MedMij FHIR Implementation Guide: BgLZ 2.0.2

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Patient Summary (BgZ)
AfsprakenstelselFunctioneelTechnischAfspraken-Functioneel-Technisch

1 Introduction

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This page provides the technical specification of the exchange of long-term healthcare information (Dutch: Basisgegevens Langdurige Zorg or BgLZ) based on a selection of Dutch Health Care Information Models. The specification is based on this functional design.

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

2 Actors involved

Actors Systems FHIR Capability Statements
Name Description Name Description Name Description
Patient The user of a personal healthcare environment. PHR Personal health record Verwijzing.png CapabilityStatement: Client FHIR Client requirements
Healthcare professional The user of a XIS XIS Healthcare information system Verwijzing.png CapabilityStatement: Server FHIR Server requirements

3 Boundaries and Relationships

The BgLZ has similarities with the Basisgegevensset Zorg (BgZ) and Basisgegevens GGZ (GGZ) but is definitely different. These information standards use much of the same HCIM based FHIR profiles for exchanging information. Wherever possible every attempt is made to re-use profiles. The BgLZ use case also has unique profiles compared to the aforementioned use cases, such as OutcomeOfCare. In addition, it uses a CareTeam profile without an underlying HCIM. A second thing to note is that also the selection of requested information per HCIM may differentiate. For example, only a subset of LaboratoryResults or AllergyIntolerance is expected to be returned by a XIS. This page, which belongs to the BgLZ functional design, and related transactions provide details on the information that is expected to be exchanged.

Medication information is part of a good overview of patients in long-term healthcare. Retrieving medication information by a PHR is however out of scope for this information standard. A separate information standard, MedicationProcess, is intended to serve this purpose.

4 Use case: Retrieve BgLZ information

This FHIR implementation guide assumes that the PHR system is able to make a connection to the right XIS that contains the patient's information. It does not provide information on finding the right XIS nor does it provide information about security. Moreover, each transaction is performed in the context of a specific authenticated patient, for whose context (token) has been established using the authentication mechanisms described in the 'Afsprakenstelsel'. Each XIS Gateway is required to perform filtering based on the patient associated with the context for the request, so only the records associated with the authenticated patient are returned. For this reason, search parameters should not be included for patient identification.

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4.1 Introduction

The retrieve BgLZ transaction is used by the PHR to retrieve long-term healthcare information from a XIS.

4.2 Actors

Transaction group Transaction Actor Role
Retrieve BgLZ (PULL) Retrieve BgLZ request Patient (using a PHR) Request long-term healthcare information from a XIS
Retrieve BgLZ response Healthcare professional (using a XIS) Serves long-term healthcare information to a PHR

4.3 Invocations

4.3.1 PHR: request message

The PHR system requests the BgLZ using individual search interactions. The BgLZ consists of multiple FHIR resources with certain constraints. To obtain the patient's BgLZ, 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 BgLZ sections, the HCIMs that constitute those sections and the specific content of the BgLZ. The last column shows the FHIR search queries to obtain the BgLZ information. These queries and expected responses are based on profiles listed in this section.

# BgLZ Section HCIM EN Content Search URL[1]
1 Patient information Patient Identification, birthdate, gender, deceasedindicator, contact details, marital status, and general practitioner (practitioner or organization)
GET [base]/Patient?_include=Patient:general-practitioner
2 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
3 Contactperson ContactPerson First relation/contact
see Patient in Patient.contact
4 Problems Problem All known problems including diagnoses; no verification status
GET [base]/Condition
5 Allergies AllergyIntolerance A selection of information from all known allergies and intolerances. The ART-DECOR transaction specification describes the selection.
GET [base]/AllergyIntolerance
6 Results LaboratoryTestResult A selection of information from the last known clinical laboratory results per type. The ART-DECOR transaction specification describes the selection.
GET [base]/Observation/$lastn?category=http://snomed.info/sct|275711006&_include=Observation:related-target&_include=Observation:specimen
7 Procedures Procedure All procedures
GET [base]/Procedure
8 Goals and interventions

