Implementasi Use Case Tuberculosis

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Implementasi pelaporan kasus Tuberculosis (TB) secara umum dapat dikelompokkan menjadi 5 tahapan proses sebagai berikut:

  1. Registrasi Kasus
  2. Case Finding
  3. Verifikasi Kasus
  4. Kunjungan Pengobatan bulanan
  5. Kunjungan Akhir Pengobatan

Proses dimulai dari meregistrasikan kasus yang berupa identitas pasien dan fasilitas pelayanan kesehatan tempat terjadinya pemeriksaan disertai dengan permintaan pemeriksaan penunjang (laboratorium dan radiologi) yang dibutuhkan untuk dapat melakukan case finding. Hasil temuan yang diperoleh dari pemeriksaan penunjang digunakan untuk melakukan verifikasi data kasus untuk menentukan bagaimana perawatan(pengobatan) kasus Tuberculosis selanjutnya.

Data yang telah Terkonfirmasi Bakteriologis dan Terdiagnosis Klinis akan ditindaklanjuti dengan pencatatan pada kunjungan perawatan bulanan. Data kunjungan tiap bulan tersebut dicatat dan dikirim sesuai tata laksana yaitu pada bulan kedua, ketiga dan kelima secara rutin. Baru kemudian pada kunjungan akhir perawatan dilakukan pencatatan hasil akhir dan dikirimkan ke SATUSEHAT.

Secara detail alur proses pencatatan dapat digambarkan sebagai berikut:

Semua resource yang mungkin terlibat dalam pencatatan ini adalah sebagai berikut:

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Gambar: Detail Pencatatan Perawatan TB secara lengkap. Lihat gambar dari sumber aslinya Diagram TB

Pengiriman bundle data ke SATUSEHAT dapat dilakukan mengikuti kunjungan perawatan atau secara bulk pada akhir proses. Akan tetapi komponen-komponen yang terlibat dalam tahapan proses dapat dikirimkan sebagai entry pada bundle yang dikirim.

No Resource Entry Mandatory
1 Encounter * Required
2 ServiceRequest * Required
3 Observation Required
4 Media * Optional
5 DiagnosticReport * Required
6 Condition Required
7 EpisodeOfCare Required
8 Medication Optional
9 MedicationRequest Optional
10 MedicationDispense Optional
11 CarePlan Required
12 QuestionnaireResponse Required

* ) Profile Resource yang harapkan oleh CHISU tersedia pada proses pencatatan Mandatory )

  1. Required: Entry resource harus dilibatkan setiap kali mengirimkan bundle
  2. Optional: Entry resource dapat tidak dilibatkan setiap kali mengirimkan bundle

Berikut adalah format Bundle data yang dikirim oleh masing-masing proses:

A. Registrasi Kasus

Bundle ini secara khusus untuk meregistrasikan data pasien, fasyankes tempat pemeriksaan serta permintaan pemeriksaan laboratorium atau radiologis. Karena data pasien di dalam SATUSEHAT sudah terdaftar lebih dulu, sehingga registrasi data pasien baru tidak perlukan. Dengan demikian maka entry data untuk resource Patient tidak perlu diikutsertakan dalam bundle data yang dikirim.

Disamping itu terkait dengan data FASYANKES tempat dilakukannya perawatan TB juga tidak perlu dikirimkan data alamat seperti Provinsi, dan Kabupaten/Kota karena data sudah tersedia pada Facility Master Index yang ada di SATUSEHAT. Referensi terkait data FASYANKES dapat dilakukan menggunakan kode referensi SATUSEHAT Number FASYANKES untuk menandai EpisodeOfCare.managingOrganization dan Encounter.serviceProvider.

