uz:V1.0.0-alpha.1 FHIR OBC

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 pilot of a new information standard, Outcomebased Care (OBC, Dutch: Uitkomstgerichte zorg), version . This initial draft focuses on converting the questionnaires into FHIR and offers a preliminary view of the expected structure for the QuestionnaireResponse profile. This IG is developed using HL7 FHIR R4. It 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.

This IG currently describes the boundaries and relationships in place.

2 Boundaries and relationships

2.1 Boundaries

• Huidige versie van deze wiki houdt klinische gegevens nog buiten beschouwing.
• Alleen focus op de structuur van de FHIR Questionnaires en antwoordgegevens.

This initial version of the OBC IG focuses solely on the manifestation of PROM questionnaires and corresponding answers in FHIR, excluding any clinical data. It does not cover use cases related to the exchange of questionnaire and response data. The current IG specifies its scope through the terminology used in the FHIR profile and the naming of the obc-QuestionnaireResponse profile. However, the IG will not provide detailed explanations about this limited scope. Instead, it will focus on describing the technical aspects of the pilot in a broad manner. This approach aims to make it easier to include a wider range of topics in future versions of the IG.

2.2 Building blocks and profiles

• Geen link met zibs en geen nl-core profielen gebruikt
• What is a FHIR Questionnaire
• QR

The questionnaire and response data within the OBC pilot version is not based on any publication of the Dutch Health and Care Information Models (Dutch: ‘zorginformatiebouwstenen’ or ‘zibs’), as there are no zibs that represent the pilot. Therefore, there is no dependency on corresponding nl-core profiles, and mappings to zib concepts are not defined. Currently, there are no plans to replace this pilot with a more general nl-core-OutcomeBasedCare profile in the future, as no corresponding zibs exist.

Within the OBC pilot, the FHIR Questionnaire focuses on capturing patient-related data in a standardized format. It is used in healthcare settings to collect information from patients, healthcare providers, or other stakeholders. The data captured through a FHIR Questionnaire can include patient demographics, medical history, symptoms, and responses to health-related questions. Within the FHIR Questionnaire, a variety of aspects can be considered, such as sensitive questions whose answers may not be available for every person. Currently, the OBC pilot consists of five transactions of five different Questionnaires. More information about the content of these Questionnaires can be found in the functional design.

The current OBC pilot includes a FHIR QuestionnaireResponse profile. This profile features a structured set of questions and their answers, representing the outcome of a PROMs (Patient Reported Outcome Measures) collection event, as well as the scores. The QuestionnaireResponse contains enough information about the questions asked that it can be interpreted somewhat independently from the Questionnaire it is based on. In other words, you don't need access to the Questionnaire to extract basic information from a QuestionnaireResponse.

2.2.1 Main building blocks

• tabel met de profielen -> alleen QR dus in dit geval.
• Link naar de r4 Questionnaire profiel
• At the time of writing no nl-core profiles.

As described above, the QuestionnaireResponse profile has no dependency on any zib counterparts, resulting in the so-called ‘obc-QuestionnaireResponse’ profile.

Building block (EN)	Building block (NL)	FHIR resource	FHIR profile
Responsedata	Antwoordgegevens	QuestionnaireResponse	http://nictiz.nl/fhir/StructureDefinition/obc-QuestionnaireResponse

Note the following:

• Since each Questionnaire profile is fixed and intended to be answered only by the QuestionnaireResponse profile, it has not been included as a building block or its subsequent resource. Instead, they are added as instances to the FHIR package. You can find the five Questionnaires here [MISSING AMIGO LINK].

2.3 Mappings between profiles and data set

• Hoe is QR en dataset gelinked
• FHIR Questionnaire worden in transacties gedefinieerd
• mapping code/id

The QuestionnaireResponse profile is connected to the functional definitions in ART-DECOR. It includes mappings to all data elements within the functional data set, (prefixed with ‘obc-dataelement-10-').

Dit weglaten? Each profile contains a Patient reference with cardinality 1..1 M. This patient is the subject in the profile, 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 of each FHIR profile. ?

Based on ART-DECOR transaction version: 2024-07-16T09:00:44

Type	Id	Concept	Cardinality	Profile	Mapping
	1405	Antwoordgegevens	0 .. *	obc-QuestionnaireResponse	QuestionnaireResponse
Any	1404	Gegeven antwoord	0 .. 1	obc-QuestionnaireResponse	QuestionnaireResponse.answer.value[x]
dateTime	1406	Datum en tijd gegeven antwoord	?0 .. 1?	obc-QuestionnaireResponse	QuestionnaireResponse.authored
reference	1407	Onderwerp	?0 .. 1?	obc-QuestionnaireResponse	QuestionnaireResponse.subject
reference	?1408?	?Vragenlijst?	?0 .. 1?	obc-QuestionnaireResponse	QuestionnaireResponse.questionnaire

Additional FHIR elements are included in the QuestionnaireResponse profile for technical purposes, meaning there is no functional translation:

• QuestionnaireResponse.item.linkId.extension:sensitivityFlag: this flag can be applied to certain questions, indicating that the answers might contain sensitive information. As a result, a specific level of authorization is required to read these answers.

A transaction for defining a Questionnaire profile is based on the following FHIR elements:

Type	Concept	Cardinality	Mapping
uri	Questionnaire Coding system	0 .. 1	Questionnaire.Coding.system
code	Questionnaire code	0 .. 1	Questionnaire.Coding.code
string	Questionnaire code display	0 .. 1	Questionnaire.Coding.display
string	Title of Questionnaire	0 .. 1	Questionnaire.title
string	Publisher/Author information	0 .. 1	Questionnaire.publisher
string	Version of Questionnaire	0 .. 1	Questionnaire.version
code	Language of Questionnaire	0 .. 1	Questionnaire.meta.language
coding	Domain code of Questionnaire	1 .. 1	Questionnaire.usageContext.code
any	Domain of Questionnaire	1 .. 1	Questionnaire.usageContext.value
markdown (string)	License information about Questionnaire	0 .. 1	Questionnaire.copyright

A transaction of the Questionnaire profile also contains elements for technical purposes:

• Read-only elements: instruction elements are displayed as read-only in the Questionnaire.
• Hidden elements: elements related to score calculation, interpretation score, and calculation rules are hidden from the subject answering the questions.
• Rendering styles: items requiring specific formatting can be rendered with different styles, such as bold and italics.