MedMij:V2019.01 FHIR AllergyIntolerance

{{#customtitle:MedMij FHIR Implementation Guide AllergyIntolerance 1.1.0}}

Introduction

This page describes a patient's use case, in a personal health record (PHR) context, for exchanging allergy and intolerance data. Functional specification of this use case is described in the functional design wiki pages. The technical specification is described here. HL7 FHIR STU3 is used for this purpose.

Actors involved

Persons		Systems		FHIR Capability Statements
Name	Description	Name	Description	Name	Description
Patient	The user of a personal healthcare enviorment.	PHR	Personal health record	CapabilityStatement: Client	AllergyIntolerance client requirements
Healthcare professional	The user of a XIS	XIS	Healthcare information system	CapabilityStatement: Server	AllergyIntolerance server requirements

Use case: Retrieve AllergyIntolerance 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.

Introduction

The retrieve AllergyIntolerance transaction is used by the PHR to retrieve allergy and intolerance information from the XIS.

Actors

Transaction group	Transaction	Actor	Role
Retrieve AllergyIntolerance(PULL)	Retrieve AllergyIntolerance request	Patient (using a PHR)	Request allergy and intolerance information from the XIS
	Retrieve AllergyIntolerance response	Healthcare professional (using a XIS)	Serves allergy and intolerance information to the PHR

Invocations

PHR: request message

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

Trigger Events

When the patient(PHR) wants to obtain allergy and intolerance information, it issues a retrieve AllergyIntolerance request message.

Message Semantics

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

GET [base]/AllergyIntolerance

Search Parameters

No query parameters are defined for this use case. The PHR searches on all AllergyIntolerance resources available for the patient using a HTTP GET on the AllergyIntolerance endpoint without parameters.

Expected Actions

The XIS shall process the query to discover AllergyIntolerance resources that match the patient in the context.

XIS: response message

The XIS returns an HTTP Status code appropriate to the processing as well as a FHIR Bundle including the allergy and intolerance medication information.

Trigger Events

The XIS completed processing of the Retrieve AllergyIntolerance request message.

Message Semantics

Based on the query results, the XIS will either return an error or success. When the XIS needs to report an error, it SHALL use HTTP error response codes and SHOULD include a FHIR OperationOutcome resource with more details on the failure. If the request message is processed successfully, whether or not any AllergyIntolerance resources are found, the HTTP status code SHALL be 200.

The response message shall be a Bundle resource of type "searchset" containing zero or more FHIR resources as entries. If the XIS is sending warnings, the Bundle resource SHALL also contain a FHIR OperationOutcome resource that contains those warnings. The FHIR specification describes the relevant sections:

• RESTful API framework
• Search errors
• Bundle resource
• OperationOutcome resource

Message resource content

The returned data to the PHR should conform to the ZIB AllergyIntolerance profile. The table below shows the relevant ZIBs and their profiles. 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	URL profile
Patient	Patient	Patient	http://fhir.nl/fhir/StructureDefinition/nl-core-patient
Zorgverlener	HealthProfessional	Practitioner	http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner
AllergieIntolerantie	AllergyIntolerance	AllergyIntolerance	http://nictiz.nl/fhir/StructureDefinition/zib-AllergyIntolerance

Expected Actions

The PHR processes the results according to application-defined rules. The PHR should be robust as the response may contain AllergyIntolerance information resources as mentioned in the former section.

Interactions, operations, search parameters

Interactions

The following logical interactions are needed for the retrieve medication information transaction:

• Search

Operations

No operations are defined or needed for this transaction.

Search parameters

No search parameters are defined or needed for this transaction.

Terminology, NamingSystems, Mappings

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.

NamingSystems

Relevant NamingSystems can be found here.

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.

All profiles include HCIM mappings. HCIM concepts are mapped to the corresponding FHIR elements using the HCIMs concept id. The top of the StructureDefinition contains meta information regarding the HCIM mapping, such as the name and uri of the HCIM. In the StructureDefinition elements, the corresponding HCIM ID is given including the mapping meta information id. This is illustrated in the following example.

<StructureDefinition>
    <id value="nl-core-patient" />
    .....
    <mapping>
        <identity value="hcim-patient-v3.1-2017EN"/>
        <uri value="https://zibs.nl/wiki/Patient-v3.1(2017EN)"/>
        <name value="HCIM Patient-v3.1(2017EN)"/>
    </mapping>
    .....
        <element id="Patient.name">
            <path value="Patient.name" />
            <short value="NameInformation" />
            <alias value="Naamgegevens" />
            <type>
                <code value="HumanName" />
                <profile value="http://fhir.nl/fhir/StructureDefinition/nl-core-humanname" />
            </type>
            <mapping>
                <identity value="hcim-patient-v3.1-2017EN"/>
                <map value="NL-CM:0.1.6"/>
            </mapping>
         </element>
     .....
</StructureDefinition>

Annex: Document history

Release notes

Release notes can be found on the functional design page.

History

Release	Date	Description
2019.01	11-03-2019	Publication of changes in version 2019.01, conform release notes. Moved release notes to the functional design page.
2018.06	12-11-2018	Added section about Terminology, NamingSystems, Mappings.
2018.06	15-10-2018	Added version in title, and document history.