Te Whatu Ora Shared Care FHIR API
0.3.9 - release New Zealand flag

Te Whatu Ora Shared Care FHIR API, published by Te Whatu Ora. This guide is not an authorized publication; it is the continuous build for version 0.3.9 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/tewhatuora/cinc-fhir-ig/ and changes regularly. See the Directory of published versions

Rheumatic Fever Data Models

FHIR data models (pilot phase)

This section provides an overview of the design of the FHIR data representations that authorized applications can use to record and interchange rheumatic fever information.

FHIR resource model

Rheumatic fever FHIR resources (pilot phase)Rheumatic fever bounded context - FHIR resource typesTe Whatu Ora national systemsTe Whatu Ora NHI/HPI«APPOINTMENT»:AppointmentAn Appointment is a planned encounter.For example, administration of secondaryprophylaxis (preventative)) medication.text "Secondary prophylaxis appointment"status:#booked | #arrivedstart: instant (UTC)end: instance (UTC)participant: Reference(Practitioner)«CAREPLAN»:RheumaticFeverCarePlanProfiles FHIR CarePlan so it can act asregistration for rheumatic fever patients.identifier[NHI] (official): NHIidentifier[case] (usual): case Id (salesforce)title "Rheumatic fever care plan for patient X"status:#activeetc.period: date rangecategory: SNOMED#tbc"RF secondary prevention care plan"intent:#Planetc.activity[]:Reference(MedicationRequest or Appointment)onlyonHoldReason: stringclosureReason: stringextensions«NZPATIENT»:RheumaticFeverPatientProfiles NzPatient so it can definewhanau care team members as contactsidentifier[NHI] (official): NHIname: HumanNamebirthDate: datecommunication.languagegender: codedeceasedBoolean: booleantelecom: ContactPoint[]address: Address[]iwi: codeethnicity 0..*: code[]nzCitizen: codepatient.contact[]. whanauMemberCareRole: Coding whanauMemberCareRelationship: string whanauMemberCarePrimary: booleaninterpreterRequired: boolean(extensions)«CARETEAM»:**RheumaticFeverCareTeamProfiles CareTeam to categorize only.Identifies practitioners/providersinvolved in patient's care(performing RF secondary prevention)category:|Secondary Prophylaxis Teamparticipant[].role«CONSENT»:Consent^data collectionRepresents a patient's active orprovisional consent to RF Servicescollection and use of data.status:#proposed | activescope:#patient-privacydateTime: dateperiod: date rangepolicy: uri«NZCONDITION»:RheumaticFeverConditionProfiles NzCondition (NZ Base) for RF 'case' details.identifier (usual): code: SNOMED diagnosis codeseverity:#mild | #moderate | #severeclinicalStatus: #active etc.recordedDate: daterhdSeverity: code (in dedicated ValueSet)diagnosticCertainty: code (in dedicated ValueSet)assessmentDate: date (UTC)extensions«MEDICATION»:Medicationcode: SNOMED (brand)ingredient: SNOMED (type)«NZMEDICATIONREQUEST»:RheumaticFeverMedicationRequestMedication that is planned for RF preventionstatus: codemedicationRequestStatusintent:#planauthoredOn: dateTime (UTC)validityPeriod: dateTime (UTC)dosageInstruction:route: SNOMEDsite: SNOMEDdoseAndRateadditionalInstruction: SNOMED [frequency]medicationFrequency: code (in dedicated ValueSet)extensions«NZMEDICATIONSTATEMENT»:MedicationStatementDetail of benzathine etc.actually administeredstatus:#completedcode: NZMTeffectiveDatePeriod: UTC dateTimenote: brand of benzathine used«NZMEDICATIONSTATEMENT»:MedicationStatementStrength of lignocaineadministered for pain reliefmedicationCodeableConcept: NZMT«QUESTIONNAIRE»:Questionnaire(definitional)Four canonical instances defined by Te Whatu Ora1Patient Medication Allergies2Medications and Follow-up Guidance3Patient & Whanau Goals and Preferences4Secondary Prophylaxis Health Assessment«QUESTIONNAIRERESPONSE»:QuestionnaireResponseCollects form data itemsas defined by a Questionnairevalue[x]: item[].answer«ENCOUNTER»:EncounterTracks patient's secondaryprophylaxis appointment.class:#AMB"ambulatory"status:#planned | #finishedparticipant[]: Reference[Patient, Practitioner]period: datetime rangelocation: Reference[HPI facility]«external data»RFCCS (Salesforce)Salesforce logical resourcelogical id: CarePlanId«external data»EpisurvNotifiable disease surveillancelogical id: Episurv number«logical resource»Patient (NHI)logical id: NHI«logical resource»HPIlogical identifier formats:NNXXXX-practitioner CPNsGXXNNN-CHPI Org Id - orgsFXXNNN-CHPI Facility Id - locs«logical resource»RelatedPersonlogical id: name«logical resource»NZMT terminologymedication coding<>supportingInformation1appointment1addresses<>supportingInfobasedOnsubject1activity.referencebasedOn"Salesforce care plan Id"1Identifier[NationalSystem]careTeamactivity.referenceCarePlan.authoridentifies Lead Providerauthorparticipant.memberparticipant.membersubject1"Episurv number"1Identifier[NationalSystem]patient1performer1"participant,serviceProvider"1medication[x]1requester1subject1partOfcontext11basedOnmedicationReference1codeingredientlignocaineconcentrationcodingIdentifier[NHI]1encounter     questionnaireNotes- Model of data types (FHIR resources) and relations (FHIR references) for national rheumatic fever FHIR data.- Arrows show direction of FHIR reference.- Solid/open dots indicate mandatory/optional data elements. Key to datatype colourscolourstereotype ghost white Standard FHIR resource in TWO Shared Care API salmon Profiled FHIR resource orange red Canonical shared resource defined by TWO sky blue Logical identifier reference to records in other national systemsHealth NZ/Te Whatu Ora. Generated from PlantUML source on 02/05/2024


