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(MM-5090: Adjusted the notebox explanation about the $lastn parameter for FunctionalOrMentalStatus)
 
(24 tussenliggende versies door 7 gebruikers niet weergegeven)
Regel 1: Regel 1:
 
__NUMBEREDHEADINGS__
 
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{{DISPLAYTITLE:MedMij FHIR Implementation Guide: BgZ {{VersieInfo|BgZ}}}}
 
{{DISPLAYTITLE:MedMij FHIR Implementation Guide: BgZ {{VersieInfo|BgZ}}}}
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[[Bestand:MedMij2.png |link=https://www.medmij.nl/|rechts|Naar medmij.nl]]
 
[[Bestand:MedMij2.png |link=https://www.medmij.nl/|rechts|Naar medmij.nl]]
Regel 7: Regel 7:
 
<imagemap>Bestand:Leeswijzer-technisch-banner 03 white.png|center|400px|alt=Afspraken-Functioneel-Technisch   
 
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circle 241 216 211 [https://www.medmij.nl/afsprakenstelsel Afsprakenstelsel]                 
 
circle 241 216 211 [https://www.medmij.nl/afsprakenstelsel Afsprakenstelsel]                 
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circle 1013 224 212 [[MedMij:V2020.01/OntwerpBGZ_2017|Functioneel]]                 
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circle 1013 224 212 [[MedMij:Vprepub-2020.01/OntwerpBGZ_2017|Functioneel]]                 
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circle 1787 230 212 [[MedMij:V2020.01/FHIR_IG|Technisch]]                 
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circle 1787 230 212 [[MedMij:Vprepub-2020.01/FHIR_IG|Technisch]]                 
 
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Regel 15: Regel 15:
  
 
==Introduction==
 
==Introduction==
−
[[Bestand:Functioneel-02.png|link=MedMij:V2020.01/Ontwerpen |100px|rechts|Functional design|Go to functional design]]
+
[[Bestand:Functioneel-02.png|link=MedMij:Vprepub-2020.01/Ontwerpen |100px|rechts|Functional design|Go to functional design]]
  
 
The program ‘Registratie aan de bron’ (Clinical documentation at the point of care) has defined Health and Care Information models ([https://zibs.nl/wiki/HCIM_Mainpage HCIMs] (English) or [https://zibs.nl/wiki/ZIB_Hoofdpagina zibs] (Dutch)) for The Netherlands. Next to these HCIMs, the program ‘Registratie aan de bron’ also made a selection of these HCIMs into the so-called ‘Basisgegevensset Zorg’ (Common Clinical Dataset, a Dutch version of a ‘patient summary’, further referred to as ‘BgZ’). The BgZ serves as a minimal healthcare dataset that is always appropriate for caregivers in order to provide continuity of care for a patient and can be seen as a representation of a patient summary.
 
The program ‘Registratie aan de bron’ (Clinical documentation at the point of care) has defined Health and Care Information models ([https://zibs.nl/wiki/HCIM_Mainpage HCIMs] (English) or [https://zibs.nl/wiki/ZIB_Hoofdpagina zibs] (Dutch)) for The Netherlands. Next to these HCIMs, the program ‘Registratie aan de bron’ also made a selection of these HCIMs into the so-called ‘Basisgegevensset Zorg’ (Common Clinical Dataset, a Dutch version of a ‘patient summary’, further referred to as ‘BgZ’). The BgZ serves as a minimal healthcare dataset that is always appropriate for caregivers in order to provide continuity of care for a patient and can be seen as a representation of a patient summary.
  
−
A subselection of the published [https://zibs.nl/wiki/HCIM_Release_2017(EN) HCIMs release 2017] constitute the [https://www.registratieaandebron.nl/pdf/BgZ_specificatie_obv_zibs_2017_v1.1.pdf BgZ 2017]. The BgZ makes a subselection of the information concepts within the HCIMs or restricts the HCIMs to a certain category. For example, only include the general practitioner of the patient or only the last known value of 'X'. MedMij created FHIR profiles that represent these HCIMs completely if no existing and usable profiles were available. The profiles represent their entire respective HCIM, to make them applicable in a broader context than a patient summary or even the MedMij context. An overview of the profiles can be found at the [[MedMij:V2020.01/FHIR_BGZ_2017#List_of_StructureDefinitions|list of StructureDefinitions]].  
+
A subselection of the published [https://zibs.nl/wiki/HCIM_Release_2017(EN) HCIMs release 2017] constitute the [https://www.registratieaandebron.nl/pdf/BgZ_specificatie_obv_zibs_2017_v1.1.pdf BgZ 2017]. The BgZ makes a subselection of the information concepts within the HCIMs or restricts the HCIMs to a certain category. For example, only include the general practitioner of the patient or only the last known value of 'X'. MedMij created FHIR profiles that represent these HCIMs completely if no existing and usable profiles were available. The profiles represent their entire respective HCIM, to make them applicable in a broader context than a patient summary or even the MedMij context. An overview of the profiles can be found at the [[MedMij:Vprepub-2020.01/FHIR_BGZ_2017#List_of_profiles|list of profiles]].  
  
