cio:V2.0.0-beta.2 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 hypersensitivities), version 2.0.0-beta.2. 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 uses the term ‘transaction’ for the various processes that are described.

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

2 Boundaries and relationships

2.1 Boundaries

Note that this version of the CiO information standard is only focused on medication contraindications and hypersensitivities due to medication (see section 1.1 of the functional specification). Technically this scope is reflected in for instance the terminology used within the FHIR profiles or the naming of the cio-MedicationContraIndication profile. In this IG however, we will not further elaborate on this narrower scope and instead describe the technical implementation of this standard as general as possible, in order to make it easier to incorporate a broadening of the scope in subsequent versions of this IG.

2.2 Building blocks and profiles

The exchange of data within the CiO standard version 2.0.0-beta.2 is partly based on the 2020 publication of the Dutch Health and Care Information Models (Dutch: ‘zorginformatiebouwstenen’ or ‘zibs’), and subsequent changes made that will be present in the 2024 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. In the prepublication of 2024 the zibs Hypersensitivity and Reaction have been overhauled in such a way that they only contain ‘diagnostic’ elements. The concepts within these zibs that were related to surveillance with respect to substances have been removed, resulting in a new zib SurveillanceDecision. Moreover, the zib Alert has changed in this prepublication such that the zib MedicationContraIndication has become superfluous, by adding a new AlertType reserved for medication contraindications. The functional data set of CiO has further built upon these four zibs, and the resulting 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 Hypersensitivity 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. Similarly, for the building block MedicationContraIndication it was not possible to derive its profile from the nl-core-Alert profile corresponding to zib publication 2020, due to incompatible changes introduced in the zib Alert in the prepublication of 2024. Lastly, the zib SurveillanceDecision is newly introduced, so obviously no derivation from nl-core profiles is possible.

In a subsequent version of the information standard, it is the intention to base the profiles for all building blocks on their respective nl-core profiles based on zib publication 2024. There are however some considerations to be taken into account, since it is only possible to use these nl-core profiles provided:

• the underlying zibs are still part of the 2024 publication;
• no incompatible changes will be added on the relevant zibs between the prepublication and publication of 2024;
• they are defined in FHIR R4 (otherwise the cio profiles would also need to be converted to another FHIR version).

It is important to note that there is still extensive discussion about the exact scope and content of the CiO building blocks, meaning that the current profiles definitely cannot be considered to be stable and ready for use. A list of discussion topics with regards to the technical implementation can be found in section 2.5.

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 1.0.0-beta.2 or compatible nictiz.fhir.nl.r4.nl-core version 0.10.0-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.

Note that the package versioning does not follow the versioning of the information standard, as CiO version 2.0.0 was the first release of the CiO information standard based on FHIR R4. This means that CiO version 2.0.0-beta.x makes use of version 1.0.0-beta.x of the nictiz.fhir.nl.r4.cio FHIR package.

2.2.1 Main building blocks

As described above, the main building blocks have no dependency on any zib counterparts of the 2020 publication, resulting in so-called ‘cio’ profiles.

Building block (EN)	Building block (NL)	FHIR resource	FHIR profile
MedicationContraIndication	MedicatieContraIndicatie	Flag	http://nictiz.nl/fhir/StructureDefinition/cio-MedicationContraIndication
SurveillanceDecision	BewakingBesluit	Flag	http://nictiz.nl/fhir/StructureDefinition/cio-SurveillanceDecision
Hypersensitivity	Overgevoeligheid	AllergyIntolerance	http://nictiz.nl/fhir/StructureDefinition/cio-Hypersensitivity
Reaction	Reactie	AllergyIntolerance	http://nictiz.nl/fhir/StructureDefinition/cio-Reaction
Condition	Aandoening	Condition	http://nictiz.nl/fhir/StructureDefinition/cio-Condition
RegistrationData	RegistratieGegevens	Provenance	http://nictiz.nl/fhir/StructureDefinition/cio-RegistrationData

