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The following table provides the overview of the FHIR query (read/search) operations needed to retrieve all the BgZ MSZ items. These queries will be specified as '''Task.input''' (type and value[x]) parameters.
 
The following table provides the overview of the FHIR query (read/search) operations needed to retrieve all the BgZ MSZ items. These queries will be specified as '''Task.input''' (type and value[x]) parameters.
  
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The '''Type''' column defines the type of query:
+
The '''FHIR Task.input.type.coding''' column defines codedConcepts that identify the BgZ MSZ item (HCIM) to retrieve. Each codedConcept is defined in terms of the codeSystem, code and display name.  
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* '''Read''' - query for a single referenced FHIR resource instances where value[x] is a '''valueReference'''.
 
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* '''Search''' - query for one or more FHIR resource instances where value[x] is a '''valueString''' representing the search string.
 
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The '''Code''' (FHIR Task.input.type) column defines codedConcepts that identify the BgZ MSZ item (HCIM) to retrieve. Each codedConcept is defined in terms of the codeSystem, code and display name.  
 
 
'''NOTE''': All codedConcepts/identifiers are defined by the Terminology Association in each HCIM - see ART DECOR [https://decor.nictiz.nl/ad/#/bgz2017-/datasets/dataset/2.16.840.1.113883.2.4.3.11.60.42.1.2/2024-03-19T12:04:40 BgZ MSZ Dataset]
 
'''NOTE''': All codedConcepts/identifiers are defined by the Terminology Association in each HCIM - see ART DECOR [https://decor.nictiz.nl/ad/#/bgz2017-/datasets/dataset/2.16.840.1.113883.2.4.3.11.60.42.1.2/2024-03-19T12:04:40 BgZ MSZ Dataset]
 
The values are copied into this table for completeness/readability purposes.
 
The values are copied into this table for completeness/readability purposes.

Versie van 14 okt 2024 om 13:24

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1 Note on this Implementation Guide - beta status - in ontwikkeling

This alpha version of the Implementation Guide (TO) is not technically complete, but even so, it is being published in order to start obtaining feedback from the stakeholders. The current version provides an early indication of the contents being proposed.

The following items require further investigation, discussion and review amongst all stakeholders.

  1. Generic description of the Notified Pull communication pattern - this is being developed by Team Radar (Generic) within Nictiz at the moment and will be referred to from this TO. The intention is to avoid duplicating information at all costs.
  2. FHIR Notification and Workflow Task profiles - the first versions of these have been developed locally and now need to be published via Simplifier so that a reference can be made to them from this TO.
  3. FHIR GET (read/search) request strings - these need to be reviewed once the Referenced BgZ Resource profiles are complete.
  4. FHIR Referenced BgZ Resource profiles - the FO defines two new data elements that enrich the BgZ items - EersteRegistratieDatumTijd (FirstRegistrationDateTime) and MutatieDatumTijd (ContentModificationDateTime). These two fields need to be added to the corresponding BgZ FHIR resources and the mechanism for doing this is under discussion at the moment. The FHIR Provenance Resource is being considered. As soon as there is some clarity on best practices then the FHIR resource profiles will be updated and references adjusted in this TO.

The intention is to finalize agreements on these issues for the beta version of the TO. This alpha version will be updated, towards a beta version, as issues are resolved.

2 Introduction

2.1 Background

The BgZ MSZ Information Standard describes the exchange of the BgZ information between healthcare providers. The BgZ information is the minimum collection of patient data that is relevant across specialty, syndrome and profession and is important for the continuity of care. This data collection can be exchanged between care institutions. The information standard focuses on the exchange between healthcare providers of specialist medical care.

This BgZ MSZ implementation guide defines the BgZ information exchanges, in terms of use cases, based on the Zib2017 and FHIR(STU3) HL7 FHIR, STU3. HL7 CDA is no longer supported for BgZ MSZ exchange. This implementation guide assumes that the reader is familiar with this FHIR version.

Apart from this document, the guidelines as specified in general FHIR Implementation Guide apply. The guide defines methods on how to proceed with implementing FHIR STU3 and what rules apply (e.g. how to handle empty reponses etc.). In particular, the reader should take note of the Use case overarching principles and the use of FHIR packages.

2.2 About this document

This BgZ MSZ implementation guide is a technical document defining the BgZ information exchanges in terms of use cases. It should be used together with the BgZ MSZ Functional Design (FO) - see Functioneel ontwerp BgZ medisch-specialistische zorg 2.0 alpha.