−
The patient journey of [https://www.nictiz.nl/ehealth/MedMij Thomas van Beek], provides a patients context for exchanging a patient summary from a healthcare provider's system (XIS) to a personal health record (PHR). MedMij created a [https://informatiestandaarden.nictiz.nl/wiki/MedMij:V2020.01/Ontwerpen functional design] of the BgZ use case. This use case consists of enabling a patient to view his own BgZ in a PHR. This page will elaborate further on the HL7 FHIR details needed to exchange the BgZ information using FHIR.
+
The patient journey of [https://www.nictiz.nl/ehealth/MedMij Thomas van Beek], provides a patients context for exchanging a patient summary from a healthcare provider's system (XIS) to a personal health record (PHR). MedMij created a [[MedMij:Vprepub-2020.01/Ontwerpen|functional design]] of the BgZ use case. This use case consists of enabling a patient to view his own BgZ in a PHR. This page will elaborate further on the HL7 FHIR details needed to exchange the BgZ information using FHIR.
  
−
'''Note''': This implementation guide builds on the general guidelines described in the [[MedMij:V2020.01/FHIR_IG#Use case overarching principles|use case overarching principles]].
+
'''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==
 
==Actors involved==
Regel 64: Regel 64:
  
 
===PHR: request message===
 
===PHR: request message===
−
The PHR system requests the BgZ using individual [https://www.hl7.org/fhir/stu3/search.html search] interactions. The BgZ consists of multiple FHIR resources with certain constraints. To obtain the patient's BgLZ, the client can use multiple individual search operations based on specified search queries. The interactions are performed by an HTTP GET as shown:
+
The PHR system requests the BgZ using individual [https://www.hl7.org/fhir/stu3/search.html search] interactions. The BgZ consists of multiple FHIR resources with certain constraints. To obtain the patient's BgZ, the client can use multiple individual search operations based on specified search queries. The interactions are performed by an HTTP GET as shown:
  
 
<code>GET [base]/[type]{?[parameters]}</code>
 
<code>GET [base]/[type]{?[parameters]}</code>
  
−
The table below shows in the first four columns the BgLZ sections, the HCIMs that constitute those sections and the specific content of the BgZ. The last column shows the FHIR search queries to obtain the BgLZ information. These queries and expected responses are based on StructureDefinitions listed in [[#List_of_StructureDefinitions| this section]].
+
The table below shows in the first four columns the BgZ sections, the HCIMs that constitute those sections and the specific content of the BgZ. The last column shows the FHIR search queries to obtain the BgZ information. These queries and expected responses are based on profiles listed in [[#List_of_profiles| this section]].
  
 
{| class="wikitable collapsible" width="100%" style="horizontal-align: right"   
 
{| class="wikitable collapsible" width="100%" style="horizontal-align: right"   
Regel 75: Regel 75:
 
!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" | 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" | Content
−
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3  width:10px" | Search URL<ref>See [[MedMij:V2020.01/FHIR_IG#Search_URLs_and_search_parameters|Search URLs and search parameters]] for the interpretation of these search URLs</ref>
+
!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>
 
|-
 
|-
 
| 1
 
| 1
Regel 110: Regel 110:
 
| Last known functional / mental status
 
| Last known functional / mental status
 
| <pre>GET [base]/Observation/$lastn?category=http://snomed.info/sct|118228005,http://snomed.info/sct|384821006</pre>
 
| <pre>GET [base]/Observation/$lastn?category=http://snomed.info/sct|118228005,http://snomed.info/sct|384821006</pre>
 +
<span id="FunctionalOrMentalStatusRemark"></span>{{NoteBox|The NL-CM:4.26.6 StatusDate concept is incorrectly mapped on the <code>effective[x]:effectivePeriod.start</code> element in the HCIM FunctionalOrMentalStatus profile, it is a date rather than a period. Presumed solution will come from a future HCIM release. See [https://bits.nictiz.nl/browse/MM-1570 MM-1570] for more information.}}
 