The last two building blocks in the above table have a special status:

• Condition is not a separate building block within the CiO data set, and the cio-Condition profile actually contains mappings to concepts within the Hypersensitivity and Reaction building blocks that relate to the underlying condition and diagnosis. Thus, in order to convey the complete Hypersensitivity or Reaction building block, it is necessary to use an instance conforming to the cio-Hypersensitivity or cio-Reaction profile, together with an instance conforming to the cio-Condition profile.
• The RegistrationData building block is part of every other main building block in the data set, containing data that relates to the registering process instead of the medical concept itself. Such data is often not (completely) mappable within the profiles corresponding to the medical concept. Hence, whenever another main building block is exchanged, it is represented by its own profile in conjunction with an instance of the cio-RegistrationData profile. In the future, if more information standards will make use of the Provenance resource to represent the administrative concepts present in RegistrationData, it is intended to create an nl-core-RegistrationData profile that replaces the cio-RegistrationData profile.

2.2.2 Secondary building blocks

Additionally, the standard uses several secondary building blocks referenced from the main building blocks. All secondary building blocks are part of the ‘nl-core’ 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
ContactPerson	Contactpersoon	RelatedPerson	http://nictiz.nl/fhir/StructureDefinition/nl-core-ContactPerson

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 takes place rather than the organizational information. However, within the CiO information standard, the HealthcareProvider is only referenced indirectly via the PractitionerRole resource, hence a reference to the Organization profile is sufficient in those cases. The Location profile is mentioned in the table above for completeness purposes.

2.2.3 Relations between building blocks

2.3 Mappings between profiles and data set

Each transaction starts with links to the functional definition in an ART-DECOR publication and references one or several FHIR profiles. The FHIR profiles contain mappings to all data elements that are present in the functional data set (prefixed with ‘cio-dataelement-20-’).

Each transaction contains a Patient building block with cardinality 1..1 M. This patient is the subject of all other building blocks in the transaction, although no explicit relation exists in the data set. 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 RegistrationData).

Relations between different building blocks exist in transactions by means of concepts with a name starting with ‘Relation…’ (Dutch: ‘Relatie…’) and an underlying concept ‘Identification’ of data type Identifier, for example RelationHypersensitivity (cio-dataelement-20-734) in building block Hypersensitivity. These relations are mapped to the FHIR data type ‘Reference’. Implementers SHOULD use literal references (using .reference) instead of logical references (using .identifier) where possible, see the general FHIR IG on the Reference data type.

2.4 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.

When patient identification requires the use of search parameters, the following search parameters SHALL be supported:

• Patient: identifier
• Flag: patient.identifier and subject:Patient.identifier

An example of a request that retrieves all Flag resources of a patient with a fake BSN of 111222333:

GET [base]/Flag?patient.identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333

Most request examples in this IG do not include patient identification mechanisms. Requesters are assumed to include these if necessary.

2.5 Discussion

As stated before, the current profiles cannot be considered to be stable and ready for use. This is partly due to the ongoing discussion about the exact scope and content of the functional building blocks in CiO. However, there are also some topics regarding the technical implementation that need to be addressed before considering the resulting FHIR profiles to be ready for use:

