Brontekst bekijken van MedMij:Vprepub-2020.01/FHIR BGZ 2017

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{{DISPLAYTITLE:MedMij FHIR Implementation Guide: BgZ {{VersieInfo|BgZ}}}}
{{MedMij:Vprepub/Issuebox_FHIR_IG}}

[[Bestand:MedMij2.png |link=https://www.medmij.nl/|rechts|Naar medmij.nl]]
[[Bestand:BGZ_icoon.png |link=|links|90px|Use case BgZ 2017|Patient Summary (BgZ)]] 
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circle 241 216 211 [https://www.medmij.nl/afsprakenstelsel Afsprakenstelsel]                
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circle 1787 230 212 [[MedMij:Vprepub/FHIR_IG|Technisch]]                
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==Introduction==
[[Bestand:Functioneel-02.png|link=MedMij:Vprepub/Ontwerpen |100px|rechts|Functional design|Go to functional design]]

The program ‘Registratie aan de bron’ (Clinical documentation at the point of care) has defined Health and Care Information models ([https://zibs.nl/wiki/HCIM_Mainpage HCIMs] (English) or [https://zibs.nl/wiki/ZIB_Hoofdpagina zibs] (Dutch)) for The Netherlands. Next to these HCIMs, the program ‘Registratie aan de bron’ also made a selection of these HCIMs into the so-called ‘Basisgegevensset Zorg’ (Common Clinical Dataset, a Dutch version of a ‘patient summary’, further referred to as ‘BgZ’). The BgZ serves as a minimal healthcare dataset that is always appropriate for caregivers in order to provide continuity of care for a patient and can be seen as a representation of a patient summary.

A subselection of the published [https://zibs.nl/wiki/HCIM_Release_2017(EN) HCIMs release 2017] constitute the [https://www.registratieaandebron.nl/pdf/BgZ_specificatie_obv_zibs_2017_v1.1.pdf BgZ 2017]. The BgZ makes a subselection of the information concepts within the HCIMs or restricts the HCIMs to a certain category. For example, only include the general practitioner of the patient or only the last known value of 'X'. MedMij created FHIR profiles that represent these HCIMs completely if no existing and usable profiles were available. The profiles represent their entire respective HCIM, to make them applicable in a broader context than a patient summary or even the MedMij context. An overview of the profiles can be found at the [[MedMij:Vprepub/FHIR_BGZ_2017#List_of_profiles|list of profiles]]. 

The patient journey of [https://www.nictiz.nl/ehealth/MedMij Thomas van Beek], provides a patients context for exchanging a patient summary from a healthcare provider's system (XIS) to a personal health record (PHR). MedMij created a [https://informatiestandaarden.nictiz.nl/wiki/MedMij:Vprepub/Ontwerpen functional design] of the BgZ use case. This use case consists of enabling a patient to view his own BgZ in a PHR. This page will elaborate further on the HL7 FHIR details needed to exchange the BgZ information using FHIR.

'''Note''': This implementation guide builds on the general guidelines described in the [[MedMij:Vprepub/FHIR_IG#Use case overarching principles|use case overarching principles]].

==Actors involved==
{| class="wikitable"
! colspan="2" style="text-align:left;" | Actors
! colspan="2" style="text-align:left;" | Systems
! colspan="2" style="text-align:left;" | FHIR Capability Statements
|-
! style="text-align:left;" |Name
! style="text-align:left;" |Description
! style="text-align:left;" |Name
! style="text-align:left;" |Description
! style="text-align:left;" |Name
! style="text-align:left;" |Description
|-
| Patient
| The user of a personal healthcare environment.
| PHR
| Personal health record
|[[Bestand: Verwijzing.png| 20px]] {{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/bgz2017-clientcapabilities|nictiz.fhir.nl.stu3.bgz|title=CapabilityStatement: Client}}
| FHIR Client requirements 
|-
| Healthcare professional
| The user of a XIS
| XIS
| Healthcare information system
|[[Bestand: Verwijzing.png| 20px]] {{Simplifier|http://nictiz.nl/fhir/CapabilityStatement/bgz2017-servercapabilities|nictiz.fhir.nl.stu3.bgz|title=CapabilityStatement: Server}}
| FHIR Server requirements 
|}

==Boundaries and Relationships==
The BgZ 2017 v1.1 use case follows the BgZ v1.0 use case. The difference between the two is the underlying HCIMs, which have been upgraded from release 2015 to release 2017. The changes are documented in a [https://github.com/Nictiz/Nictiz-STU3-Zib2017/raw/master/ReleaseNotes%20FHIR%20profielen%20ZIB2017.pdf release notes] document.

