Gebz:V1.0 FHIR IG
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{{#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
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. An example of a transaction Bundle can be found here: Example of Transaction Bundle
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: [1]
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 23-03-2020.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.)
|
Patient-related Observations | Observation | Observations such as blood type pertain to the Patient.
|
Pregnancy-related Observations | Observation | Observations such as gravidity and parity do not (only) pertain to the Patient but to a particular pregnancy.
|
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.
|
Delivery-related Observations | Observation | Observations such as onset of labor or blood loss pertain to a delivery Procedure.
|
Birth | Observation | A birth pertains to a delivery Procedure as well as a child, especially in multiple birth where multiple Birth instances point to the same delivery Procedure. A birth also provides the relation between a child and its mother, which is still the subject of the record.
|
Birth-related Observations | Observation | Observations such as parturition type pertain to a birth. They are also about the mother, which still is the subject.
|
Child | Patient | Child is a separate Patient.
|
Child-related Observations | Observation | Observations such as Apgar score and birthweight pertain to the child Patient, which is the subject of these Observations.
|
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.
Observations should include a performer if known.
List of StructureDefinitions
Please note that many birth care specific profiles are derived from nl-core profiles (e.g. bc-PregnancyObservation is derived from nl-core-observation) to support (re)use of profiles in multiple use cases. The meta.profile element of FHIR instances conforming these profiles should at least include the generic nl-core profile and preferably the specific birth care profile.
Name | PWD 2.3 id | FHIR Profile | FHIR Example | Example SEARCH URL |
---|---|---|---|---|
Vrouw | bc-Woman (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 | PractitionerRole | GET [base]/PractitionerRole/[zorgverlenerrolid] | |
GET [base]/PractitionerRole?practitioner:Practitioner.identifier=[lvrid] | ||||
Zwangerschapsdossier | bc-MaternalRecord (nl-core-episodeofcare) | EpisodeOfCare | GET [base]/EpisodeOfCare/[dossierid] | |
GET [base]/Observation,Condition,Procedure?context=[dossierid] | ||||
GET [base]/Observation,Condition,Procedure?context: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]&context=[dossierid]} |
Rhesus D Factor vrouw | peri23-dataelement-10811 | Observation | GET [base]/Observation?code=1305-2{&subject=[vrouwid]&context=[dossierid]} | |
Rhesus c Factor | peri23-dataelement-10816 | Observation | GET [base]/Observation?code=1159-3{&subject=[vrouwid]&context=[dossierid]} | |
Hb waarde | peri23-dataelement-10814 | Observation | GET [base]/Observation?code=718-7{&subject=[vrouwid]&context=[dossierid]} | |
A terme datum | peri23-dataelement-20030 | zib-Pregnancy-DueDate | Observation | GET [base]/Observation?code=11778-8{&subject=[vrouwid]&context=[dossierid]&focus=[zwangerschapid]} |
Graviditeit | peri23-dataelement-20010 | zib-Pregnancy-Gravidity | Observation | GET [base]/Observation?code=11996-6{&subject=[vrouwid]&context=[dossierid]&focus=[zwangerschapid]} |
Pariteit | peri23-dataelement-20150 | zib-Pregnancy-Parity | Observation | GET [base]/Observation?code=11977-6{&subject=[vrouwid]&context=[dossierid]&focus=[zwangerschapid]} |
Wijze einde zwangerschap | peri23-dataelement-80625 | bc-PregnancyObservation (nl-core-observation) | Observation | GET [base]/Observation?code=EindeZw{&subject=[vrouwid]&context=[dossierid]&focus=[zwangerschapid]} |
Datum einde zwangerschap | peri23-dataelement-20540 | Observation | GET [base]/Observation?code=xxx{&subject=[vrouwid]&context=[dossierid]&focus=[zwangerschapid]} | |
Bevalling | peri23-dataelement-6 | bc-DeliveryProcedure | Procedure | GET [base]/Procedure?code=236973005{&subject=[vrouwid]&context=[dossierid]&reasonReference=[zwangerschapid]} |
