BgZ Medisch-Specialistische Zorg Technical Implementation Guide 2.0

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Versie door Rick Busbridge (overleg | bijdragen) op 25 jun 2024 om 11:52 (NICTIZ-18044 - BgZ-MSZ TO - review commentaren Gabriel/Iwo bijwerken en NICTIZ 18045 - BgZ-MSZ TO - aanpassing ivm "Notified Pull – Hoe toe te passen in een informatiestandaard" - doc Marc)
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1 Note on this Implementation Guide - alpha status

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 HL7 FHIR STU3 releases. HL7 CDA is no longer supported for BgZ MSZ exchange.

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 documents also provide important background information:

  • "Kwaliteitsstandaard - Uitwisseling Basisgegevensset Zorg tussen instellingen waar medisch-specialistische zorg wordt verleend" (which translates as “Exchange of BgZ between institutions where specialist medical care is provided”) [1]
  • "NEN 7540:2024 BgZ-uitwisseling tussen instellingen voor medisch specialistische zorg" (which translates as “Exchange of BgZ between institutions for specialist medical care”) [2]
  • "Technical Agreement - Exchanging FHIR Data using a generic Notified Pull mechanism" [3]

This document assumes reader familiarity with these references.

This implementation guide is intended to provide information for implementation/deployment needs in the Netherlands. This document is part of an evolving strategy, features will likely be added, adjusted and/or removed in future versions.

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.
MedMij MedMij is an initiative of the Dutch Patient Federation and was embraced as one of the five focus programs in 2015. The Healthcare Information Council then opted for the MedMij program. To make healthcare better, more affordable and more accessible, the Information Council is working on a sustainable information system for healthcare, in which healthcare data is exchanged securely and reliably. To this end, agreements, standards, and facilities are made, together with the participants of the Information Council.
VZVZ Vereniging van Zorgaanbieders voor Zorgcommunicatie: Dutch Association for Health Providers
Zib A Zib (Zorginformatiebouwstenen) defines a clinical concept in such a way that it can be used as a building block in various healthcare situations and information systems. ZIBs form the basis for the standardization of healthcare information.

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 transaction 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.
  2. The Receiving System must support both the Notification (Task) and Workflow (Task) messages.

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 Queries section.

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 Queries section.

5 BgZ Item Type Identification

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

The BgZ item types are identified using codes taken from both LOINC and SNOMED-CT code sets as shown in the following table:

HCIM Name Code System
Patient
MaritalStatus
ContactPerson
HealthProfessional
79191-3 http://loinc.org
Payer 48768-6 http://loinc.org
TreatmentDirective 11291000146105 http://snomed.info/sct
AdvanceDirective 11341000146107 http://snomed.info/sct
FunctionalOrMentalStatus 47420-5 http://loinc.org
Problem 11450-4 http://loinc.org
LivingSituation 365508006 http://snomed.info/sct
DrugUse 228366006 http://snomed.info/sct
AlcoholUse 228273003 http://snomed.info/sct
TobaccoUse 365980008 http://snomed.info/sct
NutritionAdvice 11816003 http://snomed.info/sct
Alert 75310-3 http://loinc.org
AllergyIntolerance 48765-2 http://loinc.org
MedicationAgreement 16076005 http://snomed.info/sct
AdministrationAgreement 422037009 http://snomed.info/sct
MedicationUse2 422979000 http://snomed.info/sct
MedicalDevice 46264-8 http://loinc.org
Vaccination 11369-6 http://loinc.org
BloodPressure 85354-9 http://loinc.org
BodyWeight 29463-7 http://loinc.org
BodyHeight 8302-2 http://loinc.org
LaboratoryTestResult 15220000 http://snomed.info/sct
Procedure 47519-4 http://loinc.org
Encounter 46240-8 http://loinc.org
HealthProvider ??? http://loinc.org or http://snomed.info/sct

6 FHIR Queries

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

The BgZ is retrieved 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 the Referenced BgZ Resources 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/$lastn?category=http://snomed.info/sct|118228005,http://snomed.info/sct|384821006
6 Problems Concern All known problems
GET [base]/Condition
7 Social history LivingSituation Current living situation
GET [base]/Observation/$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
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 Care Setting HealthProvider Health provider of the patient
GET [base]/CareTeam?_include=CareTeam:participant

7 FHIR Profiles

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

7.1 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

7.2 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

7.3 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 Type column defines the type of query:

  • Read - query for a single referenced FHIR resource instances where value[x] is a valueReference
  • Search - query for one or more FHIR resource instances where value[x] is a valueString representing the search string

The Code (FHIR Task.input.type) column defines codedConcepts that identify the BgZ MSZ item to retrieve. Each codedConcept is defined in terms of the codeSystem, code and display name. NOTE: The SNOMED-CT codeSystem is used for the majority of the BgZ MSZ item identification (as required by the SNOMED-CT policy (add reference)). LOINC is also used to identify some BgZ MSZ items where no SNOMED-CT code is available.

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.

NOTE to information standard reviewers: This is table defines the core BgZ MSZ Notified Pull contents and must be reviewed, accepted and adopted by all stakeholders. Please review very carefully.