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Entry Resources yang digunakan

No Resource Entry Mandatory
1 Encounter Required
2 Condition Required
3 Observation Required
4 ServiceRequest Required

1. Encouter

{
    "resourceType": "Encounter",
    "identifier": [
        {
            "use": "official",
            "system": "http://sys-ids.kemkes.go.id/encounter/$IHS_NUMBER_FASKES",
            "value": "$ID_ENCOUNTER_2"
        }
    ],
    "status": "finished",
    "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB",
        "display": "ambulatory"
    },
    "priority": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/ValueSet/v3-ActPriority",
                "code": "R",
                "display": "routine"
            }
        ]
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "participant": [
        {
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                            "code": "ATND"
                        }
                    ]
                }
            ],
            "individual": {
                "reference": "Practitioner/$IHS_NUMBER_DOKTER"
            }
        }
    ],
    "serviceProvider": {
        "reference": "Organization/$IHS_NUMBER_FASYANKES"
    }
}
        
Variabel Deskripsi
$ID_ENCOUNTER_1 UUID Encounter yang digenerate
$ID_ENCOUNTER_2 UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES

2. Condition

Keluhan(anamnesis) pasien saat berkunjung (jika ada)

{
  "id": "$GENERATED_UUID_CONDITION1",
  "subject": {
    "reference": "Patient/$IHS_NUMBER_PASIEN",
    "display": "$NAMA_PASIEN"
  },
  "encounter": {
    "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
  },
  "code": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/sid/icd-10",
        "code": "$ICD10_CODE_R00_R99_SIGN_SYMPTOPM",
        "display": "$ICD10_DISPLAY_R00_R99_SIGN_SYMPTOPM"
      }
    ]
  },
  "category": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/condition-category",
        "code": "problem-list-item",
        "display": "Problem List Item"
      }
    ]
  },
  "bodySite": [
    {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "38266002",
          "display": "Entire body as a whole"
        }
      ]
    }
  ],
  "clinicalStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
        "code": "active",
        "display": "Active"
      }
    ]
  }
}
        

Kode diagnosa ICD-10 untuk Pasien yang masih suspek TB

{
    "resourceType": "Condition",
    "id": "$GENERATED_UUID_CONDITION2",
    "clinicalStatus": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
                "code": "active",
                "display": "Active"
            }
        ]
    },
    "code": {
        "coding": [
            {
                "system": "http://hl7.org/fhir/sid/icd-10",
                "code": "$CODE_ICD10",
                "display": "$TEXT_ICD10"
            }
        ]
    }
}
        
Variabel Deskripsi
$GENERATED_UUID_CONDITION1 UUID Condition Keluhan/Anamnesis yang digenerate
$GENERATED_UUID_CONDITION2 UUID Condition Diagnosis ICD-10 yang digenerate
$CODE_PROBLEM_OR_ILLNESS Kode keluhan(anamnesis) dimana konsepnya is-a 404684003 (Clinical finding)
$CODE_ICD10 Kode ICD-10 untuk diagnosis Tuberculosis

3. Observation

Pemeriksaan VitalSign baik yang dilakukan oleh Perawat maupun Dokter

{
  "resourceType": "Observation",
  "identifier": [
    {
      "system": "http://sys-ids.kemkes.go.id/observation/$IHS_NUMBER_FASKES",
      "value": "$GENERATED_LOCALID_OBSERVATION"
    }
  ],  
  "encounter": {
    "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
  },
  "category": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/observation-category",
        "code": "vital-signs"
      }
    ],
    "text": "Vital Signs"
  },
  "code": {
    "coding": [
      {
        "system": "$CODE_SYSTEM_VITAL_SIGNS",
        "code": "$CODE_NAME_VITAL_SIGNS",
        "display": "$DISPLAY_NAME_VITAL_SIGNS"
      }
    ]
  },
  "value": $VALUE_VITAL_SIGNS
}
        
Variabel Deskripsi
$GENERATED_UUID_ENCOUNTER UUID Encounter yang digenerate
$CODE_SYSTEM_VITAL_SIGNS CodeSystem untuk jenis pemeriksaan Vital Sign
$DISPLAY_NAME_VITAL_SIGNS Display name jenis pemeriksaan Vital Sign
$VALUE_VITAL_SIGNS Nilai pemeriksaan Vital Sign

4. ServiceRequest

{
    "resourceType": "ServiceRequest",
    "identifier": [
        {
            "system": "http://sys-ids.kemkes.go.id/servicerequest/$IHS_NUMBER_FASKES",
            "use": "official",
            "value": "$GENERATED_LOCALID_SERVICEREQUEST"
        }
    ],
    "status": "completed",
    "intent": "directive",
    "priority": "routine",
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "647-8",
                "display": "Microscopic observation [Identifier] in Sputum by Acid fast stain.Ziehl-Neelsen"
            }
        ]
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN"
    },
    "encounter": {
        "reference": "Encounter/$ID_ENCOUNTER_1"
    },
    "occurrenceDateTime": "2022-02-01T08:00:00+07:00",
    "requester": {
        "reference": "Organization/$IHS_NUMBER_FASYANKES"
    },
    "performer": [
        {
            "reference": "Organization/$IHS_NUMBER_FASYANKES"
        }
    ]
}

