CH UMZH Connect IG (R4), published by UMZH. This guide is not an authorized publication; it is the continuous build for version 1.0.0-cibuild built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/umzhconnect/umzhconnect-ig/ and changes regularly. See the Directory of published versions

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Official URL: http://fhir.ch/ig/ch-umzh-connect/ImplementationGuide/ch.fhir.ig.ch-umzh-connect				Version: 1.0.0-cibuild
Draft as of 2025-12-10				Computable Name: CHUMZHConnect
Copyright/Legal: CC0-1.0

Introduction

CH UMZH Connect is a FHIR Implementation Guide for the University Medicine Zurich (UMZH) focusing on referral and external service order processes.

UMZH-Connect is a collaborative initiative to improve digital interoperability between healthcare providers in the Zurich ecosystem—initially focusing on university hospitals and close partners. Today, key processes such as referrals, transfers, and external orders (e.g., lab or radiology requests) still require manual re-entry of clinical and administrative information across systems, causing delays, inconsistencies, and avoidable workload. The project targets these friction points by enabling “push-button” and fully automated data exchange across participants, driven by concrete, high-value use cases that can be implemented quickly and measured in terms of business and clinical benefit.

The intended solution is an API framework and shared implementation approach that allows providers to act as API producers and consumers using standardized, interoperable interfaces (e.g. FHIR and REST). A central element is a clearly defined “data contract” (FHIR implementation guidance) that supports both read and write operations for agreed workflows — starting with core referral/order content such as reason for request, diagnoses, history, medication, procedures, and administrative data, while remaining extensible for additional use cases and participants over time. The “data contract” is based on the international Clinical Order Workflow (COW) and customized for swiss-specifics in this UMZH-Connect FHIR IG.

Initial Use Cases focus on the following resource types which are based on the profiles from CH Core and CH eTOC:

• Order, service request and clinical question
• Administrative data (personal details, insurance, etc.)
• Diagnoses
• Medication
• Allergies
• Reports (documents)
• ImagingStudies

These content areas are intended to be expandable in the future.

Download: You can download this implementation guide in the NPM package format from here.

Workflow orientation

This implementation guide is based on the core principles of Clinical Order Workflow IG with a focus on the Task at Fulfiller principle where the Placer creates a ServiceRequest and POSTs a Task to the Fulfiller's FHIR server, with the ServiceRequest referenced in Task.basedOn. The Fulfiller manages the Task lifecycle and updates the Placer about progress and outcomes.

The core concepts and principles are depicted in detail here:

Workflow oriented API design

• Resource Querying: The Placer SHALL support the _include parameter for querying the ServiceRequest along with all referenced resources.

Security

This IG specifies OAuth 2.0 and OpenID Connect–based architectures for securing APIs by the use of Security profiles such as SMART on FHIR define standards and OpenID Foundation’s FAPI 2.0, which sharpens security awareness by enforcing measures to mitigate particular risk scenarios in machine-to-machine communication.

A particular focus is set on context-centric authorization, driven by the fact that authorization should be enforced based on the context of data consumption — in our case providing limited access in the context of a specific workflow object (ServiceRequest or Task).

We show approaches on how to harden eco-system exposed API's and how to enforce fine-grained authorization for our use-cases.

The detailed security concept can be found here:

Security concept

Use cases

• Orthopedic referral
• Sarcome tumorboard referral

IP Statements

This document is licensed under Creative Commons "No Rights Reserved" (CC0).

HL7®, HEALTH LEVEL SEVEN®, FHIR® and the FHIR ® are trademarks owned by Health Level Seven International, registered with the United States Patent and Trademark Office.

This implementation guide contains and references intellectual property owned by third parties ("Third Party IP"). Acceptance of these License Terms does not grant any rights with respect to Third Party IP. The licensee alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize Third Party IP in connection with the specification or otherwise.

This publication includes IP covered under the following statements.