• The functional data set defines several relations between different building blocks (concepts with a name starting with ‘Relation…’), which have been implemented in FHIR as custom extensions of data type ‘Reference’. Some of these refer to instances of the same building block and are meant to track updates done between different instances of the same building block. In that sense the approach of the Medication Process information standard is followed here, where such relations are used for building blocks that are changed or stopped. In FHIR however it is possible to just update existing resources resulting in a new version of the same instance, and therefore it is up for debate whether this approach is deemed necessary and desirable for the CiO use cases. In particular one might wonder whether this approach is justified for Flag resources, since this resource has a different nature than for instance medication-related resources. The conclusion on this topic also depends on the way object identification and mutations will be handled on a functional level within the CiO information standard. This has not been fully thought out yet and will be taken into consideration for the 2.0.0-beta.3 release.
• This is the first release of an information standard making use of the Provenance resource to represent the concepts present within the zib RegistrationData (instead of defining additional extensions for concepts like RegistrationDateTime and InformationSource). The exact use of this resource on a broader level needs to be further analyzed (and generalized).
• Several concepts within the Hypersensitivity and Reaction building blocks that are related to the underlying condition and diagnosis have been mapped to elements within a separate Condition profile, instead of adding them as extensions within the AllergyIntolerance profiles. It needs to be discussed whether this approach is feasible (also taking into account international standards) and whether this Condition resource has a ‘right’ to exist. Moreover, the Hypersensitivity and Reaction building blocks are modeled by different AllergyIntolerance profiles, as they are both representing diagnostic insight of a health professional regarding (the predisposition to develop) a reaction, while in core FHIR the relation between a hypersensitivity and reactions due to that hypersensitivity are modeled within one AllergyIntolerance. This discrepancy might result in difficulties when exchanging information on hypersensitivities and reactions on a broader/international scale. Both modeling approaches mentioned here need to be taken into account while deciding on the definitive modeling of the aforementioned building blocks.
• The exact requirements regarding the search parameters used within CiO aren't fully fledged yet, especially the _revinclude defined on Provenance.target, and the possible requirement of an _include on the contents of the flag-detail extension (the latter being out of scope for this release). Note that in general, references are required to be either resolvable or readily available in the search request results; since the reference between the Provenance resource and other resources is reversed with respect to the focal resource of the search requests, supporting the _revinclude on Provenance.target is required. Further discussion with software suppliers is necessary to finalize these requirements.

3 Transactions

This section describes the FHIR implementation of all transactions listed in section 2 of the functional specification. Transactions are paired per transaction group. Each subsection below hyperlinks the names of the transaction groups and transactions to the functional definition in an ART-DECOR publication. The ART-DECOR publication details which data elements are expected to be supported (cardinality and conformance) for each transaction. Where the functional specification uses the terms ‘Query’ and ‘Making available’, this IG uses the terms ‘Retrieving’ and ‘Serving’.

3.1 Medication Contraindication (Retrieve/Serve)

The retrieve medication contraindications transaction is used by the client to retrieve medication contraindications from a server.

Transaction group	Transaction	Actor	System role	FHIR CapabilityStatement
MedicationContraIndication (PULL)	Retrieving medication contraindications	Client	CIO-MCIR	CapabilityStatement Retrieve/serve medication contraindications
	Serving medication contraindications	Server	CIO-MCIB

3.1.1 Retrieve (request message)

When a health professional or healthcare provider wants to obtain all medication contraindications or specific ones matching various parameters, they issue a retrieve medication contraindications request message. This message uses the HTTP GET method parameterized query against the server's FHIR Flag endpoint.

The search interaction is performed by an HTTP GET conform the FHIR search specification, as shown below. This URL is configurable by the client by configuring the search query.

GET [base]/Flag?category=http://snomed.info/sct|350241000146102&_revinclude=Provenance:target{&[additional parameter(s)]}

3.1.1.1 Search parameters

All search parameters listed in the table below SHALL be supported for processing by servers and MAY be supported by clients, with the exception of the category parameter, as well as the _revinclude=Provenance:target search result parameter, which SHALL be supported by clients as well (as these are always part of the search query in this transaction).

