FHIR Implementation Guide BirthCare v1.3

Dit is een tijdelijke pagina met wijzigingen voor issue MM-5622. De gepubliceerde versie vind je hier.

Introduction

This page details the HL7 FHIR requirements for exchanging birthcare data.

The FHIR Implementation Guide for birthcare is based on PWD 3.2. The functional view for birthcare 3.2 is described in the functional design wiki pages.

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

FHIR resources and structure definitions described in this Implementation Guide (IG) can be found in the Simplifier Geboortezorg STU3 package. This IG provides links to the required resources and structure definitions for each use case.

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
Name	Description	Name	Description	Name	Description
Patient	The user of a personal healthcare environment	PHR	Personal health record		FHIR client/server requirements
Healthcare provider	The user of a XIS	XIS	Healthcare information system

Boundaries and relationships

Thie birthcare information standard includes use cases for the exchange of birthcare data between health care providers (e.g. midwifes, gynaecologists and maternity care), between health care providers and patients (e.g. in a PGO setting), and for secondary use of data by third parties (e.g. perined).

This FHIR implementation guide assumes that systems are able to connect with source systems and create resources. It does not provide information on finding the right source system nor does it provide information about security. These infrastructure and interface specifications are described in the

and, more specifically, for a PGO setting in the 'MedMij Afsprakenstelsel'.

The birthcare information standard has overlap with other standards such as the BgZ (basisgegevensset zorg), Medication Process, Vital Signs and Lab Results. Birthcare uses 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.

A high level overview

FHIR Resources and StructureDefinitions

Types of resources and relations between them

Pregnancy and maternal record

A pregnancy (Condition) starts with a pregnant woman (Patient). Her data is registered in a maternal record (EpisodeOfCare). The maternal record contains references to the pregnant woman (subject), the pregnancy (condition), the care manager (careManager:Practitioner) and managing organization (managingOrganization:Organization).

Birth and Delivery

If all goes well a pregnancy ends with a delivery (Procedure). A delivery is related to the mother (subject). It has 3 stages: 1. dilation, 2. birth of one or more children and 3. afterbirth. There are no separate resource for the first and third stages of delivery, but the second stage of delivery is another Procedure, which is related to the child (subject). The Birth Procedure is part of the Delivery Procedure and in case of a multiple pregnancy, multiple Birth Procedures can be part of the same Delivery Procedure.

Obstetric procedures

Obstetric procedures are procedures related to pregnancy, birth and delivery. These procedures can be part of (partOf) a Birth Procedure (in case of child-related procedures, like a c-section) or a Delivery Procedure (in case of maternal procedures, like a blood transfusion). The partOf element can also be left blank when the procedure is linked to the pregnancy (record), but not to birth and delivery.

Relations between pregnancy, birth and delivery

A pregnancy (Condition), birth (Procedure) and delivery (Procedure) are all related to a maternal record (EpisodeOfCare) through their context element, either with a direct reference to the EpisodeOfCare or an indirect reference to an Encounter which in itself is linked to the maternal record (EpisodeOfCare). In addition, the Birth and Delivery Procedures both include a reference to the pregnancy (reasonReference).

Patterns

For Observations and Conditions, which are often very similar, we follow patterns: an implementer will only need to implement the pattern and an associated table with codes, and be able to support all Observations. So for Observations pertaining to a particular pregnancy (not to the woman - she may have multiple pregnancies on record, neither to the delivery) all Observations will link to the Pregnancy Condition. So instead of having to inspect StructureDefinitions separately for each pregnancy observations, following a single pattern will do. The pattern has it's own StructureDefinition, so the FHIR profile is still complete. Likewise Observations for the mother, delivery and child follow patterns.

Pattern tables can be found on individual pattern pages, see links below, and on Gebz:V2.3_FHIR_mapping_addendum for 2.3 mappings and Gebz:V3.2_FHIR_mapping_addendum for 3.2 mappings.

Observation patterns

Observations follow patterns based on their subject (either the child or the mother patient) and their focal subject (either the pregnancy, birth or delivery), see table below. The use of focus extensions is a pre-adopt of FHIR R4, where it is part of Observation: "What the observation is about, when it is not about the subject of record." Focus is required for all Observations which do not pertain to the Patient. In R4, use of focus permits "reverse include" queries (give me all Observations with focus element X). In STU3, this could be a custom search.

