cio:V2.0.0 FHIR CiO

This FHIR IG is currently under development and can not be considered stable and ready for use. For questions and change requests regarding this IG, please create a ticket in [ BITS].

1 Introduction

This is the implementation guide (IG) for the information standard CiO (Dutch: Contra-indicaties en overgevoeligheden, English: Contraindications and intolerances), version . The functional specification can be found here and is implemented using HL7 FHIR R4. This implementation guide assumes that the reader is familiar with both the functional specification and this version of FHIR.

Apart from this document, the guidelines as specified in the general FHIR Implementation Guide apply. In particular, the reader should take note of the Overarching principles and the use of FHIR packages. Where the general IG uses the term ‘use case’, this IG follows the functional specification in using the term ‘transaction’ for the various processes that are described. The functional specification uses the term ‘use case’ for more practical examples.

This IG first describes the boundaries and relationships in place, after which the implementation is described per transaction.

2 Boundaries and relationships

2.1 Building blocks and profiles

The exchange of data within the CiO standard version is partly based on the 2020 publication of the Dutch Health and Care Information Models (Dutch: ‘zorginformatiebouwstenen’ or ‘zibs’), and subsequent changes made that are present in the 2022 prepublication. In particular, the prepublication of 2021 saw the introduction of the Hypersensitivity and Reaction zibs which are based on and still have quite some overlap with the zib AllergyIntolerance that already existed. The functional data set of CiO has further built upon the former two zibs (renaming the first as HypersensitivityDisposition), next to the zib MedicationContraIndication. These objects (which are actually exchanged) are referred to as ‘building blocks’ in the data set, and can thus be seen as ‘extended zibs’ suitable for implementation.

Due to new insights, the building blocks HypersensitivityDisposition and Reaction in the functional data set have deviated quite a lot from the zib AllergyIntolerance present in the 2020 publication, making them incompatible in varying degrees from a technical point of view. Therefore it was not possible to implement the FHIR profiles for these building blocks by building on and extending the nl-core profiles based on zib publication 2020. Hence the profiles for these building blocks have been created ‘independently’ from the nl-core profiles, meaning that they are not derived from nl-core-AllergyIntolerance. For the building block MedicationContraIndication on the other hand, the changes made within CiO are quite minimal with respect to its zib 2020 counterpart, making it possible to derive from nl-core-MedicationContraIndication.

Lastly it is important to note that there is still extensive discussion about the exact scope, name and structure of the HypersensitivityDisposition and Reaction building blocks, meaning that the current profiles definitely cannot be considered to be stable and ready for use. To aid in the discussion, two sets of FHIR profiles have been made for these building blocks:

• The cio-HypersensitivityDispositionReaction profile is created on the AllergyIntolerance resource and closely follows the nl-core-AllergyIntolerance profile corresponding to the zib AllergyIntolerance present in the 2020 publication. However due to incompatibilities (mainly on the level of terminology) it is not actually derived from that profile. The cio-HypersensitivityDispositionReaction profile contains both the HypersensitivityDisposition and Reaction building blocks, which makes sense as the Reaction building block is never exchanged on its own, but always in the context of a certain HypersensitivityDisposition. The main advantage in this profiling approach lies in the fact that it semantically makes the most sense, and the FHIR resource AllergyIntolerance already contains quite a lot of counterparts to the concepts in the functional data set (in particular on the level of the Reaction).
• The cio-HypersensitivityDisposition and cio-Reaction are created on the Condition and Observation resources, respectively. Using this approach there are less custom extensions necessary to properly map the concepts from the functional data set, and it makes it easier to identify and handle Reactions. The main disadvantages are semantically of nature, for instance the mapping of the SubstanceToMonitor concept (which is a key concept in the HypersensitivityDisposition building block) is not as straightforward, and quite some concepts within the Reaction building block are mapped on Observation.components, while they have a direct counterpart in the other profiling approach.

Nictiz uses the FHIR Packaging mechanism. This conveniently bundles all profiles, terminology, example material and other conformance resources you need into a single archive, which can be downloaded or installed using the appropriate FHIR tooling. This version of the information standard uses the following packages: nictiz.fhir.nl.r4.cio version 2.0.0-beta.1 or compatible nictiz.fhir.nl.r4.medicationprocess9 version 2.0.0-beta.1 or compatible nictiz.fhir.nl.r4.nl-core version 0.9.0-beta.1 or compatible Note: packages use Semantic Versioning. Other versions can be used at will as long as they have the same major.minor number or a minor number higher than the stated version.

2.1.1 Main building blocks

As described above, only the MedicationContraIndication building block has a dependency on its zib2020 counterpart. Nevertheless all building blocks have resulted in so-called ‘cio’ profiles.

Building block (EN)	Building block (NL)	FHIR resource	FHIR profile
HypersensitivityDisposition	Overgevoeligheid	AllergyIntolerance	http://nictiz.nl/fhir/StructureDefinition/cio-HypersensitivityDispositionReaction
Reaction	Reactie
HypersensitivityDisposition	Overgevoeligheid	Condition	http://nictiz.nl/fhir/StructureDefinition/cio-HypersensitivityDisposition
Reaction	Reactie	Observation	http://nictiz.nl/fhir/StructureDefinition/cio-Reaction
MedicationContraIndication	MedicatieContraIndicatie	Flag	http://nictiz.nl/fhir/StructureDefinition/cio-MedicationContraIndication

2.1.2 Supporting building blocks

Additionally, the standard uses several supporting building blocks referenced from the main building blocks. All supporting building blocks are part of either the ‘nl-core’ or ‘medicationprocess9’ package.

Building block (EN)	Building block (NL)	FHIR resource	FHIR profile
Patient	Patient	Patient	http://nictiz.nl/fhir/StructureDefinition/nl-core-Patient
HealthProfessional	Zorgverlener	PractitionerRole	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-PractitionerRole
		Practitioner	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-Practitioner
HealthcareProvider	Zorgaanbieder	Location	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider
		Organization	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization
MedicationAgreement	Medicatieafspraak	MedicationRequest	http://nictiz.nl/fhir/StructureDefinition/mp-MedicationAgreement
AdministrationAgreement	Toedieningsafspraak	MedicationDispense	http://nictiz.nl/fhir/StructureDefinition/mp-AdministrationAgreement
MedicationDispense	Medicatieverstrekking	MedicationDispense	http://nictiz.nl/fhir/StructureDefinition/mp-MedicationDispense
MedicationUse2	Medicatiegebruik2	MedicationStatement	http://nictiz.nl/fhir/StructureDefinition/mp-MedicationUse2

Note the following:

• Each occurrence of the zib HealthProfessional is normally represented by two FHIR resources: an instance of nl-core-HealthProfessional-PractitionerRole and an instance of nl-core-HealthProfessional-Practitioner. Sending systems should only fill the reference to the PractitionerRole instance where relevant. Receiving systems can resolve the reference to the Practitioner resource from that PractitionerRole instance.
• The zib HealthcareProvider is mapped to both a Location and Organization profile. In general the Location profile acts as the focal resource, because most references to this zib are concerned about the recording of the physical location where the care to patient/client takes place rather than the organizational information. However, within the main building blocks in CiO the HealthcareProvider is always present as an author, hence a reference to the Organization profile is sufficient in those cases. The Location profile, although not directly referenced from the main building blocks, is mentioned in the table above for completeness purposes (as it is referred to in supporting resources).

3 Release notes

Release notes can be found on the functional design page.