CiO search parameter	Description	FHIR search parameter	FHIR resource	Example
-	Search on MedicationContraIndication building blocks (not taking into account the RegistrationData building block).	category	Flag	Retrieves all Flag resources representing a MedicationContraIndication. GET [base]/Flag?category=http://snomed.info/sct|350241000146102
-	Include the RegistrationData building block referenced from the MedicationContraIndication.	_revinclude=Provenance:target	Flag	Retrieves all Flag and corresponding Provenance resources representing a MedicationContraIndication. GET [base]/Flag?category=http://snomed.info/sct|350241000146102&_revinclude=Provenance:target
PatientIdentificationNumber	Search on patient.	patient.identifier	Flag	Retrieves all MedicationContraIndication building blocks of a patient with a fake BSN of 111222333. GET [base]/Flag?category=http://snomed.info/sct|350241000146102&patient.identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&_revinclude=Provenance:target
ReferenceDate	Search on the MedicationContraIndication building blocks that were active on or after a certain date.	date	Flag	Retrieves all MedicationContraIndication building blocks that were active from 01-05-2023. GET [base]/Flag?category=http://snomed.info/sct|350241000146102&date=ge2023-05-01&_revinclude=Provenance:target
-	The client may request that the server returns resources related to the search results, in order to reduce the overall network delay of repeated retrievals of related resources. Supporting the include of the Patient resource referenced by building blocks is required. Others (PractitionerRole, Practitioner, RelatedPerson, Organization) are optional. However: all resources referenced per literal reference SHALL be resolvable per the Nictiz IG.	_include=Flag:patient	Flag	Retrieves all MedicationContraIndication building blocks of a patient with a fake BSN of 111222333 and includes the Patient resource in the search results. GET [base]/Flag?category=http://snomed.info/sct|350241000146102&patient.identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&_revinclude=Provenance:target&_include=Flag:patient

The following custom search parameter is defined for this transaction:

• http://nictiz.nl/fhir/SearchParameter/Flag-category

3.1.2 Serve (response message)

The server returns an HTTP Status code appropriate to the processing outcome and returns a Bundle, with Bundle.type = searchset, including the resources matching the search query. The resources included in the Bundle SHALL conform to the profiles listed in the ‘List of profiles’ below.

3.1.3 List of profiles

The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.

Building block (EN)	Building block (NL)	FHIR resource	FHIR profile
MedicationContraIndication	MedicatieContraIndicatie	Flag	http://nictiz.nl/fhir/StructureDefinition/cio-MedicationContraIndication
RegistrationData	RegistratieGegevens	Provenance	http://nictiz.nl/fhir/StructureDefinition/cio-RegistrationData
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	Organization	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization
ContactPerson	Contactpersoon	RelatedPerson	http://nictiz.nl/fhir/StructureDefinition/nl-core-ContactPerson

3.2 Medication Contraindication (Send/Receive)

The send medication contraindications transaction is used by the client to send medication contraindications to a server.

Transaction group	Transaction	Actor	System role	FHIR CapabilityStatement
MedicationContraIndication (PUSH)	Sending medication contraindications	Client	CIO-MCIS	CapabilityStatement Send/receive medication contraindications
	Receiving medication contraindications	Server	CIO-MCIO

3.2.1 Send (request message)

Because the data sent in this transaction potentially consists of several building blocks along with secondary resources, a transaction interaction is used. This allows for sending a Bundle with a set of resources in a single interaction and makes it possible to include referenced secondary resources if needed. The interaction is performed by an HTTP POST command as shown:

POST [base]

The body of the POST submission is a Bundle with Bundle.type = transaction. Each entry SHALL carry request details (Bundle.entry.request) that provide the HTTP method of the action to be executed. Usually, this will be POST, even for informative secondary resources.

The resources included in the Bundle SHALL conform to the profiles listed in the ‘List of profiles’ below.

3.2.2 Receive (response message)

The server returns an HTTP Status code appropriate to the processing outcome. If the transaction is successful, the server returns a Bundle with Bundle.type = transaction-response, that contains one entry for each entry in the request, in the same order, with the outcome of processing the entry. Included secondary resources are handled following the Nictiz IG.

If the transaction fails, the server returns an OperationOutcome with one or multiple .issue elements filled with information, as detailed as possible, that describes why the transaction failed and which resource and/or request caused this.

3.2.3 List of profiles

The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.

