Brontekst bekijken van bgz:Technical IG BgZ MSZ 2 0 0 Beta 2

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For an overview of all current documentation for BgZ-MSZ [[Landingspagina_BgZ| see BgZ main page]]
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{{DISPLAYTITLE:BgZ MSZ FHIR Implementation Guide 2.0.0-beta.2}}
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=Introduction=

This is the FHIR implementation guide (IG) for the information standard BgZ-MSZ. This IG must be used together with the functional specification: [[Landingspagina_BgZ| see BgZ main page]].

In addition, the guidelines as specified in [[FHIR:V1.0 FHIR IG STU3|general FHIR STU3 Implementation Guide]] apply. The guide defines how to implement FHIR STU3 and what rules apply (e.g. how to handle empty reponses etc.). In particular, the reader should take note of the [[FHIR:V1.0_FHIR_IG_STU3#Use_case_overarching_principles|use case overarching principles]] and the use of [[FHIR:V1.0_FHIR_IG_STU3#FHIR_Packages|FHIR packages]].

First, this IG describes the boundaries and relationships that exist. Second, it describes the implementation per transaction.

== Known issues ==
This version of the information standard has known issues. Please find them in the [[BgZ:V2.0.0-beta.2_Ontwerp_BgZ_MSZ#Bekende_problemen | functional specifications page]].

= Boundaries and relationships =

== Boundaries ==

This version of the BgZ-MSZ describes the exchange of all BgZ chapters. This includes medication-related zibs, though this version does not use the [[mp:V3.0.0_Ontwerp_medicatieproces_9#Medicamenteuze_behandeling|MBH-identifier]]  from medication process, however systems are encouraged to use the <code>.identifier</code> as stated in the [[FHIR:V1.0_FHIR_IG_STU3#When_is_.identifier_expected.3F|general FHIR STU3 Implementation Guide]].

In future versions of the BgZ it is expected that implementation guides will be modularized and that for subsets of the BgZ references will be made to other information standards such as Medication Process, and Lab. 

In future versions the gap to the European patient summary will be addressed.

== Building blocks and FHIR profiles ==

Data exchange of the BgZ is based on the [https://zibs.nl/wiki/HCIM_Release_2017(EN) Dutch zibs 2017 (clinical information models)]. 
Table 3 contains an overview of all FHIR building blocks, including custom building blocks. Please note that every FHIR profile makes use of mappings towards the baseclass HCIM BasicElements, this is relevant since some parts within a FHIR profile are not mapped in the associated HCIM profile (e.g. effectiveDateTime in livingSituation). The HCIM BasicElements are used primarily for lastn queries that depend on the effectiveDateTime element. 

* The Metadata building block is made independently of the nl-core profiles. Metadata contains data that relates to the registration process rather than the medical content. Exchange of metadata for the BgZ-MSZ is designed via a query add-on: BgZ-MSZ sections can be queried with or without metadata. When data with a specific section are exchanged, there may be metadata about the registration process that refer to instances within such a section. In the future, when more information standards will use the Provenance resource to exchange registration data, it is planned to create an nl-core-MetaData profile that will replace the current bgz-MetaData profile.

== Relations between building blocks ==

<div class="center" style="width:auto; margin-left:auto; margin-right:auto;">
[[Bestand: ChaptersAndRelationsBgZ2 v1.png|800px]]
</div>
<small><b>Figure 1.</b> Relations between building blocks.</small>

== Mapping between profiles and dataset ==

Each FHIR profile maps to the functional definition in ART-DECOR. FHIR profiles contain mappings to all data elements that are present in the functional data set. Either HCIM mappings are used (e.g., NL-CM:17.2.1) or BgZ specific mappings are used with prefix: "bgz2017-dataelement-".

Each transaction must contain a Patient building block. Therefore, a reference to a Patient resource conforming to the nl-core-Patient profile is expected in .subject or .patient of each FHIR instance of each main building block with the exception of MetaData, Patient, HealthProvider.

FHIR instances, exchanged as part of a transaction, will contain references to other instances. For example a procedure may reference a problem list item. Implementers SHOULD use literal references (using .reference) instead of logical references (using .identifier) where possible, see the [[FHIR:V1.0_FHIR_IG_STU3#Use_of_the_Reference_datatype|general FHIR IG on the Reference data type]].

== Patient identification == 

This implementation guide assumes that the client system is able to make a connection to the right server that contains the patient's information. It does not provide information on finding the right server nor does it provide information about security. Moreover, each transaction is performed in the context of a specific patient, whose context might have been established using the authentication mechanisms described in external specifications such as the MedMij ‘Afsprakenstelsel’ or through the usage of search parameters for patient identification.
Each server is required to perform filtering based on the patient associated with the context for the request or based on the patient identification search parameters, which is a chained search parameter for all resource types except Patient, so only the records associated with the authenticated patient are returned.