The following document provides background information:

  • "Technical Agreement - Exchanging FHIR Data using a generic Notified Pull mechanism" [1]

This implementation guide is intended to provide information for implementation/deployment needs in the Netherlands.

2.3 Glossary

Term Description
Basisgegevensset Zorg - medisch-specialistische zorg (BgZ MSZ) Minimum collection of patient data that is relevant across specialty, clinical picture and profession and is important for the continuity of care.
BSN The citizen service number (BSN) is a unique 9-digit personal number allocated to everyone registered in the Personal Records Database (BRP). Everyone who registers with the BRP is automatically given a BSN.
FHIR Fast Healthcare Interoperability Resources
IHE Integrating the Healthcare Enterprise
HCIM Health and Care Information models (HCIM) or Zorginformatiebouwstenen (ZIB's) are used to capture functional, semantic (non-technical) agreements for the standardization of information used in the care process.
VZVZ Vereniging van Zorgaanbieders voor Zorgcommunicatie: Dutch Association for Health Providers

Table 2.1 Glossary

3 Boundaries and Relationships

This is the first version of the BgZ MSZ information standard in which the Notified Pull communication pattern is used to implement the "Exchange BgZ for Referral" use case. A generic description of the Notified Pull communication pattern is available (add link the Nictiz Team Radar/Generic NP description). The generic description is supplemented in this Implementation Guide by specific details defining:

  1. The Notification and Workflow Tasks in terms of their FHIR profiles.
  2. The GET request strings required to read/search for the BgZ MSZ items, defined as Input parameters in the Notification/Workflow tasks, from the Sending System by the Receiving System.
  3. The referenced FHIR resource profiles corresponding to the BgZ MSZ items.

4 Use Cases

Two use cases are defined in the FO as follows:

  • Exchange BgZ for Referral ("Uitwisseling BgZ bij Verwijzing") from a referring (sending) healthcare provider to a receiving healthcare provider in the event of a planned referral or transfer between their two care institutions.
  • Retrieval of BgZ from previous practitioner ("Opvraging BgZ bij eerdere behandelaar") by a requesting healthcare provider to his/her care institution from a different care institution.

The difference between the two use cases is mainly down to which healthcare provider takes the initiative to start the exchange of the BgZ.

4.1 Exchange BgZ for Referral

In the "Exchange BgZ for Referral" use case, the current healthcare provider (Referring (Sending) Medical Specialist) takes the initiative for a referral or transfer. In doing so, information is shared, including the BgZ (and, for example, a referral letter, additional images or reports). When the patient then attends the new care institution as a result of the referral, or transfer, the Receiving Medical Specialist can (re)use the information from the BgZ.

4.1.1 Actors

Persons Systems
Name Description Name Description
Referring (Sending) Medical Specialist Medical specialist who sends a BgZ along with a referral EHR Electronic health record
Receiving Medical Specialist Medical specialist receives a BgZ along with a referral EHR Electronic health record

It is assumed that the Referring (Sending) Medical Specialist and Receiving Medical Specialist, as persons who use the BgZ sharing infrastructure, are signed on, authenticated and have 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). The way in which the persons achieve this state is beyond the scope of this implementation guide but is expected to be facilitated by use of the generic infrastructure.

4.1.2 Transactions

The "Exchange BgZ for Referral" use case can be implemented using two types of transactions:

  • Notified Pull (preferred)
  • Push

4.1.2.1 Exchange BgZ for Referral using Notified Pull Transaction

The Notified Pull communication pattern is based on the description in [3]. The Referring (Sending) Medical Specialist notifies the Receiving Medical Specialist about the referral or transfer by sending a Notification Message. The Receiving Medical Specialist can then retrieve the BgZ (at a suitable time) using the Pull Message(s) which is(are) defined as a part of the Notification Message.

Use Case - Notified Pull

This two stage approach separates the notification phase from the actual BgZ retrieval phase allowing the Receiving Medical Specialist to decide if, and when, to retrieve the BgZ.

TODO: Linked to be added to the generic description of the Notified Pull communication pattern...

