# Inicio - HL7 PT FHIR Implementation Guide: Example IG Release 1 | STU1 v1.0.0

* [**Table of Contents**](toc.md)
* **Inicio**

## Inicio

| | |
| :--- | :--- |
| *Official URL*:http://example.com/fhir/hl7pt/ImplementationGuide/hl7.fhir.pt.patient-admin-ig | *Version*:1.0.0 |
| Active as of 2020-02-26 | *Computable Name*:ExampleIG |

> The specification herewith documented is for the time being a proof of concept specification, and may not be used for any implementation purposes. No liability can be inferred from the use or misuse of this specification, or its consequences.

### Ambito

O presente guia de implementação (IG) foi desenvolvido com o objetivo de uniformizar a definição, utilização e partilha de informações entre diferentes sistemas de informação de saúde, assegurando uma interoperabilidade eficaz entre diferentes entidades e profissionais de saúde.

Este guia fornece especificações técnicas utilizando o FHIR Versão 4B, e funcionais e pressupõe que o leitor esteja familiarizado com a especificação funcional e com esta versão do FHIR.

### Introdução

Em Portugal começam a existir várias implemetações em FHIR que mapeaiam as implementações de mensagens HL7v2.x para mensagens HL7 FHIR. Este IG pretende dar suporte a integrações em FHIR que implementam o paradigma de **FHIR Messaging**, fazendo a ponte entre as implementações que já existem em HL7v2.x e mensagens HL7 FHIR. Tem como base o perfil [PatientAdministration Management](https://profiles.ihe.net/ITI/TF/Volume1/ch-14.html#14) da Estrutura Técnica de Infraestrutura de TI do IHE para a abordagem em HL7v2.x e que tem como atores **"Patient Demographics Supplier"** e **"Patient Demographics Consumer"**.

O paradigma de mensagem FHIR permite manter a comunicação assíncrona de mensagens e evoluir a comunicação para o Standard FHIR e ao mesmo tempo, usando ferramentas de conversão, manter a comunicação com os sistemas que mantém as integrações em HL7 v2 (Fig.1).

Fig.1 -Fhir Messaging Paradigms Schema

O perfil IHE PatientAdministration Management apresenta duas transações: **Patient Identity Management** e **Patient Enconter Management**. O âmbito desta IG é focado na transação **Patient Identity Management** (Fig.2) o qual inclui as operações que permitem fazer a gestão dos dados demográfios dos utentes.

Fig.2 - Atores da transação Gestão da Identidade do Utente

O termo “dados demográficos do utente” refere-se aos dados da identidade completa do utente, incluindo informações sobre pessoas relacionadas com ele, como cuidador principal, médico de família, tutor, familiares mais próximos, entidades responsáveis, etc.

A transação **Patient Identity Management** transmite dados demográficos do utente no domínio de identificação do utente e contém eventos para criação, atualização, fusão/associaçao de utentes. Esta transação é usada nos vários contextos como internamento, e todos aqueles que recebem um leito na unidade de saúde, ou urgência, consulta externa, hospital de dia, ambulatório e outros que não têm atribuído um leito na unidade de saúde.

Em Hl7v2, as mensagens que suportam as ações necessárias estão especificadas no profile IHE mencionado anteriormente prevendo a toca de mensagens com eventos especificos já defenidos pelo standard HL7 v2:

| | | |
| :--- | :--- | :--- |
| Create new patient | A28 | ADT^A28^ADT_A05 |
| Update patient information | A31 | ADT^A31^ADT_A05 |
| Change Patient Identifier List | A47 | ADT^A47^ADT_A30 |
| Merge two patients | A40 | ADT^A40^ADT_A39 |

Tabela 1 - Subconjunto de mensagens obrigatórias com a opção “Fusão” (fonte IHE)

| | | |
| :--- | :--- | :--- |
| Create new patient | A28 | ADT^A28^ADT_A05 |
| Update patient information | A31 | ADT^A31^ADT_A05 |
| Change Patient Identifier List | A47 | ADT^A47^ADT_A30 |
| Link Patient Information | A24 | ADT^A24^ADT_A24 |
| Unlink Patient Information | A37 | ADT^A37^ADT_A37 |

Tabela 2 - Subconjunto de mensagens obrigatórias com a opção “Associar/Desassociar” (fonte IHE)

Em FHIR não existe a definição de eventos para dar suporte a mensagens orientadas a eventos tal como no HL7 v2, mas o FHIR está preparado para isso. Torna-se assim necessário definir uma sistema de codificação para estes eventos de forma a tormar uniforme os codigos dos eventos a enviar nas mensagens entre os diferentes sistemas.