An example of a request that retrieves all Condition resources of a patient with a fictional BSN of 111222333:
GET [base]/Condition?patient.identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333.

Table 4 defines the FHIR queries for all BgZ chapters. These queries apply for both use cases: "Exchange BgZ for Referral" and "Retrieval of BgZ from previous practitioner".
All search parameters used in this table SHALL be supported for processing by servers and MAY be supported by clients.

= Transactions =

== Exchange BgZ for Referral ==

{| 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
|-
| Referring (Sending) Medical Specialist
| Medical specialist who sends a BgZ along with a referral
| EHR
| Electronic health record
|[[Bestand: Verwijzing.png| 20px]] [https://simplifier.net/packages/nictiz.fhir.nl.stu3.bgz/2.0.3-beta.2/files/package/capabilitystatement-client-bgz2017.json CapabilityStatement: Client]
| FHIR Client requirements 
|-
| Receiving Medical Specialist
| Medical specialist receives a BgZ along with a referral
| EHR
| Electronic health record
|[[Bestand: Verwijzing.png| 20px]] [https://simplifier.net/packages/nictiz.fhir.nl.stu3.bgz/2.0.3-beta.2/files/package/capabilitystatement-server-bgz2017.json CapabilityStatement: Server]
| FHIR Server requirements 
|}
<small><b>Table 1.</b> Actors in the BgZ exchange for referral.</small>

FHIR instances for the BgZ summary are made available at the sending system using the profiles (table 3), the definition of the ART-DÉCOR publication (see functional specification), and the FHIR query specification (table 4). The FHIR instances will remain available unchanged for as long as the task period is valid.

=== Exchange Using Notified Pull Transaction ===

The BgZ-MSZ Notification task profile (table 5) is used by the sending system to invite the receiving system to perform one or more Pull interactions (FHIR requests). The task contains the FHIR-read and FHIR-search interactions that can be performed to retrieve the data that has been made available at the sending system. The valueReference or valueString for a BgZ section is defined in Table 6. 

When generating the notification message the restriction.period, during which the data will be available, is set by the sending system. This period is identical to the duration of the referral. Working agreements describe how long queries are valid.

=== Exchange without Notified Pull Transaction ===

The sending system pushes a FHIR document with the BgZ to a receiving system. To construct a document, a FHIR Composition resource is created that summarizes and references all the resources that need to be exchanged. This Composition resource is then placed together with all referenced resources in a Bundle with Bundle.type set to "document". The Composition resource SHALL be the first entry.

The Push use case can be used by systems transitioning from HL7 CDA to HL7 FHIR where the CDA based BgZ is replaced by a FHIR Composition.

== Retrieval of BgZ from previous practitioner ==

{| class="wikitable"
! colspan="2" style="text-align:left;" | Person
! colspan="2" style="text-align:left;" | System
|-
! style="text-align:left;" |Name
! style="text-align:left;" |Description
! style="text-align:left;" |Name
! style="text-align:left;" |Description
|-
| Requesting Medical Specialist
| Medical specialist who queries for a BgZ
| EHR
| Electronic health record
|}
<small><b>Table 2.</b> Actors in the retrieval of the BgZ from a previous practitioner.</small>

In the "Retrieval of BgZ from previous practitioner" use case, the current healthcare provider (Requesting Medical Specialist) takes the initiative to retrieve the BgZ from the previous care institution.
The Requesting Medical Specialist can retrieve the BgZ (at a suitable time) using the Pull Message and the search/ read queries defined in table 4.

It is assumed that the Requesting Medical Specialist, as person who uses the BgZ sharing infrastructure, is signed on, authenticated and has authorization & consent to access the necessary (patient) information stored in the BgZ sharing infrastructure (or in other words, an authenticated healthcare professional who has an active treatment relationship with the patient).