|-
 
|-
 
| 6
 
| 6
Regel 136: Regel 137:
 
|-
 
|-
 
| NutritionAdvice
 
| NutritionAdvice
−
| All known current dietary recommendations
+
| All known dietary recommendations
 
| <pre>GET [base]/NutritionOrder</pre>
 
| <pre>GET [base]/NutritionOrder</pre>
 
|-
 
|-
Regel 164: Regel 165:
 
| Known administration agreements
 
| Known administration agreements
 
| <pre>GET [base]/MedicationDispense?category=http://snomed.info/sct|422037009&_include=MedicationDispense:medication</pre>
 
| <pre>GET [base]/MedicationDispense?category=http://snomed.info/sct|422037009&_include=MedicationDispense:medication</pre>
 +
<span id="AdministrationAgreementRemark"></span>{{NoteBox|The search on {{fhir|MedicationDispense.category}} requires a {{Simplifier|http://nictiz.nl/fhir/SearchParameter/Medications-category|nictiz.fhir.nl.stu3.zib2017|title= custom SearchParameter}} not represented in the FHIR specification. }}
 
|-
 
|-
 
| 11
 
| 11
 
| Medical aids
 
| Medical aids
−
| MedicalAid
+
| MedicalDevice
 
| Known medical aids
 
| Known medical aids
 
| <pre>GET [base]/DeviceUseStatement?_include=DeviceUseStatement:device</pre>
 
| <pre>GET [base]/DeviceUseStatement?_include=DeviceUseStatement:device</pre>
Regel 217: Regel 219:
 
*Planning an Encounter is done by using an Appointment
 
*Planning an Encounter is done by using an Appointment
 
*Planning a Procedure is done by using a ProcedureRequest
 
*Planning a Procedure is done by using a ProcedureRequest
−
*Planning a Vaccination is done by using a VaccinationRecommendation  
+
*Planning an Immunization is done by using an ImmunizationRecommendation  
−
*Planning a MedicalDevice is done by using a MedicalDeviceRequest
+
*Planning a MedicalDevice is done by using a DeviceRequest
 
}}
 
}}
 
<pre>GET [base]/ProcedureRequest?status=active</pre>
 
<pre>GET [base]/ProcedureRequest?status=active</pre>
 
<pre>GET [base]/ImmunizationRecommendation</pre>
 
<pre>GET [base]/ImmunizationRecommendation</pre>
−
<pre style="text-decoration: line-through;">GET [base]/MedicationDispense?category=http://snomed.info/sct|422037009&status=in-progress,preparation&_include=MedicationDispense:medication</pre>
+
{{NoteBox|The NL-CM:11.1.5 DesiredDateForRevaccination concept is incorrectly mapped onto the {{fhir|.recommendation.date}} element in the HCIM ImmunizationRecommendation profile. The proper element is actually {{fhir|.recommendation.dateCriterion}}. This will be fixed in the next breaking release. See [https://bits.nictiz.nl/browse/MM-2281 MM-2281] for more information.}}<pre style="text-decoration: line-through;">GET [base]/MedicationDispense?category=http://snomed.info/sct|422037009&status=in-progress,preparation&_include=MedicationDispense:medication</pre>
 
<span id="MM115Remark"></span>{{NoteBox|PlannedCareActivityForTransfer for MedicationAdministration was found unimplementable as-is. Presumed solution will come from a future HCIM release. See [https://bits.nictiz.nl/browse/MM-115 MM-115] for more information.}}
 
<span id="MM115Remark"></span>{{NoteBox|PlannedCareActivityForTransfer for MedicationAdministration was found unimplementable as-is. Presumed solution will come from a future HCIM release. See [https://bits.nictiz.nl/browse/MM-115 MM-115] for more information.}}
 
<pre>GET [base]/DeviceRequest?status=active&_include=DeviceRequest:device</pre>
 
<pre>GET [base]/DeviceRequest?status=active&_include=DeviceRequest:device</pre>
Regel 234: Regel 236:
 
|}
 
|}
 
<references/>
 
<references/>
−
{{Sjabloon:Voorbeelden}}
 
  
 
===XIS: response message===
 
===XIS: response message===
−
The returned data to the PHR should conform to the profiles listed in [[#List_of_StructureDefinitions]].
+
The returned data to the PHR should conform to the profiles listed in [[#List_of_profiles]].
  