{
    "resourceType": "ServiceRequest",
    "identifier": [
        {
            "system": "lab-x-service-request-number",
            "value": "$GENERATED_UUID_SERVICE_REQUEST_NUMBER_2",
            "assigner": {
                "reference": "Organization/$IHS_NUMBER_FASYANKES"
            }
        }
    ],
    "status": "completed",
    "intent": "directive",
    "priority": "routine",
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "89371-9",
                "display": "MTB complex DNA and rpoB RIF resistance mutation panel [Presence]"
            }
        ]
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN"
    },
    "encounter": {
        "reference": "Encounter/$ID_ENCOUNTER_1"
    },
    "occurrenceDateTime": "2022-02-01T08:00:00+07:00",
    "requester": {
        "reference": "Organization/$IHS_NUMBER_FASYANKES"
    },
    "performer": [
        {
            "reference": "Organization/$IHS_NUMBER_FASYANKES"
        }
    ]
}

{
    "resourceType": "ServiceRequest",
    "identifier": [
        {
            "system": "lab-x-service-request-number",
            "value": "$GENERATED_UUID_SERVICE_REQUEST_NUMBER_3",
            "assigner": {
                "reference": "Organization/$IHS_NUMBER_FASYANKES"
            }
        }
    ],
    "status": "completed",
    "intent": "directive",
    "priority": "routine",
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "539-7",
                "display": "Mycobacterium sp identified in Sputum by Organism specific culture"
            }
        ]
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN"
    },
    "encounter": {
        "reference": "Encounter/$ID_ENCOUNTER_1"
    },
    "occurrenceDateTime": "2022-02-01T08:00:00+07:00",
    "requester": {
        "reference": "Organization/$IHS_NUMBER_FASYANKES"
    },
    "performer": [
        {
            "reference": "Organization/$IHS_NUMBER_FASYANKES"
        }
    ]
}

{
    "resourceType": "ServiceRequest",
    "identifier": [
        {
            "system": "lab-x-service-request-number",
            "value": "$GENERATED_UUID_SERVICE_REQUEST_NUMBER_4",
            "assigner": {
                "reference": "Organization/$IHS_NUMBER_FASYANKES"
            }
        }
    ],
    "status": "completed",
    "intent": "directive",
    "priority": "routine",
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "24648-8",
                "display": "XR Chest PA upright"
            }
        ]
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN"
    },
    "encounter": {
        "reference": "Encounter/$ID_ENCOUNTER_1"
    },
    "occurrenceDateTime": "2022-02-01T08:00:00+07:00",
    "requester": {
        "reference": "Organization/$IHS_NUMBER_FASYANKES"
    },
    "performer": [
        {
            "reference": "Organization/$IHS_NUMBER_FASYANKES"
        }
    ]
}
Variabel Deskripsi
$GENERATED_UUID_SERVICE_REQUEST_NUMBER_1 UUID ServiceRequest yang digenerate untuk permintaan pemeriksaan mikroskopis
$GENERATED_UUID_SERVICE_REQUEST_NUMBER_2 UUID ServiceRequest yang digenerate untuk permintaan pemeriksaan test cepat
$GENERATED_UUID_SERVICE_REQUEST_NUMBER_3 UUID ServiceRequest yang digenerate untuk permintaan pemeriksaan biakan
$GENERATED_UUID_SERVICE_REQUEST_NUMBER_4 UUID ServiceRequest yang digenerate untuk permintaan pemeriksaan foto thorax
$ID_ENCOUNTER_1 UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES

B. Case Finding

Bundle Case Finding merupakan respon dari proses registrasi dan permintaan pemeriksaan laboratorium atau radiologis berupa DiagnosticReport.

CATATAN: Hasil pemeriksaan dapat mereferensi ke Encounter (kunjungan) yang sama dengan Encounter registrasi, jika hasil pemeriksaan dapat diperoleh di hari yang sama. Jika hasil pemeriksaan tidak bisa segera didapatkan maka harus membentuk Encounter baru.