= Materials = 

==FHIR Profiles ==

{| class="wikitable" style="horizontal-align: right" 
!style="text-align:left;  background-color: #E3E3E3 width:10px"  | Chapter
!style="text-align:left;  background-color: #E3E3E3 width:100px" | HCIM EN
!style="text-align:left;  background-color: #E3E3E3 width:100px" | Resource
!style="text-align:left;  background-color: #E3E3E3 width:400px" | Profile
|-
| rowspan="2" | 1 
| Patient
| Patient
| rowspan="2" | {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/BgZ-Patient|nictiz.fhir.nl.stu3.bgz|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.bgz|release=V2.0|namespace=BgZ}}}}
|-
| MaritalStatus
| Patient.maritalStatus
|-
| rowspan="3" | 2
| Payer
| Coverage
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Payer|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| Payer.InsuranceCompany
| Organization
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-organization|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| Payer.PayerPerson
| Patient
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/BgZ-Patient|nictiz.fhir.nl.stu3.bgz|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.bgz|release=V2.0|namespace=BgZ}}}}
|-
| rowspan="2" | 3 
| TreatmentDirective
| Consent
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}} 
|-
| AdvanceDirective
| Consent
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AdvanceDirective|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| 4 
| ContactPerson
| Patient.contact
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/BgZ-Patient|nictiz.fhir.nl.stu3.bgz|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.bgz|release=V2.0|namespace=BgZ}}}}
|-
| 5
| FunctionalOrMentalStatus
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/BgZ-FunctionalOrMentalStatus|nictiz.fhir.nl.stu3.bgz|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.bgz|release=V2.0|namespace=BgZ}}}}
|-
| 6
| Problem
| Condition
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/BgZ-Problem|nictiz.fhir.nl.stu3.bgz|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.bgz|release=V2.0|namespace=BgZ}}}} 
|-
| rowspan="5" | 7
| LivingSituation
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-LivingSituation|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}} 
|-
| DrugUse
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-DrugUse|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}} 
|-
| AlcoholUse
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AlcoholUse|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| TobaccoUse
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-TobaccoUse|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| NutritionAdvice
| NutritionOrder
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-NutritionAdvice|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| 8
| Alert
| Flag
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Alert|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| 9
| AllergyIntolerance
| AllergyIntolerance
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AllergyIntolerance|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| rowspan="5" | 10 
| MedicationAgreement
| MedicationRequest
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicationAgreement|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| AdministrationAgreement
| MedicationDispense
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AdministrationAgreement|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| MedicationUse2
| MedicationStatement
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| PharmaceuticalProduct
| Medication
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Product|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| InstructionsForUse
| Dosage
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-InstructionsForUse|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| rowspan="2" | 11 
| MedicalDevice
| DeviceUseStatement
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicalDevice|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| MedicalDevice.Product
| Device
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicalDeviceProduct|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| rowspan="2" | 12 
| Vaccination
| Immunization
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Vaccination|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| Vaccination.PreferedDateForRevaccination
| ImmunizationRecommendation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-VaccinationRecommendation|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| rowspan="3" | 13
| BloodPressure
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BloodPressure|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| BodyWeight
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyWeight|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| BodyHeight
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyHeight|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| 14
| LaboratoryTestResult
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Observation|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| 15 
| Procedure
| Procedure
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/BgZ-Procedure|nictiz.fhir.nl.stu3.bgz|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.bgz|release=V2.0|namespace=BgZ}}}}
|-
| 16 
| Encounter
| Encounter
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Encounter|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| rowspan="4" | 17
| HealthProfessional
| Practitioner
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| HealthProfessional.Specialty
| PractitionerRole
| | {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-practitionerrole|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| HealthProfessional.HealthProfessionalRole
| CareTeam
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-careteam|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| HealthcareProvider
| Organization
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-organization|nictiz.fhir.nl.stu3.zib2017|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.zib2017|release=V2.0|namespace=BgZ}}}}
|-
| 16 
| Provenance
| Provenance
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/bgz-metadata|nictiz.fhir.nl.stu3.bgz|pkgVersion={{VersieInfo|nictiz.fhir.nl.stu3.bgz|release=V2.0|namespace=BgZ}}}}
|}
<small><b>Table 3.</b> FHIR Profiles used to exchange BgZ MSZ sections. The reader should take note of the [https://informatiestandaarden.nictiz.nl/wiki/FHIR:V1.0_FHIR_IG_STU3#Relating_FHIR_profiles_with_their_functional_definitions 'Relating FHIR profiles with their functional definitions'] in the FHIR STU3 Implementation Guide.</small>

=== Future changes in FHIR BgZ related profiles ===
Certain BgZ related FHIR profiles are derived from zib and nl-core profiles. In future versions of the standard, BgZ profiles will possibly be replaced by their predaopt zib2020 counterparts.

==FHIR Query Specification==
The table below provides an overview of the FHIR queries to exchange all BgZ-MSZ sections.

