FHIR Implementation Guide: GP care and Paramedical care 0.1.0-dev

This FHIR IG is currently under development and can not be considered stable and ready for use. Development of the FHIR artifacts can be followed on GitHub and Simplifier. For questions and change requests regarding this IG, please create a ticket in BITS.

1 Introduction

This is the implementation guide for the information standard GP Care and Paramedical care (Dutch: Huisartsenzorg en Paramedische Zorg). This standard is described in this functional specification and implemented here using HL7 FHIR R4. This implementation guide assumes that the reader is familiar with both the functional specification and the FHIR standard.

Apart from this document, the guidelines as specified in general FHIR Implementation Guide apply.

2 Workflow and message structure

2.1 Overview

The use cases described in this IG are limited in sense of workflow: events are handled on a per use case basis where the sender does not explicitly requests a response (e.g. a status update). Future insights might require more workflow and it is conceivable that the FHIR Task resource will be used to fulfill that. At this point in time, the ServiceRequest and Composition resources are sufficient for the use cases described in this IG. In a later stage, more (mostly zib based) resource profiles will be added for the transfer of the medical record.

2.2 ServiceRequest

A ServiceRequest resource is used to represent a (request for) referral. The requirements for the ServiceRequest resource in the context of this information standard are specified using the http://nictiz.nl/fhir/StructureDefinition/hg-ReferralServiceRequest profile. This profile SHALL be used in referral use cases.

Each referral SHALL be captured by a dedicated ServiceRequest. When a referral is sent to multiple parties, each party receives it's own unique ServiceRequest. Revoking referrals after a certain period of time based on whether action is taken or not is out of scope of this information standard.

2.2.1 Actionable tag

To indicate that the ServiceRequest is a resource that has to be acted upon by the receiver, the actionable tag is used. Tags are Coding elements present in Resource.meta.tag used for workflow management. When a ServiceRequest is created to send a referral, sending systems SHALL use meta.tag with .system = http://terminology.hl7.org/CodeSystem/common-tags and .code = actionable.

It is up to systems to determine how and when the transactions using the actionable tag are handled from a functional perspective. Systems may store the resource including the actionable tag or remove it either upon storing or when the request is acted upon. However, systems SHALL make sure the tag is removed when serving or sending the resource as part of an informative transaction.

2.3 Composition

A Composition resource is used to capture relevant data that supports the referral, for instance the reason for referral or guidance noted down by the general practitioner. The requirements for the Composition resource in the context of this information standard are specified using the http://nictiz.nl/fhir/StructureDefinition/hg-ReferralComposition profile. This profile SHALL be used in referral use cases.

2.3.1 Handling free text concepts

Some concepts in the data set are of data type string, as some of the relevant data is entered manually by the referrer in the context of a specific referral. This data is often not represented as a persistent object in EHR's but more likely stored as a form or a questionnaire entry. In order to send this data within the Composition, the extension http://nictiz.nl/fhir/StructureDefinition/ext-TextValue is used on Composition.section, accompanied by a distinctive code on Composition.section.code.

Example:

<Composition>
...
<section>
    <extension url="http://nictiz.nl/fhir/StructureDefinition/ext-TextValue">
        <valueString value="paracetamol indien nodig"/>
    </extension>
    <title value="Ingestelde behandeling"/>
    <code>
        <coding>
            <system value="http://snomed.info/sct"/>
            <code value="108631000146107"/>
            <display value="behandeling lopende (situatie)"/>
        </coding>
    </code>
    <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml">Ingestelde behandeling: paracetamol indien nodig</div>
    </text>
</section>
...
</Composition>

3 Use cases

Currently this IG only covers the #Use_case:_Referral_from_general_practitioner_to_paramedic and specifically just the referral and not the transfer of relevant medical record entries. As development moves on, more use cases will be added.

3.1 Use case: Referral from general practitioner to paramedic

This is the technical counterpart of use case 2.5 "Huisarts verwijst naar paramedicus" as described in the functional design.

3.1.2 Actors involved

Actors		Systems		FHIR CapabilityStatements
Name	Description	Name	Description	Name	Description
General practitioner	The user of a HIS	HIS	General practitioner information system	n/a	n/a
Paramedic	The user of a PARIS	PARIS	Paramedic information system	n/a	n/a

4 FHIR profiles

Profile name	FHIR Resource	Canonical URL
hg-ReferralServiceRequest	ServiceRequest	http://nictiz.nl/fhir/StructureDefinition/hg-ReferralServiceRequest
hg-ReferralComposition	Composition	http://nictiz.nl/fhir/StructureDefinition/hg-ReferralComposition