FHIR careplan instance lifecycle

Typical sequence of rheumatic fever FHIR resource instance creationpatient registrationcare plan setupMedication planningSecondary prophylaxis activity recordingongoing care coordinationConsentcreated and linkedConsentCarePlan -->#draftInitial diagnosis completedCondition (updated)CareTeam definedCareTeamAllergies recordedQuestionnaire type AResponseMedications & Follow-upGuidance capturedQuestionnaire type BResponsePatient / WhanauGoals & PrefsrecordedQuestionnaire type CResponsewhen all parts readyPlan a period of medication (say2023)MedicationRequest 2023Medication (Benzathine)SP medication frequencyis set (say every 28 days)Book appointmentsAppointment(planned encounter)July 11#bookedAppointment(planned encounter)August 8 2023#bookedAppointment(planned encounter)Sept. 5 2023#bookedmore appointments...MedicationRequest -->#active & appointments plannedWhen medication plannedfor a sufficient periodFirst appointment data capture (sayAugust 2023)MedicationStatement (aug)Questionnaire type DResponse (aug)Encounter ofaug appointmentAppointment (aug)-->#fulfilledSecond appointment data capture (saySeptember 2023)MedicationStatement (sept)Questionnaire type DResponse (sept)Encounter ofsept appointmentAppointment (sept)-->#fulfilledSimilar further instance sets ...FHIR resources accumulateas rheumatic fever patientcare continues.CarePlan#activeCarePlan#on-holdCarePlan cancelled (#revoked)CarePlan closed (#completed)NzPatient created/updatedNzPatientCarePlancreatedCarePlanConditionOn registration, CarePlan moves into#draftstate.Other sector health applications can interpret from thisthat a patient is "registered" with an NZ RF SecondaryPrevention Service.CarePlan -->#activePatient not registered /no FHIR records.Patient has an existing FHIR representation.okokokHealth NZ/Te Whatu Ora. Generated from PlantUML source on 02/05/2024