−
===The <code>lastn</code> operation===
+
===The {{fhir|$lastn}} operation===
 
The following [http://hl7.org/fhir/STU3/operations.html operation] is needed for this use case.
 
The following [http://hl7.org/fhir/STU3/operations.html operation] is needed for this use case.
 
* [http://hl7.org/fhir/STU3/observation-operations.html#lastn Last N Observations Query]
 
* [http://hl7.org/fhir/STU3/observation-operations.html#lastn Last N Observations Query]
  
−
The <code>lastn</code> query meets the common need for searching for the most recent or last n=number of observations for a subject. For example, retrieving the last 5 temperatures for a patient to view trends or fetching the most recent laboratory results or vital signs. The link will provide more detailed information and examples regarding this operation.
+
The {{fhir|$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 vital signs. The link will provide more detailed information and examples regarding this operation.
  
−
The FHIR STU3 specification is vague regarding the sorting mechanism of <code>lastn</code>. In FHIR R4 however, this has been clarified and can be read as follows: when using <code>lastn</code>, the <code>effective[x]</code> element is used for sorting of Observations, sorted from most recent to the oldest.
+
The [http://hl7.org/fhir/STU3/observation-operations.html#{{fhir|$lastn}} FHIR STU3] specification is vague regarding the sorting mechanism of {{fhir|$lastn}}. In [http://hl7.org/fhir/R4/observation-operation-lastn.html FHIR R4] however, this has been clarified and can be read as follows: when using {{fhir|$lastn}}, the {{fhir|effective[x]}} element is used for sorting of Observations, sorted from most recent to the oldest.
  
−
==List of StructureDefinitions==
+
{{NoteBox|The {{fhir|$lastn}} can actually return more than one Observation. This is due to the fact that queries with {{fhir|$lastn}} returns the last n Observations ''after'' grouping by the value on {{fhir|Observatin.code}}. The HCIM BodyHeight resource can contain up to three different values ('body height', 'body height lying' and 'body height standing') on this element and so {{fhir|$lastn}} may yield up to three resources. The HCIM FunctionalOrMentalStatus uses {{fhir|Observation.code}} to distinguish each distinct functional or mental status, so {{fhir|$lastn}} queries returns the last Observation for each of them, which is the intended behavior according to the functional specifications.}}
 +
 
 +
==List of profiles==
 
The profiles represent their entire respective HCIM, to make them applicable in a broader context than the exchange of BgZ or a MedMij context. An example of reuse of existing profiles is those of the patient administration resources and vital signs.
 
The profiles represent their entire respective HCIM, to make them applicable in a broader context than the exchange of BgZ or a MedMij context. An example of reuse of existing profiles is those of the patient administration resources and vital signs.
  
−
{{MedMij:NoteBoxPackage|p1=nictiz.fhir.nl.stu3.bgz|p2=nictiz.fhir.nl.stu3.zib2017|p3=nictiz.fhir.nl.stu3.eafspraak}}
+
{{MedMij:Vprepub-2020.01/NoteBoxPackage|p1=nictiz.fhir.nl.stu3.bgz|p2=nictiz.fhir.nl.stu3.zib2017|v2Min=2.0.0|p3=nictiz.fhir.nl.stu3.eafspraak}}
  
 
{| class="wikitable" style="horizontal-align: right"  
 
{| class="wikitable" style="horizontal-align: right"  
Regel 259: Regel 262:
 
!style="background-color: #1F497D; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:400px" | FHIR Profile
 
!style="background-color: #1F497D; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:400px" | FHIR Profile
 
|-
 
|-
−
| 1  
+
| rowspan="2" | 1  
 
| Patient
 
| Patient
−
| #Zib Patient|Patient
 
 
| Patient
 
| Patient
−
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017}}
+
| Patient
 +
| rowspan="2" | {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017}}
 +
|-
 +
| BurgerlijkeStaat
 +
| MaritalStatus
 +
| Patient.maritalStatus
 
|-
 
|-
−
| rowspan="3" |2
+
| rowspan="3" | 2
 
| rowspan="3" | Betaler
 
| rowspan="3" | Betaler
 
| rowspan="3" | Payer
 
| rowspan="3" | Payer
Regel 277: Regel 284:
 