The Workflow Task message is optional in the BgZ MSZ exchange and no statement about it's inclusion is made by this Implementation Guide. However, in terms of system support the following rules apply:

  1. The Sending System can support either a standalone Notification Task message or the combined use of the Notification Task and Workflow Task messages. If the Notified Pull is part of a workflow managed by the Sending System, then the Sending System will create a Workflow Task locally and indicate its use in the Notification Task message sent to the Receiving System.
  2. The Receiving System must support both the use of a standalone Notification Task message and the combined Notification / Workflow Tasks messages, depending on which option is indicated for use in the Notification Task message. When a Workflow Task is indicated then the Receiving System must retrieve the Worklow Task message from the Sending System using a separate GET operation.

The FHIR profiles describing the Notification Task message, the Workflow Task message and the retrieved BgZ item resources are defined in the FHIR Profiles section.

The FHIR search/read queries used to retrieve the BgZ item resources are defined in the FHIR Task.input Query Specification section.

NOTE: The Notified Pull, as described in [3], identifies two additional transactions based on the Notification Task:

  1. Notification Update
  2. Notification Cancellation

Both of these transactions are out of scope for this version of the Implementation Guide.

4.1.2.2 Exchange BgZ for Referral using Push Transaction

The Referring (Sending) Medical Specialist pushes the BgZ to the Receiving Medical Specialist at the time of referral or transfer and not necessarily at the time when the Receiving Medical Specialist requires the BgZ (if it is required at all).

Use Case - Push

The Push method always transfers the BgZ to the Receiving Medical Specialist even when it might not be wanted or needed.

The FHIR profiles describing the BgZ item resources are defined in the FHIR Profiles section.

Note: 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 and pushed between sending and receiving systems.

4.2 Retrieval of BgZ from previous practitioner (out of scope V2.0)

In the "Retrieval of BgZ from previous practitioner" use case, the current healthcare provider (Requesting Medical Specialist) is aware that the patient has had some previous treatment (through, for example, information provided by the patient) and takes the initiative to retrieve the details of this previous treatment from the previous care institution.

4.2.1 Actors

Persons Systems
Name Description Name Description
Requesting Medical Specialist Medical specialist who queries for a BgZ EHR Electronic health record

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). The way in which the person achieves this state is beyond the scope of this implementation guide but is expected to be facilitated by use of the generic infrastructure.

4.2.2 Transactions

4.2.2.1 Retrieval of BgZ from previous practitioner using Pull Transaction

The Requesting Medical Specialist can retrieve the BgZ (at a suitable time) using the Pull Message.

Use Case - Pull

The FHIR profiles describing the retrieved BgZ item resources are defined in the FHIR Profiles section.

The FHIR search/read queries used to retrieve the BgZ item resources are defined in the FHIR Task.input Query Specification section. The Task.input.value[x] definitions define the query search/read values to use.

5 FHIR Profiles

Note: These FHIR Profiles are under review and will be finalized by the beta version of the TO.

5.1 FHIR Notification Task

A BgZ MSZ Notification Task instance is created in the Receiving System by the Sending System issuing an HTTP POST operation to the Receiving System.

The following table identifies the location of the Notification Task FHIR profile.

FHIR Resource FHIR Profile
(Notification) Task http://fhir.nl/fhir/StructureDefinition/bgz-msz-notification-task-location-to-be-added

5.2 FHIR Workflow Task

If the Sending System supports the management of the BgZ MSZ information exchange, it will create a Workflow Task instance locally, and include details of the Workflow Task in the Notification Task exchanged with the Receiving System. The Recieving System can retrieve the Workflow Task by issuing an HTTP GET operation to the Sending System.

The following table identifies the location of the Workflow Task FHIR profile.

FHIR Resource FHIR Profile
(Workflow) Task http://fhir.nl/fhir/StructureDefinition/bgz-msz-workflow-task-location-to-be-added

5.3 FHIR Task Patient Identification

Although a patient is formally identified by their BSN in the BgZ MSZ information standard, this patient identifier is never exchanged as part of either the Notification Task or Workflow Task content. Instead, an "authorization base" token is exchanged, which only gives access by the Receiving System to specific data of a single patient managed by the Sending System.

The authorization base token is exchanged as one of the Task.input parameters in the Notification Task with a format as shown in the table below.

FHIR Task.input.type FHIR Task.input.value[x] as valueString 
codeSystem: http://fhir.nl/fhir/NamingSystem/TaskParameter
code: authorization-base
 
authorization base token value (encrypted)

5.4 FHIR Query Specification

The table below provides an overview of the FHIR queries to exchange all BgZ-msz elements.

