Advance Care Planning (PZP), published by IKNL. This guide is not an authorized publication; it is the continuous build for version 1.0.0-rc2 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IKNL/PZP-FHIR-R4/ and changes regularly. See the Directory of published versions

Data Model Overview

This page provides an overview of the FHIR profiles used to represent the ACP dataset, many of which are based on nl-core profiles.

FHIR Data Model Overview

The diagram below illustrates the FHIR data model for this implementation guide. The resources represent the core event where the advance care plan is discussed, the individuals involved in the ACP process, the documented outcomes of the ACP and additional clinical context relevant to the ACP agreements.

Data Model Overview Diagram

ACP Questionnaire

A patient's ACP preferences can be documented using a structured form, such as the one developed by IKNL. This implementation guide provides a corresponding FHIR Questionnaire resource to ensure standardized and interoperable data capture.

The Questionnaire's primary function is to specify its identity and question identifiers required to capture answers in a QuestionnaireResponse. The Questionnaire is based on the ACP form dataset and aims to preserve the zib structure as much as possible. To ensure the intended meaning is preserved in both the Questionnaire and QuestionnaireResponse, some questions correspond to zib concepts with preset answer codes that are marked as readOnly. This approach tightly couples the Questionnaire and QuestionnaireResponse to the underlying zib data model. The Questionnaire is not specifically designed for direct use in a user interface, though this is possible. For optimal user interaction, the questionnaire may need customization, for example, hiding preselected and read-only questions.

Two example QuestionnaireResponse resources, based on this Questionnaire, are included:

• QuestionnaireResponse for Hendrik Hartman (01-01-2020)
• QuestionnaireResponse for Hendrik Hartman (08-11-2022)

Associating ACP dataset to FHIR

The FHIR profiles in this guide are directly linked to the ACP dataset elements published in ART-DECOR.

Each StructureDefinition includes a StructureDefinition.mapping.uri that points to the specific version of the ACP dataset used. Additionally, every element within a profile is individually mapped to its corresponding dataset element using the ElementDefinition.mapping property. The mapping table below shows all mappings in one view, while the "Mappings" tab of each profile page displays the mappings consolidated per profile. These mappings provide a straightforward way to highlight the elements that are especially relevant for the ACP use case.

Obligation flags

To indicate which elements are essential for the ACP use case, Obligation flags have been added to all elements mapped to the ACP dataset. These flags are visible in the formal profile views.

In this version of the IG, Obligation flags are applied to all mapped elements, regardless of whether the dataset element is mandatory or optional. The obligations are defined for the following actors:

• ACP Actor Provider: SHALL:populate-if-known
• ACP Actor Consulter: SHALL:no-error

In future versions of the IG, these obligations may be refined on a per-element basis.

Note on referenced zibs

The ACP dataset is built from reusable components known as Zorginformatiebouwstenen (zibs). A zib can reference other zibs to create a comprehensive clinical picture. The ACP dataset, however, only includes the first level of these references. If a nested zib (i.e., a zib referenced by another) was not deemed essential for the primary ACP use case, it was not added to the dataset and is therefore not profiled or mapped in this guide.

Nevertheless, the FHIR profiles in this guide are based on the nl-core (zib) profiles and remain open by design. If a system contains deeper information that is not explicitly profiled in this ACP guide, it is encouraged to include it.

For example, the zib AdvanceDirective can reference the zib Problem to which the directive applies. While this guide does not define a specific ACP profile for the target Problem, this data provides important context. When including such information, systems should make it available by conforming to the general-purpose nl-core profiles for those resources.

Mappings by dataset ID

This table provides an overview of all dataset elements that are mapped to FHIR profiles in this implementation guide.