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Entry Resources yang digunakan

No Resource Entry Mandatory
1 Encounter Required
2 Media Optional
3 Observation Required
4 DiagnosticReport Required

1. Encouter

{
    "resourceType": "Encounter",
    "identifier": [
        {
            "use": "official",
            "system": "http://sys-ids.kemkes.go.id/encounter/$IHS_NUMBER_FASKES",
            "value": "$ID_ENCOUNTER_2"
        }
    ],
    "status": "finished",
    "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB",
        "display": "ambulatory"
    },
    "priority": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/ValueSet/v3-ActPriority",
                "code": "R",
                "display": "routine"
            }
        ]
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "participant": [
        {
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                            "code": "ATND"
                        }
                    ]
                }
            ],
            "individual": {
                "reference": "Practitioner/$IHS_NUMBER_DOKTER"
            }
        }
    ],
    "serviceProvider": {
        "reference": "Organization/$IHS_NUMBER_FASYANKES"
    }
}
        
Variabel Deskripsi
$ID_ENCOUNTER_1 UUID Encounter yang digenerate
$ID_ENCOUNTER_2 UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES

2. Media

{
    "resourceType": "Media",
    "id": "$GENERATED_UUID_MEDIA",
    "status": "completed",
    "type": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/media-type",
                "code": "image",
                "display": "Image"
            }
        ]
    },
    "modality": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/media-modality",
                "code": "diagram"
            }
        ]
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN"
    },
    "createdDateTime": "2022-07-07",
    "issued": "2022-07-07T00:00:00Z",
    "operator": {
        "reference": "Practitioner/$IHS_NUMBER_DOKTER"
    },
    "height": $IMAGE_HEIGHT,
    "width": $IMAGE_WIDTH,
    "frames": 1,
    "content": {
        "contentType": "image/$IMAGE_TYPE",
        "data": "$IMAGE_BASE64_DATA",
        "creation": "$IMAGE_CREATION"
    }
}
        
Variabel Deskripsi
$GENERATED_UUID_MEDIA UUID Media yang digenerate
$IMAGE_TYPE Tipe image media
$IMAGE_BASE64_DATA Base64 Binary image data
$IMAGE_HEIGHT Height (tinggi) image
$IMAGE_WIDTH Width (panjang) image
$IMAGE_CREATION Image creation date
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes

3. Observation

Hasil Pemeriksaan Mikroskopis

{
    "resourceType": "Observation",
    "identifier": [
        {
            "system": "http://sys-ids.kemkes.go.id/observation/$IHS_NUMBER_FASKES",
            "value": "$GENERATED_LOCALID_OBSERVATION"
        }
    ],
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "647-8"
                "display": "Microscopic observation [Identifier] in Sputum by Acid fast stain.Ziehl-Neelsen"
            }
        ]
    },
    "category": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                "code": "laboratory"
            }
        ],
        "text": "Laboratory"
    },
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "value": {
        "coding": [
            {
                "system": "$CODE_OBSERVATION_1",
                "code": "$VALUE_OBSERVATION_1",
                "display": "$DISPLAY_OBSERVATION_1",
            }
        ]
    },
    "dataAbsentReason": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/data-absent-reason",
                "code": "not-performed",
                "display": "Not Performed"
            }
        ]
    }
}
        

Hasil Pemeriksaan Test Cepat

{
    "resourceType": "Observation",
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "89371-9",
                "display": "MTB complex DNA and rpoB RIF resistance mutation panel [Presence]"
            }
        ]
    },
    "category": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                "code": "laboratory",
                "display": "Laboratory"
            }
        ]
    },
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "value": {
        "coding": [
            {
                "system": "$CODE_OBSERVATION_2",
                "code": "$VALUE_OBSERVATION_2",
                "display": "$DISPLAY_OBSERVATION_2"
            }
        ]
    },
    "dataAbsentReason": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/data-absent-reason",
                "code": "not-performed",
                "display": "Not Performed"
            }
        ]
    }
}
        

