Gebz:V1.0 FHIR IG

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

Introduction

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

A high level overview:

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

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'.