v2.0.0 draft

eReferral Implementation Guide
2.0.0 - Belgium flag

eReferral Implementation Guide, published by Riziv-Inami Platform. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/referral-uhmep/ and changes regularly. See the Directory of published versions

Diagnostic Imaging

Prescription type code: diagnostic imaging prescription type from be-vs-prescription-type.

Example: example-drp-clinical-imaging.

This table maps the business fields to the corresponding FHIR elements.

Business fields

Business field Values / constraints Data type Notes
Prescription type Required code Required imaging prescription type.
Discipline Required code Required diagnostic imaging discipline.
Track Required.
Possible values:
- inpatient
- ambulatory
- urgency		 code Required request track.
Requested imaging Required code Imaging request.
Priority Required code Optional request priority. When the value is urgent, an urgency justification must also be present.
Urgency justification Required when priority is urgent. String Value must be encrypted with a pseudonymized key
Patient Required Reference / Identifier Contained Patient reference; SSIN identifier must follow pseudonymization rules.
Patient birthdate Required Date Patient.birthDate must not carry a clear value; the encrypted date is carried in _birthDate with be-ext-pseudonymized-content.
Patient gender at birth Required code The visible code is fixed to administrative gender other; the actual value is encrypted in be-ext-pseudonymized-content.
Additionnal relevant information Required Reference Must reference the contained eReferralImagingAttentionConditionsResponse.
Patient condition One or more Patient conditions. Use either an allowed code or encrypted free text in CodeableConcept.text. code  
Prior request Zero or more prior imaging request references or coded/textual prior-request details. Reference / code Captures relevant prior imaging request information.

FHIR mapping

Business field FHIR representation FHIR JSON example Terminology
Prescription type ServiceRequest.category[prescriptionType] 
{
  "category": [
    {
      "coding": [
        {
          "system": "https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-prescription-type",
          "code": "diagnostic-imaging-appendix-82"
        }
      ]
    }
  ]
}
Discipline ServiceRequest.category[discipline] 
{
  "category": [
    {
      "coding": [
        {
          "code": "363679005",
          "system": "http://snomed.info/sct"
        }
      ]
    }
  ]
}
Track ServiceRequest.category[track] 
{
  "category": [
    {
      "coding": [
        {
          "code": "ambulatory",
          "system": "https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-request-track"
        }
      ]
    }
  ]
}
Requested imaging ServiceRequest.code 
{
  "code": {
    "coding": [
      {
        "code": "77477000",
        "system": "http://snomed.info/sct"
      }
    ]
  }
}
Priority ServiceRequest.priority 
{
  "priority": "urgent"
}
Urgency justification ServiceRequest.extension[urgencyJustification] 
{
  "extension": [
    {
      "url": "https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-urgency-justification",
      "valueString": "urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}",
      "_valueString": {
        "extension": [
          {
            "url": "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymization",
            "extension": [
              {
                "url": "marker",
                "valueBoolean": true
              },
              {
                "url": "format",
                "valueCode": "encrypted"
              },
              {
                "url": "version",
                "valuePositiveInt": 1
              }
            ]
          }
        ]
      }
    }
  ]
}
Patient ServiceRequest.subject.reference 
{
  "subject": {
    "reference": "#patient",
    "identifier": {
      "use": "official",
      "system": "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin",
      "value": "urn:be:fgov:pseudo:v2:{{SEC1}}:{{transit-info}}",
      "_value": {
        "extension": [
          {
            "url": "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymization",
            "extension": [
              {
                "url": "marker",
                "valueBoolean": true
              },
              {
                "url": "format",
                "valueCode": "direct"
              },
              {
                "url": "version",
                "valuePositiveInt": 2
              }
            ]
          }
        ]
      }
    }
  },
  "contained": [
    {
      "id": "patient",
      "resourceType": "Patient"
    }
  ]
}
Patient birthdate ServiceRequest.contained[Patient].birthDate 
{
  "contained": [
    {
      "resourceType": "Patient",
      "id": "patient",
      "_birthDate": {
        "extension": [
          {
            "url": "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymized-content",
            "extension": [
              {
                "url": "encryptedValue",
                "valueString": "urn:be:fgov:pseudo-encrypted:v1:{{kid}}:{{jwe}}"
              },
              {
                "url": "marker",
                "valueBoolean": true
              },
              {
                "url": "format",
                "valueCode": "encrypted"
              },
              {
                "url": "version",
                "valuePositiveInt": 1
              }
            ]
          }
        ]
      }
    }
  ]
}
Patient gender at birth ServiceRequest.contained[Patient].extension[genderAtBirth] 
{
  "contained": [
    {
      "resourceType": "Patient",
      "id": "patient",
      "extension": [
        {
          "url": "https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-ext-gender-at-birth",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://hl7.org/fhir/administrative-gender",
                "code": "other"
              }
            ],
            "extension": [
              {
                "url": "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymized-content",
                "extension": [
                  {
                    "url": "encryptedValue",
                    "valueString": "urn:be:fgov:pseudo-encrypted:v1:{{kid}}:{{jwe}}"
                  },
                  {
                    "url": "marker",
                    "valueBoolean": true
                  },
                  {
                    "url": "format",
                    "valueCode": "encrypted"
                  },
                  {
                    "url": "version",
                    "valuePositiveInt": 1
                  }
                ]
              }
            ]
          }
        }
      ]
    }
  ]
}
Additionnal relevant information ServiceRequest.supportingInfo[safetyChecklist].reference 
{
  "supportingInfo": [
    {
      "extension": [
        {
          "url": "https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-radiology-supporting-info-role",
          "valueCode": "safety-checklist"
        }
      ],
      "reference": "#ci-attention-qr"
    }
  ]
}
Patient condition ServiceRequest.supportingInfo[patientCondition] 
{
  "supportingInfo": [
    {
      "extension": [
        {
          "url": "https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-radiology-supporting-info-role",
          "valueCode": "patient-condition"
        },
        {
          "url": "https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-codeable-concept",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-pss-qsi-indications",
                "code": "2506",
                "display": "AAA screening, family history of AAA"
              }
            ],
            "text": "urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}",
            "_text": {
              "extension": [
                {
                  "url": "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymization",
                  "extension": [
                    {
                      "url": "marker",
                      "valueBoolean": true
                    },
                    {
                      "url": "format",
                      "valueCode": "encrypted"
                    },
                    {
                      "url": "version",
                      "valuePositiveInt": 1
                    }
                  ]
                }
              ]
            }
          }
        }
      ]
    }
  ]
}
Prior request ServiceRequest.supportingInfo[priorRequest] 
{
  "supportingInfo": [
    {
      "extension": [
        {
          "url": "https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-radiology-supporting-info-role",
          "valueCode": "prior-request"
        }
      ],
      "reference": "ServiceRequest/example-prior-drp-clinical-imaging"
    }
  ]
}
Status reason ServiceRequest.extension[request-statusReason] 
{
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/request-statusReason",
      "valueCodeableConcept": {
        "text": "urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}",
        "_text": {
          "extension": [
            {
              "url": "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymization",
              "extension": [
                {
                  "url": "marker",
                  "valueBoolean": true
                },
                {
                  "url": "format",
                  "valueCode": "encrypted"
                },
                {
                  "url": "version",
                  "valuePositiveInt": 1
                }
              ]
            }
          ]
        }
      }
    }
  ]
}