HL7 Czech Electronic medical report Implementation Guide
0.0.1 - ci-build

HL7 Czech Electronic medical report Implementation Guide, published by HL7 Czech Republic. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-cz/elp/ and changes regularly. See the Directory of published versions

## Workflow

### Electronic medical assessment

Issuance:

1. Patient request – the patient requires an assessment for a specific purpose (employment, driver's license, social benefits).
2. Health assessment – the physician performs an examination and evaluates the patient's medical fitness.
3. Filling in the ELP template – in the information system (IS) of the healthcare provider (HIS/CIS) or directly in the central ELP system.
4. Electronic signature – the ELP assessment is signed/stamped and time-stamped.
5. Storage in the central ELP repository – the ELP assessment is assigned a unique identifier and the status Valid.
6. Access for the patient – via the National Electronic Health Portal or the 'EZKarta' application.

Updates:

1. Change detected – e.g., new examination, deterioration of health, appeal, or review of the assessment.
2. Assessment revision – the assessing physician creates a new version of the Electronic Health Report (ELP).
3. Status of the original assessment – automatically changes to Invalid.
4. New assessment – receives Valid status and is stored in the central ELP system.

Invalidation:

- At the request of the physician or patient (if the assessment was issued incorrectly or has been reviewed).
- Automatically – if the validity period specified in the assessment expires.
- Based on a new assessment – the issuance of a new document changes the status of the previous one to invalid.

> The ELP system always stores the history of assessments – invalid assessments are unavailable for active use but remain traceable for audit purposes.

Accessibility:

- Patient – has access to valid and historical assessments via the National Electronic Health Portal and EZKarta.
- Healthcare provider – access to assessments according to authorization and care context.
- Public administration institutions – e.g., Czech Police, Czech Social Security Administration, Ministry of Transport – access via the Shared Services Information System, exclusively to assessments relevant to their agenda.
- Patient representatives – access enabled through the Register of Rights and Authorizations (RO), based on consent or legal representation.

Audit and traceability:

- Each assessment has a unique identifier and audit record (who, when, and in what context created, changed, or made the assessment available).
- The ELP system records all operations in an activity log – visible to both the patient and the supervisory authorities.
- This ensures the legal validity of assessments and the possibility of retrospective checks.

### Overview of the medical assessment lifecycle

The lifecycle includes the following main phases:

1. Creation of a request
   - Triggering event: A patient or institution (e.g., employer, employment office, transport authority) requests an assessment.
   - Responsible person: The assessing physician within the healthcare provider (PZS).
   - Technical step: A record of the request is created in the PZS IS system and an assessment template is opened according to the purpose (occupational medicine, driver's license, firearms license, etc.).
2. Issuing the assessment
   - Triggering event: After the examination, the physician evaluates the patient's medical fitness.
   - Responsible person: Assessing physician.
   - Technical step:
     - Fill in the required information (patient identification, purpose, conclusion, validity, instructions).
     - Affix a qualified electronic signature or PZS seal and time stamp to the document.
     - The assessment is assigned a unique identifier and the status Valid.
3. Storage and central registration
   - Triggering event: The signed assessment is completed.
   - Responsible person: ELP system.
   - Technical step:
     - Storage in the ELP central repository.
     - Entry in the activity log (who created the assessment and when).
     - Notification to the patient (National Electronic Health Portal, EZKarta).
4. Making the assessment available
   - Triggering event: The patient or institution needs to view the assessment.
   - Authorized entities:
     - Patient (in the National Electronic Health Portal / EZKarta) .
     - Healthcare providers and healthcare professionals (within the context of care).
     - Public administration institutions (e.g., Czech Social Security Administration, Ministry of Transport of the Czech Republic, Police of the Czech Republic) via the Shared Services Information System.
   - Technical step: Authentication and authorization, issuance of the assessment in JSON/XML format according to authorization.
5. Update of the assessment
   - Triggering event: New examination, review, or correction of data.
   - Responsible person: Assessing physician.
   - Technical step:
     - Issuance of a new version of the ELP.
     - The original assessment is marked as Invalid.
     - The new assessment is given the status Valid and is saved with a new identifier.
6. Invalidation of assessment
   - Triggering event:
     - Automatically – after expiry of validity.
     - Manually – the physician invalidates the assessment (error, appeal, replacement with a new one).
   - Technical step:
     - Change of status to Invalid or Invalidated.
     - Entry in the activity log and notification of the patient.
7. Archiving and history
   - Triggering event: The assessment has expired.
   - Responsible person: ELP system.
   - Technical step:
     - Storage of the invalid assessment in the central database.
     - Ensuring audit traceability (history of all versions, reasons for change).
     - The patient can also view historical assessments.