Brontekst bekijken van MedMij:Vissue-MM-2967/FHIR GP Data

{{IssuePaginaWaarschuwing|MM-2967|MedMij:V2020.01/FHIR_GP_Data}}
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{{DISPLAYTITLE:MedMij FHIR Implementation Guide GP Patient Data {{VersieInfo|Huisartsgegevens}}}}
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[[Bestand:MedMij2.png |link=https://www.medmij.nl/|rechts|Naar medmij.nl]]
[[Bestand:Huisartsgegevens.png |link=|links|90px|Use case GP Patient Data|GP Patient Data]] 
<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-2020.01/OntwerpHuisartsgegevens|Functioneel]]                
circle 1787 230 212 [[MedMij:Vprepub-2020.01/FHIR_IG|Technisch]]                
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__TOC__

==Introduction==
[[Bestand:Functioneel-02.png|link=MedMij:Vprepub-2020.01/Ontwerpen |100px|rechts|Functional design|Go to functional design]]

The input document "[[MedMij:Vprepub-2020.01/OntwerpHuisartsgegevens#richtlijn-huisarts-patient|Richtlijn online inzage in het H-EPD door patiënt]]" (Dutch) described online access of GP data by patients. The use case evolves around a GP specific Patient Data that consists of 10 sections plus the patient and the healthcare provider (GP). These sections correspond to the "[[MedMij:Vprepub-2020.01/OntwerpHuisartsgegevens#his-referentiemodel-2016|HIS referentiemodel Publieksversie 2016]]" (Dutch). ''HIS referentiemodel'' is the GP information system reference model (GP-IS-RM).

Some but not all sections in the GP Patient Data correspond to Health and Care Information Models ([https://zibs.nl/wiki/HCIM_Mainpage HCIMs] (English) or [https://zibs.nl/wiki/ZIB_Hoofdpagina zibs] (Dutch)). A joint initiative project between [http://www.nictiz.nl Nictiz] and the Dutch GP association [https://www.nhg.org NHG] is underway to analyse the relationship between the GP-IS-RM and the HCIMs and propose updates where needed. This analysis will not yield results before 2019. This specification thus predates the analysis, and will updated accordingly moving forward.

This page will elaborate further on the HL7 FHIR details needed to exchange the GP Patient Data information using FHIR.

'''Note''': This implementation guide builds on the general guidelines described in the [[MedMij:Vprepub-2020.01/FHIR_IG#Use case overarching principles|use case overarching principles]].

==Actors involved==
{| class="wikitable"
! colspan="2" style="text-align:left;" | Persons
! 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/gp-patientdata2017-clientcapabilities|nictiz.fhir.nl.stu3.zib2017|title=CapabilityStatement: Client}}
| GP Patient Data client requirements 
|-
| Healthcare professional
| The user of a XIS
| XIS
| Healthcare information system
|[[Bestand: Verwijzing.png| 20px]] {{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/gp-patientdata2017-servercapabilities|nictiz.fhir.nl.stu3.zib2017|nictiz.fhir.nl.stu3.zib2017|title=CapabilityStatement: Server}}
| GP Patient Data server requirements 
|}

==Boundaries and Relationships==
The GP Patient Data use case has similarities and differences with other use cases such as the [[MedMij:Vcurrent_FHIR_IG|BgZ]], Medication Process, Vital Signs 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 GP Patient Data also has a few unique profiles compared to the aforementioned use cases. A second thing to note is that while the selection criteria of certain sections like lab do not match, this does not affect the response profiles. For example it is irrelevant for the response profile lab if you request the 'latest lab result' or 'every result since date X'.

==List of invocations==
[[Bestand:Afsprakenstelsel-01.png|link=https://www.medmij.nl/afsprakenstelsel/|rechts |100px|Go to Afsprakenstelsel]]
{{FHIR-IG-Afsprakenstelsel-Note}}

===Client - PHR===
The PHR system requests the GP Patient Data using individual [https://www.hl7.org/fhir/stu3/search.html search] interactions. The search interaction searches the current resources based on some filter criteria. The interactions are performed by an HTTP GET or command as shown:

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

The table below shows in the first four columns the GP Patient Data sections, the GP-IS-RM sections / HCIMs that constitute those sections and the specific content of the GP Patient Data. The last column shows the FHIR search queries to obtain the GP Patient Data information. These queries are based on profiles listed in [[#List_of_profiles|this section]]. As noted in the [[#Introduction|introduction]], the associated HCIMs are ahead of a separate joint initiative project that aims to analyse and harmonize this further.

