MedMij FHIR Implementation Guide basic GGZ data 2.0.1

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GGZ
AfsprakenstelselFunctioneelTechnischAfspraken-Functioneel-Technisch

1 Introduction

The page describes the FHIR requirements for exchanging GGZ information between the patients and healthcare providers in the context of MedMij.

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 GGZ use case has similarities and differences with other use cases such as the BgZ, Medication Process, Vital Signs, GP Patient Data and Lab Results. These use cases use much of the same HCIM based FHIR profiles for exchanging information. Wherever possible every attempt is made to re-use the profiles as used in the BgZ. The GGZ use case also has unique profiles compared to the aforementioned use cases. In addition, it has a CareTeam profile without an underlying HCIM. A second thing to note is that while the selection criteria of certain sections like procedure do not match with the BgZ or other use cases, this does not affect the profiles in use. For example, it is irrelevant for the response profile for procedures if you request ' surgical procedures' or 'every procedure'.

4 Use case: retrieve GGZ information

Go to MedMij Afsprakenstelsel

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.

4.1 PHR: request message

The PHR system requests the patients GGZ information using individual search interactions. The BgGGZ consists of multiple FHIR resources with certain constraints. To obtain the patient's BgGGZ, 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 three columns the HCIM name in Dutch, in English and what HCIM content is requested. The last column shows the FHIR search queries to obtain this information. These queries and expected responses are based on profiles listed in this section.

HCIM NL HCIM EN Content Search URL[1]
Patient Patient Identification, birthdate, gender, deceasedindicator, contact details, marital status, legal status, and general practitioner (practitioner or organization)
GET [base]/Patient?_include=Patient:general-practitioner
BurgerlijkeStaat MaritalStatus Known marital status see Patient
Betaler Payer Insurance information
GET [base]/Coverage?_include=Coverage:payor:Patient&_include=Coverage:payor:Organization
BehandelAanwijzing TreatmentDirective All known treatment directives
GET [base]/Consent?category=http://snomed.info/sct|11291000146105
Wilsverklaring AdvanceDirective All known advance directives
GET [base]/Consent?category=http://snomed.info/sct|11341000146107
JuridischeStatus LegalStatus Known legal status see Patient and FreedomRestrictingMeasures procedure
VrijheidbeperkendeMaatregelen FreedomRestrictingMeasures All known freedom restricting measures see Procedure
Contactpersoon Contact First relation/contact see Patient.contact
FunctioneleOfMentaleStatus FunctionalOrMentalStatus All known functional / mental status
GET [base]/Observation?category=http://snomed.info/sct|118228005,http://snomed.info/sct|384821006
Probleem Problem All known problems
GET [base]/Condition
Druggebruik DrugUse All known drug use
GET [base]/Observation?code=http://snomed.info/sct|228366006
Alcoholgebruik AlcoholUse All known alcohol use
GET [base]/Observation?code=http://snomed.info/sct|228273003
Tabakgebruik TobaccoUse All known tobacco use
GET [base]/Observation?code=http://snomed.info/sct|365980008
Woonsituatie LivingSituation Last known living situation
GET [base]/Observation/$lastn?code=http://snomed.info/sct|365508006
Gezinssituatie FamilySituation All known family situations
GET [base]/Observation?code=http://snomed.info/sct|365470003
GezinssituatieKind FamilySituationChild All known family situations of child patient
GET [base]/Observation?code=http://snomed.info/sct|55801000146105
Taalvaardigheid LanguageProficiency Known language proficiency see Patient
ParticipatieInMaatschappij ParticipationInSociety All known participation in society status
GET [base]/Observation?code=http://snomed.info/sct|314845004
HulpVanAnderen HelpFromOthers All known help from others
GET [base]/CarePlan?category=http://snomed.info/sct|243114000
LaboratoriumUitslag LaboratoryTestResult Last known laboratory results per type (incl. medication levels like lithium)
GET [base]/Observation/$lastn?category=http://snomed.info/sct|275711006&_include=Observation:related-target&_include=Observation:specimen
AlgemeneMeting GeneralMeasurement All known questionaire (for example HONOS, OQ-45, CQ index, 4DKL) outcome scores.
GET [base]/Observation?category=http://hl7.org/fhir/observation-category|survey
Verrichting Procedure All known GGZ procedures (includes all known freedom restricting measures)
GET [base]/Procedure
TekstUitslag TextResult All known text results of GGZ procedures
GET [base]/DiagnosticReport
- - CareTeam: primary healthprofessional and other relevant healthprofessionals including the healthcare provider.
GET [base]/CareTeam?_include=CareTeam:participant
Zorgverlener HealthProfessional General Practitioner of the patient see Patient, CareTeam
Zorgaanbieder HealthProvider General Practitioner's organization of the patient see Patient, CareTeam
  1. See Search URLs and search parameters for the interpretation of these search URLs