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017}}
 
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017}}
 
|-
 
|-
−
| rowspan="2" |3  
+
| rowspan="2" | 3  
 
| BehandelAanwijzing
 
| BehandelAanwijzing
 
| TreatmentDirective
 
| TreatmentDirective
Regel 295: Regel 302:
 
|-
 
|-
 
| 5
 
| 5
−
| Funct. OfMentaleStatus
+
| FunctioneleOfMentaleStatus
 
| FunctionalOrMentalStatus
 
| FunctionalOrMentalStatus
 
| Observation
 
| Observation
Regel 345: Regel 352:
 
|-
 
|-
 
| rowspan="3" | 10  
 
| rowspan="3" | 10  
−
| rowspan="3" | MedicatieGebruik
+
| MedicatieGebruik2
−
| MedicationUse
+
| MedicationUse2
 
| MedicationStatement
 
| MedicationStatement
 
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse|nictiz.fhir.nl.stu3.zib2017}}
 
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse|nictiz.fhir.nl.stu3.zib2017}}
 
|-
 
|-
 +
| Medicatieafspraak
 
| MedicationAgreement
 
| MedicationAgreement
 
| MedicationRequest
 
| MedicationRequest
 
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicationAgreement|nictiz.fhir.nl.stu3.zib2017}}
 
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicationAgreement|nictiz.fhir.nl.stu3.zib2017}}
 
|-
 
|-
 +
| Toedieningsafspraak
 
| AdministrationAgreement
 
| AdministrationAgreement
 
| MedicationDispense
 
| MedicationDispense
Regel 446: Regel 455:
 
|}
 
|}
  
−
==Terminology, NamingSystems, Mappings==
+
=Release notes=
 +
Release notes can be found on the [[MedMij:Vprepub-2020.01/OntwerpBGZ_2017#Release_notes|functional design page]].
  
−
===Terminology===
+
{{MedMij:Sjabloon_Support}}
−
Relevant value sets can be found [https://simplifier.net/NictizSTU3-Zib2017/~resources?category=ValueSet using the ValueSet category]. All resources can be downloaded in a .zip in XML or JSON format. In the .zip, the value sets are stored in the directory 'value sets'.
 
−
 
 
−
===NamingSystems===
 
−
Relevant NamingSystems can be found [https://simplifier.net/NictizSTU3-Zib2017/~resources?category=NamingSystem using the NamingSystem category].
 
−
 
 
−
===Mappings===
 
−
A FHIR ConceptMap resource is provided when a FHIR value set is used instead of a HCIM value set. A ConceptMap maps the values between the two value sets. These ConceptMaps can be found [https://simplifier.net/NictizSTU3-Zib2017/~resources?category=ConceptMap here].
 
−
 
 
−
An explanation about mappings can be found at [[MedMij:V2020.01/FHIR_IG#Mapping_of_coded_concepts|Mapping of coded concepts]].
 
−
 
 
−
=Release notes=
 
−
Release notes can be found on the [[MedMij:V2020.01/OntwerpBGZ_2017#Release_notes|functional design page]].
 

Huidige versie van 27 feb 2024 om 09:39


Issue icon.png

Work in progress - See official publication here.

Naar medmij.nl
Patient Summary (BgZ)
AfsprakenstelselFunctioneelTechnischAfspraken-Functioneel-Technisch

1 Introduction

Go to functional design

The program ‘Registratie aan de bron’ (Clinical documentation at the point of care) has defined Health and Care Information models (HCIMs (English) or zibs (Dutch)) for The Netherlands. Next to these HCIMs, the program ‘Registratie aan de bron’ also made a selection of these HCIMs into the so-called ‘Basisgegevensset Zorg’ (Common Clinical Dataset, a Dutch version of a ‘patient summary’, further referred to as ‘BgZ’). The BgZ serves as a minimal healthcare dataset that is always appropriate for caregivers in order to provide continuity of care for a patient and can be seen as a representation of a patient summary.

A subselection of the published HCIMs release 2017 constitute the BgZ 2017. The BgZ makes a subselection of the information concepts within the HCIMs or restricts the HCIMs to a certain category. For example, only include the general practitioner of the patient or only the last known value of 'X'. MedMij created FHIR profiles that represent these HCIMs completely if no existing and usable profiles were available. The profiles represent their entire respective HCIM, to make them applicable in a broader context than a patient summary or even the MedMij context. An overview of the profiles can be found at the list of profiles.

The patient journey of Thomas van Beek, provides a patients context for exchanging a patient summary from a healthcare provider's system (XIS) to a personal health record (PHR). MedMij created a functional design of the BgZ use case. This use case consists of enabling a patient to view his own BgZ in a PHR. This page will elaborate further on the HL7 FHIR details needed to exchange the BgZ information using FHIR.

