhir.nl.stu3.zib2017}}
|-
| LaboratoriumUitslag
| LaboratoryTestResult
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Observation|nictiz.fhir.nl.stu3.zib2017}}
|-
| AlgemeneMeting
| GeneralMeasurement
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-GeneralMeasurement|nictiz.fhir.nl.stu3.zib2017}}
|-
| Verrichting
| Procedure
| Procedure
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Procedure|nictiz.fhir.nl.stu3.zib2017}}
|-
| TekstUitslag
| TextResult
| DiagnosticReport
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-TextResult|nictiz.fhir.nl.stu3.zib2017}}
|-
| Zorgverlener
| HealthProfessional
| Practitioner
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner|nictiz.fhir.nl.stu3.zib2017}}
|-
| Zorgaanbieder
| HealthProfessional
| Organization
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-organization|nictiz.fhir.nl.stu3.zib2017}}
|-
| -
| -
| CareTeam
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-careteam|nictiz.fhir.nl.stu3.zib2017}}
|}
<blockquote>* LegalStatus is a single concept of the HCIM FreedomRestrictingMeasures and does not represent a complete HCIM yet. This concept will become an independent HCIM in a future release of the HCIM.</blockquote>

=Release notes=
Release notes can be found on the [[MedMij:Vprepub/OntwerpGGZ#Release_notes|functional design page]].