{| class="wikitable"
! scope="col" style="text-align: left;" | Query
! scope="col" style="text-align: left;" | Description
|-
! colspan="2" style="text-align: left;" | 1 Demographics and identification
|-
! colspan="2" style="text-align: left;" | 1.1 Patient
|-
| <pre>
GET [base]/Patient?
_include=Patient:general-practitioner
</pre>
|
The patient information available in the source system is exchanged as a FHIR patient instance that conforms to the nl-core-patient profile.
* The last known marital status available in the source system is exchanged using the patient.maritalStatus field.
* If available in the source system, the general practitioner (GP) is exchanged (a) as a FHIR Practitioner instance conforming to the nl-core-practitioner profile, where the Practitioner.identifier indicates a GP, and/or (b) as a FHIR Organization instance conforming to the nl-core-organization profile. The specified referenced resources are returned in full.
* Information regarding the primary partner/contact available in the source system is exchanged using elements of the patient instance. It is not exchanged using the RelatedPerson resource.
|-
!   colspan="2" style="text-align: left;" | 1.2 Marital status
|-
|
<pre>
see Patient.maritalStatus
</pre>
|
Marital status data are exchanged via the patient resource (see 1.1).
|-
!  colspan="2" style="text-align: left;" | 2 Financial information
|-
!  colspan="2" style="text-align: left;" | 2.1 Payer
|-
| <pre>
GET [base]/Coverage?
_include=Coverage:payor
</pre>
| 
The payer data available in the source system is exchanged as a FHIR coverage instance that conforms to the zib-Payer profile.
* The specified referenced payor resource instances, that may be of type nl-core-organization, nl-core-patient, or nl-core-relatedperson, are returned in full.
|-
! scope="row" colspan="2" style="text-align: left;" | 3 Treatment restrictions
|-
!  colspan="2" style="text-align: left;" | 3.1 Treatment instructions
|-
| <pre>GET [base]/Consent?
category=http://snomed.info/sct|11291000146105</pre>
| 
All treatmentDirectives available in the source system are exchanged as FHIR consent instances, which conform to the zib-TreatmentDirective profile.
* The consent.category is fixed to ‘treatment instructions’ (code = '11291000146105' in codeSystem 'SNOMED CT').
|-
!  colspan="2" style="text-align: left;" | 3.2 Advance directive
|-
| <pre>GET [base]/Consent?
category=http://snomed.info/sct|11341000146107</pre>
| 
All AdvanceDirectives available in the source system are exchanged as FHIR consent instances, which conform to the zib-AdvanceDirective profile.
* The consent.category is fixed to ‘levenstestament en wilsverklaring in dossier’ (code = '11341000146107' in codeSystem 'SNOMED CT').
* the document is only exchanged via a pdf.
|-
! scope="row" colspan="2" style="text-align: left;" | 4 Contact persons
|-
!  colspan="2" style="text-align: left;" | 4.1 Contact
|-
| <pre>Patient.contact</pre>
| 
Primary partner/contact data are exchanged via the patient resource (see 1.1).
|-
! scope="row" colspan="2" style="text-align: left;" | 5 Functional/mental status
|-
!  colspan="2" style="text-align: left;" | 5.1 Functional or mental status
|-
| <pre>GET [base]/Observation?
category=http://snomed.info/sct|118228005,
http://snomed.info/sct|384821006</pre>
| 
All functional or mental status information available in the source system is exchanged as FHIR observation data that conforms to the zib-FunctionalOrMentalStatus profile.
* Functional status data are exchanged with the observation.category fixed to ‘Functional finding’ (code = '118228005' in codeSystem 'SNOMED CT').
* Mental status data are exchanged with the observation.category fixed to ‘Mental state, behavior and/or psychosocial function finding’ (code = '384821006 ' in codeSystem 'SNOMED CT').
* please note that as defined in the BgZ dataset, the category may be both a functional and a mental status.
* The target system may be configured to optimize the use of this information. For example, it may be configured to group and categorize according to StatusName regarding mental, hearing, vision, mobility and language skills.
|-
! scope="row" colspan="2" style="text-align: left;" | 6 Complaints and diagnoses
|-
!  colspan="2" style="text-align: left;" | 6.1 Problem
|-
| <pre>GET [base]/Condition</pre>
| 
All problems available in the source system are returned as zib-Problem instances.
* The condition.ProblemStatus must be populated when exchanging data. In cases where for legacy data there is no Problem.ProblemStatus recorded in the source system then the Condition.clinicalStatus field must be populated with an assumed state such as “active” if there is no problemEndDate defined. It is a known problem that the data-absent-reason cannot be used. This aspect is under investigation.
* Note that no Condition.category (e.g. diagnosis or symptom) may be assumed while exchanging data if the condition.category is not known.
* Note that the condition.code can exchange multiple encodings for the same problem. In the transaction it is defined that a problem may contain an additional more specific problemName that is exchanged using a second condition.code.coding.
|-
! scope="row" colspan="2" style="text-align: left;" | 7 Social history
|-
!  colspan="2" style="text-align: left;" | 7.1 Living Situation
|-
| <pre>GET [base]/Observation?
code=http://snomed.info/sct|365508006</pre>
| 
All living situations available in the source system are exchanged as FHIR Observation instances that conform to the zib-LivingSituation profile.