The BgZ use case has similarities and differences with other use cases such as Medication Process, Vital Signs and Lab Results. These use cases use the same HCIM based FHIR profiles for exchanging information. The BgZ use case covers practically all profiles included in the other use cases. However, the BgZ differs in the scope of the actual health information content that should be exchanged. For example, the BgZ conveys only the last known lab result of each type while the Lab Results use case may cover all known information.

==Use Case: Retrieve BGZ information==
[[Bestand:Afsprakenstelsel-01.png|link=https://www.medmij.nl/afsprakenstelsel/|rechts |100px|Go to MedMij Afsprakenstelsel]]

{{FHIR-IG-Afsprakenstelsel-Note}}

===PHR: request message===
The PHR system requests the BgZ using individual [https://www.hl7.org/fhir/stu3/search.html search] interactions. The BgZ 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:

<code>GET [base]/[type]{?[parameters]}</code>

The table below shows in the first four columns the BgLZ 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 BgLZ information. These queries and expected responses are based on profiles listed in [[#List_of_profiles| this section]].

{| class="wikitable collapsible" width="100%" style="horizontal-align: right"  
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:10px" | #
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:10px" | BgZ Section
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:10px" | HCIM EN
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:10px" | Content
!style="background-color: #4AB8A7; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3  width:10px" | Search URL<ref>See [[MedMij:Vprepub/FHIR_IG#Search_URLs_and_search_parameters|Search URLs and search parameters]] for the interpretation of these search URLs</ref>
|-
| 1
| Patient information
| Patient
| Identification, birth date, gender, deceased indicator, contact details, last known marital status, and general practitioner (practitioner or organization)
| <pre>GET [base]/Patient?_include=Patient:general-practitioner</pre>
|-
| 2
| Payment details
| Payer
| Insurance information
| <pre>GET [base]/Coverage?_include=Coverage:payor:Patient&_include=Coverage:payor:Organization</pre>
|-
| rowspan="2" | 3
| rowspan="2" | Treatment directives
| TreatmentDirective
| Known treatment directives
| <pre>GET [base]/Consent?category=http://snomed.info/sct|11291000146105</pre>
|-
| AdvanceDirective
| Known advance directives
| <pre>GET [base]/Consent?category=http://snomed.info/sct|11341000146107</pre>
|-
| 4
| Contact persons
| ContactPerson
| First relation/contact
| <pre style="font-style: italic;">see Patient</pre>
|-
| 5
| Functional status
| FunctionalOrMentalStatus
| Last known functional / mental status
| <pre>GET [base]/Observation/$lastn?category=http://snomed.info/sct|118228005,http://snomed.info/sct|384821006</pre>
|-
| 6
| Problems
| Concern
| All known problems
| <pre>GET [base]/Condition</pre>
|-
| rowspan="5" | 7
| rowspan="5" | Social history
| LivingSituation
| Current living situation
| <pre>GET [base]/Observation/$lastn?code=http://snomed.info/sct|365508006</pre>
|-
| DrugUse
| All known drug use
| <pre>GET [base]/Observation?code=http://snomed.info/sct|228366006</pre>
|-
| AlcoholUse
| All known alcohol use
| <pre>GET [base]/Observation?code=http://snomed.info/sct|228273003</pre>
|-
| TobaccoUse
| All known tobacco use
| <pre>GET [base]/Observation?code=http://snomed.info/sct|365980008</pre>
|-
| NutritionAdvice
| All known current dietary recommendations
| <pre>GET [base]/NutritionOrder</pre>
|-
| 8
| Alerts
| Alert
| All known alerts
| <pre>GET [base]/Flag</pre>
|-
| 9
| Allergies
| AllergyIntolerance
| All known information regarding allergies
| <pre>GET [base]/AllergyIntolerance</pre>
|-
| rowspan="3" | 10
| rowspan="3" | Medication
| MedicationUse
| Known medication use
| <pre>GET [base]/MedicationStatement?category=urn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3|6&_include=MedicationStatement:medication</pre>
|-
| MedicationAgreement
| Known medication agreements
| <pre>GET [base]/MedicationRequest?category=http://snomed.info/sct|16076005&_include=MedicationRequest:medication</pre>
|-
| AdministrationAgreement
| Known administration agreements
| <pre>GET [base]/MedicationDispense?category=http://snomed.info/sct|422037009&_include=MedicationDispense:medication</pre>
|-
| 11
| Medical aids
| MedicalDevice
| Known medical aids
| <pre>GET [base]/DeviceUseStatement?_include=DeviceUseStatement:device</pre>
|-
| 12
| Vaccinations
| Vaccination
| Known vaccinations
| <pre>GET [base]/Immunization?status=completed</pre>
|-
| rowspan="3" | 13
| rowspan="3" | Vital signs
| BloodPressure
| Last known blood pressure
| <pre>GET [base]/Observation/$lastn?code=http://loinc.org|85354-9</pre>
|-
| BodyWeight
| Last known body weight
| <pre>GET [base]/Observation/$lastn?code=http://loinc.org|29463-7</pre>
|-
| BodyHeight
| Last known body height
| <pre>GET [base]/Observation/$lastn?code=http://loinc.org|8302-2,http://loinc.org|8306-3,http://loinc.org|8308-9</pre>
|-
| 14
| Results
| LaboratoryTestResult
| Last known laboratory results per type
| <pre>GET [base]/Observation/$lastn?category=http://snomed.info/sct|275711006&_include=Observation:related-target&_include=Observation:specimen</pre>
|-
| 15
| Procedures
| Procedure
| Known surgical procedures
| <pre>GET [base]/Procedure?category=http://snomed.info/sct|387713003</pre>
|-
| 16
| Encounters
| Contact
| Known hospital admissions (no outpatient contacts)
| <pre>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</pre>
|-
| 17
| Planned care
| PlannedCareActivityForTransfer
| Known planned care activities
| <span id="PlannedCareRemark"></span>{{NoteBox|The HCIM PlannedCareActivityForTransfer represents a planned activity as a (reference to) the HCIM for that activity in the 'planned' status. However, FHIR doesn't recognize this status; instead it uses dedicated resources for planning. Therefore, the FHIR implementation of this HCIM uses these dedicated resources instead of a distinct profile::

