Brontekst bekijken van MedMij:V2020.01/FHIR BGLZ

__NUMBEREDHEADINGS__
{{DISPLAYTITLE:MedMij FHIR Implementation Guide: BgLZ {{VersieInfo|BgLZ}}}}
{{MedMij:V2020.01/Issuebox_FHIR_IG}}

{{NoteBox|1= As of 01-12-2021 this version (2020.01) is no longer in use for MedMij and will no longer be qualified upon. For the currently supported version please visit [[MedMij:V2020.02/FHIR_IG]].}}
[[Bestand:MedMij2.png |link=https://www.medmij.nl/|rechts|Naar medmij.nl]]
[[Bestand:BgLZ-icon.png |link=|links|90px|Use case BgZ 2017|Patient Summary (BgZ)]] 
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circle 241 216 211 [https://www.medmij.nl/afsprakenstelsel Afsprakenstelsel]                
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__TOC__

=Introduction=
[[Bestand:Functioneel-02.png|link=MedMij:V2020.01/Ontwerpen |100px|rechts|Functional design|Go to functional design]]

This page provides the technical specification of the exchange of long-term healthcare information (Dutch: Basisgegevens Langdurige Zorg or BgLZ) based on a selection of Dutch Health Care Information Models. The specification is based on this [[MedMij:V2020.01/OntwerpLangdurigeZorg|functional design]].

'''Note''': This implementation guide builds on the general guidelines described in the [[MedMij:V2020.01/FHIR_IG#Use case overarching principles|use case overarching principles]].

=Actors involved=
{| class="wikitable"
! colspan="2" style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;" | Actors
! colspan="2" style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;" | Systems
! colspan="2" style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;" | FHIR Capability Statements
|-
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"|Name
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"|Description
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"|Name
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"|Description
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"|Name
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"|Description
|-
| Patient
| The user of a personal healthcare environment.
| PHR
| Personal health record
|[[Bestand: Verwijzing.png| 20px]] {{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/bglz-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/bglz-servercapabilities|nictiz.fhir.nl.stu3.zib2017|title=CapabilityStatement: Server}}
| FHIR Server requirements 
|}

=Boundaries and Relationships=
The BgLZ has similarities with the [[MedMij:V2020.01/FHIR_BGZ_2017|Basisgegevensset Zorg (BgZ)]] and [[MedMij:V2020.01/FHIR_GGZ|Basisgegevens GGZ (GGZ)]] but is definitely different. These information standards use much of the same HCIM based FHIR profiles for exchanging information. Wherever possible every attempt is made to re-use profiles. The BgLZ use case also has unique profiles compared to the aforementioned use cases, such as OutcomeOfCare. In addition, it uses a CareTeam profile without an underlying HCIM.
A second thing to note is that also the selection of requested information per HCIM may differentiate. For example, only a subset of LaboratoryResults or AllergyIntolerance is expected to be returned by a XIS. [[MedMij:V2020.01/InhoudLangdurigeZorg|This page]], which belongs to the BgLZ functional design, and related [https://decor.nictiz.nl/decor/services/RetrieveTransaction?id=2.16.840.1.113883.2.4.3.11.60.58.4.3&effectiveDate=2019-04-09T16:33:35&language=nl-NL&ui=nl-NL&format=html&hidecolumns=34567 transactions] provide details on the information that is expected to be exchanged. 

Medication information is part of a good overview of patients in long-term healthcare. Retrieving medication information by a PHR is however out of scope for this information standard. A separate information standard, [[MedMij:V2020.01/FHIR_MedicationProcess|MedicationProcess]], is intended to serve this purpose.

=Use case: Retrieve BgLZ information=
{{FHIR-IG-Afsprakenstelsel-Note}}

[[Bestand:Afsprakenstelsel-01.png|link=https://www.medmij.nl/afsprakenstelsel/|rechts |100px|Go to Afsprakenstelsel]]

==Introduction==
The retrieve BgLZ transaction is used by the PHR to retrieve long-term healthcare information from a XIS.