Hasil Pemeriksaan Biakan

{
    "resourceType": "Observation",
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "539-7",
                "display": "Mycobacterium sp identified in Sputum by Organism specific culture"
            }
        ]
    },
    "category": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                "code": "laboratory",
                "display": "Laboratory"
            }
        ]
    },
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "value": {
        "coding": [
            {
                "system": "$CODE_OBSERVATION_3",
                "code": "$VALUE_OBSERVATION_3",
                "display": "$DISPLAY_OBSERVATION_3"
            }
        ]
    },
    "dataAbsentReason": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/data-absent-reason",
                "code": "not-performed",
                "display": "Not Performed"
            }
        ]
    }
}
        

Hasil Pemeriksaan Foto Thorax

{
    "resourceType": "Observation",
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "24648-8",
                "display": "XR Chest PA upright"
            }
        ]
    },
    "category": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                "code": "imaging",
                "display": "Imaging"
            }
        ]
    },
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "value": {
        "coding": [
            {
                "system": "$CODE_OBSERVATION_4",
                "code": "$VALUE_OBSERVATION_4",
                "display": "$DISPLAY_OBSERVATION_4"
            }
        ]
    },
    "dataAbsentReason": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/data-absent-reason",
                "code": "not-performed",
                "display": "Not Performed"
            }
        ]
    }
}
        
Variabel Deskripsi
$GENERATED_UUID_ENCOUNTER UUID Encounter yang digenerate
$CODE_OBSERVATION_1 CodeSystem pemeriksaan mikroskopis
$CODE_OBSERVATION_2 CodeSystem pemeriksaan test cepat
$CODE_OBSERVATION_3 CodeSystem pemeriksaan biakan
$CODE_OBSERVATION_4 CodeSystem pemeriksaan foto thorax
$VALUE_OBSERVATION_1 Value pemeriksaan mikroskopis
$VALUE_OBSERVATION_2 Value pemeriksaan test cepat
$VALUE_OBSERVATION_3 Value pemeriksaan biakan
$VALUE_OBSERVATION_4 Value pemeriksaan foto thorax

4. DiagnosticReport

{
    "resourceType": "DiagnosticReport",
    "identifier": [
        {
            "system": "http://sys-ids.kemkes.go.id/diagnostic/$IHS_NUMBER_FASKES/lab",
            "use": "official",
            "value": "$GENERATED_UUID_DIAGNOSTIC_REPORT"
        }
    ],
    "status": "final",
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "????"
            }
        ],
        "text": "????"
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN"
    },
    "effectiveDateTime": "2022-07-07",
    "issued": "2022-07-07T00:00:00+07:00",
    "performer": [
        {
            "reference": "Organization/$IHS_NUMBER_FASYANKES",
            "display": "$NAMA_FASYANKES"
        }
    ],
    "result": [
        {
            "reference": "Observation/$GENERATED_UUID_OBSERVATION_1"
        },
        {
            "reference": "Observation/$GENERATED_UUID_OBSERVATION_2"
        },
        {
            "reference": "Observation/$GENERATED_UUID_OBSERVATION_3"
        },
        {
            "reference": "Observation/$GENERATED_UUID_OBSERVATION_4"
        }
    ],
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "conclusionCode": [
        {
            "coding": [
                {
                    "system": "http://snomed.info/sct",
                    "code": "$SNOMEDCT_TB_CONCLUSION",
                    "display": "$SNOMEDCT_TB_CONCLUSION_DISPLAY"
                }
            ]
        }
    ]
}
        
Variabel Deskripsi
$GENERATED_UUID_DIAGNOSTIC_REPORT UUID DiagnosticReport yang digenerate
$GENERATED_UUID_OBSERVATION_1 UUID pemeriksaan mikroskopis yang digenerate
$GENERATED_UUID_OBSERVATION_2 UUID pemeriksaan test cepat yang digenerate
$GENERATED_UUID_OBSERVATION_3 UUID pemeriksaan biakan yang digenerate
$GENERATED_UUID_OBSERVATION_4 UUID pemeriksaan foto thorax yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES
$NAMA_FASYANKES Nama FASYANKES
$SNOMEDCT_TB_CONCLUSION Kode SNOMED CT hasil diagnosa
$SNOMEDCT_TB_CONCLUSION_DISPLAY Teks SNOMED CT hasil diagnosa

C. Verifikasi Kasus

Data verifikasi kasus temuan merupakan kumpulan data hasil pemeriksaan lab dan diagnosis kasus TB yang terbungkus melalui resource Encounter (kunjungan).