Vaginale kunstverlossing | peri23-dataelement-40190 | bc-ObstetricProcedure | Procedure | GET [base]/Procedure?code=3311000146109{&subject=[vrouwid]&context=[dossierid]&partof=[bevallingid,uitdrijvingsfaseid]} |
Tijdstip begin actieve ontsluiting | peri23-dataelement-20590 | bc-DeliveryObservation (nl-core-observation) | Observation | GET [base]/Observation?code=249120008{&subject=[vrouwid]&context=[dossierid]&focus=[bevallingid]} |
Hoeveelheid bloedverlies | peri23-dataelement-20640 | Observation | GET [base]/Observation?code=64332008{&subject=[vrouwid]&context=[dossierid]&focus=[bevallingid]} | |
Conditie perineum postpartum | peri23-dataelement-80673 | Observation | GET [base]/Observation?code=364297003{&subject=[vrouwid]&context=[dossierid]&focus=[bevallingid]} | |
Geboorte | bc-Birth (nl-core-observation) | Observation | GET [base]/Observation?code=3950001{&subject=[vrouwid]&context=[dossierid]&focus=[geboorteid]&focus=[kindid]} | |
Tijdstip actief meepersen | peri23-dataelement-30030 | bc-BirthObservation (nl-core-observation) | Observation | GET [base]/Observation?code=249163006{&subject=[vrouwid]&context=[dossierid]&focus=[geboorteid]} |
Type partus | peri23-dataelement-80626 | Observation | GET [base]/Observation?code=364336006{&subject=[vrouwid]&context=[dossierid]&focus=[geboorteid]} | |
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]&context=[dossierid]} |
Geboortegewicht | peri23-dataelement-40060 | bc-BirthWeight | Observation | GET [base]/Observation?code=29463-7{&subject=[kindid]&context=[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'.
Use case: Register Parturition Record
Introduction
The Register Parturition Record transaction is used by the sending XIS to send the relevant data to the registry.
Actors
Transaction group | Transaction | Actor | Role |
---|---|---|---|
Register Parturition Record(PUSH) | Register Parturition Record | Healthcare professional (using a XIS) | Sends Parturition Record data to registry |
Retrieve Parturition Record(PULL) | Querying XIS | Healthcare professional (using a XIS) | Retrieves Parturition Record 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. An example of a transaction Bundle can be found here: Example of Transaction Bundle
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: [2]
Search
Example search URLs can be found in the list of StructureDefinitions below.
FHIR Resources and StructureDefinitions [NOT YET COMPLETE]
Graphical overview
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.)
|
Patient-related Observations | Observation | Observations such as blood type pertain to the Patient.
|
Pregnancy-related Observations | Observation | Observations such as gravidity and parity do not (only) pertain to the Patient but to a particular pregnancy.
|
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.
|
Delivery-related Observations | Observation | Observations such as onset of labor or blood loss pertain to a delivery Procedure.
|
Birth | Observation | A birth pertains to a delivery Procedure as well as a child, especially in multiple birth where multiple Birth instances point to the same delivery Procedure. A birth also provides the relation between a child and its mother, which is still the subject of the record.
|
Birth-related Observations | Observation | Observations such as parturition type pertain to a birth. They are also about the mother, which still is the subject.
|
Child | Patient | Child is a separate Patient.
|
Child-related Observations | Observation | Observations such as Apgar score and birthweight pertain to the child Patient, which is the subject of these Observations.
|
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.
Observations should include a performer if known.
List of StructureDefinitions [NOT YET COMPLETE]
Please note that many birth care specific profiles are derived from nl-core profiles (e.g. bc-PregnancyObservation is derived from nl-core-observation) to support (re)use of profiles in multiple use cases. The meta.profile element of FHIR instances conforming these profiles should at least include the generic nl-core profile and preferably the specific birth care profile.