Pattern	Subject	Focus
Patient-related Observations	Mother patient	x
Pregnancy-related Observations	Mother patient	Pregnancy
Delivery-related Observations	Mother patient	Delivery
Birth-related Observations	Mother patient	Birth
Child-related Observations	Child patient	x
Fetus-related Observations	Mother patient	Fetus

Condition patterns

Conditions follow patterns based on their category (disorders related to either pregnancy, labor and delivery, postpartum or child disorders). Pregnancy, birth and delivery related disorders use partOf to link to these concepts, see table below.

Pattern	Subject	Category	PartOf
Pregnancy-related disorder	Mother patient	173300003	Pregnancy
Delivery-and-birth-related disorder	Mother patient	362972006	Delivery
Postpartum disorder	Mother patient	362973001	Delivery
Child-related disorder	Child patient	414025005	x

Guiding principles for resource use

1. Pregnancy identification

Determining whether data published from different sources belong to the same pregnancy can be done using the definitive term date. If this is not (yet) available, the estimated term date can be used.

Because in practice there can be some variation in the registered term date, a bandwidth of 4 weeks can be used. If the term date from source X differs by 4 weeks or less from the term date from source Y, it can be safely assumed that it is the same pregnancy of a woman.

For applications that can only publish the BgZ, the term date from a different source can be used to calculate a pregnancy period. This runs from term date – 40 weeks to term date + 6 weeks. Based on this, the BgZ data can be classified into the correct pregnancy(ies).

2. Practitioner.telecom and PractitionerRole.telecom

Practitioner and PractitionerRole instances should not contain telecom elements to prevent the exchange of personal information of care professionals like private phone numbers and email. The Organization resource contains the appropriate contact information for other professionals within the network.

3. EpisodeOfCare title

To make them uniformly and recognisable for end users the EpisodeOfCare.extension:title should be filled with the short name for the condition, i.e. “Zwangerschap“, followed by gravidity, parity and mater in the form of “{G}/{P}/{M}”. Example: “Zwangerschap 3/2/2“

4. Context level

Context element of resources should reference the lowest level of granularity available. Therefor, they should reference Encounters when they can and only Episode of care if they must.

5. Encounters

All moments of contact with the client should be published as Encounters including an Observation "Zwangerschapsduur" (PregnancyDuration, see next point).

6. Zwangerschapsduur (PregnancyDuration)

If one of the following resources is published it must be accompanied by an Observation "Zwangerschapsduur" (PregnancyDuration):

• Encounter
• "Probleem (Zwangerschap)" (DisorderOfPregnancy)
• "Verrichting (Zwangerschap)" (ObstetricProcedure)
• "Bevalling" (DeliveryProcedure)
• "Probleem (Maternaal)" (Problem, DisorderOfLaborAndDelivery, DisorderPostPartum)
• "Verrichting (Maternaal)" (ObstetricProcedure)

