Additional Resources Included in Document

Entry 1 - fullUrl = http://example.com/fhir/Composition/1-tvt

Resource Composition:

Case study 1

Suspicion of deep vein thrombosis

A patient, Tobias Timmermann, presents to Dr. med. Marc Mustermann at the Olten group practice on 09.03.2016. He verbally identifies himself via his master data as Tobias Timmermann, 01.01.1984. He reports unclear leg pain in the left lower leg as well as simultaneously occurring respiratory pain and cough. The doctor carries out the anamnesis and physical examination and prescribes the following laboratory parameters:

• Blood cell count incl. differentiation
• CRP
• D-dimer

The doctor carries out the Blood count and the CRP determination himself by means of point of care diagnostics, the D-dimer diagnostics is prescribed as quantitative diagnostics in an external sending laboratory. To obtain the sample, a Blood sample is taken lying down (1 EDTA tube, 2 citrate tubes of 5 ml). The order is transmitted to the external laboratory and the sample is sent to the external dispatch laboratory by courier ordered by telephone. The results of the internal point of care diagnostics (Blood count and CRP) are entered in the patient`s laboratory sheet in the doctor`s office software (manually or via locally installed electronic interfaces). A prescription is therefore issued by the doctor to the patient for self-administration of an anti-thrombotic agent. The results of the sending-in laboratory arrive electronically at the GP`s on the same evening and are also entered in the patient`s laboratory sheet. By using the present exchange format, this process can be fully automated. After a telephone enquiry by the doctor at the sending laboratory due to a borderline D-dimer result, the information is given that a deep vein thrombosis cannot be ruled out in this situation by means of D-dimer and the patient is therefore called back the next day for a sonography of the legs.

As it is probably a primary leg vein thrombosis, Dr Eva Erlenmeier from the Pipette laboratory sends feedback to Dr Mustermann with the recommendation to carry out a thrombophilia screening, which includes the following analyses: Quick, aPTT, fibrinogen, antithrombin (funct.), thrombin time I 2.5 NIH/ml, APC resistance, D-dimers, protein C, (aPTT method), protein S antigen. The analyses can be carried out directly from the samples of the citrate tubes sent along.

Entry 2 - fullUrl = http://example.com/fhir/Patient/TobiasTimmermann

Resource Patient:

id: TobiasTimmermann

meta:

identifier: 012/08.111111

name: Tobias Timmermann

gender: MALE

birthDate: Jan 01, 1981

maritalStatus: unverheiratet (Details : {$ech-11-maritalstatus code '5' = '5', given as 'unverheiratet'})

Communications

-	Language	Preferred
*	Deutsch (Schweiz) (Details : {urn:ietf:bcp:47 code 'de-CH' = 'German (Region=Schweiz))	true

Entry 3 - fullUrl = http://example.com/fhir/Practitioner/MarcMustermann

Resource Practitioner:

Generated Narrative: Practitioner MarcMustermann

identifier: GLN/7601000050700, urn:oid:2.16.756.5.30.1.123.100.2.1.1/A123309

name: Marc Mustermann (Official)

telecom: ph: 033 444 22 11(Work), marc.mustermann@gruppenpraxis.ch

Entry 4 - fullUrl = http://example.com/fhir/Organization/Gruppenpraxis

Resource Organization:

Generated Narrative: Organization Gruppenpraxis

identifier: GLN/7601000241115

name: Gruppenpraxis Olten

contact

telecom: +41555556677, info@gruppenpraxis.ch, http://www.gruppenpraxis.ch

address: Gerbergasse 12 Olten 4600 CH

Entry 5 - fullUrl = http://example.com/fhir/PractitionerRole/MarcMustermannGruppenpraxis

Resource PractitionerRole:

Generated Narrative: PractitionerRole MarcMustermannGruppenpraxis

practitioner: Practitioner Marc Mustermann (official)

organization: Organization Gruppenpraxis Olten

Entry 6 - fullUrl = http://example.com/fhir/Practitioner/EvaErlenmeyer

Resource Practitioner:

Generated Narrative: Practitioner EvaErlenmeyer

identifier: GLN/7601000050717, urn:oid:2.16.756.5.30.1.123.100.2.1.1/A123315

name: Eva Erlenmeyer (Official)

telecom: ph: 033 444 55 66(Work), eva.erlenmeyer@labor-pipette.ch

Entry 7 - fullUrl = http://example.com/fhir/Organization/LaborPipette

Resource Organization:

Generated Narrative: Organization LaborPipette

identifier: GLN/7601000234407

name: Labor Pipette

contact

telecom: +41223345566, info@labor-pipette.ch, http://www.labor-pipette.ch

address: Laborstrasse 23 Olten 4600 CH

Entry 8 - fullUrl = http://example.com/fhir/PractitionerRole/EvaErlenmeyerLaborPipette

Resource PractitionerRole:

Generated Narrative: PractitionerRole EvaErlenmeyerLaborPipette

identifier: urn:oid:2.16.756.5.30.1.123.100.2.1.1/A123444

practitioner: Practitioner Eva Erlenmeyer (official)

organization: Organization Labor Pipette

Entry 9 - fullUrl = http://example.com/fhir/Coverage/HealthInsuranceCardTobiasTimmermann

Resource Coverage:

Generated Narrative: Coverage HealthInsuranceCardTobiasTimmermann

identifier: Insurance Card Number/A123456780-1

status: Active

type: According to KVG

subscriber: Tobias Timmermann Male, DoB: 1984-01-01 ( Medical record number)

beneficiary: Tobias Timmermann Male, DoB: 1984-01-01 ( Medical record number)

period: ?? --> 2024-12-31

Entry 10 - fullUrl = http://example.com/fhir/Condition/ConditionRenalInsufficiency

Resource Condition:

Generated Narrative: Condition ConditionRenalInsufficiency

clinicalStatus: Active

verificationStatus: Confirmed

category: diagnosis

severity: Mild to moderate (qualifier value)

code: Chronic renal insufficiency (disorder)

subject: Tobias Timmermann

onset: 2023-08-05

recordedDate: 2023-10-05

Entry 11 - fullUrl = http://example.com/fhir/Specimen/Serum-1-tvt

Resource Specimen:

Generated Narrative: Specimen Serum-1-tvt

identifier: 48736-12345-75465

accessionIdentifier: 4e88a-12345-dd888

status: Available

type: Serum specimen (specimen)

subject: Tobias Timmermann Male, DoB: 1984-01-01 ( Medical record number)

Collections

-	Collector	Collected[x]	BodySite	FastingStatus[x]
*	Practitioner Marc Mustermann (official)	2015-08-16 06:40:17+0000	No display for Specimen.collection.bodySite (concept: Structure of median cubital vein (body structure))	Patient was fasting prior to the procedure.

container

Entry 12 - fullUrl = http://example.com/fhir/Specimen/Blood-coag-1-tvt

Resource Specimen:

Generated Narrative: Specimen Blood-coag-1-tvt

identifier: 48736-55555-75465

accessionIdentifier: 4e88a-66666-dd888

status: Available

type: Blood sample

subject: Tobias Timmermann Male, DoB: 1984-01-01 ( Medical record number)

receivedTime: 2023-12-01 16:40:17+0000

Collections

-	Collector	Collected[x]
*	Practitioner Marc Mustermann (official)	2023-12-01 17:00:17+0000

Processings

-	Time[x]
*	2023-12-01 17:00:17+0000 --> 2023-12-01 17:30:17+0000

container

Entry 13 - fullUrl = http://example.com/fhir/Specimen/Blood-1-tvt

Resource Specimen:

Generated Narrative: Specimen Blood-1-tvt

status: Available

type: Blood sample

subject: Tobias Timmermann Male, DoB: 1984-01-01 ( Medical record number)

Collections

-	Collector	Collected[x]	BodySite
*	Practitioner Marc Mustermann (official)	2015-08-16 06:40:17+0000	No display for Specimen.collection.bodySite (concept: Structure of superficial vein of left upper limb (body structure))

container

note: Specimen is grossly lipemic

Entry 14 - fullUrl = http://example.com/fhir/ServiceRequest/1-tvt-service-request-0

Resource ServiceRequest:

Generated Narrative: ServiceRequest 1-tvt-service-request-0

identifier: Placer Identifier/123

basedOn: ServiceRequest 25-Hydroxyvitamin D3+25-Hydroxyvitamin D2 [Mass/volume] in Serum or Plasma

status: Active

intent: Original Order

priority: Urgent

subject: Tobias Timmermann Male, DoB: 1984-01-01 ( Medical record number)

requester: PractitionerRole

insurance: Coverage: identifier = Insurance Card Number; status = active; type = According to KVG; period = (?) --> 2024-12-31

Entry 15 - fullUrl = http://example.com/fhir/ServiceRequest/1-tvt-service-request-1

Resource ServiceRequest:

Generated Narrative: ServiceRequest 1-tvt-service-request-1

identifier: Placer Identifier/123

status: Active

intent: Original Order

priority: Urgent

code: No display for ServiceRequest.code (concept: CBC panel - Blood by Automated count)

subject: Tobias Timmermann Male, DoB: 1984-01-01 ( Medical record number)

requester: PractitionerRole

insurance: Coverage: identifier = Insurance Card Number; status = active; type = According to KVG; period = (?) --> 2024-12-31

specimen: Specimen: status = available; type = Blood sample; note = Specimen is grossly lipemic

Entry 16 - fullUrl = http://example.com/fhir/ServiceRequest/1-tvt-service-request-2

Resource ServiceRequest:

Generated Narrative: ServiceRequest 1-tvt-service-request-2

identifier: Placer Identifier/123

status: Active

intent: Original Order

priority: Urgent

code: No display for ServiceRequest.code (concept: CBC W Auto Differential panel - Blood)

subject: Tobias Timmermann Male, DoB: 1984-01-01 ( Medical record number)

requester: PractitionerRole

insurance: Coverage: identifier = Insurance Card Number; status = active; type = According to KVG; period = (?) --> 2024-12-31

specimen: Specimen: status = available; type = Blood sample; note = Specimen is grossly lipemic

Entry 17 - fullUrl = http://example.com/fhir/ServiceRequest/1-tvt-service-request-3

Resource ServiceRequest:

Generated Narrative: ServiceRequest 1-tvt-service-request-3

identifier: Placer Identifier/123

status: Active

intent: Original Order

priority: Urgent

code: No display for ServiceRequest.code (concept: Short Fibrin D-dimer FEU and DDU panel - Platelet poor plasma)

subject: Tobias Timmermann Male, DoB: 1984-01-01 ( Medical record number)

requester: PractitionerRole

insurance: Coverage: identifier = Insurance Card Number; status = active; type = According to KVG; period = (?) --> 2024-12-31

specimen: Specimen: identifier = 48736-55555-75465; accessionIdentifier = 4e88a-66666-dd888; status = available; type = Blood sample; receivedTime = 2023-12-01 16:40:17+0000

Entry 18 - fullUrl = http://example.com/fhir/ServiceRequest/1-tvt-service-request-4

Resource ServiceRequest:

Generated Narrative: ServiceRequest 1-tvt-service-request-4

identifier: Placer Identifier/123

status: Active

intent: Original Order

priority: Urgent

code: No display for ServiceRequest.code (concept: C reactive protein [Mass/Volume] in Serum or Plasma)

subject: Tobias Timmermann Male, DoB: 1984-01-01 ( Medical record number)

requester: PractitionerRole

insurance: Coverage: identifier = Insurance Card Number; status = active; type = According to KVG; period = (?) --> 2024-12-31

specimen: Serum specimen

Entry 19 - fullUrl = http://example.com/fhir/ServiceRequest/1-tvt-service-request-5

Resource ServiceRequest:

Generated Narrative: ServiceRequest 1-tvt-service-request-5

identifier: Placer Identifier/123

status: Active

intent: Original Order

priority: Urgent

code: No display for ServiceRequest.code (concept: 25-Hydroxyvitamin D3+25-Hydroxyvitamin D2 [Mass/volume] in Serum or Plasma)

subject: Tobias Timmermann Male, DoB: 1984-01-01 ( Medical record number)

requester: PractitionerRole

insurance: Coverage: identifier = Insurance Card Number; status = active; type = According to KVG; period = (?) --> 2024-12-31

supportingInfo: No display for ServiceRequest.supportingInfo (reference: ->Condition Chronic renal insufficiency (disorder))

specimen: Serum specimen