==Actors==
{| class="wikitable" "cellpadding="10"
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"| '''Transaction group'''
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"| '''Transaction'''
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"| '''Actor'''
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"| '''Role'''
|-
|style="background-color: white;" rowspan="2"|Retrieve BgLZ (PULL)
|style="background-color: white;vertical-align:top;"|Retrieve BgLZ request
|style="background-color: white;vertical-align:top;"|Patient (using a PHR)
|style="background-color: white;vertical-align:top;"|Request long-term healthcare information from a XIS
|-
|style="background-color: white;vertical-align:top;"|Retrieve BgLZ response
|style="background-color: white;vertical-align:top;"|Healthcare professional (using a XIS)
|style="background-color: white;vertical-align:top;"|Serves long-term healthcare information to a PHR
|}

==Invocations==

===PHR: request message===
The PHR system requests the BgLZ using individual [https://www.hl7.org/fhir/stu3/search.html search] interactions. The BgLZ consists of multiple FHIR resources with certain constraints. To obtain the patient's BgLZ, 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 four columns the BgLZ sections, the HCIMs that constitute those sections and the specific content of the BgLZ. The last column shows the FHIR search queries to obtain the BgLZ information. These queries and expected responses are based on profiles listed in [[#List_of_profiles|this section]].

{| class="wikitable collapsible" width="100%" style="horizontal-align: right"  
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:10px" | #
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:10px" | BgLZ Section
!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:V2020.01/FHIR_IG#Search_URLs_and_search_parameters|Search URLs and search parameters]] for the interpretation of these search URLs</ref>
|-
| 1
| Patient information
| Patient
| Identification, birthdate, gender, deceasedindicator, contact details, marital status, and general practitioner (practitioner or organization)
| <pre>GET [base]/Patient?_include=Patient:general-practitioner</pre>
|-
| rowspan="2" | 2
| rowspan="2" | Treatment Directives
| TreatmentDirective
| Known treatment directives
| <pre>GET [base]/Consent?category=http://snomed.info/sct|11291000146105</pre>
|-
| AdvanceDirective
| Known advance directives
| <pre>GET [base]/Consent?category=http://snomed.info/sct|11341000146107</pre>
|-
| 3
| Contactperson
| ContactPerson
| First relation/contact
| <pre style="font-style: italic;">see Patient in Patient.contact</pre>
|-
| 4
| Problems
| Problem
| All known problems including diagnoses; no verification status
| <pre>GET [base]/Condition</pre>
|-
| 5
| Allergies
| AllergyIntolerance
| A selection of information from all known allergies and intolerances. The [https://decor.nictiz.nl/decor/services/RetrieveTransaction?id=2.16.840.1.113883.2.4.3.11.60.58.4.3&effectiveDate=2019-04-09T16:33:35&language=nl-NL&ui=nl-NL&format=html&hidecolumns=34567 ART-DECOR transaction] specification describes the selection.
| <pre>GET [base]/AllergyIntolerance</pre>
|-
| 6
| Results
| LaboratoryTestResult
| A selection of information from the last known clinical laboratory results per type. The [https://decor.nictiz.nl/decor/services/RetrieveTransaction?id=2.16.840.1.113883.2.4.3.11.60.58.4.3&effectiveDate=2019-04-09T16:33:35&language=nl-NL&ui=nl-NL&format=html&hidecolumns=34567 ART-DECOR transaction] specification describes the selection.
| <pre>GET [base]/Observation/$lastn?category=http://snomed.info/sct|275711006&_include=Observation:related-target&_include=Observation:specimen</pre>
|-
| 7
| Procedures
| Procedure
| All procedures
| <pre>GET [base]/Procedure</pre>
|-
| rowspan="4" | 8
| rowspan="4" | Goals and interventions 
''* see the NoteBox above''
| NursingIntervention
| NursingInterventions beloning to active problems
| rowspan="4" | <pre>GET [base]/CarePlan?_include=CarePlan:activity-goal:Goal
&_include=CarePlan:activity-outcomereference:Observation
&_include=CarePlan:activity-medicaldevice:DeviceUseStatement
&_include:recurse=DeviceUseStatement:device:Device</pre>
|-
| TreatmentObjective
| All treatment objectives beloning to NursingInterventions
|-
| MedicalDevice
| All MedicalDevices belonging to NursingInterventions; only product type and anatomical location
|-
| OutcomeOfCare
| Known treatment outcomes
|-
| rowspan="2" | 9
| rowspan="2" | Caresetting / CareTeam
| HealthProfessional
| rowspan="2" | 
* General practitioner of the patient ''(see Patient.generalPractitioner)''
* Primary practitioner - information of the primary care giver, no ID, adress/contact information
* Other practitioners - information of all practitioners given care to the patient, no ID, adress/contact information
* Healthcare provider - organization where care is given
| rowspan="2" | <pre>GET [base]/CareTeam?_include=CareTeam:participant</pre>
|-
| HealthcareProvider
|}
<references/>