List of resources and relations between them

Profile	Pattern	Base profile	FHIR resource	HCIM EN	Canonical URL	Description
bc-AbilityToTakeCareOfChild		bc-MaternalObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-AbilityToTakeCareOfChild	An Observation profile describing the woman's ability to take care of her child as defined by BabyConnect. Patient-related Observations are about the (pregnant) woman, which is the subject of the Observation.
bc-AmnioticFluid		bc-FetusObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-AmnioticFluid	An Observation profile describing the amniotic fluid as defined by BabyConnect. 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: 1. A patient / fetus record is present. The subject of the Observation is the (unborn) child Patient. The focus extension can be left blank. 2. A patient / fetus record is not present. The subject of the Observation is the woman Patient. The focus extension refers to the fetus BodySite.
bc-BarthelIndex		bc-MaternalObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-BarthelIndex	An Observation profile describing self-reliance of the woman after birth as defined by BabyConnect. The subject is the woman Patient.
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: A partOf extension, pointing to the Delivery The subject is the Child The context is the Maternal Record EpisodeOfCare The pregnancy is captured in the reasonReference
bc-BirthControl		nl-core-observation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-BirthControl	An Observation profile describing birth control as defined by BabyConnect.
bc-BirthObservation	Birth-related Observation	nl-core-observation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-BirthObservation	An Observation profile describing birth-related Observations as defined by BabyConnect. Birth-related Observations, such as parturition type, pertain to a birth, which is the focus of the Observation (extension). They are also about the mother, which still is the subject of the Observation. Birth-related Observations use focus extension to point to a birth Birth-related Observations refer to the EpisodeOfCare with Observation.context.reference
bc-BreastFindings		bc-MaternalObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-BreastFindings	An Observation profile describing findings related to the breasts as defined by BabyConnect. The subject is the woman Patient.
bc-CareAgreement		CarePlan	CarePlan		http://nictiz.nl/fhir/StructureDefinition/bc-CareAgreement	A CarePlan profile describing the care arrangement between a pregnant woman and her caregiver(s) as defined by BabyConnect.
bc-CareTeam		nl-core-careteam	CareTeam		http://nictiz.nl/fhir/StructureDefinition/bc-CareTeam	A CareTeam profile describing the involvement of (other) care providers in the care of a patient and her child, such as a pediatrician. These care providers are included as participants in the CareTeam using the CareTeam.participant.member element. Participants may either be Practitioners or Organizations. Their role and period of involvement are described at the participant level (that is CareTeam.participant.role and CareTeam.participant.period). The reason of involvement is described in CareTeam.reasonCode
bc-Child		nl-core-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-ChildBirthAssistance		bc-Encounter	Encounter		http://nictiz.nl/fhir/StructureDefinition/bc-ChildBirthAssistance	An Encounter profile describing (childbirth) assistance to a woman in labor as defined by BabyConnect. The woman Patient is the subject of the Encounter The place of birth is described in Encounter.class using a ConceptMap to map values to available FHIR codes The Encounter.diagnosis element refers to the Pregnancy (Condition) The Encounter.participant element containts a list of care providers that were present during delivery. Family members could also be included in this list. Additional details can be defined at participant level, such as participant type and time of arrival. The latter uses an extension at participant level with a coded list of time of arrival. Childbirth Assistance refers to the EpisodeOfCare with Encounter.EpisodeOfCare.reference
bc-ChildObservation	Child-related Observation	nl-core-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. - Child observations refer to the EpisodeOfCare with Observation.context.reference
bc-ChildRecord		nl-core-episodeofcare	EpisodeOfCare		http://nictiz.nl/fhir/StructureDefinition/bc-ChildRecord	An EpisodeOfCare profile describing the child care record as defined by BabyConnect.
bc-ClinicalImpression		ClinicalImpression	ClinicalImpression		http://nictiz.nl/fhir/StructureDefinition/bc-ClinicalImpression	A ClinicalImpression profile describing the caregiver's professional assessment around the woman's pregnancy as defined by BabyConnect.
bc-DeliveryObservation	Pregnancy-related disorder	nl-core-observation	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. Delivery-related Observations use focus extension to point to the delivery Procedure they're about. Delivery-related Observations refer to the EpisodeOfCare with Observation.context.reference
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. Delivery refers to the EpisodeOfCare with Procedure.context.reference Delivery refers to the Pregnancy with Procedure.reasonReference.reference 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-DigitalVaginalExamination		DiagnosticReport	DiagnosticReport		http://nictiz.nl/fhir/StructureDefinition/bc-DigitalVaginalExamination	A DiagnosticReport profile describing a digital vaginal examination as defined by BabyConnect. The digital vaginal examination DiagnosticReport groups Observations related to the digital vaginal examination. The woman Patient is the subject of the report. This report refers to the EpisodeOfCare with DiagnosticReport.context.reference