Building block (EN)	Building block (NL)	FHIR resource	FHIR profile
MedicationContraIndication	MedicatieContraIndicatie	Flag	http://nictiz.nl/fhir/StructureDefinition/cio-MedicationContraIndication
RegistrationData	RegistratieGegevens	Provenance	http://nictiz.nl/fhir/StructureDefinition/cio-RegistrationData
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	Organization	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization
ContactPerson	Contactpersoon	RelatedPerson	http://nictiz.nl/fhir/StructureDefinition/nl-core-ContactPerson

3.3 Medication Hypersensitivity (Retrieve/Serve)

The retrieve medication hypersensitivities transaction is used by the client to retrieve medication hypersensitivities from a server.

Transaction group	Transaction	Actor	System role	FHIR CapabilityStatement
MedicationHypersensitivity (PULL)	Retrieving medication hypersensitivities	Client	CIO-GOR	CapabilityStatement Retrieve/serve medication hypersensitivities
	Serving medication hypersensitivities	Server	CIO-GOB

3.3.1 Retrieve (request message)

When a health professional or healthcare provider wants to obtain all medication hypersensitivities or specific ones matching various parameters, they issue a retrieve medication hypersensitivities request message. This message uses the HTTP GET method parameterized query against the server's FHIR Flag endpoint.

The search interaction is performed by an HTTP GET conform the FHIR search specification, as shown below. This URL is configurable by the client by configuring the search query.

GET [base]/Flag?category=http://snomed.info/sct|225419007&_revinclude=Provenance:target{&[additional parameter(s)]}

References within the flag-detail extension (in the Flag resources present in the search result) to instances conforming to the cio-Hypersensitivity or cio-Reaction profiles can be resolved afterwards by individual read operations. The same holds true for instances conforming to the cio-Condition profile referenced from Provenance.target.

3.3.1.1 Search parameters

All search parameters listed in the table below SHALL be supported for processing by servers and MAY be supported by clients, with the exception of the category parameter, as well as the _revinclude=Provenance:target search result parameter, which SHALL be supported by clients as well (as these are always part of the search query in this transaction).

CiO search parameter	Description	FHIR search parameter	FHIR resource	Example
-	Search on SurveillanceDecision building blocks (not taking into account the RegistrationData building block).	category	Flag	Retrieves all Flag resources representing a SurveillanceDecision. GET [base]/Flag?category=http://snomed.info/sct|225419007
-	Include the RegistrationData building block referenced from the SurveillanceDecision.	_revinclude=Provenance:target	Flag	Retrieves all Flag and corresponding Provenance resources representing a SurveillanceDecision. GET [base]/Flag?category=http://snomed.info/sct|225419007&_revinclude=Provenance:target
PatientIdentificationNumber	Search on patient.	patient.identifier	Flag	Retrieves all SurveillanceDecision building blocks of a patient with a fake BSN of 111222333. GET [base]/Flag?category=http://snomed.info/sct|225419007&patient.identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&_revinclude=Provenance:target
ReferenceDate	Search on the SurveillanceDecision building blocks that were active on or after a certain date.	date	Flag	Retrieves all SurveillanceDecision building blocks that were active from 01-05-2023. GET [base]/Flag?category=http://snomed.info/sct|225419007&date=ge2023-05-01&_revinclude=Provenance:target
-	The client may request that the server returns resources related to the search results, in order to reduce the overall network delay of repeated retrievals of related resources. References to AllergyIntolerance and Condition resources are resolved by individual read operations, as mentioned above. Supporting the include of the Patient resource referenced by building blocks is required. Others (PractitionerRole, Practitioner, RelatedPerson, Organization) are optional. However: all resources referenced per literal reference SHALL be resolvable per the Nictiz IG.	_include=Flag:patient	Flag	Retrieves all SurveillanceDecision building blocks of a patient with a fake BSN of 111222333 and includes the Patient resource in the search results. GET [base]/Flag?category=http://snomed.info/sct|225419007&patient.identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333&_revinclude=Provenance:target&_include=Flag:patient

The following custom search parameter is defined for this transaction:

• http://nictiz.nl/fhir/SearchParameter/Flag-category

3.3.2 Serve (response message)

The server returns an HTTP Status code appropriate to the processing outcome and returns a Bundle, with Bundle.type = searchset, including the resources matching the search query. The resources included in the Bundle SHALL conform to the profiles listed in the ‘List of profiles’ below.