===XIS: response message===
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.

===Custom search parameters===
The following custom search parameters are defined for this use case:

* {{Simplifier|http://nictiz.nl/fhir/SearchParameter/careplan-activity-goal|nictiz.fhir.nl.stu3.zib2017}}
* {{Simplifier|http://nictiz.nl/fhir/SearchParameter/careplan-activity-outcomereference|nictiz.fhir.nl.stu3.zib2017}}
* {{Simplifier|http://nictiz.nl/fhir/SearchParameter/careplan-medicaldevice|nictiz.fhir.nl.stu3.zib2017}}

==List of profiles==
The profiles represent their entire respective HCIM, to make them applicable in a broader context than the exchange of BgLZ or a MedMij context. 

{{MedMij:V2020.01/NoteBoxPackage|p1=nictiz.fhir.nl.stu3.zib2017|v1Min=2.0.0}}

{| class="wikitable" "cellpadding="10" 
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"|Zib NL
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"|HCIM EN
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"|FHIR Resource
!style="background-color: #4AB8A7;; color: white; font-weight: bold; text-align:left; border: 1px solid black;"|FHIR Profile
|-
| style="background-color: white;"| [https://zibs.nl/wiki/Patient-v3.1(2017NL) Patiënt]
| style="background-color: white;"| [https://zibs.nl/wiki/Patient-v3.1(2017EN) Patient]
| style="background-color: white;"| Patient
| style="background-color: white;"| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017}}
|-
| style="background-color: white;"| [https://zibs.nl/wiki/BehandelAanwijzing-v3.1(2017NL) BehandelAanwijzing]
| style="background-color: white;"| [https://zibs.nl/wiki/TreatmentDirective-v3.1(2017EN) TreatmentDirective]
| style="background-color: white;"| Consent
| style="background-color: white;"| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective|nictiz.fhir.nl.stu3.zib2017}} 
|-
| style="background-color: white;"| [https://zibs.nl/wiki/Wilsverklaring-v3.1(2017NL) Wilsverklaring]
| style="background-color: white;"| [https://zibs.nl/wiki/AdvanceDirective-v3.1(2017EN) AdvanceDirective]
| style="background-color: white;"| Consent
| style="background-color: white;"| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AdvanceDirective|nictiz.fhir.nl.stu3.zib2017}}
|-
| style="background-color: white;"| [https://zibs.nl/wiki/Probleem-v4.1(2017NL) Probleem]
| style="background-color: white;"| [https://zibs.nl/wiki/Problem-v4.1(2017EN) Problem]
| style="background-color: white;"| Condition
| style="background-color: white;"| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Problem|nictiz.fhir.nl.stu3.zib2017}} 
|-
| style="background-color: white;"| [https://zibs.nl/wiki/AllergieIntolerantie-v3.2(2017NL) AllergieIntolerantie]
| style="background-color: white;"| [https://zibs.nl/wiki/AllergyIntolerance-v3.2(2017EN) AllergyIntolerance]
| style="background-color: white;"| AllergyIntolerance
| style="background-color: white;"| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AllergyIntolerance|nictiz.fhir.nl.stu3.zib2017}}
|-
| style="background-color: white;"| [https://zibs.nl/wiki/LaboratoriumUitslag-v4.1(2017NL) LaboratoriumUitslag]
| style="background-color: white;"| [https://zibs.nl/wiki/LaboratoryTestResult-v4.1(2017EN) LaboratoryTestResult]
| style="background-color: white;"| Observation