bc-DisorderOfChild	Child disorder	zib-Problem	Condition		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. Child disorders can refer to the EpisodeOfCare with Condition.context.reference A ConceptMap is available to map verification status to accepted FHIR codes
bc-DisorderOfLaborAndDelivery		zib-Problem	Condition		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. Delivery-related Disorders use partOf extension to point to (birth or delivery) Procedure they're about. Delivery-related Disorders refer to the EpisodeOfCare through Condition.context.reference
bc-DisorderOfPregnancy	Pregnancy-related disorder	zib-Problem	Condition		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. Pregnancy-related Disorders use the partOf extension to point to the Condition they're about. In some cases the partOf Condition may not be available. The BGZ for instance does not relate Conditions to particular pregnancies. Pregnancy-related Disorders refer to the EpisodeOfCare through Condition.context.reference
bc-DisorderPostPartum		zib-Problem	Condition		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. A partOf extension is used to point to the Delivery. The context is the Maternal Record or an Encounter.
bc-Donor		nl-core-relatedperson	RelatedPerson		http://nictiz.nl/fhir/StructureDefinition/bc-Donor	A RelatedPerson profile describing donor characteristics as defined by BabyConnect.
bc-DonorObservation	Donor-related Observation	nl-core-observation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-DonorObservation	An Observation profile describing donor-related Observations, as defined by BabyConnect. These are observations about the donor, such as their age. Donor-related Observations use the focus extension to point to the RelatedPerson (donor) they are about Donor-related Observations refer to the EpisodeOfCare with Observation.context.reference
bc-Encounter		zib-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. Encounter.type specifies the type of encounter, e.g. prenatal visit, postnatal follow up or counseling. Encounter.episodeOfCare points to the maternal record that is the context of the Encounter Encounter.diagnosis points to the pregnancy (and optional other Conditions) Encounter.serviceProvider points to the responsible Organization for the Encounter
bc-ExcretionFeces		bc-ChildObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-ExcretionFeces	An Observation profile describing a newborn's fecal excretion as defined by BabyConnect.
bc-ExcretionUrine		bc-ChildObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-ExcretionUrine	An Observation profile describing a newborn's urine excretion as defined by BabyConnect.
bc-FamilyMemberHistory		FamilyMemberHistory	FamilyMemberHistory		http://nictiz.nl/fhir/StructureDefinition/bc-FamilyMemberHistory	A FamilyMemberHistory profile as defined by BabyConnect describing the relevant family history of a pregnant woman. FamilyMemberHistory.patient points to the woman Patient FamilyMemberHistory.relationship describes the relation (e.g. father or sister) of the family member to the woman Patient FamilyMemberHistory.condition points to the (significant) condition(s) of the family member. The optional contributedToDeath extension can be used to indicate if a specific condition caused death FamilyMemberHistory.deceased[x] indicates whether the family member has deceased. This can either be a boolean (true/false) or more specific information can be provided like age. If an age is present, it implies that the family member is deceased and in this case the boolean value should be left out.
bc-FamilySituationAssessment		bc-MaternalObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-FamilySituationAssessment	An Observation profile as defined by BabyConnect describing the assessment of the family situation of a pregnant woman. Indications for additional care may be based on this assessment.
bc-FeedingPatternInfant		zib-FeedingPatternInfant	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-FeedingPatternInfant	An Observation profile describing the infant's feeding pattern as defined by BabyConnect.
bc-FetalHeartRate		bc-FetusObservation	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: 1. A patient / fetus record is present. The subject of the Observation is the (unborn) child Patient. The focus extension must be left blank. 2. A patient / fetus record is not present. The subject of the Observation is the woman Patient. The focus extension refers to the fetus BodySite.
bc-FetalMonitoring		bc-FetusObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-FetalMonitoring	An Observation profile derived from the fetus Observation profile describing fetal monitoring as defined by BabyConnect. Fetal monitoring 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: 1. A patient / fetus record is present. The subject of the Observation is the (unborn) child Patient. The focus extension must be left blank. 2. A patient / fetus record is not present. The subject of the Observation is the woman Patient. The focus extension refers to the fetus BodySite.