{| class="wikitable collapsible" cellpadding="10"
! style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:center; border: 1px solid black;"  colspan="6" | Bijlage 1 Richtlijn Online inzage in het H-EPD door patiënt
|-
! 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"| GP Patient Data 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:Vprepub-2020.01/FHIR_IG#Search_URLs_and_search_parameters|Search URLs and search parameters]] for the interpretation of these search URLs</ref>
|-
| style="background-color: white;vertical-align:top;"| 1
| style="background-color: white;vertical-align:top;"| General Practitioner/Practice
| style="background-color: white;vertical-align:top;"| [https://zibs.nl/wiki/HealthProfessional-v3.1(2017EN) HealthProfessional v3.1 (2017)]<br/>[https://zibs.nl/wiki/HealthcareProvider-v3.1(2017EN) HealthcareProvider v3.1 (2017)]
| style="background-color: white;vertical-align:top;"| The GP or GP practice that originates the patient data.
| style="background-color: white;vertical-align:top;"| <pre style="font-style: italic;">see Patient</pre>
'''Note''': a separate query for General Practitioner/Practice is not required as this data is attached in context to the Patient resource. 
|-
| style="vertical-align:top;"| 2
| style="vertical-align:top;"| Patient
| style="vertical-align:top;"| [https://zibs.nl/wiki/Patient-v3.1(2017EN) Patient v3.1 (2017)]
| style="vertical-align:top;"| De patient data of the patient the data is for. Note that retrieving patient data separately may not be supported by GP systems in some circumstances. Patient data will however be part of the other responses in that case.
| style="vertical-align:top;"| <pre>GET [base]/Patient?_include=Patient:general-practitioner</pre>
'''Note''': a separate query for Patient may not be necessary for clients or supported by servers as this data is attached in context to every other (clinical) resource. 
|-
| style="background-color: white;vertical-align:top;"| 3
| style="background-color: white;vertical-align:top;"| Episodes
| style="background-color: white;" rowspan="3"|
| style="background-color: white;vertical-align:top;"| A health concern like a complaint of illness, that may change in nature as diagnoses are made and/or the illness develops.
| style="background-color: white;" rowspan="3"| <pre>GET [base]/EpisodeOfCare</pre>
A server MAY implement inclusion of associated Flag resources indicating that the GP has added an attention value to this episode. The reference from the Flag to the EpisodeOfCare is handled though <code>Flag.extension(ConcernReference)</code>. For this reason, it is not possible for clients to request this information explicitly using <code>_include</code> or <code>_revInclude</code> parameters. Note that attention flags on a an episode are aimed at the GP, not at the patient.
|-
| style="vertical-align:top;"| 4
| style="vertical-align:top;"| Episodes with alert flag
| style="vertical-align:top;"| Episodes may have an associated alert signaling extra attention to the episode is requested. The alert flag may stay active even if after closing the episode, if the user deems it important to stay aware.
|-
| style="background-color: white;vertical-align:top;"| 5
| style="background-color: white;vertical-align:top;"| Open and closed episodes
| style="background-color: white;vertical-align:top;"| Episodes may be open (currently active) or closed (no longer active).
|- style="vertical-align:top;"
| 6
| Treatment
| 
| Procedure on the patient targeting the patients health situation. E.g. operative and (severe) procedures like radiation or chemotherapy.
| ''TODO: No HCIM. GP systems do not yet export this info.''
|-
| style="background-color: white;vertical-align:top;"| 7
| style="background-color: white;vertical-align:top;"| Prophylaxis en precaution
| style="background-color: white;vertical-align:top;"|
| style="background-color: white;vertical-align:top;"| Prophylaxis and precaution contain precautionary measures required for or to prevent certain medical conditions. See [https://referentiemodel.nhg.org/tabellen/894/publieksversie/published NHG Tabel 56]
| style="background-color: white;vertical-align:top;"| ''TODO: No HCIM. GP systems do not yet export this info. Unclear if it'll be anything beyond the Table 56 code (id, time, author, text?)''
|-
| style="vertical-align:top;"| 8
| style="vertical-align:top;"|Current medication
| style="vertical-align:top;"|[https://zibs.nl/wiki/MedicationAgreement-v1.0(2017EN) MedicationAgreement v1.0 (2017)]
| style="vertical-align:top;"|MedicationAgreement <br/>The prescriber proposed use of medication that the patient agrees with. The agreement may signal starting, repeating, updating or stopping the medication. The list of MedicationAgreements is also known as the list of medication the patient is '''currently''' using. Note that "currently" means that the period of use is still active. This is conveyed in the MedicationRequest extension {{fhir|periodOfUse}}. This extension may or may not be populated. If it is not, the Medicationagreement is assumed to be current. The search parameter {{Simplifier|http://nictiz.nl/fhir/SearchParameter/Medications-periodofuse|nictiz.fhir.nl.stu3.zib2017|title=periodofuse}} allows filtering for current MedicationAgreements.