BgZ Section Type Code

(FHIR Task.input.type)

Value

(FHIR Task.input.value[x])

Description
1 Patient information Search
http://snomed.info/sct
116154003
"Patient" (MaritalStatus ContactPerson HealthProfessional)
GET [base]/Patient?
_include=Patient:general-practitioner
Identification, birth date, gender, deceased indicator, contact details, last known marital status, and general practitioner (practitioner or organization)
2 Payment details Search
http://loinc.org
48768-6
"Payer"
GET [base]/Coverage?
_include=Coverage:payor:Patient&
_include=Coverage:payor:Organization
Insurance information
3 Treatment directives Search
http://snomed.info/sct
11291000146105
"Treatment instructions"
GET [base]/Consent?
category=http://snomed.info/sct|11291000146105
Known treatment directives
Search
http://snomed.info/sct
11341000146107
"Living will and advance directive record"
GET [base]/Consent?
category=http://snomed.info/sct|11341000146107
Known advance directives
4 Contact persons Search
http://snomed.info/sct
70862002
"Contact person"
see Patient
First relation/contact
5 Functional status Search
http://snomed.info/sct
118228005
"Functional finding"
GET [base]/Observation/$lastn?
category=http://snomed.info/sct|118228005,
http://snomed.info/sct|384821006
Last known functional / mental status
6 Problems Read
http://snomed.info/sct
55607006
"Problem"
GET [base]/Condition
All known problems
7 Social history Search
http://snomed.info/sct
365508006
"Residence and accommodation circumstances - finding"
GET [base]/Observation/$lastn?
code=http://snomed.info/sct|365508006
Current living situation
Search
http://snomed.info/sct
228366006
"Finding relating to drug misuse behavior"
GET [base]/Observation?
code=http://snomed.info/sct|228366006
All known drug use
Search
http://snomed.info/sct
228273003
"Finding relating to alcohol drinking behavior"
GET [base]/Observation?
code=http://snomed.info/sct|228273003
All known alcohol use
Search
http://snomed.info/sct
365980008
"Finding of tobacco use and exposure"
GET [base]/Observation?
code=http://snomed.info/sct|365980008
All known tobacco use
Search
http://snomed.info/sct
300893006
"Nutritional finding"
GET [base]/Observation?
code=http://snomed.info/sct|300893006

NOTE: Query 1.x is: GET [base]/NutritionOrder

All known dietary recommendations
8 Alerts Read
http://loinc.org
75310-3
"Alert"
GET [base]/Flag
All known alerts
9 Allergies Read
http://snomed.info/sct
420134006
"Propensity to adverse reaction"
GET [base]/AllergyIntolerance
All known information regarding allergies
10 Medication Search
http://snomed.info/sct
422979000
"Medication regimen behavior finding"
GET [base]/MedicationStatement?
category=
urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3|6&
_include=MedicationStatement:medication
Known medication use
Search
http://snomed.info/sct
422037009
"Provider medication administration instructions"
GET [base]/MedicationDispense?
category=http://snomed.info/sct|422037009&
_include=MedicationDispense:medication
Known administration agreements
Search
http://snomed.info/sct
16076005
"Prescription"
GET [base]/MedicationRequest?
category=http://snomed.info/sct|16076005&
_include=MedicationRequest:medication
Known medication agreements
11 Medical aids Read
http://loinc.org
46264-8
"Medical Device"
GET [base]/DeviceUseStatement?
_include=DeviceUseStatement:device
Known medical aids
12 Vaccinations Read
http://snomed.info/sct
33879002
"Active immunization"
GET [base]/Immunization?
status=completed
Known vaccinations
13 Vital signs Search
http://snomed.info/sct
75367002
"Blood pressure"
GET [base]/Observation/$lastn?
code=http://snomed.info/sct|75367002
Last known blood pressure
Search
http://snomed.info/sct
27113001
"Body weight"
GET [base]/Observation/$lastn?
code=http://snomed.info/sct|27113001
Last known body weight
Search
http://snomed.info/sct
50373000
"Body height measure"
GET [base]/Observation/$lastn?
code=http://loinc.org|8302-2,
http://loinc.org|8306-3,
http://loinc.org|8308-9

QUESTION: How is SNOMED related to the LOINC codes here?

Last known body height
14 Results Search
http://snomed.info/sct
118246004
"Laboratory test finding"
GET [base]/Observation/$lastn?
category=http://snomed.info/sct|118246004&
_include=Observation:related-target&
_include=Observation:specimen
Last known laboratory results per type
15 Procedures Search
http://snomed.info/sct
50731006
"Medical procedure"
GET [base]/Procedure?
category=http://snomed.info/sct|50731006
All known medical procedures
16 Encounters Search
http://snomed.info/sct
308335008
"Patient encounter procedure"
GET [base]/Encounter?
class=http://snomed.info/sct|308335008
Known hospital admissions (no outpatient contacts)
17 Care Setting Read
http://snomed.info/sct
43741000
"Site of care"
GET [base]/CareTeam?
_include=CareTeam:participant
Health provider of the patient

7.4 Referenced BgZ Resources

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.

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

8 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?)

9 References

Reference Document Title Date, Version, Source
[1] Kwaliteitsstandaard - Uitwisseling Basisgegevensset Zorg tussen instellingen waar medisch-specialistische zorg wordt verleend

Translates as “Exchange of BgZ between institutions where specialist medical care is provided”

Commentaarfase februari 2023
[2] NEN 7540:2024 BgZ-uitwisseling tussen instellingen voor medisch specialistische zorg

Translates as “Exchange of BgZ between institutions for specialist medical care”

ICS 11.020.01;35.240.80 maart 2024
[3] Technical Agreement - Exchanging FHIR Data using a generic Notified Pull mechanism Version: 1.0.0 06-03-24

10 Release Notes

Changes compared to previous release.

BITS ticket Short description
NICTIZ-14769 Ontwikkelen/schrijven van de TO in de wiki
  1. See Search URLs and search parameters for the interpretation of these search URLs