Secondary prophylaxis appointment planning and recording instances

Rheumatic fever -- secondary prophylaxis medication planning and appointment recordingMedication definitionPlanning and recording of secondary prophylaxis medication activity<CarePlan.activity[].reference>July 2023 completed appointment detailAugust 2023 completed appointment detailmedication ingredientNZMT ..6105-benzathine penicillinNZMT ..6107-amoxicillinNZMT ..6109-penicillin VKNZMT ..6100-erythromycinBenzathine brandNZMT ..6108-Bicillin L-ANZMT tbc-TardocillinNZMT tbc-LentocillinMed. routeSNOMED..1000-Intramuscular routeSNOMED..3006-Oral routeMed. siteSNOMED..10101-Left ventrogluteal .....-etc.«Medication»:MedicationPlanned secondary prophylaxis medication brand and ingredient«CarePlan»:RheumaticFeverCarePlanFHIR CarePlans contain a listof (references to) activities.FHIR activity types shown hereare Appointments andMedicationRequests.These three instances, added to theoriginal Appointment instance, capturedetail from acompletedsecondary prophylaxis appointment:-Encounterthe who / what / where etc.-MedicationStatementthe actual meds given-QuestionnaireResponsehealth assessmentThe next planned patient secondaryprophylaxis encounter is represented bythis Appointment instance in#bookedstatus.    Its main purpose is to convey the due date,to which adherence is important for effective RF care.  After the care encounter, the status updatesto #fulfilled. The medication administered andassessmention question responses are captured inother FHIR resource instances, as shown above for Julyand August.«MedicationRequest»:RheumaticFeverMedicationRequesttext: "Benzathine medication plan 2023"status:#activeintent:#plandosageInstruction-route:SNOMED-site:SNOMED-additionalInstruction [frequency]-doseAndRate:Dosageperformer: Ref(Practitioner)validityPeriod: eg.2023-01 to 2023-12medicationFrequency:Every twenty eight days- extension -July2023:Appointmentcompleted care encounteridentifier[case] (usual): case Id (salesforce)status:#fulfilledstart:2023-07-11supportingInfo: service provider Ref(HPI org)participant: Reference(Practitioner)August2023:Appointmentcompleted care encounteridentifier: type #CarePlanActivityId (SF)status:#fulfilledstart:2023-08-08supportingInfo: service provider Ref(HPI org)participant: Reference(Practitioner)September2023:Appointmentplannednext care encounteridentifier: type #CarePlanActivityId (SF)status:#bookedstart:2023-09-05supportingInfo: service provider Ref(HPI org)participant: Reference(Practitioner)july2023:Encounterstatus:#finishedperiod: 2023-07-11participant: Ref(Practitioner)serviceProvider: Ref(Organisation):MedicationStatement(Benzathine)status:#completedeffectiveDateTime: 2023-07-11dosage: Dosage// actual dose quantity,site,route:QuestionnaireResponse(health assessment)questionnaire: Canonical(SPHA)status:#completedauthored: 2023-07-11item.*: responsesaugust2023:Encounterstatus:#finishedperiod: 2023-08-08participant: Ref(Practitioner)serviceProvider: Ref(Organisation):MedicationStatement(Benzathine)status:#completedeffectiveDateTime: 2023-08-08dosage: Dosage// actual dose quantity,site,route:QuestionnaireResponse(health assessment)questionnaire: Canonical(SPHA)status:#completedauthored: 2023-08-08item.*: responses ingredientcodecontextencountercontextencounteractivitysupportingInfoappointmentsupportingInfoappointmentmedication[x]11routesitebasedOnbasedOnmedicationReferencemedicationReferenceLegend1) Arrows indicate direction of FHIR reference2) Object colour shading reflects colours used inData Dictionarymapping.FHIR resource instances object model


Secondary prophylaxis appointment planning and recording states model

Secondary prophylaxis recording: FHIR instance lifecyclesPlannedAppointmentPROPOSEDFINISHEDCANCELLEDENTERED-IN-ERRORPatient's next SP treatment duedate is represented in FHIR by anAppointment instance in their CarePlansecondary prophylaxis treatment recordsEncounterMedicationStatementQuestionnaireResponseFINISHEDENTERED-IN-ERRORCOMPLETEDENTERED-IN-ERRORCOMPLETEDENTERED-IN-ERRORAfter the treatment encounter takes place, 3 more FHIR resources record the details.Typically these three instances are created directly in their terminal state.state colourmeaning lime green starting state (if applicable) orange terminal state (if applicable)Health NZ/Te Whatu Ora. Generated from PlantUML source on 02/05/2024