• CC0-1.0
  Show Usage
  • Condition Category: Condition/HeartFailureHFrEF, Condition/SarcomaKnee and Condition/SuspectedACLRupture
  • Coverage Identifier Type: Coverage/CoverageMeier
  • EDQM - Standard Terms: Medication/MedAspirin, MedicationStatement/MedicationAspirin, MedicationStatement/MedicationConcor and MedicationStatement/MedicationEntresto
• ISO maintains the copyright on the country codes, and controls its use carefully. For further details see the ISO 3166 web page: https://www.iso.org/iso-3166-country-codes.html
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  • ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code: CHUMZHConnect, ChUmzhConnectCoordinationTask... Show 12 more, ChUmzhConnectServiceRequest, ChUmzhConnectServiceRequestCategoryVS, Questionnaire/QuestionnaireSmokingStatus, UMZHConnectFulfiller, UMZHConnectPlacer, UMZHconnectRestServer, ch-umzhconnectig-servicerequest-insurance, ch-umzhconnectig-servicerequest-reasonreference, ch-umzhconnectig-servicerequest-supportinginfo, ch-umzhconnectig-task-inputreference, ch-umzhconnectig-task-outputcanonical and ch-umzhconnectig-task-outputreference
• Some content from IHE® Copyright © 2015 IHE International, Inc. This content is from the IHE Technical Frameworks and Supplements, available for free download and use at http://www.ihe.net/Technical_Frameworks/
  Show Usage
  • Endpoint Connection Type: Fulfiller FHIR API and Placer FHIR API
  • Endpoint Payload Type: Fulfiller FHIR API and Placer FHIR API
• The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
  Show Usage
  • Unified Code for Units of Measure (UCUM): MedicationStatement/MedicationAspirin, MedicationStatement/MedicationConcor and MedicationStatement/MedicationEntresto
• These codes are excerpted from Digital Imaging and Communications in Medicine (DICOM) Standard, Part 16: Content Mapping Resource, Copyright © 2011 by the National Electrical Manufacturers Association.
  Show Usage
  • DICOM Controlled Terminology Definitions: ImagingStudy/ImagingCT and ImagingStudy/ImagingPET
• This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
  Show Usage
  • SNOMED Clinical Terms® (SNOMED CT®): ChUmzhConnectServiceRequest, ChUmzhConnectServiceRequestCategoryVS... Show 12 more, DocumentReference/DocDischargeReportOrthopedics, Medication/MedAspirin, MedicationStatement/MedicationConcor, MedicationStatement/MedicationEntresto, Orthopedic Surgery, Questionnaire/QuestionnaireSmokingStatus, QuestionnaireResponse/QuestionnaireResponseSmokingStatus, Sarcoma Tumor Board, ServiceRequest/ReferralOrthopedicSurgery, ServiceRequest/ReferralTumorboard, Task/TaskReferralOrthopedicSurgeryCompleted and Task/TaskReferralOrthopedicSurgeryUpdated

Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (ch.fhir.ig.ch-umzh-connect.r4) and R4B (ch.fhir.ig.ch-umzh-connect.r4b) are available.

Dependency Table

Package hl7.fhir.uv.extensions.r4#5.2.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Mon, Feb 10, 2025 21:45+1100+11:00)

Package hl7.fhir.uv.extensions.r4#5.3.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, May 16, 2026 18:32+1000+10:00)

Package hl7.fhir.uv.extensions.r4#5.3.0-ballot-tc1 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Aug 3, 2025 06:28+1000+10:00)

Package ch.fhir.ig.ch-core#6.0.0 FHIR implementation guide CH Core (built Tue, Dec 16, 2025 07:58+0000+00:00)

Package ch.fhir.ig.ch-emed#6.0.0 Implementation Guide for the eMedication in Switzerland. (built Tue, Dec 16, 2025 11:07+0000+00:00)

Package hl7.fhir.uv.sdc#3.0.0 The SDC specification provides an infrastructure to standardize the capture and expanded use of patient-level data collected within an EHR. This includes two components: * Support more sophisticated questionnaire/form use-cases such as those needed for research, oncology, pathology and other clinical domains. *Support pre-population and auto-population of EHR data into forms/questionnaires for uses outside direct clinical care (patient safety, adverse event reporting, public health reporting, etc.). (built Tue, Mar 8, 2022 18:32+0000+00:00)

Package ch.fhir.ig.ch-orf#3.0.2 Order & Referral by Form - Implementation Guide (CH ORF) (built Tue, Dec 16, 2025 09:33+0000+00:00)

Package ch.fhir.ig.ch-etoc#3.0.1 Implementation guide for eTOC based on CH ORF (built Tue, Dec 16, 2025 15:53+0000+00:00)

Package hl7.fhir.uv.subscriptions-backport.r4#1.1.0 The Subscription R5 Backport Implementation Guide enables servers running versions of FHIR earlier than R5 to implement a subset of R5 Subscriptions in a standardized way. (built Wed, Jan 11, 2023 15:34+1100+11:00)

Package hl7.fhir.uv.cow#1.0.0-ballot An Implementation Guide providing the foundational guidance for order-based workflow FHIR interoperability (built Mon, Apr 7, 2025 15:35+0000+00:00)

Package hl7.fhir.uv.tools.r4#1.1.2 This IG defines the extensions that the tools use internally. Some of these extensions are content that are being evaluated for elevation into the main spec, and others are tooling concerns (built Tue, Mar 24, 2026 11:13+1100+11:00)

Globals Table

There are no Global profiles defined