New Zealand Rheumatic Fever FHIR Implementation Guide
1.0.0 - draft

New Zealand Rheumatic Fever FHIR Implementation Guide, published by Te Whatu Ora. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/tewhatuora/fhir-rheumatic-fever/ and changes regularly. See the Directory of published versions

Changelog

Changelog

v1.0.0 September 25 2024 published version

v0.5.0 updates

  • Updated CapabilityStatement to specify DSH/Connector Plane security and generate an OpenAPI Specification via HNZ Digital Tooling
  • Updated OpenAPI specification links
  • Documented Resource-Context custom header requirements in developer guide page, CapabilityStatement and OpenAPI specification
  • Upgraded NZBase IG dependency to v3.1 (current). Due to this update, the NZ Base NzPatient profile now contains the interpreter-required extension which this IG re-uses (instead of the old local extension named interpreterRequired which has been dropped). Example patient instances updated to use the NZ Base extension.

v0.4.9 updates

  • Updates to consent documentation.
  • The coding of relationship type 'Other' has changed to use the code #O (upper case letter 'O') from the FHIR/HL7 relationship type codes.

v0.4.8 updates

National system (RFCCS) identifiers

  • Consolidated national identifier system type codes into the IG CodeSystem (formerly a separate CodeSystem)
  • All national identifiers (slices on resource.Identifier) now have the system Url set to the HISO standard NamingSystem value https://standards.digital.health.nz/ns/rf-ccs-id

eSAM identifiers

The patient's address in the example diagnosis encounter now has an eSAM identifier with system Url set to the HISO standard NamingSystem value https://standards.digital.health.nz/ns/nz-address-id

Examples

  • In Patient with care team, membership has been adjusted to include a care team member with role/relationship type 'Other' using the correct coding.

Doc

  • Corrected Consent FHIR data models
  • Revised Terminology documentation page

v0.4.7 fixes

Renamed capability statement instance. Reinstated Consent.performer in consent examples.

v0.4.6 Updated canonical Url

The canonical base Url for the IG has been updated to https://fhir-ig.digital.health.nz/rheumatic-fever for publishing at the official HISO IG site.

This IG now appears in the HISO Implementation Guide index (UAT)

v0.4.5 Coding fixes and general updates

Classifiers for OAUTH scoping of RF data

Filtering classifiers added to various RF resource types to enable OAUTH scoping as follows:

  • Appointments have .serviceCategory set to $sct#58718002
  • Encounters have .type set to $sct#58718002
  • MedicationStatements have .category set to $sct#58718002

RF resource tagging

  • To enable OAuth scoped access controls, all RF resource instances should be tagged with the RF SNOMED code (meta.tag.code=58718002)
  • The RF profiles on CarePlan, Condition, CareTeam, Observation (DiagnosisGroup), MedicationRequest and Patient resource types now have an invariant requiring the RF SNOMED code tag.
  • All example instances have been RF-tagged
  • A tagging section has been added to the data standards page.

Consolidation of SNOMED NZ Edition terminology into one local CodeSystem

Testing has shown that applications cannot practically use codes defined in the NZ SNOMED edition because the New Zealand Health Terminology Service (NZHTS) is unable to support lookup and validation of these codes. (This stems from SNOMED affiliate licensing restrictions affecting the NZ Edition.)

As NZ SNOMED terms are in effect unusable for NZ applications, all these codes have been brought into a CodeSystem in the IG, so the IG itself defines the codes.

The IG now has a single local CodeSystem which consolidates all the special codes needed for New Zealand rheumatic fever FHIR data representation.
This CodeSystem includes codes which previously sat in their own systems eg. the RF diagnostic certainty codes.

The various ValueSets used throughout this IG now draw all their codes from the new common IG CodeSystem, or from applicable public terminology systems (http://snomed.sct/info, http://nzmt.org.nz).

The following IG artefacts have changed to draw some or all of their codes from the new common local CodeSystem:

  • RFConditionDiagnosticCertaintyValueSet
  • RFConditionRHDSeverityValueSet
  • RFConditionSummaryDiagnosisValueSet
  • RFDiagnosisGroupValueSet
  • RFRelatedPersonRoleValueSet (renamed from RFCareTeamParticipantRoleValueSet)
  • RFMedicationRequestMedicationFrequencyValueSet (renamed from RheumaticFeverMedicationRequestMedicationFrequencyValueSet)
  • RFMedicationAllergyValueSet (renamed from RheumaticFeverMedicationAllergyValueSet)

All instance examples featuring NZ-specific codings now use the local codesystem Uri in this IG instead of a SNOMED NZ edition Uri

DiagnosisGroup (Observation) profile strengthened

The DiagnosisGroup (Observation) profile now requires:

  1. All Observation instances (group-level) to be coded using local codes instead of SNOMED codes (however, the same code numbers are used as per the SNOMED terms.)
  2. All Observation component items are to be coded from a new ValueSet RFDiagnosisObservationCodingValueSet which draws all the diagnosis SNOMED codes plus one special local code #448021000210106 (Indolent carditis (disorder))

Revised categories in CarePlans and Conditions

The following profiles now require use of the local code #rf-nz to categorise all instances:

  • CarePlan profile requires instances to be categorised #rf-nz (was SNOMED #320721000210102)
  • Condition profile requires instances to be dual-categorised #rf-nz, SNOMED #58718002 (was SNOMED category only)
  • CareTeam profile requires instances to be categorised #rf-nz (was SNOMED #320741000210108)

Miscellaneous fixes

  • Altered relationship role ValueSet to include all codes from the (as per binding of FHIR RelatedPerson.relationship)
  • Medication statement examples - removed incorrect profile reference
  • Fixed a publisher error on the example Uri for the code system of the national identifier slice on identifier in CarePlan, CareTeam, Condition and Observation profiles.
  • Adjusted patient care team for example SageWestbrookAndWhanau to demonstrate a legal guardian type contact.

v0.4.4 CarePlan profile status history and examples updates

Profiles

  • RF CarePlan profile
    • Added a new complex extension to capture CarePlan status change with dates and reasons.
    • Removed the old specific extensions which tracked the reason a CarePlan instance entered on-hold or closed status.
    • Updated CarePlan example instances to illustrate build-up of status change history

Examples

  • Reworked Encounter example instances to use official test data
    • Encounter service providers now use HPI Organisation identifiers from HPI test data
    • Encounters at hospital and clinic Locations now use HPI Facility identifiers from HPI test data
    • Sample school location now identified with its (real) School Numbers from the New Zealand Schools Directory
  • Revised patient example instances and all references to use official NHI test identifiers

Documentation

  • Added RFCCS to FHIR CarePlan status mapping information to the data mapping page.

v0.4.3 MVP phase 2 updates

Separated rheumatic fever API from shared care IG into the dedicated IG.

  • The Artifacts page is now simply the IG publisher output list format with standard artifact groupings. Only consent items and canonical instances definitions are grouped separately.
  • Rewrote consent-based access control page.
  • Updated Consent data models to address consent to treatment and opt-out.
  • Updated all Consent examples

Questionnaires

Updated examples

  • Added new example questionnaire response HealthAssessmentAtOralProphylaxisEncounter
  • All Observation example instances now have a .performer
  • All Encounter example instances now have a .serviceProvider
  • Added new examples for a FOLLOW-UP (dentist) appointment and encounter recording.
  • CarePlan examples renamed and refactored
  • Added example of a security-labelled resource instance (for revised data access control scheme)

v0.4.2 phase 2 updates part 2 (June 2024)

Profiles

Examples

  • A new Condition with diagnosis evidence example illustrates linking Observations via evidence[].detail references.
  • Examples of enhanced diagnosis linked to a Condition
  • The various example CarePlans now illustrate use of the lifelong secondary prophylaxis extension and have been revised so that creation adn period dates are UTC dateTime values.
  • SP Appointments and Encounters now have .serviceType = $sct#360271000 "Prophylaxis"
  • Sage Westbrook example patient - changed language code to #en (English) to fix BCP-47 terminology publisher validation problem
  • Pania Punga example patient - changed language code for Maori to #mi to fix BCP-47 terminology publisher validation problem

Terminology

Miscellany

  • Changed date values to dateTime datatype in elements that need to be accurately convert to/from UTC representation
  • Publisher-generated narrative text suppressed in canonical Questionnaires and CareTeam
  • Updated FHIR data models

v0.4.0 phase updates 2 part 1 (May 2024)

Data model designs

  • Revised secondary prophylaxis medication planning and recording model: Added nested lignocaine medication request and statement; simplified appointments.

  • Added new model of diagnosis data representation

  • Added new model for planning/recording of other care appointments

Definitions

  • Moved the LeadProvidersGroup from Examples to Definitions section

  • Expanded the membership of the LeadProvidersGroup to encompass all 18 NZ Rheumatic Fever Secondary Prevention Services.

Profiles

Condition RF profile:

  • two new extensions for RF-specific diagnosis attributes
  1. Date of RHD severity assessment (Condition.assessmentDate)
  2. Symptom status at time of RF diagnosis (Condition.symptomStatusAtDiagnosis)

Examples

Shared care provider scenario

These examples have been adjusted to correctly reflect the Taranaki RF SP service as a shared care provider by referencing its HPI org Id G0M744-C

Condition and diagnosis extensions

  • Expanded RfCondition example to use a new extension (symptomStatusAtDiagnosis) and reference a diagnosis Encounter (see below)

Medication planning and recording

  • Renamed the planned medication example to PlannedBenzathineMedication
  • Added a second example of planned medication PlannedBenzathineMedicationWithLignocaine showing how lignocaine strength/dosage represented in a contained MedicationRequest. This instance is now used as the planned medication by the IG example RF CarePlans.
  • Lignocaine recording via a contained MedicationStatement instance is now demonstrated in two example MedicationStatements:
  1. MedicationStatement-August
  2. SecondaryProphylaxisAugustEncounterBundle

Miscellaneous

  • Added a new example Diagnosis Encounter capturing representing context and locations of RF diagnosis.
  • In consent-based access control added example instance data model showing patient opt-out of data sharing
  • Consistency and readability improvements to existing Consent example instance models

Terminology

  • Added an RFCCS Observation object identifier to the codesystem for external system identifier types