Gebz:V1.0 FHIR IG

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{{#customtitle:FHIR Implementation Guide Geboortezorg v2.3 | FHIR Implementation Guide Geboortezorg v2.3}}

AfsprakenstelselFunctioneelTechnischAfspraken-Functioneel-Technisch

Introduction

This page details the HL7 FHIR requirements for exchanging the Geboortezorg v2.3 data described in Functioneel.

A high level overview: Fhir-model-overview.png

Use case: Register Prio1 data

Introduction

The Register Prio1 transaction is used by the sending XIS to send the relevant data to the registry.

Actors

Transaction group Transaction Actor Role
Register Prio1(PUSH) Register Prio1 Healthcare professional (using a XIS) Sends Prio1 data to registry
Retrieve Prio1(PULL) Querying XIS Healthcare professional (using a XIS) Retrieves Prio1 data from registry

Invocations

Sending XIS: request message

Trigger Events

Message Semantics

The source executes the following HTTP requests:

1. A HTTP POST request of a Bundle with Bundle.type = transaction to the target's base endpoint. The first Bundle.entry contains a Composition resource, and each subsequent entry contains a resource that is referenced from the Composition resource. Each Bundle.entry should contain an entry.request with request.method = POST and request.ifNoneExists = [condition], so it will be processed as a conditional create interaction (i.e. if a resource exists that meets the condition it will be updated and it will be created otherwise).

POST [base]{&_format=[mime-type]}

2. A HTTP GET request to the target's Composition endpoint, handling the createDocumentOperation with persist=true. The target's response is a FHIR Document Bundle, which is generated from the Composition resource and stored to the target's Bundle endpoint.

GET [base]/Composition/[id]/$document?persist=true{&_format=[mime-type]}

Retrieving XIS: request message

FHIR Document Bundles can be retrieved by a HTTP GET request to the target's Bundle endpoint. Note that FHIR Document Bundles are immutable and its entries refer to a time-related version of a resource which is not necessarily its latest version.

GET [base]/Bundle/[id]{&_format=[mime-type]}

Individual resources can be retrieved by HTTP GET requests to specific resource endpoints, see the Search section and list of StructureDefinitions below.

Examples

Example FHIR resources can be found here: Birthcare FHIR examples

Search

Example search URLs can be found in the list of StructureDefinitions below. Some searches require the implementation of custom search parameters. These parameters can be found here: https://simplifier.net/geboortezorg-stu3/~resources?category=SearchParameter

FHIR Resources and StructureDefinitions

Graphical overview

The following link Media:FHIR Geboortezorg Profielen Prio1 27-02-2020.png provides a graphical overview of the structure definitions and their relations.

Types of resources and relations between them

For pregnancy-, delivery- and child related observations detailed information is given, follow links below.

Name FHIR resource Description
Woman (Vrouw) Patient The core of each pregnancy is the pregnant woman, a FHIR Patient.
Generic resources Practitioner, PractitionerRole, Organization Those are not used differently than in other Dutch projects.
Pregnancy, Pregnancy file (Zwangerschap, zwangerschapsdossier) Condition, EpisodeOfCare Each pregnancy is a Condition. It is also represented as an EpisodeOfCare for each involved Organization. The pregnancy includes references to an Organization and responsible Practitioner. (Practitioners responsible for the actual data may be included there, i.e. in Procedures, Observations.)
  • Condition points to the EpisodeOfCare through a EpisodeOfCare.context.reference element. (Note: different providers may each have their own Condition resource.)
  • EpisodeOfCare points to the Condition through a EpisodeOfCare.diagnosis.condition element.
  • Condition points to the Patient with Condition.subject.reference
  • Condition.status must be 'active' for ongoing pregnancies and 'inactive' for past ones.
Patient-related Observations Observation Observations such as blood type pertain to the Patient.
  • Observations can refer to an EpisodeOfCare with Observation.context.reference
Pregnancy-related Observations Observation Observations such as gravidity and parity do not (only) pertain to the Patient but to a particular pregnancy.
  • Condition-related Observations use focus extension to point to Condition they're about. Without this, all gravidities would only be Observations about a Patient.
Delivery (Bevalling) Procedure Delivery is modeled with Procedure (even for uncomplicated natural births for consistency).
Obstetric Procedures Procedure Obstetric Procedures, such as vacuum delivery, are Procedures conducted as part of the Delivery Procedure.
  • Obstetric Procedures use Procedure.partOf element to point to the delivery Procedure they're part of.
Delivery-related Observations Observation Observations such as onset of labor or blood loss pertain to a delivery Procedure.
  • Procedure-related Observations use focus extension to point to the delivery Procedure they're about.
Child Patient Child is a separate Patient.
  • Procedure-related Observations use focus extension to point to the child Patient they're about.
Child-related delivery Observations Observation Observations such as parturition type pertain to a delivery Procedure as well as a child (especially for multiple births). They are also about the mother, which still is the subject.
  • Child-related delivery Observations use focus extension to point to the delivery Procedure.
  • Child-related delivery Observations use focus extension to point to the child Patient.
  • Child-related delivery observations refer to the EpisodeOfCare with Observation.context.reference
Child-related Observations Observation Observations such as Apgar score and birthweight pertain to the child Patient, which is the subject of these Observations.
  • Child observations refer to the EpisodeOfCare with Observation.context.reference