bc-Fetus		BodySite	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-FetusObservation		nl-core-observation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-FetusObservation	An Observation profile describing fetus-related Observations in a pregnancy, such as movement and heart action, as defined by BabyConnect. 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: 1. A patient / fetus record is present. The subject of the Observation is the (unborn) child Patient. The focus extension must be left blank. 2. A patient / fetus record is not present. The subject of the Observation is the woman Patient. The focus extension refers to the fetus BodySite.
bc-IndividualCarePlan-Goal		zib-TreatmentObjective	Goal		http://nictiz.nl/fhir/StructureDefinition/bc-IndividualCarePlan-Goal	A Goal profile describing the goal(s) of an individual care plan of a pregnant woman as defined by BabyConnect.
bc-IndividualCareplan		nl-core-careplan	CarePlan		http://nictiz.nl/fhir/StructureDefinition/bc-IndividualCareplan	A CarePlan profile describing the individual care plan of a pregnant woman as defined by BabyConnect.
bc-LegalSituation-LegalStatus		Condition	Condition		http://nictiz.nl/fhir/StructureDefinition/bc-LegalSituation-LegalStatus	A Condition profile describing legal status as defined by BabyConnect. The legal status indicates the basis on which the patient is staying in a healthcare organization. This can be either voluntary or involuntary, however the legal status is always determined by a judge.
bc-LegalSituation-Representation		Condition	Condition		http://nictiz.nl/fhir/StructureDefinition/bc-LegalSituation-Representation	A Condition profile describing legal representation as defined by BabyConnect. Representation is important in situations where a person is legally not competent to give permission and/or factually (partly) incapable of doing so. A representative supports and takes decisions in the interest of the representee when they cannot do so themselves (temporarily or permanently).
bc-MaternalObservation	Patient-related Observation	nl-core-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		nl-core-episodeofcare	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. The maternal record has a fixed type (.type = 364320009). Additional types may be provided to indicate a specific period of care. The maternal record includes references to a managing 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: 1. The maternal record groups all data related to one pregnancy for the managing Organization 2. The groupIdentifier (.extension:groupIdentifier) is a unique identifier of the pregnancy which can be used to group all data related to one pregnancy across Organizations Relations between the pregnancy (Condition) and the maternal record (EpisodeOfCare): Condition points to the EpisodeOfCare through a EpisodeOfCare.context.reference element. EpisodeOfCare points to the Condition through a EpisodeOfCare.diagnosis.condition element. Condition and EpisodeOfCare both point to the Patient with .subject.reference Condition.clinicalStatus and EpisodeOfCare.status must be 'active' for ongoing pregnancies Condition.clinicalStatus must be 'inactive' and EpisodeOfCare.status must be 'finished' for past pregnancies
bc-MotherOf		RelatedPerson	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. The RelatedPerson.patient refers to the child Patient The RelatedPerson.link refers to the mother Patient, RelatedPerson.link.type is set to seealso
bc-MultidisciplinaryTeamMeeting		Encounter	Encounter		http://nictiz.nl/fhir/StructureDefinition/bc-MultidisciplinaryTeamMeeting	An Encounter profile describing a team care conference as defined by BabyConnect. In a team care conference caregivers discuss patient cases in absence or presence of the patient.
bc-MultidisciplinaryTeamMeeting-Plan		CarePlan	CarePlan		http://nictiz.nl/fhir/StructureDefinition/bc-MultidisciplinaryTeamMeeting-Plan	A CarePlan profile related to the multidisciplinary team meeting as defined by BabyConnect.
bc-ObstetricProcedure		zib-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. For obstetric procedures related to the pregnancy, use Procedure.reasonReference For obstetric procedures related to birth and delivery, use the (optional) partOf extension to point to the Delivery (maternal data) or the Birth (child-specific data) The context is the Maternal Record or an Encounter
bc-PerinatalDeath		bc-FetusObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-PerinatalDeath	An Observation profile describing perinatal and (early) neonatal death as defined by BabyConnect. The subject may be either an unborn, stillborn or living born child. In case of an unborn or stillborn child, a patient or fetus record may not be present. In this case the subject is the woman Patient. Use the focus extension to refer to the fetus BodySite. In all other cases the subject is the child Patient and the focus extension can be left blank.
bc-PerinealAssessment		bc-MaternalObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-PerinealAssessment	An Observation profile describing the perineal assessment as defined by BabyConnect.
bc-PlacentaLocalization		bc-FetusObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-PlacentaLocalization	An Observation profile describing the localization of the placenta as defined by BabyConnect. 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: 1. A patient / fetus record is present. The subject of the Observation is the (unborn) child Patient. The focus extension can be left blank. 2. A patient / fetus record is not present. The subject of the Observation is the woman Patient. The focus extension refers to the fetus BodySite.