Query Description
1 Demographics and identification
1.1 Patient 
GET [base]/Patient?
_include=Patient:general-practitioner

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.
  • The general practitioner (GP) available in the source system is exchanged (a) as a FHIR Practitioner instance conforming to the nl-core-practitioner profile, where the Practitioner.identifier indicates a GP, 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.
1.2 Marital status 
Patient.maritalStatus

Marital status data are exchanged via the patient resource (see 1.1).

2 Financial information
2.1 Payer 
GET [base]/Coverage?
_include=Coverage:payor
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.
3 Treatment restrictions
3.1 Treatment instructions 
GET [base]/Consent?
category=http://snomed.info/sct|11291000146105&
_sort=-period.start&_count=1

The last known TreatmentDirective available in the source system is exchanged as a FHIR consent instance that conforms to the zib-TreatmentDirective profile.

  • The consent.category is fixed to ‘treatment instructions’ (code = '11291000146105' in codeSystem 'SNOMED CT').
  • The TreatmentDirective with the most recent TreatmentDirective.startdate (zib) is exchanged, which corresponds to the consent.period.start (FHIR).
3.2 Advance directive 
GET [base]/Consent?
category=http://snomed.info/sct|11341000146107&
_sort=-dateTime&_count=1

The last known AdvanceDirective available in the source system is exchanged as a FHIR consent instance that conforms to the zib-AdvanceDirective profile.

  • The consent.category is fixed to ‘levenstestament en wilsverklaring in dossier’ (code = '11341000146107' in codeSystem 'SNOMED CT').
  • The AdvanceDirective with the most recent TreatmentDirective. LivingWillDate (zib) is exchanged, which corresponds to the consent.datetime (FHIR). Please be aware of the difference in the use of timestamps between TreatmentDirective and AdvanceDirective.
4 Contact persons
4.1 Contact 
Patient.contact
 Primary partner/contact data are exchanged via the patient resource (see 1.1).
5 Functional/mental status
5.1 Functional or mental status 
GET [base]/Observation?
category=http://snomed.info/sct|118228005,
http://snomed.info/sct|384821006

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').
  • The target system may be configured to optimize the use of this information, so that it facilitates in filtering the last known status regarding mental, hearing, vision, mobility and language skills.
6 Complaints and diagnoses
6.1 Problem 
GET [base]/Condition

All problems available in the source system are returned as zib-Problem instances.

  • The condition.clinicalStatus must be populated according to the zib-Problem profile. In exceptional cases where for legacy data there is no Problem.ProblemStatus recorded in the source system then the Condition.clinicalStatus field MUST be populated with the ‘unknown’ data-absent-reason.
"clinicalStatus":{
   "extension": [{
      "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
      "valueCode": "unknown"
    }]
  },
  • Typically, the problem.ProblemType is not recorded as part of the problem list items in a source system. Note that no Condition.category (e.g. diagnosis or symptom) may be assumed while exchanging this data.
7 Social history
7.1 Living Situation 
GET [base]/Observation/$lastn?
code=http://snomed.info/sct|365508006

The last known living situation available in the source system is exchanged as a FHIR Observation instance that conforms to the zib-LivingSituation profile.

  • The Observation.category is fixed to ‘Residence and accommodation circumstances - finding’ (code = ' 365508006' in codeSystem 'SNOMED CT').
7.2 Drug Use 
GET [base]/Observation?
code=http://snomed.info/sct|228366006

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, filtering the last known data for a specific DrugOrMedicationType.
7.3 Alcohol Use 
GET [base]/Observation/$lastn?
code=http://snomed.info/sct|228273003

The last known alcohol use available in the source system is exchanged as a FHIR Observation instance that conforms to the zib-AlcoholUse profile.

  • The Observation.category is fixed to ‘Finding relating to alcohol drinking behavior’ (code = '228273003' in codeSystem 'SNOMED CT').
7.4 Tobacco Use 
GET [base]/Observation/$lastn?
code=http://snomed.info/sct|365980008

The last known Tobacco Use available in the source system is exchanged as a FHIR Observation instance that conforms to the zib-TobaccoUse profile.

  • The Observation.category is fixed to ‘Finding of tobacco use and exposure’ (code = ' 365980008' in codeSystem 'SNOMED CT').
7.5 Nutrition Advice 
GET [base]/NutritionOrder

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, filtering the last known data for a specific NutritionOrder.oralDiet.type.
8 Alerts
8.1 Alert 
GET [base]/Flag

All alerts available in the source system is exchanged as a FHIR Flag instances that conform to the zib-Alert profile.