The use of focus extensions is a pre-adopt of FHIR R4, where it is part of Observation: "What the observation is about, when it is not about the subject of record." Focus is required for all Observations which do not pertain to the Patient. In R4, use of focus permits "reverse include" queries (give me all Observations with focus element X). In STU3, this could be a custom search.

The use of context is encouraged for all resources which have a context element. It is a reference to an EpisodeOfCare or an Encounter. Context should point to an Encounter when appropriate (scheduled maternity checks etc.) and to the EpisodeOfCare in all other cases. Possibly it will be absent in Observations where the source is not birth care, so readers should not rely on it's presence.

List of StructureDefinitions

Name PWD 2.3 id FHIR Profile FHIR Example Example SEARCH URL
Vrouw bc-Woman (derived from nl-core-patient) Patient
GET [base]/Patient/[vrouwid]
GET [base]/Patient?identifier=[bsn]
Zorgverlener nl-core-practitioner Practitioner
GET [base]/Practitioner/[zorgverlenerid]
GET [base]/Practitioner?identifier=[lvrid]
Zorginstelling nl-core-organization Organization
GET [base]/Organization/[zorginstellingid]
GET [base]/Organization?identifier=[lvrid]
Zorgverlenerrol nl-core-practitionerrole Patient
GET [base]/PractitionerRole/[zorgverlenerrolid]
GET [base]/PractitionerRole?practitioner:Practitioner.identifier=[lvrid]
Zwangerschapsdossier bc-MaternalRecord EpisodeOfCare
GET [base]/EpisodeOfCare/[dossierid]
GET [base]/Observation,Condition,Procedure?eoc=[dossierid]
GET [base]/Observation,Condition,Procedure?eoc:EpisodeOfCare.condition:Condition.clinical-status=active
Zwangerschap peri23-dataelement-3 zib-Pregnancy Condition
GET [base]/Condition/[zwangerschapid]
GET [base]/Condition?clinicalstatus=active
GET [base]/Condition?clinicalstatus=inactive&_sort=_-id&_count=1
GET [base]/Condition?subject=[patientid]&_revinclude=Observation:focus
Bloedgroep vrouw peri23-dataelement-10810 zib-LaboratoryTestResult-Observation Observation
GET [base]/Observation?code=883-9{&subject=[vrouwid]&eoc=[dossierid]}
Rhesus D Factor vrouw peri23-dataelement-10811 zib-LaboratoryTestResult-Observation Observation
GET [base]/Observation?code=1305-2{&subject=[vrouwid]&eoc=[dossierid]}
Rhesus c Factor peri23-dataelement-10816 zib-LaboratoryTestResult-Observation Observation
GET [base]/Observation?code=1159-3{&subject=[vrouwid]&eoc=[dossierid]}
Hb waarde peri23-dataelement-10814 zib-LaboratoryTestResult-Observation Observation
GET [base]/Observation?code=718-7{&subject=[vrouwid]&eoc=[dossierid]}
A terme datum peri23-dataelement-20030 zib-Pregnancy-DueDate Observation
GET [base]/Observation?code=11778-8{&subject=[vrouwid]&eoc=[dossierid]&focus=[zwangerschapid]}
Graviditeit peri23-dataelement-20010 zib-Pregnancy-Gravidity Observation
GET [base]/Observation?code=11996-6{&subject=[vrouwid]&eoc=[dossierid]&focus=[zwangerschapid]}