* The Observation.category is fixed to ‘Residence and accommodation circumstances - finding’ (code = ' 365508006' in codeSystem 'SNOMED CT').
* The HouseType cardinality is 1..1R and must be exchanged accordingly.
|-
!  colspan="2" style="text-align: left;" | 7.2 Drug Use
|-
| <pre>GET [base]/Observation?
code=http://snomed.info/sct|228366006</pre>
|
All drug use available in the source system is exchanged as a FHIR Observation instances that conform to the zib-DrugUse profile.
* The Observation.category is fixed to ‘Finding relating to drug misuse behavior’ (code = '228366006' in codeSystem 'SNOMED CT').
* The target system may be configured to optimize the use of this information. For example, grouping data according to a specific DrugOrMedicationType.
|-
!  colspan="2" style="text-align: left;" | 7.3 Alcohol Use
|-
| <pre>GET [base]/Observation?
code=http://snomed.info/sct|228273003</pre>
|
All known alcohol use, available in the source system, is exchanged as FHIR Observations that conform to the zib-AlcoholUse profile.
* The Observation.category is fixed to ‘Finding relating to alcohol drinking behavior’ (code = '228273003' in codeSystem 'SNOMED CT').
|-
!  colspan="2" style="text-align: left;" | 7.4 Tobacco Use
|-
| <pre>GET [base]/Observation?
code=http://snomed.info/sct|365980008</pre>
| 
All known Tobacco Use, available in the source system, is exchanged as FHIR Observation instances that conform to the zib-TobaccoUse profile.
* The Observation.category is fixed to ‘Finding of tobacco use and exposure’ (code = ' 365980008' in codeSystem 'SNOMED CT').
|-
!  colspan="2" style="text-align: left;" | 7.5 Nutrition Advice
|-
| <pre>GET [base]/NutritionOrder</pre>
|
All Nutrition Advice available in the source system is exchanged as a FHIR NutritionOrder instances that conform to the zib-NutritionAdvice profile.
* The target system may be configured to optimize the use of this information. For example, grouping data according to a specific NutritionOrder.oralDiet.type.
|-
! scope="row" colspan="2" style="text-align: left;" | 8 Alerts
|-
!  colspan="2" style="text-align: left;" | 8.1 Alert
|-
| <pre>GET [base]/Flag</pre>
| 
All alerts available in the source system are exchanged as a FHIR Flag instances that conform to the zib-Alert profile.
|-
! scope="row" colspan="2" style="text-align: left;" | 9 Allergies
|-
!  colspan="2" style="text-align: left;" | 9.1 Allergy Intolerance
|-
| <pre>GET [base]/AllergyIntolerance</pre>
| 
All allergies and intolerances available in the source system are exchanged as a FHIR AllergyIntolerance instances that conform to the zib-AllergyIntolerance profile.
* According to the BgZ-MSZ transactions, the AllergyIntolerance.Reaction.Symptom must be exchanged if available. In cases where for legacy data there is no Symptom recorded, then the Reaction.manifestation field MUST be populated with a value from the Valueset-data-absent-reason.
<pre>
"manifestation":{
   "extension": [{
      "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
      "valueCode": "unknown"
    }]
  },
</pre> 
|-
! scope="row" colspan="2" style="text-align: left;" | 10 Medication
|-
!  colspan="2" style="text-align: left;" | 10.1 Medication Agreement
|-
| <pre>GET [base]/MedicationRequest?
category=http://snomed.info/sct|16076005&
_include=MedicationRequest:medication</pre>
| 
All medication agreements available in the source system are exchanged FHIR MedicationRequest instances that conform to the zib-MedicationAgreement profile.
* The MedicationRequest.category is fixed to ‘Prescription’ (code = '16076005' in codeSystem 'SNOMED CT')
* The PharmaceuticalProduct agreed upon to be used is returned in full as FHIR Medication instance according to the zib-Product profile.
|-
!  colspan="2" style="text-align: left;" | 10.2 Administration Agreement
|-
| <pre>GET [base]/MedicationDispense?
category=http://snomed.info/sct|422037009&
_include=MedicationDispense:medication</pre>
| 
All administration agreements available in the source system are exchanged FHIR MedicationDispense instances that conform to the zib-AdministrationAgreement profile.
* The MedicationDispense.category is fixed to ‘Provider medication administration instructions’ (code = '422037009' in codeSystem 'SNOMED CT')
* The PharmaceuticalProduct in the agreement is returned in full as FHIR Medication instance according to the zib-Product profile.
|-
!  colspan="2" style="text-align: left;" | 10.3 Medication Use
|-
| <pre>GET [base]/MedicationStatement?
category=
urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3|6&
_include=MedicationStatement:medication</pre>
| 
All medication use available in the source system are exchanged FHIR MedicationStatement instances that conform to the zib-MedicationUse profile.
* The MedicationStatement.category is fixed to ‘Medicatiegebruik’ (code = '6' in codeSystem ' 2.16.840.1.113883.2.4.3.11.60.20.77.5.3')
* The PharmaceuticalProduct that is used is returned in full as FHIR Medication instance according to the zib-Product profile.
|-
! scope="row" colspan="2" style="text-align: left;" | 11 Medical devices
|-
!  colspan="2" style="text-align: left;" | 11.1 Medical device
|-
| <pre>GET [base]/DeviceUseStatement?
_include=DeviceUseStatement:device</pre>
| 
All device use statements available in the source system are exchanged as FHIR DeviceUseStatement instances that conform to the zib-MedicalDevice profile.
* The actual medical device products are returned in full as FHIR Device instances that conform to the zib-MedicalDevice profile.
|-
! scope="row" colspan="2" style="text-align: left;" | 12 Vaccinations
|-