Note: This implementation guide builds on the general guidelines described in the use case overarching principles.

2 Actors involved

Actors Systems FHIR Capability Statements
Name Description Name Description Name Description
Patient The user of a personal healthcare environment. PHR Personal health record Verwijzing.png CapabilityStatement: Client FHIR Client requirements
Healthcare professional The user of a XIS XIS Healthcare information system Verwijzing.png CapabilityStatement: Server FHIR Server requirements

3 Boundaries and Relationships

The BgZ 2017 v1.1 use case follows the BgZ v1.0 use case. The difference between the two is the underlying HCIMs, which have been upgraded from release 2015 to release 2017. The changes are documented in a release notes document.

The BgZ use case has similarities and differences with other use cases such as Medication Process, Vital Signs and Lab Results. These use cases use the same HCIM based FHIR profiles for exchanging information. The BgZ use case covers practically all profiles included in the other use cases. However, the BgZ differs in the scope of the actual health information content that should be exchanged. For example, the BgZ conveys only the last known lab result of each type while the Lab Results use case may cover all known information.

4 Use Case: Retrieve BGZ information

Go to MedMij Afsprakenstelsel

This FHIR implementation guide assumes that the PHR system is able to make a connection to the right XIS that contains the patient's information. It does not provide information on finding the right XIS nor does it provide information about security. Moreover, each transaction is performed in the context of a specific authenticated patient, for whose context (token) has been established using the authentication mechanisms described in the 'Afsprakenstelsel'. Each XIS Gateway is required to perform filtering based on the patient associated with the context for the request, so only the records associated with the authenticated patient are returned. For this reason, search parameters should not be included for patient identification.

4.1 PHR: request message

The PHR system requests the BgZ using individual search interactions. The BgZ consists of multiple FHIR resources with certain constraints. To obtain the patient's BgZ, the client can use multiple individual search operations based on specified search queries. The interactions are performed by an HTTP GET as shown:

GET [base]/[type]{?[parameters]}

The table below shows in the first four columns the BgZ sections, the HCIMs that constitute those sections and the specific content of the BgZ. The last column shows the FHIR search queries to obtain the BgZ information. These queries and expected responses are based on profiles listed in this section.

# BgZ Section HCIM EN Content Search URL[1]
1 Patient information Patient Identification, birth date, gender, deceased indicator, contact details, last known marital status, and general practitioner (practitioner or organization) 
GET [base]/Patient?_include=Patient:general-practitioner
2 Payment details Payer Insurance information 
GET [base]/Coverage?_include=Coverage:payor:Patient&_include=Coverage:payor:Organization
3 Treatment directives TreatmentDirective Known treatment directives 
GET [base]/Consent?category=http://snomed.info/sct|11291000146105
AdvanceDirective Known advance directives 
GET [base]/Consent?category=http://snomed.info/sct|11341000146107
4 Contact persons ContactPerson First relation/contact 
see Patient
5 Functional status FunctionalOrMentalStatus Last known functional / mental status 
GET [base]/Observation/$lastn?category=http://snomed.info/sct|118228005,http://snomed.info/sct|384821006

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The NL-CM:4.26.6 StatusDate concept is incorrectly mapped on the effective[x]:effectivePeriod.start element in the HCIM FunctionalOrMentalStatus profile, it is a date rather than a period. Presumed solution will come from a future HCIM release. See MM-1570 for more information.

6 Problems Concern All known problems 
GET [base]/Condition
7 Social history LivingSituation Current living situation 
GET [base]/Observation/$lastn?code=http://snomed.info/sct|365508006
DrugUse All known drug use 
GET [base]/Observation?code=http://snomed.info/sct|228366006
AlcoholUse All known alcohol use 
GET [base]/Observation?code=http://snomed.info/sct|228273003
TobaccoUse All known tobacco use 
GET [base]/Observation?code=http://snomed.info/sct|365980008
NutritionAdvice All known dietary recommendations 
GET [base]/NutritionOrder
8 Alerts Alert All known alerts 
GET [base]/Flag
9 Allergies AllergyIntolerance All known information regarding allergies 
GET [base]/AllergyIntolerance
10 Medication MedicationUse Known medication use 
GET [base]/MedicationStatement?category=urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3|6&_include=MedicationStatement:medication
MedicationAgreement Known medication agreements 
GET [base]/MedicationRequest?category=http://snomed.info/sct|16076005&_include=MedicationRequest:medication
AdministrationAgreement Known administration agreements 
GET [base]/MedicationDispense?category=http://snomed.info/sct|422037009&_include=MedicationDispense:medication

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The search on MedicationDispense.category requires a custom SearchParameter not represented in the FHIR specification.