*Planning an Encounter is done by using an Appointment
*Planning a Procedure is done by using a ProcedureRequest
*Planning an Immunization is done by using an ImmunizationRecommendation  
*Planning a MedicalDevice is done by using a DeviceRequest
}}
<pre>GET [base]/ProcedureRequest?status=active</pre>
<pre>GET [base]/ImmunizationRecommendation</pre>
<pre style="text-decoration: line-through;">GET [base]/MedicationDispense?category=http://snomed.info/sct|422037009&status=in-progress,preparation&_include=MedicationDispense:medication</pre>
<span id="MM115Remark"></span>{{NoteBox|PlannedCareActivityForTransfer for MedicationAdministration was found unimplementable as-is. Presumed solution will come from a future HCIM release. See [https://bits.nictiz.nl/browse/MM-115 MM-115] for more information.}}
<pre>GET [base]/DeviceRequest?status=active&_include=DeviceRequest:device</pre>
<pre>GET [base]/Appointment?status=booked,pending,proposed</pre>
|-
| 18
| General practitioner
| HealthProfessional
| General Practitioner of the patient
| <pre style="font-style: italic;">see Patient</pre>
|}
<references/>

===XIS: response message===
The returned data to the PHR should conform to the profiles listed in [[#List_of_profiles]].

===The <code>lastn</code> operation===
The following [http://hl7.org/fhir/STU3/operations.html operation] is needed for this use case.
* [http://hl7.org/fhir/STU3/observation-operations.html#lastn Last N Observations Query]

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

==List of profiles==
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.

{{MedMij:Vissue-MM-1522/NoteBoxPackage|p1=nictiz.fhir.nl.stu3.bgz|p2=nictiz.fhir.nl.stu3.zib2017|p3=nictiz.fhir.nl.stu3.eafspraak}}