!  colspan="2" style="text-align: left;" | 12.1 Vaccination
|-
| <pre>GET [base]/Immunization?
status=completed</pre>
| 
All administered vaccinations available in the source system are exchanged as FHIR Immunization instances conforming to the zib-Vaccination profile.
* Only vaccinations that have been administered are exchanged. Effectively, the Immunization.status is always fixed to ‘completed’.
|-
! scope="row" colspan="2" style="text-align: left;" | 13 vital signs and measurements
|-
!  colspan="2" style="text-align: left;" | 13.1 Blood pressure
|-
| <pre>GET [base]/Observation/$lastn?
code=http://loinc.org|85354-9</pre>
| 
The last known Blood pressure available in the source system is exchanged as a FHIR Observation instance that conforms to the zib-BloodPressure profile.
* The Observation.category is fixed to ‘Blood pressure panel with all children optional’ (code = '85354-9' in codeSystem 'LOINC').
* The Observation.effectiveDateTime is used to determine the last known Observation.
|-
!  colspan="2" style="text-align: left;" | 13.2 Body weight
|-
| <pre>GET [base]/Observation/$lastn?
code=http://loinc.org|29463-7</pre>
| 
The last known Body Weight available in the source system is exchanged as a FHIR Observation instance that conforms to the zib-BodyWeight profile.
* The Observation.category is fixed to ‘Body weight’ (code = ' 29463-7' in codeSystem 'LOINC').
* The Observation.effectiveDateTime is used to determine the last known Observation.
|-
!  colspan="2" style="text-align: left;" | 13.3 Body height
|-
| <pre>GET [base]/Observation/$lastn?
code=http://loinc.org|8302-2, 
http://loinc.org|8306-3, 
http://loinc.org|8308-9 </pre>
| 
The last known Body Height available in the source system is exchanged as a FHIR Observation instance that conforms to the zib-BodyHeight profile.
* By default, the Observation.category is fixed to ‘Body height’ (code = ' 29463-7' in codeSystem 'LOINC').
* If it is recorded that a measurement is taken while the patient is lying or standing, ‘Body height --lying’ (code = ‘8306-3’ in CodeSystem ‘LOINC’) or ‘Body height --standing’ (code = ‘8308-9’ in CodeSystem ‘LOINC’) are used.
* The Observation.effectiveDateTime is used to determine the last known Observation.
|-
! scope="row" colspan="2" style="text-align: left;" | 14 Results
|-
!  colspan="2" style="text-align: left;" | 14.1 Laboratory test result
|-
| <pre>GET [base]/Observation/$lastn?
category=http://snomed.info/sct|49581000146104
&_include=Observation:related-target</pre>
| 
All last known Laboratory results, with the most recent test result for each PanelOrBattery, are exchanged as FHIR observations conforming to the zib-LaboratoryTestResult-Observation profile.
* Per PanelOrBattery, all known laboratory tests are exchanged, regardless of their TestDateTime. They are exchanged as related observations with the PanelOrBattery-observation.
* The optional ResultType is not used when selecting Laboratory results for exchange.
* The resultStatus cardinality is 1..1R in contract to the zib and must be exchanged accordingly. The LaboratoryTestResult has a DateTime property that is used by the lastn algorithm.
|-
! scope="row" colspan="2" style="text-align: left;" | 15 Procedures
|-
!  colspan="2" style="text-align: left;" | 15.1 Procedure
|-
| <pre>GET [base]/Procedure?
category=http://snomed.info/sct|387713003,
http://snomed.info/sct|258174001</pre>
| 
All operative and image-guided procedures available in the source system are exchanged as FHIR Procedure instances that conform to the zib-Procedure profile.
* Surgical procedures are exchanged via an instance with the Procedure.category fixed to ‘Surgical procedure’ (code = ‘387713003’ in CodeSystem ‘SNOMED CT’).
* Image-guided procedures are exchanged via an instance where the procedure category is fixed to ‘Imaging guidance’ (code = ‘258174001’ in CodeSystem ‘SNOMED CT’).
Procedure instances with any other category than the two specified above are not exchanged. The default category for the BgZ MSZ is ‘procedure’ (code = ‘71388002’ in CodeSystem ‘SNOMED CT’). 
|-
! scope="row" colspan="2" style="text-align: left;" | 16 Encounters
|-
!  colspan="2" style="text-align: left;" | 16.1 Encounter
|-
| <pre>GET [base]/Encounter</pre>
| 
All Encounters available in the source system are exchanged as FHIR Encounter instances that conform to the zib-Encounter profile. 
|-
! scope="row" colspan="2" style="text-align: left;" | 17 Planned care activity
|-
!  colspan="2" style="text-align: left;" | 17.1 Procedure
|-
| 
<pre>
GET [base]/ProcedureRequest?status=active
</pre>
|
All planned procedures available in the source system are exchanged as FHIR ProcedureRequest instances according to the zib-ProcedureRequest profile.
|-
! scope="row" colspan="2" style="text-align: left;" | 18 Care Setting
|-
!  colspan="2" style="text-align: left;" | 18.1 Health professional
|-
| 
<pre>
GET [base]/CareTeam?status=active&_include=CareTeam:participant
</pre>
| 
All health professionals available in the source system are exchanged as part of a CareTeam instance according to the nl-core-careteam profile.
* Practitioners are returned in full as FHIR Practitioner instances according to the nl-core-practitioner profile.
|-
!  colspan="2" style="text-align: left;" | 18.2 Healthcare provider
|-
| 
<pre>
see Procedure.performer
see Encounter.serviceProvider
</pre>
|
Providers are exchanged as part of the BgZ information elements according to the nl-core-organization profile. There is no specific query to retrieve Healthcare Providers.
|}
<small><b>Table 4.</b> FHIR queries used to retrieve BgZ MSZ components.</small>


