FHIR Implementation Guide: Pregnancy Card Kraam DRAFT
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Note that this is draft material for further development during designathons |
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1 Introduction
This page describes the process of collecting maternity care data in a patient's personal health record (PHR). The process is initiated by the patient (pregnant woman).
This Implementation Guide (IG) is a technical representation of the functional design and follows the principles of the general use case overarching principles.
Technical details of the FHIR resources and structure definitions described in this IG can be found in the birthcare information standard and the Simplifier Geboortezorg STU3 package.
The technical specifications described in this IG are based on the PWD (Perinataal Woordenboek & Dataset) 3.2.
2 Actors involved
The table shows the relevant actors, systems and FHIR CapabilityStatements. The CapabilityStatements demonstrate the minimum conformance requirements for the described use cases.
| Actors | Systems | FHIR CapabilityStatements | |||
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| Name | Description | Name | Description | Name | Description |
| Patient | The user of a personal healthcare environment | PHR | Personal health record | CapabilityStatement:Receive | FHIR client requirements |
| Healthcare provider | The user of a XIS | XIS | Healthcare information system | CapabilityStatement:Send | FHIR server requirements |
3 Boundaries and relationships
This FHIR implementation guide assumes that the PHR system is able to make a connection with the XIS and create resources. It does not provide information on finding the right XIS nor does it provide information about security. These infrastructure and interface specifications are described in the 'MedMij Afsprakenstelsel'.
The Maternity Care Data Set is an addition to the Pregnancy Card (Dutch: gegevensdienst Integrale Zwangerschapskaart), which has overlap with other standards such as the BgZ (Basisgegevensset Zorg), Medication Process, Vital Signs and Lab Results. The Pregnancy Card and Maternity Care Data Set use the same HCIM based FHIR profiles for exchanging information as used in other standards extended with additional birthcare specific profiles. Most of these birthcare specific profiles are derived from the base HCIM FHIR profiles. For example, the bc-Woman is in fact a nl-core-patient with additional specifications for relating the pregnant woman to the (unborn) child.
4 Use case: retrieve maternity care data set
This use case covers the process of retrieving the Maternity Care Data Set in the Personal Health Record (PHR) of the (pregnant) woman.
4.1 PHR: request message
The PHR system requests the Maternity Care Data Set using individual search interactions. The Maternity Care Data Set consists of multiple FHIR resources with certain constraints. To obtain the patient's Maternity Care Data Set, 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]}
4.1.1 List of requests
To retrieve all known data of the Maternity Care Data Set, a client has to execute the following requests.
4.1.2 PWD to FHIR mapping table
The table below shows in the first three columns the PWD 3.2 data elements, in the fifth and sixth column their mapping to the FHIR profiles.
The mapping table below is based on the corresponding ART-DECOR transaction [...]
4.2 XIS: response message
The returned data to the PHR should conform to the profiles listed in FHIR profiles.
5 FHIR profiles
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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. |
5.1 Generic HCIM profiles
5.2 Birthcare specific profiles
| Profile name | Pattern | FHIR Resource | HCIM EN | Canonical URL | Description |
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| bc-Birth | Procedure | Procedure | http://nictiz.nl/fhir/StructureDefinition/bc-Birth | A Procedure profile describing the birth of a child as defined by BabyConnect.
This groups findings and procedures related to a particular child in a delivery - important in multiple births. A pregnancy can lead to one delivery Procedure and one or multiple birth Procedures. In multiple birth, multiple birth instances point to the same delivery Procedure. A birth also provides the relation between a child and its mother: The mother Patient is the subject of the delivery Procedure and the child Patient is the subject of the birth Procedure. A Birth has:
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| bc-Child | Patient | Patient | http://nictiz.nl/fhir/StructureDefinition/bc-Child | A Patient profile for the child Patient as defined by BabyConnect.
Child is a separate Patient. | |
| bc-ChildObservation | Child-related Observation | Observation | http://nictiz.nl/fhir/StructureDefinition/bc-ChildObservation | An Observation profile describing child-related Observations (not captured in other existing profiles), as defined by BabyConnect. Child-related Observations, such as Apgar score and birthweight, pertain to the child Patient, which is the subject of the Observation. If the child is unborn and no patient record exists for the child, bc-FetusObservation should be used instead.
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| bc-DeliveryObservation | Pregnancy-related disorder | Observation | http://nictiz.nl/fhir/StructureDefinition/bc-DeliveryObservation | An Observation profile describing delivery-related Observations, as defined by BabyConnect.
Observations such as onset of labor or blood loss pertain to a delivery Procedure.
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| bc-DeliveryProcedure | Procedure | Procedure | http://nictiz.nl/fhir/StructureDefinition/bc-DeliveryProcedure | A Procedure profile describing the delivery (including uncomplicated natural births for consistency), as defined by BabyConnect. A pregnancy can lead to one delivery Procedure, even in multiple birth. The mother Patient is the subject of the delivery Procedure.