Name | PWD 2.3 id | FHIR Profile | FHIR Example | Example SEARCH URL |
---|---|---|---|---|
Vrouw | bc-Woman (nl-core-patient) | Patient | GET [base]/Patient/[vrouwid] | |
GET [base]/Patient?identifier=[bsn] | ||||
Partner | peri23-dataelement-80633 | nl-core-relatedperson | [RelatedPerson] | GET [base]/RelatedPerson?patient=[vrouwid] |
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 | PractitionerRole | GET [base]/PractitionerRole/[zorgverlenerrolid] | |
GET [base]/PractitionerRole?practitioner:Practitioner.identifier=[lvrid] | ||||
Verwijsdetails | peri23-dataelement-82012 | bc-ReferralRequest | ReferralRequest | GET [base]/ReferralRequest?subject=[vrouwid] |
GET [base]/ReferralRequest?context=[dossierid] | ||||
Zwangerschapsdossier | bc-MaternalRecord (nl-core-episodeofcare) | EpisodeOfCare | GET [base]/EpisodeOfCare/[dossierid] | |
GET [base]/Observation,Condition,Procedure?context=[dossierid] | ||||
GET [base]/Observation,Condition,Procedure?context: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]&context=[dossierid]} |
Rhesus D Factor vrouw | peri23-dataelement-10811 | Observation | GET [base]/Observation?code=1305-2{&subject=[vrouwid]&context=[dossierid]} | |
Hb waarde | peri23-dataelement-10814 | Observation | GET [base]/Observation?code=718-7{&subject=[vrouwid]&context=[dossierid]} | |
Voornemens | peri23-dataelement-80671 | bc-MaternalPreferences | [List] | GET [base]/List?subject=[vrouwid] |
Voorgenomen plaats baring | peri23-dataelement-20261 | bc-MaternalPreference | [Observation] | GET [base]/Observation?code=PRN4209{&subject=[vrouwid]&context=[dossierid]} |
Voorgenomen voeding | peri23-dataelement-82009 | [Observation] | GET [base]/Observation?code=169740003{&subject=[vrouwid]&context=[dossierid]} | |
A terme datum | peri23-dataelement-20030 | zib-Pregnancy-DueDate | Observation | GET [base]/Observation?code=11778-8{&subject=[vrouwid]&context=[dossierid]&focus=[zwangerschapid]} |
Bevalling | peri23-dataelement-6 | bc-DeliveryProcedure | Procedure | GET [base]/Procedure?code=236973005{&subject=[vrouwid]&context=[dossierid]&reasonReference=[zwangerschapid]} |
Tijdstip begin actieve ontsluiting | peri23-dataelement-20590 | bc-DeliveryObservation (nl-core-observation) | Observation | GET [base]/Observation?code=249120008{&subject=[vrouwid]&context=[dossierid]&focus=[bevallingid]} |
Compleetheid vliezen | peri23-dataelement-80792 | [Observation] | GET [base]/BodySite?subject=[vrouwid] | |
Hoeveelheid bloedverlies | peri23-dataelement-20640 | Observation | GET [base]/Observation?code=64332008{&subject=[vrouwid]&context=[dossierid]&focus=[bevallingid]} | |
Conditie perineum postpartum | peri23-dataelement-80673 | Observation | GET [base]/Observation?code=364297003{&subject=[vrouwid]&context=[dossierid]&focus=[bevallingid]} | |
Conditie perineum postpartum | peri23-dataelement-80673 | Observation | GET [base]/Observation?code=364297003{&subject=[vrouwid]&context=[dossierid]&focus=[bevallingid]} | |
Placenta | peri23-dataelement-80612 | bc-Placenta | BodySite | GET [base]/BodySite?subject=[vrouwid] |
Placenta compleet | peri23-dataelement-20631 | bc-PlacentaObservation | [Observation] | GET [base]/Observation?code=364343000{&subject=[vrouwid]&context=[dossierid]&focus=placenta} |