Pariteit peri23-dataelement-20150 zib-Pregnancy-Parity Observation
GET [base]/Observation?code=11977-6{&subject=[vrouwid]&eoc=[dossierid]&focus=[zwangerschapid]}
Wijze einde zwangerschap peri23-dataelement-80625 bc-Pregnancy-EndType Observation
GET [base]/Observation?code=EindeZw{&subject=[vrouwid]&eoc=[dossierid]&focus=[zwangerschapid]}
Datum einde zwangerschap peri23-dataelement-20540 bc-Pregnancy-EndDate Observation
GET [base]/Observation?code=xxx{&subject=[vrouwid]&eoc=[dossierid]&focus=[zwangerschapid]}
Zwangerschapsduur peri23-dataelement-20062 zib-Pregnancy-Duration
GET [base]/Observation?code=57036006{&subject=[vrouwid]&eoc=[dossierid]&focus=[zwangerschapid]}
Bevalling peri23-dataelement-6 bc-DeliveryProcedure Procedure
GET [base]/Procedure?code=236973005{&subject=[vrouwid]&eoc=[dossierid]&reasonReference=[zwangerschapid]}
Ontsluitingsfase, uitdrijvingsfase, nageboortefase peri23-dataelement-6 bc-Delivery-StageOfLabor Observation
GET [base]/Observation?code=6893006,42857002,15898009{&subject=[vrouwid]&eoc=[dossierid]&partof=[bevallingid]&focus=[kindid]}
Tijdstip begin actieve ontsluiting peri23-dataelement-20590 bc-OnsetOfLaborFirstStage Observation
GET [base]/Observation?code=249120008{&subject=[vrouwid]&eoc=[dossierid]&focus=[ontsluitingsfaseid]}
Tijdstip actief meepersen peri23-dataelement-30030 bc-OnsetOfPushing Observation
GET [base]/Observation?code=249163006{&subject=[vrouwid]&eoc=[dossierid]&focus=[uitdrijvingsfaseid]}
Type partus peri23-dataelement-80626 bc-ParturitionType Observation
GET [base]/Observation?code=364336006{&subject=[vrouwid]&eoc=[dossierid]&focus=[uitdrijvingsfaseid]}
Hoeveelheid bloedverlies peri23-dataelement-20640 bc-BloodLoss Observation
GET [base]/Observation?code=64332008{&subject=[vrouwid]&eoc=[dossierid]&focus=[uitdrijvingsfaseid]}
Vaginale kunstverlossing peri23-dataelement-40190 bc-ObstetricProcedure Procedure
GET [base]/Procedure?code=3311000146109{&subject=[vrouwid]&eoc=[dossierid]&partof=[bevallingid,uitdrijvingsfaseid]}
Conditie perineum postpartum peri23-dataelement-80673 bc-StatePerineumPostPartum Observation
GET [base]/Observation?code=364297003{&subject=[vrouwid]&eoc=[dossierid]&focus=[nageboortefaseid]}
Kind bc-Child (of nl-core-patient) Patient
GET [base]/Patient/[kindid]
Geboortedatum peri23-dataelement-40050 bc-Child (of nl-core-patient) Patient.birthdate
GET [base]/Patient/[kindid]
Apgarscore na 5 min. peri23-dataelement-40071 zib-ApgarScore Observation
GET [base]/Observation?code=9274-2{&subject=[kindid]&eoc=[dossierid]}
Geboortegewicht peri23-dataelement-40060 zib-BodyWeight Observation
GET [base]/Observation?code=29463-7{&subject=[kindid]&eoc=[dossierid]}

Terminology, NamingSystems, Mappings

Terminology

Relevant value sets can be found here. All resources can be downloaded in a .zip in XML or JSON format. In the .zip, the value sets are stored in the directory 'value sets'.