| style="vertical-align:top;"|<pre>GET [base]/MedicationRequest?periodofuse=ge[today]&category=http://snomed.info/sct|16076005&_include=MedicationRequest:medication</pre>
|-
| style="background-color: white;vertical-align:top;"| 9
| style="background-color: white;vertical-align:top;"|Medication intolerance
| style="background-color: white;vertical-align:top;"| [https://zibs.nl/wiki/AllergyIntolerance-v3.1(2017EN) AllergyIntolerance v3.1 (2017)]
| style="background-color: white;vertical-align:top;"|A medication intolerance concerns the intolerance of a patient for a specific drug, substance or substance group, that needs to be taken into account when prescribing, dispensing or administering medication.
| style="background-color: white;vertical-align:top;"| <pre>GET [base]/AllergyIntolerance?category=medication</pre>
|-
| style="vertical-align:top;"| 10
| style="vertical-align:top;"| Correspondence
| style="vertical-align:top;"| 
| style="vertical-align:top;"| Incoming: an incoming letter about a patient, recorded as such in the patients medical record.<br/>Outbound: a letter created by a healthcare professional for a third party healthcare professional.
| style="vertical-align:top;"| ''TODO: No HCIM. GP systems do not yet export this info. For PDF(/A) based correspondence it is possible to turn to the [[MedMij:Vcurrent_Ontwerpen|relevant information standard]] for that type of data.''
|-
| style="background-color: white;vertical-align:top;" rowspan="9"| 11
| style="background-color: white;vertical-align:top;" rowspan="9"| Diagnostic and lab results
| style="background-color: white;vertical-align:top;"| [https://zibs.nl/wiki/LaboratoryTestResult-v4.0(2017EN) LaboratoryTestResult v4.0 (2017)]
| style="background-color: white;vertical-align:top;" rowspan="9"|A lab test is an objectifiable diagnostic procedure. The result is the outcome of the procedure. Lab tests include vital signs like blood pressure, weight and lab results like ferro in blood.<br/><br/>Note that GP (lab) results are normally coded using [https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen NHG Tabel 45]. While some of these codes might be convertible to LOINC or SNOMED CT, this is '''not''' expected at present. Bridging code systems between primary and secondary care is part of a larger national discussion<br/><br/>Note that the date parameter is optional and needs calculation, e.g. current-date() - 14 months. The business rules in the [[MedMij:Vprepub-2020.01/OntwerpHuisartsgegevens#richtlijn-huisarts-patient|guide lines]] determine the maximum range for the returned results. If the date parameter is omitted, the maximum range is assumed
| style="background-color: white;" rowspan="9"| <pre>GET [base]/Observation?code=https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen|&_include=Observation:related-target&_include=Observation:specimen&date=ge2017-01-01</pre>
|-
| style="background-color: white;vertical-align:top;"| [https://zibs.nl/wiki/BloodPressure-v3.1(2017EN) BloodPressure v3.1 (2017)]
|-
| style="background-color: white;vertical-align:top;"| [https://zibs.nl/wiki/BodyHeight-v3.1(2017EN) BodyHeight v3.1 (2017)]
|-
| style="background-color: white;vertical-align:top;"| [https://zibs.nl/wiki/BodyTemperature-v3.1(2017EN) BodyTemperature v3.1 (2017)]
|-
| style="background-color: white;vertical-align:top;"| [https://zibs.nl/wiki/BodyWeight-v3.1(2017EN) BodyWeight v3.1 (2017)]
|-
| style="background-color: white;vertical-align:top;"| [https://zibs.nl/wiki/GeneralMeasurement-v3.0(2017EN) GeneralMeasurement v3.0 (2017)]
|-
| style="background-color: white;vertical-align:top;"| [https://zibs.nl/wiki/HeartRate-v3.1(2017EN) HeartRate v3.1 (2017)]
|-
| style="background-color: white;vertical-align:top;"| [https://zibs.nl/wiki/O2Saturation-v3.1(2017EN) O2Saturation v3.1(2017)]
|-
| style="background-color: white;vertical-align:top;"| [https://zibs.nl/wiki/PulseRate-v3.1(2017EN) PulseRate v3.1(2017)]
|- style="vertical-align:top;"
| 12
|E- and P-journal entries of the SOAP (EN) or SOEP (NL) structure - ''recorded after introduction of online access''
|
| Information from an encounter, recorded in free text using the SOAP structure. The acronym SOAP stands for Subjective, Objective, Assessment and Plan. The E entry contains the consultation conclusion and the P entry contains potential next steps.<br/><br/>Note that the profile for SOAP entries is yet to be created and the  code system value is preliminary
| <pre>GET [base]/Composition?type=http://loinc.org|67781-5</pre>
{{NoteBox|The underlying guideline does not explicitly mention encounters nor partial encounters (Dutch: ''deelcontacten''), but journal entries are normally 'grouped' as encounters based on the entry complaint (journal entry type Subjective). If multiple entry complaints have been discussed based during a single encounter, these are regarded as partial encounters. 