11 Medical aids MedicalDevice Known medical aids 
GET [base]/DeviceUseStatement?_include=DeviceUseStatement:device
12 Vaccinations Vaccination Known vaccinations 
GET [base]/Immunization?status=completed
13 Vital signs BloodPressure Last known blood pressure 
GET [base]/Observation/$lastn?code=http://loinc.org|85354-9
BodyWeight Last known body weight 
GET [base]/Observation/$lastn?code=http://loinc.org|29463-7
BodyHeight Last known body height 
GET [base]/Observation/$lastn?code=http://loinc.org|8302-2,http://loinc.org|8306-3,http://loinc.org|8308-9
14 Results LaboratoryTestResult Last known laboratory results per type 
GET [base]/Observation/$lastn?category=http://snomed.info/sct|275711006&_include=Observation:related-target&_include=Observation:specimen
15 Procedures Procedure Known surgical procedures 
GET [base]/Procedure?category=http://snomed.info/sct|387713003
16 Encounters Contact Known hospital admissions (no outpatient contacts) 
GET [base]/Encounter?class=http://hl7.org/fhir/v3/ActCode|IMP,http://hl7.org/fhir/v3/ActCode|ACUTE,http://hl7.org/fhir/v3/ActCode|NONAC
17 Planned care PlannedCareActivityForTransfer Known planned care activities

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The HCIM PlannedCareActivityForTransfer represents a planned activity as a (reference to) the HCIM for that activity in the 'planned' status. However, FHIR doesn't recognize this status; instead it uses dedicated resources for planning. Therefore, the FHIR implementation of this HCIM uses these dedicated resources instead of a distinct profile::

  • Planning an Encounter is done by using an Appointment
  • Planning a Procedure is done by using a ProcedureRequest
  • Planning an Immunization is done by using an ImmunizationRecommendation
  • Planning a MedicalDevice is done by using a DeviceRequest
 
GET [base]/ProcedureRequest?status=active
GET [base]/ImmunizationRecommendation

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The NL-CM:11.1.5 DesiredDateForRevaccination concept is incorrectly mapped onto the .recommendation.date element in the HCIM ImmunizationRecommendation profile. The proper element is actually .recommendation.dateCriterion. This will be fixed in the next breaking release. See MM-2281 for more information. 

GET [base]/MedicationDispense?category=http://snomed.info/sct|422037009&status=in-progress,preparation&_include=MedicationDispense:medication

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PlannedCareActivityForTransfer for MedicationAdministration was found unimplementable as-is. Presumed solution will come from a future HCIM release. See MM-115 for more information. 

GET [base]/DeviceRequest?status=active&_include=DeviceRequest:device
GET [base]/Appointment?status=booked,pending,proposed
18 General practitioner HealthProfessional General Practitioner of the patient 
see Patient
  1. ↑ See Search URLs and search parameters for the interpretation of these search URLs

4.2 XIS: response message

The returned data to the PHR should conform to the profiles listed in #List_of_profiles.

4.3 The $lastn operation

The following operation is needed for this use case.

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 vital signs. The link will provide more detailed information and examples regarding this operation.

The $lastn FHIR STU3 specification is vague regarding the sorting mechanism of $lastn. In FHIR R4 however, this has been clarified and can be read as follows: when using $lastn, the effective[x] element is used for sorting of Observations, sorted from most recent to the oldest.

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The $lastn can actually return more than one Observation. This is due to the fact that queries with $lastn returns the last n Observations after grouping by the value on Observatin.code. The HCIM BodyHeight resource can contain up to three different values ('body height', 'body height lying' and 'body height standing') on this element and so $lastn may yield up to three resources. The HCIM FunctionalOrMentalStatus uses Observation.code to distinguish each distinct functional or mental status, so $lastn queries returns the last Observation for each of them, which is the intended behavior according to the functional specifications.

5 List of profiles

The profiles represent their entire respective HCIM, to make them applicable in a broader context than the exchange of BgZ or a MedMij context. An example of reuse of existing profiles is those of the patient administration resources and vital signs.


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MedMij 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:

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.