{| class="wikitable"
! colspan="3" style="text-align: left;" | Meta data
|-
! scope="col" style="text-align: left;" | Query
! scope="col" style="text-align: left;" | Description
! scope="col" style="text-align: left;" | Example
|-
| <pre>GET [base]/[FHIR resource]?_revinclude=Provenance:target</pre>
| When metadata may be required, provenance data available in the source system for a specific BgZ summary should be exchanged according to the BgZ-metadata profile as FHIR Provenance instances.
| 14.1 Laboratory test result incl. meta data
<pre>GET [base]/Observation/$lastn?_revinclude=Provenance:target&category=http://snomed.info/sct|49581000146104&_include=Observation:related-target</pre>
|-
|}
<small><b>Table 5.</b> The FHIR query and explanation to retrieve metadata.</small>

==Notified Pull Query Specification==
The following table provides the overview of codings needed to retrieve all the BgZ MSZ sections. 
The coding column defines codedConcepts that identify the BgZ MSZ section (HCIM) to retrieve.  

{| class="wikitable" width="100%" style="horizontal-align: right"
! style="text-align:left;  background-color: #E3E3E3 width:200px" | Chapter
! style="text-align:left;  background-color: #E3E3E3 width:200px" | Section
! style="text-align:left;  background-color: #E3E3E3 width:200px" | Notified Pull coding
|-
| rowspan="2" | 1 Demographics and identification
| 1.1 Patient
| <span STYLE="font-family:'Courier'; font-weight:700">http://loinc.org/79191-3</span>
|-
| 1.2 Marital status
| <span STYLE="font-family:'Courier'; font-weight:700">Data are exchanged as part of the patient.</span>
|-
| 2 Financial information
| 2.1 Payer
| <span STYLE="font-family:'Courier'; font-weight:700">http://loinc.org/48768-6</span>
|-
| rowspan="2" | 3 Treatment restrictions
| 3.1 Treatment instructions
| <span STYLE="font-family:'Courier'; font-weight:700">http://snomed.info/sct/11291000146105</span>
|-
| 3.2 Advance directive
| <span STYLE="font-family:'Courier New'; font-weight:700">http://snomed.info/sct/11341000146107</span>
|-
| 4 Contact persons
| 4.1 Contact
| <span STYLE="font-family:'Courier'; font-weight:700">Data are exchanged as part of the patient.</span>
|-
| 5 Functional/mental status
| 5.1 Functional or mental status
| <span STYLE="font-family:'Courier New'; font-weight:700">http://loinc.org/47420-5</span>
|-
| 6 Complaints and diagnoses
| 6.1 Problem
| <span STYLE="font-family:'Courier New'; font-weight:700">http://loinc.org/11450-4</span>
|-
| rowspan="5" | 7 Social history
| 7.1 Living Situation
| <span STYLE="font-family:'Courier New'; font-weight:700">http://snomed.info/sct/365508006</span>
|-
| 7.2 Drug Use
| <span STYLE="font-family:'Courier New'; font-weight:700">http://snomed.info/sct/228366006</span>
|-
| 7.3 Alcohol Use
| <span STYLE="font-family:'Courier New'; font-weight:700">http://snomed.info/sct/228273003</span>
|-
| 7.4 Tobacco Use
| <span STYLE="font-family:'Courier New'; font-weight:700">http://snomed.info/sct/365980008</span>
|-
| 7.5 Nutrition Advice
| <span STYLE="font-family:'Courier New'; font-weight:700">http://snomed.info/sct/11816003</span>
|-
| 8 Alerts
| 8.1 Alert
| <span STYLE="font-family:'Courier New'; font-weight:700">http://loinc.org/75310-3</span>
|-
| 9 Allergies
| 9.1 Allergy Intolerance
| <span STYLE="font-family:'Courier New'; font-weight:700">http://loinc.org/48765-2</span>
|-
| rowspan="3" | 10 Medication
| 10.1 Medication Agreement
| <span STYLE="font-family:'Courier'; font-weight:700">http://snomed.info/sct/422979000</span>
|-
| 10.2 Administration Agreement
| <span STYLE="font-family:'Courier'; font-weight:700">http://snomed.info/sct/422037009</span>
|-
| 10.3 Medication Use
| <span STYLE="font-family:'Courier'; font-weight:700">http://snomed.info/sct/16076005</span>
|-
| 11 Medical devices
| 11.1 Medical device
| <span STYLE="font-family:'Courier'; font-weight:700">http://loinc.org/46264-8</span>
|-
| 12 Vaccinations
| 12.1 Vaccination
| <span STYLE="font-family:'Courier'; font-weight:700">http://loinc.org/11369-6</span>
|-
| rowspan="3" | 13 vital signs and measurements
| 13.1 Blood pressure
| <span STYLE="font-family:'Courier'; font-weight:700">http://loinc.org/85354-9</span>
|-
| 13.2 Body weight
| <span STYLE="font-family:'Courier'; font-weight:700">http://loinc.org/29463-7</span>
|-
| 13.3 Body height
| <span STYLE="font-family:'Courier'; font-weight:700">http://loinc.org/8302-2</span>
|-
| 14 Results
| 14.1 Laboratory test result
| <span STYLE="font-family:'Courier'; font-weight:700">http://snomed.info/sct/15220000</span>
|-
| 15 Procedures
| 15.1 Procedure
| <span STYLE="font-family:'Courier'; font-weight:700">http://loinc.org/47519-4</span>
|-
| 16 Encounters
| 16.1 Encounter
| <span STYLE="font-family:'Courier'; font-weight:700">http://loinc.org/46240-8</span>
|-
| 17 Planned care activity
| 17.1 Procedure
| <span STYLE="font-family:'Courier'; font-weight:700">http://loinc.org/18776-5</span>
|-
| rowspan="2" | 18 Care Setting
| 18.1 Health professional
| <span STYLE="font-family:'Courier'; font-weight:700">http://snomed.info/sct/229774002</span>
|-
| 18.2 Healthcare provider
| <span STYLE="font-family:'Courier'; font-weight:700">Data are exchanges as part of other BgZ components.</span>
|-
| Meta data
| Meta data
| <span STYLE="font-family:'Courier'; font-weight:700">http://snomed.info/sct/257733005</span>
|-
|}
<small><b>Table 6.</b> FHIR Task.input Query Specification.</small>