The expectation of each encounter report (Composition) is that it combines the journal entries that constitute a partial encounter. If there is just one issue discussed during the encounter, there is only one encounter report. If there is more than one partial contact, there could be multiple encounter reports pointing to the same encounter. 

Note that while FHIR supports Encounter resources being part of other Encounter resources, this does not reflect how GP systems are organized. Encounter parts do not not have individual properties to manage and act as a kind of virtual compartment within the encounter.}}
|-
| style="background-color: white;vertical-align:top;"| 13
| style="background-color: white;vertical-align:top;"|Encounters
| style="background-color: white;vertical-align:top;"|[https://zibs.nl/wiki/Encounter-v3.1(2017EN) Encounter v3.1(2017)]
| style="background-color: white;vertical-align:top;"|Encounters are expected to have at least an identifier, a type, a date possibly with start/end times, a responsible GP, and potentially an alternative performer such as an out-of-hour-services colleague (Dutch: ''waarnemer'' or ''triagist''). Other things that could be recorded against an Encounter, such as the appointment, people escorting the patient (relatives, translator, neighbor) are not normally communicated.

Minimum expectation for returned Encounters is that this query should yield Encounters being referred to from other parts of the information standard.
| style="background-color: white;vertical-align:top;"| <pre>GET [base]/Encounter</pre>
|}
<references/>

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

===Custom search parameters===
Clients can search for MedicationRequest and MedicationDispense resources based on the period of use, using the custom search parameter {{Simplifier|http://nictiz.nl/fhir/SearchParameter/Medications-periodofuse|title=Medications-periodofuse}}. This search should be treated as a search on {{datatype|Period}} as described by the [http://hl7.org/fhir/stu3/search.html#date FHIR specification]. During processing of the search, servers should take into account the {{datatype|Period}} value from the {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Medication-PeriodOfUse|title=Medication-PeriodOfUse extension}} and the {{datatype|Duration}} value from the {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Duration|title=MedicationUse-Duration extension}} in these resources. This {{datatype|Duration}} should be used to dynamically calculate Period.end if this is not specified.

