MedMij:Vprepub-6/FHIR Vaccination-Immunization

1 Introduction

This page describes patient's use case for the retrieval of vaccination results, in a personal health environment (PHR) context. Functional specifications are described at the functional design wiki page. The technical specification is described here. HL7 FHIR R4 is used for this purpose.

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

1.1 Vaccinations

Vaccination results are represented by the Immunization resources. It contains the relevant data elements per single vaccination about the administered vaccination such as DateTime of administration, vaccination indication and pharmaceutical product. The transaction consists of all available administered vaccinations at the XIS. The transactions:

Retrieve vaccination results

2 Actors involved

Persons		Systems		FHIR Capability Statements
Name	Description	Name	Description	Name	Description
Patient	The user of a personal healthcare environment.	PHR	Personal health record	CapabilityStatement: Client	Vaccination process client requirements
(Health)care provider	The user of a XIS	XIS	(Healthcare) information system	CapabilityStatement: Server	Vaccination server requirements

3 Use case 1: Retrieve vaccinations

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.

3.1 Introduction

The retrieve vaccinations transaction is used by the PHR to retrieve vaccinations from a XIS.

3.2 Actors

Transaction group	Transaction	Actor	Role
Retrieve vaccinations(PULL)	Retrieve vaccinations request	Patient (using a PHR)	Request vaccinations from the XIS
	Retrieve vaccinations response	(Healthcare) provider (using a XIS)	Serves vaccinations to the PHR

3.3 Invocations

3.3.1 PHR: request message

The request message represents an HTTP GET parameterized query from the PHR to the XIS.

3.3.1.1 Trigger Events

When the patient(PHR) wants to obtain vaccinations, it issues a retrieve vaccinations request message.

3.3.1.2 Message Semantics

The PHR executes an HTTP GET conform to the FHIR RESTful and search specification against the XIS's Observation endpoint. This search query URL is configurable by the PHR and has the following format:

---> ANDER VOORBEELD CODE HIER???????????????

GET [base]/Observation?category=http://snomed.info/sct|49581000146104{&[parameters]}

The PHR may use, and the XIS shall be capable of processing, the following parameters to configure the search query:

Name	Description	Examples
date	Obtained date/time for the result. If the result was obtained over a period, this parameter should be interpreted as a date that falls in this period.	Retrieve all zib LaboratoryTestResults Observation resources that have an effective date greater than 01-01-2010: GET [base]/Observation?category=http://snomed.info/sct|49581000146104&date=ge2010-01-01 Retrieve all zib LaboratoryTestResults Observation resources that have an effective date within a 2 year period: GET [base]/Observation?_include=Observation:specimen&category=http://snomed.info/sct|49581000146104date=ge2010-01-01&date=le2011-12-31
category	The classification of the type of observation.	Retrieve all zib LaboratoryTestResults Observation resources: GET [base]/Observation?category=http://snomed.info/sct|49581000146104
_include	The PHR may request that the XIS returns resources related to the search results, in order to reduce the overall network delay of repeated retrievals of related resources.	Retrieve all zib LaboratoryTestResults Observation resources and include Specimen information in the search results: GET [base]/Observation?_include=Observation:specimen&category=http://snomed.info/sct|49581000146104

3.3.1.2.1 Expected Actions

The XIS shall process the query to discover Observation resources that match the search parameters given.

3.3.2 XIS: response message

The XIS returns an HTTP Status code appropriate to the processing as well as a FHIR Bundle including the matching observation information.

3.3.2.1 Trigger Events

The XIS completed processing of the retrieve vaccinations request message.

3.3.2.2 Message Semantics

The returned data to the PHR should conform to the HCIMs and their associated profiles listed in the table below. The resources in the response message SHALL be a valid instance of these profiles. All resources SHALL include their related profile canonical URL in the meta.profile element in order to show compliance.