{| class="wikitable" style="horizontal-align: right" 
!style="background-color: #1F497D; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:10px"  | Section
!style="background-color: #1F497D; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:100px" | Zib NL
!style="background-color: #1F497D; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:100px" | HCIM EN
!style="background-color: #1F497D; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:100px" | FHIR Resource
!style="background-color: #1F497D; color: white; font-weight: bold; text-align:left;  background-color: #E3E3E3 width:400px" | FHIR Profile
|-
| 1 
| Patient
| #Zib Patient|Patient
| Patient
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017}}
|-
| rowspan="3" |2
| rowspan="3" | Betaler
| rowspan="3" | Payer
| Coverage
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Payer|nictiz.fhir.nl.stu3.zib2017}}
|-
| Organization
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-organization|nictiz.fhir.nl.stu3.zib2017}}
|-
| Patient
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017}}
|-
| rowspan="2" |3 
| BehandelAanwijzing
| TreatmentDirective
| Consent
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective|nictiz.fhir.nl.stu3.zib2017}} 
|-
| Wilsverklaring
| AdvanceDirective
| Consent
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AdvanceDirective|nictiz.fhir.nl.stu3.zib2017}}
|-
| 4 
| Contactpersoon
| ContactPerson
| Patient.contact
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017}}
|-
| 5
| Funct. OfMentaleStatus
| FunctionalOrMentalStatus
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-FunctionalOrMentalStatus|nictiz.fhir.nl.stu3.zib2017}}
|-
| 6
| Probleem
| Problem
| Condition
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Problem|nictiz.fhir.nl.stu3.zib2017}} 
|-
| rowspan="5" | 7
| Woonsituatie
| LivingSituation
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-LivingSituation|nictiz.fhir.nl.stu3.zib2017}} 
|-
| DrugsGebruik
| DrugUse
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-DrugUse|nictiz.fhir.nl.stu3.zib2017}} 
|-
| AlcoholGebruik
| AlcoholUse
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AlcoholUse|nictiz.fhir.nl.stu3.zib2017}}
|-
| TabakGebruik
| TobaccoUse
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-TobaccoUse|nictiz.fhir.nl.stu3.zib2017}}
|-
| Voedingsadvies
| NutritionAdvice
| NutritionOrder
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-NutritionAdvice|nictiz.fhir.nl.stu3.zib2017}}
|-
| 8
| Alert
| Alert
| Flag
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Alert|nictiz.fhir.nl.stu3.zib2017}}
|-
| 9
| AllergieIntolerantie
| AllergyIntolerance
| AllergyIntolerance
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AllergyIntolerance|nictiz.fhir.nl.stu3.zib2017}}
|-
| rowspan="3" | 10 
| rowspan="3" | MedicatieGebruik
| MedicationUse
| MedicationStatement
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse|nictiz.fhir.nl.stu3.zib2017}}
|-
| MedicationAgreement
| MedicationRequest
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicationAgreement|nictiz.fhir.nl.stu3.zib2017}}
|-
| AdministrationAgreement
| MedicationDispense
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AdministrationAgreement|nictiz.fhir.nl.stu3.zib2017}}
|-
| rowspan="2" | 11 
| rowspan="2" | MedischHulpmiddel
| rowspan="2" | MedicalDevice
| Device
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicalDeviceProduct|nictiz.fhir.nl.stu3.zib2017}}
|-
| DeviceUseStatement
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicalDevice|nictiz.fhir.nl.stu3.zib2017}}
|-
| rowspan="2" | 12 
| rowspan="2" | Vaccinatie
| rowspan="2" | Vaccination
| Immunization
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Vaccination|nictiz.fhir.nl.stu3.zib2017}}
|-
| ImmunizationRecommendation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-VaccinationRecommendation|nictiz.fhir.nl.stu3.zib2017}}
|-
| rowspan="3" | 13
| Bloeddruk
| BloodPressure
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BloodPressure|nictiz.fhir.nl.stu3.zib2017}}
|-
| LichaamsGewicht
| BodyWeight
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyWeight|nictiz.fhir.nl.stu3.zib2017}}
|-
| LichaamsLengte
| BodyHeight
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyHeight|nictiz.fhir.nl.stu3.zib2017}}
|-
| rowspan="2" | 14
| rowspan="2" | LaboratoriumUitslag
| rowspan="2" | LaboratoryTestResult
| Observation
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Observation|nictiz.fhir.nl.stu3.zib2017}}
|-
| Specimen
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Specimen|nictiz.fhir.nl.stu3.zib2017}}
|-
| 15 
| Verrichting
| Procedure
| Procedure
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Procedure|nictiz.fhir.nl.stu3.zib2017}}
|-
| 16 
| Contact
| Encounter
| Encounter
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Encounter|nictiz.fhir.nl.stu3.zib2017}}
|-
| rowspan="5" | 17 
| rowspan="5" | OverdrachtGeplandeZorgActiviteit
| rowspan="5" | PlannedCareActivityForTransfer
| ProcedureRequest [[#PlannedCareRemark|*]]
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-ProcedureRequest|nictiz.fhir.nl.stu3.zib2017}}
|-
| <span style="text-decoration: line-through;">MedicationDispense</span> [[#MM115Remark|**]]
| <span style="text-decoration: line-through;">{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-AdministrationAgreement|nictiz.fhir.nl.stu3.zib2017}}</span>
|-
| ImmunizationRecommendation [[#PlannedCareRemark|*]]
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-VaccinationRecommendation|nictiz.fhir.nl.stu3.zib2017}}
|-
| DeviceRequest [[#PlannedCareRemark|*]]
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-MedicalDeviceRequest|nictiz.fhir.nl.stu3.zib2017}}
|-
| Appointment [[#PlannedCareRemark|*]]
| {{Simplifier|http://nictiz.nl/fhir/StructureDefinition/eAfspraak-Appointment|nictiz.fhir.nl.stu3.eafspraak}}
|-
| rowspan="3" | 18
| rowspan="2" | Zorgverlener
| rowspan="2" | HealthProfessional
| Practitioner
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner|nictiz.fhir.nl.stu3.zib2017}}
|-
| PractitionerRole
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-practitionerrole|nictiz.fhir.nl.stu3.zib2017}}
|-
| Zorgaanbieder
| HealthcareProvider
| Organization
| {{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-organization|nictiz.fhir.nl.stu3.zib2017}}
|}

=Release notes=
Release notes can be found on the [[MedMij:Vprepub/OntwerpBGZ_2017#Release_notes|functional design page]].