9 Allergies
9.1 Allergy Intolerance 
GET [base]/AllergyIntolerance

All allergies and intolerances available in the source system is 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 exceptional cases where for legacy data there is no Symptom recorded, then the Reaction.manifestation field MUST be populated with the ‘unknown’ data-absent-reason.
"manifestation":{
   "extension": [{
      "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
      "valueCode": "unknown"
    }]
  },
10 Medication
10.1 Medication Agreement 
GET [base]/MedicationRequest?
category=http://snomed.info/sct|16076005&
_include=MedicationRequest:medicationReference

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.
10.2 Administration Agreement 
GET [base]/MedicationDispense?
category=http://snomed.info/sct|422037009&
_include=MedicationDispense:medicationReference

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.
10.3 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:medicationReference

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.
11 Medical devices
11.1 Medical device 
GET [base]/DeviceUseStatement?
_include=DeviceUseStatement:device

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.
12 Vaccinations
12.1 Vaccination 
GET [base]/Immunization?
status=completed

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 at ‘completed’.
13 vital signs and measurements
13.1 Blood pressure 
GET [base]/Observation/$lastn?
code=http://loinc.org|85354-9

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.
13.2 Body weight 
GET [base]/Observation/$lastn?
code=http://loinc.org|29463-7

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.
13.3 Body height 
GET [base]/Observation/$lastn?
code=http://loinc.org|8302-2, 
http://loinc.org|8306-3, 
http://loinc.org|8308-9

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.
14 Results
14.1 Laboratory test result 
GET [base]/Observation/$lastn?
category=http://snomed.info/sct|49581000146104
&_include=Observation:related-target

All last known Laboratory results, where for each PanelOrBattery the last known results, are exchanged as FHIR observations conforming the zib-LaboratoryTestResult-Observation profile.

  • The optional result Type of the Laboratory Result is not used for filtering.
  • All known Laboratory test results are shared per PanelOrBattery.
15 Procedures
15.1 Procedure 
GET [base]/Procedure?
category=http://snomed.info/sct|387713003,
http://snomed.info/sct|258174001

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 procedure 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’).
  • When instances are used in a FHIR store or test purposes and none of the above types apply, the Procedure.category is fixed to ‘procedure’ (code = ‘71388002’ in CodeSystem ‘SNOMED CT’).
  • ordered by… zib-ProcedureRequest
16 Encounters
16.1 Encounter 
GET [base]/Encounter?
_include=Encounter:serviceProvider

All Encounters available in the source system are exchanged as FHIR Encounter instances that conform to the zib-Encounter profile.

17 Planned care activity
17.1 Procedure 
GET [base]/ProcedureRequest? {future date}

All planned procedures available in the source system are exchanged FHIR ProcedureRequest instances according to the zib-ProcedureRequest profile.

  • All procedureRequests are exchanged. The target system facilitates in filtering of future events based on the actual time of using the data.
18 Care Setting
18.1 Health professional 
GET [base]/CareTeam?status=active&_include=CareTeam:participant

Procedure.performer (nl-code-practitioner)
Encounter.participant (nl-code-practitioner)
DeviceUseStatement.source (nl-code-practitioner)

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.
18.2 Healthcare provider 
Procedure.performer (nl-code-organization)
Encounter.serviceProvider (nl-code-organization)

Providers, are exchanged as part of the BgZ information elements. There is no specific query to retrieve Health Providers.

  • When providers are exchanged, they are exchanged as Organization instances accorting to the nl-core-organization profile.
19 Meta data
19.1 Meta data 
GET [base]/Provenance

All provenance data available in the source system is exchanged as FHIR provenance instances according to the bgz-metadata profile.

5.5 FHIR Task.input Query Specification

The following table provides the overview of the FHIR query (read/search) operations needed to retrieve all the BgZ MSZ items. These queries will be specified as Task.input (type and value[x]) parameters.

The FHIR Task.input.type.coding column defines codedConcepts that identify the BgZ MSZ item (HCIM) to retrieve. Each codedConcept is defined in terms of the codeSystem, code and display name. NOTE: All codedConcepts/identifiers are defined by the Terminology Association in each HCIM - see ART DECOR BgZ MSZ Dataset The values are copied into this table for completeness/readability purposes.

The Value (FHIR Task.input.value[x]) column defines the query performed to retrieve the identified BgZ MSZ item.

The same Task.input parameters are applicable to the Notification Task or the Workflow Task depending on which is used to specify the BgZ MSZ retrieval operation.