bc-PractitionerRole		nl-core-practitionerrole	PractitionerRole		http://nictiz.nl/fhir/StructureDefinition/bc-PractitionerRole	A PractitionerRole profile describing the role of a practitioner as defined by BabyConnect.
bc-PregnancyObservation	Pregnancy-related Observation	nl-core-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. Pregnancy-related Observations use the focus extension to point to the Condition they are about. Without this, all gravidities would only be Observations about a Patient. Pregnancy-related Observations refer to the EpisodeOfCare with Observation.context.reference
bc-PregnancyUltraSound		DiagnosticReport	DiagnosticReport		http://nictiz.nl/fhir/StructureDefinition/bc-PregnancyUltraSound	A DiagnosticReport profile describing a pregnancy ultrasound as defined by BabyConnect. The ultrasound DiagnosticReport groups Observations related to the pregnancy ultrasound. The woman Patient is the subject of the report. This report refers to the EpisodeOfCare with DiagnosticReport.context.reference
bc-PregnancyUltraSoundGeneralFindings		bc-FetusObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-PregnancyUltraSoundGeneralFindings	An Observation profile describing general ultrasound findings for the fetus as defined by BabyConnect. 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: 1. A patient / fetus record is present. The subject of the Observation is the (unborn) child Patient. The focus extension can be left blank. 2. A patient / fetus record is not present. The subject of the Observation is the woman Patient. The focus extension refers to the fetus BodySite.
bc-ProcedureObservation	Procedure-related Observation	nl-core-observation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-ProcedureObservation	An Observation profile describing procedure-related Observations as defined by BabyConnect. Procedure-related Observations are Observations about a procedure, which is the focus of the Observation (extension). They are also about the mother, which still is the subject of the Observation. For example, embryo transfer date and oocyte retrieval date are observations related to an IVF/ICSI procedure. Procedure-related Observations use focus extension to point to a birth Procedure-related Observations refer to the EpisodeOfCare with Observation.context.reference
bc-ReferralRequest		ReferralRequest	ReferralRequest		http://nictiz.nl/fhir/StructureDefinition/bc-ReferralRequest	A ReferralRequest profile describing referral details as defined by BabyConnect. Referral details (such as type of referral, reason code, referrer and target of the referral) are described in ReferralRequest. The pregnant woman is the subject, the context is the pregnancy file (EpisodeOfCare).
bc-RelatedPerson		nl-core-relatedperson	RelatedPerson		http://nictiz.nl/fhir/StructureDefinition/bc-RelatedPerson	A RelatedPerson profile as defined by BabyConnect to describe a related person (e.g. partner) of the woman Patient: RelatedPerson.extension:role defines the role of the contact in relation to the woman Patient, for partner use the code 1 Eerste relatie/contactpersoon RelatedPerson.extension:ethnicity defines the ethnicity of the related person RelatedPerson.patient points to the woman Patient RelatedPerson.relationship describes the relation to the woman Patient, for partner use the code DOMPART Partner
bc-TreatmentDirective		Consent	Consent		http://nictiz.nl/fhir/StructureDefinition/bc-TreatmentDirective	A Consent profile as defined by BabyConnect. This profile is based on the zib 2020 and is a preadopt of the R4 zib 2020 package. A treatment directive contains a joint decision between a health professional (for example a general practitioner) and a patient or his representative(s) about the desirability of performing a certain treatment, such as resuscitation, before this treatment becomes (acute) necessary. When the need arises and the treatment cannot be discussed with the patient or representative (s), that decision is an important indication for the treating health professional (for example an ER doctor). The term treatment limit is a synonym of the term treatment directive.
bc-UmbilicalCord		bc-FetusObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-UmbilicalCord	An Observation profile describing the umbilical cord a as defined by BabyConnect. 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: 1. A patient / fetus record is present. The subject of the Observation is the (unborn) child Patient. The focus extension can be left blank. 2. A patient / fetus record is not present. The subject of the Observation is the woman Patient. The focus extension refers to the fetus BodySite.
bc-UterusActivity		bc-MaternalObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-UterusActivity	An Observation profile derived from the maternal Observation profile describing uterus activity as defined by BabyConnect. Uterus activity is a patient-related Observation. Patient-related Observations are about the (pregnant) woman, which is the subject of the Observation.
bc-VitaminKAdministration	Child-related Observation	bc-ChildObservation	Observation		http://nictiz.nl/fhir/StructureDefinition/bc-VitaminKAdministration	An Observation profile describing the administration of vitamin K to a newborn as defined by BabyConnect. The base definition is a child-related Observation. Child-related Observations pertain to the child Patient, which is the subject of the Observation. Child observations refer to the EpisodeOfCare with Observation.context.reference
bc-Woman		nl-core-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.