Datum/tijd geboorte placenta | peri23-dataelement-80791 | [Observation] | GET [base]/Observation?code=[XXXX]{&subject=[vrouwid]&context=[dossierid]&focus=placenta} | |
Geboorte | bc-Birth (nl-core-observation) | Observation | GET [base]/Observation?code=3950001{&subject=[vrouwid]&context=[dossierid]&focus=[geboorteid]&focus=[kindid]} | |
Tijdstip breken vliezen | peri23-dataelement-80619 | bc-BirthObservation (nl-core-observation) | [Observation] | GET [base]/Observation?code=289251005{&subject=[vrouwid]&context=[dossierid]&focus=[geboorteid]} |
Tijdstip actief meepersen | peri23-dataelement-30030 | [Observation] | GET [base]/Observation?code=249163006{&subject=[vrouwid]&context=[dossierid]&focus=[geboorteid]} | |
Type partus | peri23-dataelement-80626 | Observation | GET [base]/Observation?code=364336006{&subject=[vrouwid]&context=[dossierid]&focus=[geboorteid]} | |
Kind | bc-Child (of nl-core-patient) | Patient | GET [base]/Patient/[kindid] | |
Apgarscore na 1 min. | peri23-dataelement-40070 | zib-ApgarScore | Observation | GET [base]/Observation?code=9272-6{&subject=[kindid]&context=[dossierid]} |
Apgarscore na 5 min. | peri23-dataelement-40071 | GET [base]/Observation?code=9274-2{&subject=[kindid]&context=[dossierid]} | ||
Apgarscore na 10 min. | peri23-dataelement-80757 | GET [base]/Observation?code=[XXXX]{&subject=[kindid]&context=[dossierid]} | ||
Geboortegewicht | peri23-dataelement-40060 | bc-BirthWeight | Observation | GET [base]/Observation?code=29463-7{&subject=[kindid]&context=[dossierid]} |
Schedelomtrek | peri23-dataelement-80760 | nl-core-observation | [Observation] | GET [base]/Observation?code=[XXX]{&subject=[kindid]&context=[dossierid]} |
Ligging bij geboorte | peri23-dataelement-40140 | bc-BirthObservation (nl-core-observation) | Observation] | GET [base]/Observation?code=LigGbrt{&subject=[kindid]&context=[dossierid]} |
Navelstreng vaten | peri23-dataelement-80793 | [Observation] | GET [base]/Observation?code=249191003{&subject=[kindid]&context=[dossierid]} | |
Vitamine K | peri23-dataelement-80761 | [Observation] | GET [base]/Observation?code=[XXX]{&subject=[kindid]&context=[dossierid]} | |
Vaginaal toucher | peri23-dataelement-40060 | bc-DigitalVaginalExamination | [DiagnosticReport] | GET [base]/DiagnosticReport?code=51597003{&subject=[vrouwid]&context=[dossierid]} |
Portio | peri23-dataelement-20612 | bc-DigitalVaginalExaminationObservation (nl-core-observation) | [Observation] | GET [base]/Observation?code=[249021005]{&subject=[kindid]&context=[dossierid]} |
Positie portio | peri23-dataelement-82372 | [Observation] | GET [base]/Observation?code=[248920001]{&subject=[kindid]&context=[dossierid]} | |
Ontsluiting | peri23-dataelement-20613 | [Observation] | GET [base]/Observation?code=[289761004]{&subject=[kindid]&context=[dossierid]} | |
Vliezen | peri23-dataelement-20614 | [Observation] | GET [base]/Observation?code=[112074005]{&subject=[kindid]&context=[dossierid]} | |
Indaling Hodge | peri23-dataelement-20615 | [Observation] | GET [base]/Observation?code=[364611006]{&subject=[kindid]&context=[dossierid]} | |
Aard van het voorliggend deel | peri23-dataelement-80616 | [Observation] | GET [base]/Observation?code=[364612004]{&subject=[kindid]&context=[dossierid]} | |
Stand | peri23-dataelement-80618 | [Observation] | GET [base]/Observation?code=[163520002]{&subject=[kindid]&context=[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'.