### Autores e Colaboradores

| | | | |
| :--- | :--- | :--- | :--- |
| Autor | Liliana Correia |  | lilianamsacorreia@gmail.com |
| Colaborador | Liliane Sousa |  |  |
| Colaborador | Márcia Amaral |  |  |
| Colaborador | Ana Nunes |  |  |
| Colaborador | André Bernardo |  |  |

### Referências

* [PatientAdministration Management](https://profiles.ihe.net/ITI/TF/Volume1/ch-14.html#14)
* [Visita do utente](https://hl7-pt.github.io/workflow-ep-ig/)



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          }
        ],
        "url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
      },
      {
        "extension" : [
          {
            "url" : "code",
            "valueCode" : "tabbed-snapshots"
          },
          {
            "url" : "value",
            "valueString" : "true"
          }
        ],
        "url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
      }
    ],
    "resource" : [
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:extension"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/birthplace-pt"
        },
        "name" : "Birthplace Extension",
        "description" : "Extensão para o local de nascimento do utente.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:extension"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/address-pt"
        },
        "name" : "Endereço estruturado PT",
        "description" : "Extensão complexa para endereço com tipo e códigos INE.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "ValueSet"
          }
        ],
        "reference" : {
          "reference" : "ValueSet/vs-patient-identity-events"
        },
        "name" : "Eventos FHIR para Gestão de Identidade de Utentes",
        "description" : "Eventos FHIR relacionados com a gestão da identidade de utentes.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "CodeSystem"
          }
        ],
        "reference" : {
          "reference" : "CodeSystem/cs-fhir-events"
        },
        "name" : "FHIR Events CodeSystem",
        "description" : "Código dos eventos FHIR relacionados com transações baseadas em mensagens HL7v2.\nEste CodeSystem inclui mapeamentos para eventos de diferentes domínios (ex: gestão de utentes, emergência, etc.).",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:extension"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/nationality-pt"
        },
        "name" : "Nationality Extension",
        "description" : "Represents the patient's nationality",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "Bundle"
          }
        ],
        "reference" : {
          "reference" : "Bundle/patient-link"
        },
        "name" : "patient-link",
        "exampleBoolean" : true
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "Bundle"
          }
        ],
        "reference" : {
          "reference" : "Bundle/patient-new"
        },
        "name" : "patient-new",
        "exampleBoolean" : true
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "Bundle"
          }
        ],
        "reference" : {
          "reference" : "Bundle/patient-update"
        },
        "name" : "patient-update",
        "exampleBoolean" : true
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:resource:abstract"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/BundleMessage-Pt"
        },
        "name" : "PTBundleMessage",
        "description" : "Perfil de BundleMessage para contexto de comunicação _Messaging_.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:extension"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/ContactIndicative-Pt"
        },
        "name" : "PTContactIndicative",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:resource"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/Coverage-Pt"
        },
        "name" : "PTCoverage",
        "description" : "Perfil de Coverage para contexto PT, com tipos de coberturas/isenções, beneficiários (numero de beneficiários, apólices) e entidades responsáveis associadas.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:extension"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/coverage-reason-pt"
        },
        "name" : "PTCoverageReason",
        "description" : "Extensão para codigo do motivo de isenção do utente .",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:resource"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/MessageHeader-Pt"
        },
        "name" : "PTMessageHeader",
        "description" : "Perfil de MessageHeader para contexto de comunicação _Messaging_.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:extension"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/Notes-pt"
        },
        "name" : "PTNotes",
        "description" : "Extensão para notas relativas ao registo do utente.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:resource"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/Organization-Pt"
        },
        "name" : "PTOrganization",
        "description" : "Perfil de Organization para contexto PT, com identificadores institucionais e requisitos mínimos de nome/contactos.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:resource"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/Patient-Pt"
        },
        "name" : "PTPatient",
        "description" : "Perfil de Patient para contexto PT, incluindo tipos de indentificadores, nacionalidade, naturalidade (INE), notas, endereços codidificados, contactos, inscrição nos CSP.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:extension"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/PatientEnrollmentCategoryPrimarycare-Pt"
        },
        "name" : "PTPatientEnrollmentCategoryPrimarycare",