==Glossary==
{| class="wikitable"
|-
! Term !! Description
|-
| HCIM || Health and Care Information models ([https://zibs.nl/wiki/HCIM_Mainpage HCIM]) or Zorginformatiebouwstenen ([https://zibs.nl/wiki/Hoofdpagina ZIB]'s) are used to capture functional, semantic (non-technical) agreements for the standardization of information used in the care process.
|-
|}
<small><b>Table 7.</b> Glossary.</small>

= Release notes =

== 2.0 Beta 2 ==
[https://nictiz.atlassian.net/browse/MSZ-211 MSZ-211: Data absent reason verplicht unknown is onlogisch en onwenselijk]

[https://nictiz.atlassian.net/browse/MSZ-214 MSZ-214: Inconsistentie tussen functioneel en technisch ontwerp rond provenance]

[https://nictiz.atlassian.net/browse/MSZ-216 MSZ-216: Specificatie notified pull tasks lijkt onnodig en is onjuist]

== 2.0 Alpha ==

Compared to version 1.0 we made amongst others the following improvements:
* CDA is deprecated 
* Metadata section is changed and improved, making use of international FHIR profile Provenance 
* Notified Pull is included 
* Planned Care Activity Section is improved 
* Procedure.Category is included 
* Medication zib's are included

{{MedMij:Sjabloon_Support}}