* see the NoteBox above

NursingIntervention NursingInterventions beloning to active problems
GET [base]/CarePlan?_include=CarePlan:activity-goal:Goal
&_include=CarePlan:activity-outcomereference:Observation
&_include=CarePlan:activity-medicaldevice:DeviceUseStatement
&_include:recurse=DeviceUseStatement:device:Device
TreatmentObjective All treatment objectives beloning to NursingInterventions
MedicalDevice All MedicalDevices belonging to NursingInterventions; only product type and anatomical location
OutcomeOfCare Known treatment outcomes
9 Caresetting / CareTeam HealthProfessional
  • General practitioner of the patient (see Patient.generalPractitioner)
  • Primary practitioner - information of the primary care giver, no ID, adress/contact information
  • Other practitioners - information of all practitioners given care to the patient, no ID, adress/contact information
  • Healthcare provider - organization where care is given
GET [base]/CareTeam?_include=CareTeam:participant
HealthcareProvider
  1. See Search URLs and search parameters for the interpretation of these search URLs

4.3.2 XIS: response message

The returned data to the PHR should conform to the profiles listed in #List_of_profiles.

4.3.3 The lastn operation

The following operation is needed for this use case.

The lastn query meets the common need for searching for the most recent or last n=number of observations for a subject. For example, retrieving the last 5 temperatures for a patient to view trends or fetching the most recent laboratory results or vital signs. The link will provide more detailed information and examples regarding this operation.

The FHIR STU3 specification is vague regarding the sorting mechanism of lastn. In FHIR R4 however, this has been clarified and can be read as follows: when using lastn, the effective[x] element is used for sorting of Observations, sorted from most recent to the oldest.

4.3.4 Custom search parameters

The following custom search parameters are defined for this use case:

4.4 List of profiles

The profiles represent their entire respective HCIM, to make them applicable in a broader context than the exchange of BgLZ or a MedMij context.

Zib NL HCIM EN FHIR Resource FHIR Profile
Patiënt Patient Patient http://fhir.nl/fhir/StructureDefinition/nl-core-patient
BehandelAanwijzing TreatmentDirective Consent http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective
Wilsverklaring AdvanceDirective Consent http://nictiz.nl/fhir/StructureDefinition/zib-AdvanceDirective
Probleem Problem Condition http://nictiz.nl/fhir/StructureDefinition/zib-Problem
AllergieIntolerantie AllergyIntolerance AllergyIntolerance http://nictiz.nl/fhir/StructureDefinition/zib-AllergyIntolerance
LaboratoriumUitslag LaboratoryTestResult Observation http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Observation
Verrichting Procedure Procedure http://nictiz.nl/fhir/StructureDefinition/zib-Procedure
VerpleegkundigeInterventie * NursingIntervention * CarePlan http://fhir.nl/fhir/StructureDefinition/nl-core-careplan
Behandeldoel TreatmentObjective
MedischHulpmiddel MedicalDevice
UitkomstVanZorg OutcomeOfCare
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

* The 2018 release of the HCIM NursingIntervention is used because the 2017 release is not suitable. The functional design page provides more information. In addition, the CarePlan resource is used to transfer the HCIM NursingIntervention. The BgLZ does not use the Procedure resource for HCIM NursingIntervention.

Example instances of FHIR resources can be found on Simplifier. Please note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of any information standard.

4.5 Terminology, NamingSystems, Mappings

Relevant ValueSets, NamingSystems and ConceptMaps can be found in the packages referenced in the List of profiles section.

The HCIM ValueSets used in the profiles are included in the package (or one of its dependencies). When a FHIR core ValueSet must be used instead of an HCIM ValueSet, a FHIR ConceptMap resource is provided to map the values between the two sets. An explanation about mappings can be found at in the overarching principles.

5 Release notes

Release notes can be found on the functional design page.