Section Zib NL HCIM EN FHIR Resource FHIR Profile
1 Patient Patient Patient http://fhir.nl/fhir/StructureDefinition/nl-core-patient
BurgerlijkeStaat MaritalStatus Patient.maritalStatus
2 Betaler Payer Coverage http://nictiz.nl/fhir/StructureDefinition/zib-Payer
Organization http://fhir.nl/fhir/StructureDefinition/nl-core-organization
Patient http://fhir.nl/fhir/StructureDefinition/nl-core-patient
3 BehandelAanwijzing TreatmentDirective Consent http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective
Wilsverklaring AdvanceDirective Consent http://nictiz.nl/fhir/StructureDefinition/zib-AdvanceDirective
4 Contactpersoon ContactPerson Patient.contact http://fhir.nl/fhir/StructureDefinition/nl-core-patient
5 FunctioneleOfMentaleStatus FunctionalOrMentalStatus Observation http://nictiz.nl/fhir/StructureDefinition/zib-FunctionalOrMentalStatus
6 Probleem Problem Condition http://nictiz.nl/fhir/StructureDefinition/zib-Problem
7 Woonsituatie LivingSituation Observation http://nictiz.nl/fhir/StructureDefinition/zib-LivingSituation
DrugsGebruik DrugUse Observation http://nictiz.nl/fhir/StructureDefinition/zib-DrugUse
AlcoholGebruik AlcoholUse Observation http://nictiz.nl/fhir/StructureDefinition/zib-AlcoholUse
TabakGebruik TobaccoUse Observation http://nictiz.nl/fhir/StructureDefinition/zib-TobaccoUse
Voedingsadvies NutritionAdvice NutritionOrder http://nictiz.nl/fhir/StructureDefinition/zib-NutritionAdvice
8 Alert Alert Flag http://nictiz.nl/fhir/StructureDefinition/zib-Alert
9 AllergieIntolerantie AllergyIntolerance AllergyIntolerance http://nictiz.nl/fhir/StructureDefinition/zib-AllergyIntolerance
10 MedicatieGebruik2 MedicationUse2 MedicationStatement http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse
Medicatieafspraak MedicationAgreement MedicationRequest http://nictiz.nl/fhir/StructureDefinition/zib-MedicationAgreement
Toedieningsafspraak AdministrationAgreement MedicationDispense http://nictiz.nl/fhir/StructureDefinition/zib-AdministrationAgreement
11 MedischHulpmiddel MedicalDevice Device http://nictiz.nl/fhir/StructureDefinition/zib-MedicalDeviceProduct
DeviceUseStatement http://nictiz.nl/fhir/StructureDefinition/zib-MedicalDevice
12 Vaccinatie Vaccination Immunization http://nictiz.nl/fhir/StructureDefinition/zib-Vaccination
ImmunizationRecommendation http://nictiz.nl/fhir/StructureDefinition/zib-VaccinationRecommendation
13 Bloeddruk BloodPressure Observation http://nictiz.nl/fhir/StructureDefinition/zib-BloodPressure
LichaamsGewicht BodyWeight Observation http://nictiz.nl/fhir/StructureDefinition/zib-BodyWeight
LichaamsLengte BodyHeight Observation http://nictiz.nl/fhir/StructureDefinition/zib-BodyHeight
14 LaboratoriumUitslag LaboratoryTestResult Observation http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Observation
Specimen http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Specimen
15 Verrichting Procedure Procedure http://nictiz.nl/fhir/StructureDefinition/zib-Procedure
16 Contact Encounter Encounter http://nictiz.nl/fhir/StructureDefinition/zib-Encounter
17 OverdrachtGeplandeZorgActiviteit PlannedCareActivityForTransfer ProcedureRequest * http://nictiz.nl/fhir/StructureDefinition/zib-ProcedureRequest
MedicationDispense ** http://nictiz.nl/fhir/StructureDefinition/zib-AdministrationAgreement
ImmunizationRecommendation * http://nictiz.nl/fhir/StructureDefinition/zib-VaccinationRecommendation
DeviceRequest * http://nictiz.nl/fhir/StructureDefinition/zib-MedicalDeviceRequest
Appointment * http://nictiz.nl/fhir/StructureDefinition/eAfspraak-Appointment
18 Zorgverlener HealthProfessional Practitioner http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner
PractitionerRole http://fhir.nl/fhir/StructureDefinition/nl-core-practitionerrole
Zorgaanbieder HealthcareProvider Organization http://fhir.nl/fhir/StructureDefinition/nl-core-organization

6 Release notes

Release notes can be found on the functional design page.


7 Support

For questions and change requests regarding the information on this page, please create a ticket in Servicedesk Portal.

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