Use cases

De Use cases zijn nog in ontwikkeling en nog niet allemaal geschikt voor gebruik!

Introduction

Birthcare supports the following (types of) use cases.

• Patient use cases, in a personal health record (PHR) context

1. Pregnancy data

• Health provider use cases, in a primary care context

1. Midwife data
2. Maternity data
3. Neonatology data
4. Youth care data
5. Ultrasound data
6. Lab results
7. PDF/A

• Secondary use of data

1. Minimum data set (Perined): obstetrics
2. Screening (RIVM): counseling
3. Screening (RIVM): Non-invasive prenatal screening (NIPT) request
4. Screening (RIVM): Non-invasive prenatal screening (NIPT) result
5. Screening (RIVM): Ultrasound scan (SEO) request 1st term
6. Screening (RIVM): Ultrasound scan (SEO) result 1st term
7. Screening (RIVM): Ultrasound scan (SEO) result 2nd term

Use case: Client collects data from healthcare providers about her pregnancy in her personal health environment

This is a patient's use case, in a personal health record (PHR) context, for exchanging pregnancy data. Functional specification of this use case is described in the functional design wiki pages.

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

List of StructureDefinitions

Please note that many birth care specific profiles are derived from nl-core profiles (e.g. bc-PregnancyObservation is derived from nl-core-observation) to support (re)use of profiles in multiple use cases. The meta.profile element of FHIR instances conforming these profiles should at least include the generic nl-core profile and preferably the specific birth care profile.

Use case: Midwife data

This is health provider use case for exchanging midwife data. Functional specification of this use case is described in the functional design wiki pages.

List of StructureDefinitions

Please note that many birth care specific profiles are derived from nl-core profiles (e.g. bc-PregnancyObservation is derived from nl-core-observation) to support (re)use of profiles in multiple use cases. The meta.profile element of FHIR instances conforming these profiles should at least include the generic nl-core profile and preferably the specific birth care profile.

Use case: Maternity data

This is health provider use case for exchanging maternity data. Functional specification of this use case is described in the functional design wiki pages.

List of StructureDefinitions

Please note that many birth care specific profiles are derived from nl-core profiles (e.g. bc-PregnancyObservation is derived from nl-core-observation) to support (re)use of profiles in multiple use cases. The meta.profile element of FHIR instances conforming these profiles should at least include the generic nl-core profile and preferably the specific birth care profile.

Use case: Neonatology

De Use case moet nog ontwikkeld worden!

Use case: Youth care

De Use case moet nog ontwikkeld worden!

Use case: Minimum data set (Perined)

De Use case is nog niet gepubliceerd!

Use case: Ultrasound data

This is a health provider use case for exchanging ultrasound data. Functional specification of this use case is described in the functional design wiki pages.

List of StructureDefinitions

Please note that many birth care specific profiles are derived from nl-core profiles (e.g. bc-PregnancyObservation is derived from nl-core-observation) to support (re)use of profiles in multiple use cases. The meta.profile element of FHIR instances conforming these profiles should at least include the generic nl-core profile and preferably the specific birth care profile.

Use case: PDF/A

For the exchange of unstructured documents the format PDF/A is used conform the MedMij/MHD specifications for PDF/A.

• DocumentReference.subject contains a reference to the Patient (bc-Woman) resource.
• DocumentReference.context.related econtains a reference to the EpisodeOfCare (bc-MaternalRecord) resource.

FHIR resource	Example
DocumentReference	PDF/A DocumentReference
Binary	PDF/A Binary