        "description" : "Extensão para código do tipo de utente no contexto de cuidados primários.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:extension"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/PatientPrimaryCarePeriod-Pt"
        },
        "name" : "PTPatientPrimaryCarePeriod",
        "description" : "Extensão para período de inscrição nos cuidados primários do utente.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:extension"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/PersonEducation-Pt"
        },
        "name" : "PTPersonEducation",
        "description" : "Extensão para registo de escolaridade do utente.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:extension"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/PersonOccupation-Pt"
        },
        "name" : "PTPersonOccupation",
        "description" : "Extensão para registo de ocupação do utente.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:extension"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/PersonRecordType-Pt"
        },
        "name" : "PTPersonRecordType",
        "description" : "Extensão para tipo de registo do utente.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "StructureDefinition:resource"
          }
        ],
        "reference" : {
          "reference" : "StructureDefinition/Practitioner-Pt"
        },
        "name" : "PTPractitioner",
        "description" : "Perfil de Practitioner para contexto PT, com identificadores institucionais e requisitos mínimos de nome/contatos.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "ValueSet"
          }
        ],
        "reference" : {
          "reference" : "ValueSet/patient-identifier-type"
        },
        "name" : "Tipos de Identificadores de Paciente",
        "description" : "Conjunto de tipos válidos de identificadores para pacientes em Portugal.",
        "exampleBoolean" : false
      },
      {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
            "valueString" : "ValueSet"
          }
        ],
        "reference" : {
          "reference" : "ValueSet/practitioner-identifier-type"
        },
        "name" : "Tipos de Identificadores de Profissionais",
        "description" : "Conjunto de tipos válidos de identificadores para profissionais em Portugal.",
        "exampleBoolean" : false
      }
    ],
    "page" : {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
          "valueUrl" : "toc.html"
        }
      ],
      "nameUrl" : "toc.html",
      "title" : "Table of Contents",
      "generation" : "html",
      "page" : [
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
              "valueUrl" : "index.html"
            }
          ],
          "nameUrl" : "index.html",
          "title" : "Inicio",
          "generation" : "markdown"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
              "valueUrl" : "fun_spec.html"
            }
          ],
          "nameUrl" : "fun_spec.html",
          "title" : "Especificação Funcional",
          "generation" : "markdown"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
              "valueUrl" : "tech_spec.html"
            }
          ],
          "nameUrl" : "tech_spec.html",
          "title" : "Especificação Técnica",
          "generation" : "markdown"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
              "valueUrl" : "conversionV2Fhir.html"
            }
          ],
          "nameUrl" : "conversionV2Fhir.html",
          "title" : "Conversão de mensagens entre Standards",
          "generation" : "markdown"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
              "valueUrl" : "conversionFhirV2.html"
            }
          ],
          "nameUrl" : "conversionFhirV2.html",
          "title" : "Conversão de mensagens entre Standards",
          "generation" : "markdown"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
              "valueUrl" : "examples.html"
            }
          ],
          "nameUrl" : "examples.html",
          "title" : "Exemplos de mensagens",
          "generation" : "markdown"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
              "valueUrl" : "downloads.html"
            }
          ],
          "nameUrl" : "downloads.html",
          "title" : "Downloads",
          "generation" : "markdown"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
              "valueUrl" : "changes.html"
            }
          ],
          "nameUrl" : "changes.html",
          "title" : "Histórico de Alterações",
          "generation" : "html"
        }
      ]
    },
    "parameter" : [
      {
        "code" : "path-resource",
        "value" : "input/capabilities"
      },
      {
        "code" : "path-resource",
        "value" : "input/examples"
      },
      {
        "code" : "path-resource",
        "value" : "input/extensions"
      },
      {
        "code" : "path-resource",
        "value" : "input/models"
      },
      {
        "code" : "path-resource",
        "value" : "input/operations"
      },
      {
        "code" : "path-resource",
        "value" : "input/profiles"
      },
      {
        "code" : "path-resource",
        "value" : "input/resources"
      },
      {
        "code" : "path-resource",
        "value" : "input/vocabulary"
      },
      {
        "code" : "path-resource",
        "value" : "input/maps"
      },
      {
        "code" : "path-resource",
        "value" : "input/testing"
      },
      {
        "code" : "path-resource",
        "value" : "input/history"
      },
      {
        "code" : "path-resource",
        "value" : "fsh-generated/resources"
      },
      {
        "code" : "path-pages",
        "value" : "template/config"
      },
      {
        "code" : "path-pages",
        "value" : "input/images"
      },
      {
        "code" : "path-tx-cache",
        "value" : "input-cache/txcache"
      }
    ]
  }
}

```