4.2 Server - XIS

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

4.3 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.

4.4 List of profiles

The profiles represent their entire respective HCIM and are applicable in a broader context than the exchange of GGZ information.

HCIM NL HCIM EN FHIR Resource FHIR Profile
Patient Patient Patient http://fhir.nl/fhir/StructureDefinition/nl-core-patient
Betaler Payer Coverage http://nictiz.nl/fhir/StructureDefinition/zib-Payer
BehandelAanwijzing TreatmentDirective Consent http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective
Wilsverklaring AdvanceDirective Consent http://nictiz.nl/fhir/StructureDefinition/zib-AdvanceDirective
JuridischeStatus* LegalStatus* Extension http://nictiz.nl/fhir/StructureDefinition/nl-core-patient or http://nictiz.nl/fhir/StructureDefinition/zib-FreedomRestrictingMeasures
VrijheidbeperkendeMaatregelen FreedomRestrictingMeasures Procedure http://nictiz.nl/fhir/StructureDefinition/zib-FreedomRestrictingMeasures
FunctioneleOfMentaleStatus FunctionalOrMentalStatus Observation http://nictiz.nl/fhir/StructureDefinition/zib-FunctionalOrMentalStatus
Probleem Problem Condition http://nictiz.nl/fhir/StructureDefinition/zib-Problem
Woonsituatie LivingSituation Observation http://nictiz.nl/fhir/StructureDefinition/zib-LivingSituation
Druggebruik 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
Gezinssituatie FamilySituation Observation http://nictiz.nl/fhir/StructureDefinition/zib-FamilySituation
GezinssituatieKind FamilySituationChild Observation http://nictiz.nl/fhir/StructureDefinition/zib-FamilySituationChild
Taalvaardigheid LanguageProficiency Patient http://nictiz.nl/fhir/StructureDefinition/nl-core-patient
ParticipatieInMaatschappij ParticipationInSociety Observation http://nictiz.nl/fhir/StructureDefinition/zib-ParticipationInSociety
HulpVanAnderen HelpFromOthers CarePlan http://nictiz.nl/fhir/StructureDefinition/zib-HelpFromOthers
LaboratoriumUitslag LaboratoryTestResult Observation http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Observation
AlgemeneMeting GeneralMeasurement Observation http://nictiz.nl/fhir/StructureDefinition/zib-GeneralMeasurement
Verrichting Procedure Procedure http://nictiz.nl/fhir/StructureDefinition/zib-Procedure
TekstUitslag TextResult DiagnosticReport http://nictiz.nl/fhir/StructureDefinition/zib-TextResult
Zorgverlener HealthProfessional Practitioner http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner
Zorgaanbieder HealthProfessional Organization http://fhir.nl/fhir/StructureDefinition/nl-core-organization
- - CareTeam http://fhir.nl/fhir/StructureDefinition/nl-core-careteam

* LegalStatus is a single concept of the HCIM FreedomRestrictingMeasures and does not represent a complete HCIM yet. This concept will become an independent HCIM in a future release of the HCIM.

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.

5 Terminology, NamingSystems, Mappings

5.1 Terminology

Relevant ValueSets can be found through the ValueSet bindings in the listed StructureDefinitions. All ValueSets can be found here here and can be downloaded as a .zip in XML or JSON format.

5.2 NamingSystems

Relevant NamingSystems can be found here.

5.3 Mappings

A FHIR ConceptMap resource is provided when a FHIR value set is used instead of a HCIM value set. A ConceptMap maps the values between the two value sets. These ConceptMaps can be found here.

An explanation about mappings can be found at Mapping of coded concepts.

6 Release notes

Release notes can be found on the functional design page.