A delivery Procedure is related to one or more birth Procedures. The child Patient is the subject of the birth Procedure. In case of multiple birth, multiple birth Procedures will point to the same delivery Procedure. | |
| bc-DisorderOfChild | Child disorder | Condition | Problem | http://nictiz.nl/fhir/StructureDefinition/bc-DisorderOfChild | A Condition profile describing child disorders as defined by BabyConnect.
Child disorders, such as chromosomal and congenital abnormalities or other problems are disorders of the child. The subject is either the child Patient (in case the child is born or a fetal patient record is in place) or the woman Patient (in case the child is unborn and there is no fetal patient record in place). In the second case, use the bodySite reference extension to refer to the fetus.
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| bc-DisorderOfLaborAndDelivery | Condition | Problem | http://nictiz.nl/fhir/StructureDefinition/bc-DisorderOfLaborAndDelivery | A Condition profile describing disorders and complications related to labor and delivery as defined by BabyConnect. These disorders are part of the delivery, which is defined in the part of extension.
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| bc-DisorderOfPregnancy | Pregnancy-related disorder | Condition | Problem | http://nictiz.nl/fhir/StructureDefinition/bc-DisorderOfPregnancy | A Condition profile describing disorders related to a pregnancy as defined by BabyConnect. For example, Conditions such as cholestasis and hypertension do not (only) pertain to the Patient but to a particular pregnancy.
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| bc-DisorderPostPartum | Condition | Problem | http://nictiz.nl/fhir/StructureDefinition/bc-DisorderPostPartum | A Condition profile describing post partum disorders or complications as defined by BabyConnect. Post partum disorders, such as post partum depression, occur after delivery and are related to the Delivery Procedure.
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| bc-Encounter | Encounter | Encounter | http://nictiz.nl/fhir/StructureDefinition/bc-Encounter | An Encounter profile describing birthcare related encounters as defined by BabyConnect. The woman Patient is the subject of the Encounter.
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| bc-FetalHeartRate | Observation | http://nictiz.nl/fhir/StructureDefinition/bc-FetalHeartRate | An Observation profile describing fetal heart rate as defined by BabyConnect. The base definition is a fetus-related Observation. Fetus-related Observations are Observations about a fetus, which is the focus of the Observation (extension). Fetus identification is necessary in these Observations, especially in multiple pregnancy. There are two ways of using this profile depending on the presence of a patient / fetus record for the unborn child:
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| bc Fetus | BodySite | http://nictiz.nl/fhir/StructureDefinition/bc-Fetus | A BodySite profile as defined by BabyConnect.
This BodySite profile refers to the unborn fetus in case no fetal record (yet) exists. In case a fetal record is created the unborn fetus will be registered as a (child) Patient. | ||
| bc-MaternalObservation | Patient-related Observation | Observation | http://nictiz.nl/fhir/StructureDefinition/bc-MaternalObservation | An Observation profile describing patient-related Observations, which are not captured in other existing profiles, as defined by BabyConnect.
Patient-related Observations are findings related to the (pregnant) woman, before, during or after pregnancy childbirth. The pregnant woman is the subject, the context is the pregnancy file (EpisodeOfCare). Examples are risk status or maternal ultrasound observations. | |
| bc-MaternalRecord | EpisodeOfCare | http://nictiz.nl/fhir/StructureDefinition/bc-MaternalRecord | An EpisodeOfCare profile describing a maternal record (or pregnancy file) as defined by BabyConnect.
Each pregnancy is a Condition. It is also represented as an EpisodeOfCare (maternal record) for each involved Organization. The maternal record defines care responsibility for a specific period of time and groups all data related to this period of care. It includes references to an Organization and responsible Practitioner. The maternal record defines care responsibility for a specific period of time and groups all data related to this period of care:
Relations between the pregnancy (Condition) and the overarching maternal record (EpisodeOfCare):
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| bc-MotherOf | RelatedPerson | http://nictiz.nl/fhir/StructureDefinition/bc-MotherOf | A RelatedPerson profile describing the relation between mother and child as defined by BabyConnect.
The RelatedPerson is the mother, which is a related person of the child Patient.
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| bc-ObstetricProcedure | Procedure | Procedure | http://nictiz.nl/fhir/StructureDefinition/bc-ObstetricProcedure | A Procedure profile describing obstetric procedures, as defined by BabyConnect. Obstetric procedures are procedures related to pregnancy, birth and delivery, such as vacuum delivery.
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| bc-PregnancyObservation | Pregnancy-related Observation | Observation | http://nictiz.nl/fhir/StructureDefinition/bc-PregnancyObservation | An Observation profile describing pregnancy-related Observations, as defined by BabyConnect.
Observations such as gravidity and parity do not (only) pertain to the Patient but also to a particular pregnancy.
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| bc-Woman | Patient | Patient | http://nictiz.nl/fhir/StructureDefinition/bc-Woman | A Patient profile describing the woman who is or was pregnant as defined by BabyConnect.
The pregnant woman, a FHIR patient, is the core of each pregnancy. |
6 Release notes
Release notes can be found on the functional design page.
7 Support
For questions and change requests regarding this IG, please create a ticket in BITS.