Section Component FHIR Task.input.type.coding
1 Demographics and identification 1.1 Patient http://loinc.org/79191-3
1.2 Marital status Data are exchanged as part of the patient instance.
2 Financial information 2.1 Payer http://loinc.org/48768-6
3 Treatment restrictions 3.1 Treatment instructions http://snomed.info/sct/11291000146105
3.2 Advance directive http://snomed.info/sct/11341000146107
4 Contact persons 4.1 Contact Data are exchanged as part of the patient instance.
5 Functional/mental status 5.1 Functional or mental status http://loinc.org/47420-5
6 Complaints and diagnoses 6.1 Problem http://loinc.org/11450-4
7 Social history 7.1 Living Situation http://snomed.info/sct/365508006
7.2 Drug Use http://snomed.info/sct/228366006
7.3 Alcohol Use http://snomed.info/sct/228273003
7.4 Tobacco Use http://snomed.info/sct/365980008
7.5 Nutrition Advice http://snomed.info/sct/11816003
8 Alerts 8.1 Alert http://loinc.org/75310-3
9 Allergies 9.1 Allergy Intolerance http://loinc.org/48765-2
10 Medication 10.1 Medication Agreement http://snomed.info/sct/422979000
10.2 Administration Agreement http://snomed.info/sct/422037009
10.3 Medication Use http://snomed.info/sct/16076005
11 Medical devices 11.1 Medical device http://loinc.org/46264-8
12 Vaccinations 12.1 Vaccination http://loinc.org/11369-6
13 vital signs and measurements 13.1 Blood pressure http://loinc.org/85354-9
13.2 Body weight http://loinc.org/29463-7
13.3 Body height http://loinc.org/8302-2
14 Results 14.1 Laboratory test result http://snomed.info/sct/15220000
15 Procedures 15.1 Procedure http://snomed.info/sct/71388002
16 Encounters 16.1 Encounter http://loinc.org/46240-8
17 Planned care activity 17.1 Procedure PM
18 Care Setting 18.1 Health professional http://snomed.info/sct/229774002
18.2 Healthcare provider Data are exchanges as part of other BgZ components.
19 Meta data 19.1 Meta data http://loinc.org/67723-7

Table 5.1 FHIR Task.input Query Specification

5.6 Referenced BgZ FHIR Resources

Each FHIR profile contains a 'mappings' tab that reflects the identifiers, found at release 2017 zibs/HCIMs. The reader should take note of the 'Relating FHIR profiles with their functional definitions' regarding mappings in FHIR.

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 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
CareTeam http://fhir.nl/fhir/StructureDefinition/nl-core-careteam
16 Meta data Provenance Provenance http://nictiz.nl/fhir/StructureDefinition/bgz-metadata

Table 5.2 Referenced BgZ FHIR Resources

6 Infrastructure

6.1 Generic Infrastructure

The implementation guideline assumes that a generic infrastructure is available to provide for services like:

  • Identification [NEN-7518] (of client and provider - who are you?)
  • Authentication [NEN-7518] (establish that you really are who you say)
  • Localization [NEN-7519] (where/what information known about the client and provider?)
  • Consent [NEN-7517] (from the patient for the sharing of medical information)
  • Authorization (what information are you allowed to access?)
  • Addressing (digital address of provider or organization)
  • Logging [NEN-7513] (audit trail - who did what, where, when and why?)

6.2 Expiration Time (exp) Claim

The "exp" (expiration time) claim identifies the expiration time on or after which the JWT MUST NOT be accepted for processing.

The value of the expiration time used in this Implementation Guide is (to be filled in).

7 References

Reference Document Title Date, Version, Source
[1] Technical Agreement - Exchanging FHIR Data using a generic Notified Pull mechanism Version: 1.0.0 06-03-24

8 Release Notes

Changes compared to previous release.

BITS ticket Short description
NICTIZ-14769 Ontwikkelen/schrijven van de TO in de wiki
NICTIZ-18044 BgZ-MSZ TO - review commentaren Gabriel/Iwo bijwerken
NICTIZ-18045 BgZ-MSZ TO - aanpassing ivm "Notified Pull – Hoe toe te passen in een informatiestandaard"
MSZ-139 BgZ-MSZ alpha 2.0 Technical Design Feedback
Overgenomen van "https://informatiestandaarden.nictiz.nl/index.php?title=BgZ:V2.0_Beta_BgZ_2017_Technical_IG&oldid=228638"