3.3.3 List of profiles

The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.

Building block (EN)	Building block (NL)	FHIR resource	FHIR profile
SurveillanceDecision	BewakingBesluit	Flag	http://nictiz.nl/fhir/StructureDefinition/cio-SurveillanceDecision
Hypersensitivity	Overgevoeligheid	AllergyIntolerance	http://nictiz.nl/fhir/StructureDefinition/cio-Hypersensitivity
Reaction	Reactie	AllergyIntolerance	http://nictiz.nl/fhir/StructureDefinition/cio-Reaction
Condition	Aandoening	Condition	http://nictiz.nl/fhir/StructureDefinition/cio-Condition
RegistrationData	RegistratieGegevens	Provenance	http://nictiz.nl/fhir/StructureDefinition/cio-RegistrationData
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	Organization	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization
ContactPerson	Contactpersoon	RelatedPerson	http://nictiz.nl/fhir/StructureDefinition/nl-core-ContactPerson

3.4 Medication Hypersensitivity (Send/Receive)

The send medication hypersensitivities transaction is used by the client to send medication hypersensitivities to a server.

Transaction group	Transaction	Actor	System role	FHIR CapabilityStatement
MedicationHypersensitivity (PUSH)	Sending medication hypersensitivities	Client	CIO-GOS	CapabilityStatement Send/receive medication hypersensitivities
	Receiving medication hypersensitivities	Server	CIO-GOO

3.4.1 Send (request message)

Because the data sent in this transaction potentially consists of several building blocks along with secondary resources, a transaction interaction is used. This allows for sending a Bundle with a set of resources in a single interaction and makes it possible to include referenced secondary resources if needed. The interaction is performed by an HTTP POST command as shown:

POST [base]

The body of the POST submission is a Bundle with Bundle.type = transaction. Each entry SHALL carry request details (Bundle.entry.request) that provide the HTTP method of the action to be executed. Usually, this will be POST, even for informative secondary resources.

The resources included in the Bundle SHALL conform to the profiles listed in the ‘List of profiles’ below.

3.4.2 Receive (response message)

The server returns an HTTP Status code appropriate to the processing outcome. If the transaction is successful, the server returns a Bundle with Bundle.type = transaction-response, that contains one entry for each entry in the request, in the same order, with the outcome of processing the entry. Included secondary resources are handled following the Nictiz IG.

If the transaction fails, the server returns an OperationOutcome with one or multiple .issue elements filled with information, as detailed as possible, that describes why the transaction failed and which resource and/or request caused this.

3.4.3 List of profiles

The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.

Building block (EN)	Building block (NL)	FHIR resource	FHIR profile
SurveillanceDecision	BewakingBesluit	Flag	http://nictiz.nl/fhir/StructureDefinition/cio-SurveillanceDecision
Hypersensitivity	Overgevoeligheid	AllergyIntolerance	http://nictiz.nl/fhir/StructureDefinition/cio-Hypersensitivity
Reaction	Reactie	AllergyIntolerance	http://nictiz.nl/fhir/StructureDefinition/cio-Reaction
Condition	Aandoening	Condition	http://nictiz.nl/fhir/StructureDefinition/cio-Condition
RegistrationData	RegistratieGegevens	Provenance	http://nictiz.nl/fhir/StructureDefinition/cio-RegistrationData
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	Organization	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization
ContactPerson	Contactpersoon	RelatedPerson	http://nictiz.nl/fhir/StructureDefinition/nl-core-ContactPerson

4 Release notes

Release notes can be found on the functional design page.