Zib name NL	Zib name EN	FHIR Resource
Patient	Patient	Patient	http://fhir.nl/fhir/StructureDefinition/nl-core-patient
Zorgverlener	HealthProfessional	Practitioner	http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner
Zorgaanbieder	HealthcareProvider	Organization	http://fhir.nl/fhir/StructureDefinition/nl-core-organization
LaboratoriumUitslag	LaboratoryTestResult	Observation	http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Observation

3.3.2.3 Expected Actions

The PHR shall process the results according to application-defined rules. The PHR should be robust as the response may contain observation and specimen resources that match the query parameters.

4 Use case: retrieve laboratory results DiagnosticReport

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 Introduction

The retrieve laboratory diagnostic report transaction is used by the PHR to retrieve laboratory results from a XIS.

4.2 Actors

Transaction group	Transaction	Actor	Role
Retrieve Laboratory Results(PULL)	Retrieve laboratory diagnostic report request	Patient (using a PHR)	Request laboratory diagnostic report from the XIS
	Retrieve laboratory diagnostic report response	Healthcare professional (using a XIS)	Serves laboratory diagnostic report to the PHR

4.3 Invocations

4.3.1 PHR: request message

The request message represents an HTTP GET parameterized query from the PHR to the XIS.

4.3.1.1 Trigger Events

When the patient(PHR) wants to obtain laboratory diagnostic report, it issues a retrieve laboratory diagnostic report request message.

4.3.1.2 Message Semantics

The PHR executes an HTTP GET conform to the FHIR RESTfull and search specification against the XIS's DiagnosticReport endpoint. This search query URL is configurable by the PHR and has the following format.

GET [base]/DiagnosticReport?category=http://snomed.info/sct|4241000179101{&[parameters]}

The PHR may use, and the XIS shall be capable of processing, the following parameters to configure the search query:

Name	Description	Example(s)
date	The clinically relevant time of the report.	Retrieve all zib LaboratoryTestResult DiagnosticReport resources that have an effective date greater than 01-01-2010. GET [base]/DiagnosticReport?category=http://snomed.info/sct|4241000179101&date=ge2010-01-01 Retrieve all zib LaboratoryTestResult DiagnosticReport resources that have an effective date within a 2 year period. GET [base]/DiagnosticReport?category=http://snomed.info/sct|4241000179101&date=ge2010-01-01&date=le2011-12-31
category	Which diagnostic discipline/department created the report.
_include	The PHR may request that the XIS returns resources related to the search results, in order to reduce the overall net	Retrieves all zib LaboratoryTestResult DiagnosticReport resources and include the referenced Observation resources in the search results. GET [base]/DiagnosticReport?category=http://snomed.info/sct|4241000179101&include=DiagnosticReport:result&date=ge2010-01-01&date=le2011-12-31

4.3.1.2.1 Expected Actions

The XIS shall process the query to discover DiagnosticReport resources that match the search parameters given.

4.3.2 XIS: response message

The XIS returns an HTTP Status code appropriate to the processing as well as a FHIR Bundle including the matching laboratory diagnostic report information.

4.3.2.1 Trigger Events

The XIS completed processing of the retrieve laboratory diagnostic report request message.

4.3.2.2 Message Semantics

The returned data to the PHR should conform to the HCIMS and their associate profiles listed in the table below. The resources in the response message SHALL be a valid instance of these profiles. All resources SHALL include their related profile canonical URL in the meta.profile element in order to show compliance.

Zib name NL	Zib name EN	FHIR Resource
Patient	Patient	Patient	http://fhir.nl/fhir/StructureDefinition/nl-core-patient
Zorgverlener	HealthProfessional	Practitioner	http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner
Zorgaanbieder	HealthcareProvider	Organization	http://fhir.nl/fhir/StructureDefinition/nl-core-organization
LaboratoriumUitslag	LaboratoryTestResult	DiagnosticReport	http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-DiagnosticReport
		Observation	http://nictiz.nl/fhir/StructureDefinition/zib-LaboratoryTestResult-Observation

4.3.2.3 Expected Actions

The PHR shall process the results according to application-defined rules. The PHR should be robust as the response may contain DiagnosticReport, Observation and Specimen resources that match the query parameters.

5 Release notes

Release notes can be found on the functional design page.