| style="background-color: white;"| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Observation|nictiz.fhir.nl.stu3.zib2017}}
|-
| style="background-color: white;"| [https://zibs.nl/wiki/Verrichting-v4.1(2017NL) Verrichting]
| style="background-color: white;"| [https://zibs.nl/wiki/Procedure-v4.1(2017EN) Procedure]
| style="background-color: white;"| Procedure
| style="background-color: white;"| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Procedure|nictiz.fhir.nl.stu3.zib2017}}
|-
| style="background-color: white;"| [https://zibs.nl/wiki/VerpleegkundigeInterventie-v3.2(2018NL) VerpleegkundigeInterventie *]
| style="background-color: white;"| [https://zibs.nl/wiki/NursingIntervention-v3.2(2018EN) NursingIntervention *]
| rowspan="4" style="background-color: white;"| CarePlan
| rowspan="4" style="background-color: white;"| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-careplan|nictiz.fhir.nl.stu3.zib2017}}
|-
| style="background-color: white;"| [https://zibs.nl/wiki/Behandeldoel-v3.1(2017NL) Behandeldoel]
| style="background-color: white;"| [https://zibs.nl/wiki/TreatmentObjective-v3.1(2017EN) TreatmentObjective]
|-
| style="background-color: white;"| [https://zibs.nl/wiki/MedischHulpmiddel-v3.1(2017NL) MedischHulpmiddel]
| style="background-color: white;"| [https://zibs.nl/wiki/MedicalDevice-v3.1(2017EN) MedicalDevice]
|-
| style="background-color: white;"| [https://zibs.nl/wiki/UitkomstVanZorg-v3.1(2017NL) UitkomstVanZorg]
| style="background-color: white;"| [https://zibs.nl/wiki/OutcomeOfCare-v3.1(2017EN) OutcomeOfCare]
|-
| rowspan="2" style="background-color: white;" | [https://zibs.nl/wiki/Zorgverlener-v3.2(2017NL) Zorgverlener]
| rowspan="2" style="background-color: white;" | [https://zibs.nl/wiki/HealthProfessional-v3.2(2017EN) HealthProfessional]
| style="background-color: white;"| Practitioner
| style="background-color: white;"| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner|nictiz.fhir.nl.stu3.zib2017}}
|-
| style="background-color: white;"| PractitionerRole
| style="background-color: white;"| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-practitionerrole|nictiz.fhir.nl.stu3.zib2017}}
|-
| style="background-color: white;"| [https://zibs.nl/wiki/Zorgaanbieder-v3.1.1(2017NL) Zorgaanbieder]
| style="background-color: white;"| [https://zibs.nl/wiki/HealthcareProvider-v3.1.1(2017EN) HealthcareProvider]
| style="background-color: white;"| Organization
| style="background-color: white;"| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-organization|nictiz.fhir.nl.stu3.zib2017}}
|-
| style="background-color: white;"| -
| style="background-color: white;"| -
| style="background-color: white;"| CareTeam
| style="background-color: white;"| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-careteam|nictiz.fhir.nl.stu3.zib2017}}
|}

<blockquote>* The 2018 release of the HCIM NursingIntervention is used because the 2017 release is not suitable. The functional design page provides more information. In addition, the CarePlan resource is used to transfer the HCIM NursingIntervention. The BgLZ does not use the Procedure resource for HCIM NursingIntervention.</blockquote>

=Release notes=
Release notes can be found on the [[MedMij:V2020.01/OntwerpLangdurigeZorg#Release_notes|functional design page]].

{{MedMij:Sjabloon_Support}}