Radiology workflow clarifications

• Remove an assignment on the ambulatory track: An assignment may be removed while the radiology prescription is READY or IN_PROGRESS and its execution task is ready or in-progress. The task is deleted and the prescription returns to READY. Other tracks and prescription types retain their applicable removal rules.
• Complete execution on the urgency track: Radiology execution may be completed while the prescription remains in business state READY. When completing an existing execution, the backend starts the caregiver activity before completing it.
• Cancel a radiology prescription: A Patient may cancel a radiology prescription while its business state is PENDING or READY. This rule is specific to radiology.

FHIR profile constraints and examples

• The Annex 81 technical-type category and the nursing and diagnostic-imaging prescription-type categories are explicitly required.
• ServiceRequest.reasonCode is required by the nursing and diagnostic-imaging profiles. Updated examples represent free-text reasons with the pseudonymization extension.
• The prior diagnostic-imaging example now uses an active request, and the urgency requester example uses the PractitionerRole identifier expected by its references.

Radiology terminology and scenarios

• PSS/QSI indication and diagnostic-imaging procedure terminology is updated, including the corresponding value sets used by the diagnostic-imaging profile.
• Ten illustrative PSS radiology business-case examples demonstrate the updated terminology in diagnostic-imaging requests.

FHIR validation and profile compatibility

The FHIR Gateway now aligns validation with the current NIHDI/RIZIV-INAMI profiles. For backward compatibility, it continues to accept the supported legacy eHealth profile URLs and rewrites them to the corresponding NIHDI/RIZIV-INAMI canonical URLs before validation. The mappings cover diagnostic imaging ServiceRequests, nursing ServiceRequests, and Annex 81 resources.

The rewrite is transparent and does not transform resource content. Validation may therefore be stricter than in previous releases, and resources with profile deviations may now produce errors. Existing nursing integrations remain compatible but should progressively adopt the current canonical URLs. Radiology integrations must conform to the latest diagnostic imaging profile. See Profile Rewriting.

Radiology track management

Radiology prescriptions now use their required ambulatory, inpatient, or urgency track when the API applies assignment, validation, substitution, execution, and refusal rules. See Guidance – Radiology Track Management.

Security and compliance

• Free-text prescription fields use the JWE-based encryption model provided by the eHealth Pseudonymization service.
• Privacy audit logging has been extended.
• Treatment execution traceability has been improved through the documented Task lifecycle and tracing requirements.

See Technical – Encryption and API Integration – Pseudonymization.

Documentation consolidation

The Implementation Guide remains the single authoritative source for supported workflows, FHIR structures, profiles, validation rules, and integration examples. The retired PDF Cookbook must not be used as the reference for new development. This consolidation was introduced in v2.0.0; v2.1.0 reinforces the migration recommendation without duplicating the Cookbook content.

Cookbook integration

The legacy eReferral API cookbook (UHMEP_API_cookbook.pdf) has been fully integrated into this Implementation Guide. This IG now supersedes the cookbook and serves as the single source of truth for integrators.

Nursing support

Profiling

New nursing profiles to add constraints on nursing prescriptions and Annex 81 proposals:

• eReferralServiceRequestNursing
• eReferralAnnex81

Mapping tables

Field-by-field mapping tables have been added for every prescription type, showing exactly how business concepts map to FHIR:

• Nursing — Generic
• Nursing — Medication Preparation (Annex 81)
• Nursing — Bloodletting
• Nursing — Chronic Dialysis
• Nursing — Glycemic Test
• Nursing — Hygienic Care
• Nursing — Medication Prefill (not refunded)
• Nursing — Sampling
• Nursing — Diabetes Education (multiple variants)

Radiology (Diagnostic Imaging) support

Profiling

New profiles and operations enable prescription and management of radiology exams:

• eReferral Service Request — Diagnostic Imaging
• eReferral Imaging Attention Conditions Response

New radiology-specific operations

Three new operations handle specific parts of radiology prescription workflows:

1. Accept a Radiology Prescription — confirms the requested exam and readiness to perform the exam
2. Substitute a Radiology Exam — replaces the exam (e.g., CT instead of X-ray)
3. Refuse a Radiology Exam — declines to perform the requested exam

Mapping tables for integrators

Field-by-field mapping table has been added for radiology prescription, showing exactly how business concepts map to FHIR:

• Radiology / Diagnostic Imaging

Machine-to-Machine (M2M) integration

The following operations have been expanded to support M2M workflows:

1. Create Medical Document — now supports creation of a medical document, prescription or proposal, by an internal professional of an organization
2. Assign Care Provider — expanded to:
   • Assign to an organization (BeOrganizationTask)
   • Assign to an internal professional within an organization (BePerformerTask)
3. Record Execution Start — now supports initiation by an internal professional of an organization via POST
4. Unassign Care Provider — operation to withdraw assignments of an organization or internal professional from a prescription
5. Evaluate Proposal — now supports evaluation by an internal professional of an organization
6. Evaluate Radiology Prescription — supports evaluation by an internal professional of an organization

Security & privacy

• Authentication via Identity & Authorization Management (I.AM)
• Free-text and sensitive fields protected via Pseudonymization REST service
• See API Integration for full authentication and header requirements

Reference materials

• API Integration — authentication, headers, request/response structure
• API Operations — overview of all available operations
• Technical — entry points, support contacts, certificates
• Access Control Matrix — which roles can perform which operations
• Error Codes — complete error catalogue and troubleshooting
• Visibility & Blacklisting — data filtering rules