To illustrate the expected behavior: if a client requests MedicationRequest resources after March 7th, 2023, like so:

  <nowiki>GET http://example.org/MedicationRequest?periodofuse=ge2023-03-07</nowiki>

The server should include a MedicationRequest resource where Period.start is populated with 2023-03-01 and the Duration is populated with 14 days, because the date searched on falls between Period.start en the dynamically calculated Period.end.

In order to allow the client to be confident about what search parameters were used as criteria by the server, the server SHALL return the parameters that were actually used to process the search. Applications processing search results SHALL check these returned values where necessary. For example, if the server did not support some of the filters specified in the search, a client might manually apply those filters to the retrieved result set, display a warning message to the user or take some other action.

In the case of a RESTful search, these parameters are encoded in the self link in the bundle that is returned:
<syntaxhighlight lang="xml">
<link>
  <relation value="self"/>
  <url value="http://example.org/MedicationRequest?periodofuse=ge2023-03-14/>
</link>
</syntaxhighlight>

Link to the relevant FHIR specification: http://hl7.org/fhir/STU3/http.html#search

==Interactions, operations, search parameters==

===Interactions===

The following logical interactions are needed for the GP Patient Data use case:
* [http://hl7.org/fhir/STU3/http.html#search Search]
* [http://hl7.org/fhir/STU3/http.html#transaction Batch/Transaction]

===Operations===
There are no operations required to support this use case
<!--The following [http://hl7.org/fhir/STU3/operations.html operation] is needed to support this use case.
* [http://hl7.org/fhir/STU3/observation-operations.html#lastn Last N Observations Query]

The lastn 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 vitals signs. The link will provide more detailed information and examples regarding this operation.
-->
===Search parameters===
The following search parameter types and search result parameters need to be supported for this use case.

Search parameter types:
<!--
* [http://hl7.org/fhir/STU3/search.html#token token]
** Including modifier 'in'
* [http://hl7.org/fhir/STU3/search.html#reference reference]
-->

Search result parameters:
* [http://hl7.org/fhir/STU3/search.html#include _include]
* [http://hl7.org/fhir/STU3/search.html#include _revinclude]
* {{Simplifier|http://nictiz.nl/fhir/SearchParameter/Medications-periodofuse|nictiz.fhir.nl.stu3.zib2017|title=periodofuse}} *

<nowiki>*</nowiki> This SearchParameter searches on the FHIR DataType Period in the PeriodOfUse extension, which is added to profiles on MedicationRequest and MedicationDispense resources. Clients use date parameter searches as described by the [http://hl7.org/fhir/stu3/search.html#date FHIR specification]. Servers are expected to take the [http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Duration MedicationUse-Duration extension] into account when processing a client's search. This means that either a Period.start + Period.end or Period.start + Duration is used to determine the search results. To illustrate the expected behavior: if a Period.start and a Duration is known, but not the Period, the Duration should be added to the Period.start date to calculate the Period.end. The calculated Period.end date is then used to determine the search results.

==List of profiles==
The profiles represent their entire respective HCIM, to make them applicable in a broader context than the exchange of GP Patient Data or a MedMij context. An example for reuse of existing profiles are those of the patient administration resources and vital signs.
{{MedMij:Vprepub-2020.01/NoteBoxPackage|p1=nictiz.fhir.nl.stu3.zib2017|v1Min=2.0.0}}
{| class="wikitable collapsible" cellpadding="10"
! style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:center; border: 1px solid black;"  colspan="6" | Bijlage 1 Richtlijn Online inzage in het H-EPD door patiënt
|-
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:10px"  | Section
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:100px" | Zib NL
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:100px" | HCIM EN
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:100px" | FHIR Resource
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:400px" | URL Profile
|-
| style="background-color: white;" rowspan="2"| 1
| style="background-color: white;"| Zorgverlener
| style="background-color: white;"| HealthProfessional
| style="background-color: white;"|
| style="background-color: white;"| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner|nictiz.fhir.nl.stu3.zib2017}}
|-
| style="background-color: white;"| Zorgaanbieder
| style="background-color: white;"| HealthcareProvider
| style="background-color: white;"| Organization
| style="background-color: white;"| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-organization|nictiz.fhir.nl.stu3.zib2017}}
|-
| 2
|Patiënt
|Patient
| Patient
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017}}
|-
| style="background-color: white;"| 3
| style="background-color: white;" rowspan="3"| 
| style="background-color: white;" rowspan="3"| 
| style="background-color: white;" rowspan="3"| EpisodeOfCare
| style="background-color: white;" rowspan="3"| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Alert|nictiz.fhir.nl.stu3.zib2017}}<br/>{{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-episodeofcare|nictiz.fhir.nl.stu3.zib2017}}
|-
| 4
|-
| style="background-color: white;"| 5
|-
| 8
| MedicatieAfspraak
| MedicationAgreement
| MedicationRequest
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicationAgreement|nictiz.fhir.nl.stu3.zib2017}}
|-
| style="background-color: white;"| 9
| style="background-color: white;"| AllergieIntolerantie
| style="background-color: white;"| AllergyIntolerance 
| style="background-color: white;"| AllergyIntolerance
| style="background-color: white;"| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AllergyIntolerance|nictiz.fhir.nl.stu3.zib2017}}
|-
| rowspan="9"| 11
| LaboratoriumUitslag
| LaboratoryTestResult
| rowspan="9"| Observation
| rowspan="9"| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/gp-DiagnosticResult|nictiz.fhir.nl.stu3.zib2017}} (NHG Table 45 codes of type D)<br/>{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/gp-LaboratoryResult|nictiz.fhir.nl.stu3.zib2017}} (NHG Table 45 codes of type L)
|-
| Bloeddruk
| BloodPressure
|-
| Lichaamslengte
| BodyHeight
|-
| Lichaamstemperatuur
| BodyTemperature
|-
| Lichaamsgewicht
| BodyWeight
|-
| AlgemeneMeting
| GeneralMeasurement
|-
| Harfrequentie
| HeartRate
|-
| O2Saturatie
| O2Saturation
|-
| Polsfrequentie
| PulseRate
|-
| style="background-color: white;" | 12
| style="background-color: white;" | 
| style="background-color: white;" | 
| style="background-color: white;" | Composition<br/>Observation
| style="background-color: white;" | {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/gp-EncounterReport|nictiz.fhir.nl.stu3.zib2017}}<br/>{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/gp-JournalEntry|nictiz.fhir.nl.stu3.zib2017}}
|-
| 13
|Contact
|Encounter
| Encounter
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/gp-Encounter|nictiz.fhir.nl.stu3.zib2017}}
|}
===Referencing encounters and episodes===
During early testing of the published information standard, an omission was found. Any journal entry or other activity, and in some cases medication agreement and diagnostic results is associated with an encounter (Encounter resource in FHIR), but an additional association with one or more episodes (EpisodeOfCare in FHIR) is also normal GP practice. However, it is not possible to do this natively in the currently used FHIR version STU3: many resources define the element {{fhir|.context}} (Encounter <nowiki>|</nowiki> EpisodeOfCare), but restricts its cardinality to 0..1, meaning that a resource can be connected to either an Encounter or EpisodeOfCare resource, but not both.

The recommendation is to use {{fhir|.context}} for associating the Encounter, not the EpisodeOfCare. This approach aligns with the changes in FHIR version R4, where the {{fhir|.context}} element is replaced by {{fhir|.encounter}} to support just a reference to an Encounter resource. EpisodeOfCare resource can be referenced through a new extension published in the spring of 2021 (package 2.1.1): {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/extension-context-nl-core-episodeofcare|nictiz.fhir.nl.stu3.zib2017}}.

Compatibility note: systems that went in production before this new extension was published will not be able to interpret it, unless they update for it. These systems will ignore the extension and read - as specified - the {{fhir|.context}} which is normally claimed by a reference to Encounter. Updated and newer systems may now anticipate episode associations on journal entries, diagnostic results, medication agreements and potential other encounter activities, as applicable. For more details, please see [https://bits.nictiz.nl/browse/MM-1521 issue MM-1521].

=Release notes=
Release notes can be found on the [[MedMij:Vprepub-2020.01/OntwerpHuisartsgegevens#Release_notes| functional design page]].

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