Pembuatan Resource EpisodeOfCare bergantung pada hasil asesmen kasus TB. Jika asesmen menyatakan bahwa kasus Terkonfirmasi Bakteriologis atau Terdiagnosis Klinis maka entry resource EpisodeOfCare harus dipersiapkan terlebih dahulu sebagai wadah referensi untuk tiap Encounter yang dibuat baik pada tahap verifikasi kasus maupun saat melakukan kunjungan perawatan TB. Jika hasil asesmen tidak merujuk pada kesimpulan tersebut maka tidak perlu dibuatkan EpisodeOfCare, MedicationStatement dan QuestionnaireResponse untuk melengkapi pencatatan TB. Dengan demikian maka kasus dapat ditutup.

alt text

Entry Resources yang digunakan

No Resource Entry Mandatory
1 Condition Required
2 EpisodeOfCare Required
3 Encounter Required
4 Medication Optional
5 MedicationRequest Optional
6 MedicationDispense Optional
7 CarePlan Required
8 QuestionnaireResponse Required

1. Condition

{
    "resourceType": "Condition",
    "id": "$GENERATED_UUID_DIAGNOSIS",
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "clinicalStatus": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
                "code": "active",
                "display": "Active"
            }
        ]
    },
    "code": {
        "coding": [
            {
                "system": "http://hl7.org/fhir/sid/icd-10",
                "code": "$CODE_ICD10"
                "display": "$DISPLAY_ICD10"
            }
        ]
    }
}
        
Variabel Deskripsi
$GENERATED_UUID_DIAGNOSIS UUID untuk Diagnosis ICD-10 TB yang digenerate
$CODE_ICD10 Kode ICD-10 untuk diagnosis Tuberculosis

2. EpisodeOfCare

{
    "resourceType": "EpisodeOfCare",
    "id": "$GENERATED_UUID_EPISODEOFCARE",
    "status": "active",
    "patient": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "managingOrganization": {
        "reference": "Organization/$IHS_NUMBER_FASYANKES"
    },
    "period": {
        "start": "$DATETIME_MULAI_PENGOBATAN"
    }
}
        
Variabel Deskripsi
$GENERATED_UUID_EPISODEOFCARE UUID EpisodeOfCare yang digenerate
$DATETIME_MULAI_PENGOBATAN DateTime mulai pengobatan TB
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES

3. Encounter

{
    "resourceType": "Encounter",
    "identifier": [
        {
            "use": "official",
            "system": "http://sys-ids.kemkes.go.id/encounter/$IHS_NUMBER_FASKES",
            "value": "$ID_ENCOUNTER_2"
        }
    ],
    "status": "finished",
    "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB",
        "display": "ambulatory"
    },
    "priority": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/ValueSet/v3-ActPriority",
                "code": "R",
                "display": "routine"
            }
        ]
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "participant": [
        {
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                            "code": "ATND",
                            "display": "attender"
                        }
                    ]
                }
            ],
            "individual": {
                "reference": "Practitioner/$IHS_NUMBER_DOKTER"
            }
        }
    ],
    "serviceProvider": {
        "reference": "Organization/$IHS_NUMBER_FASYANKES"
    }
}
        
Variabel Deskripsi
$ID_ENCOUNTER_1 UUID Encounter yang digenerate
$ID_ENCOUNTER_2 UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES

4. Medication

{
    "resourceType": "Medication",
    "identifier": [
        {
            "use": "official",
            "system": "http://sys-ids.kemkes.go.id/medication/$IHS_NUMBER_FASKES",
            "value": "$GENERATED_UUID_MEDICATION"
        }
    ],
    "code": {
        "coding": [
            {
                "system": "http://hl7.org/fhir/sid/ndc",
                "code": "$CODE_OBAT_TB",
                "display": "$CODE_NAMA_OBAT_TB"
            }
        ]
    },
    "form": {
        "coding": [
            {
                "system": "http://snomed.info/sct",
                "code": "$KODE_BENTUK_SEDIAAN",
                "display": "$NAMA_BENTUK_SEDIAAN"
            }
        ]
    }
}
        
Variabel Deskripsi
$CODE_OBAT_TB Kode obat sesuai kategori perawatan TB
$CODE_NAMA_OBAT_TB Nama obat sesuai kategori perawatan TB
$KODE_BENTUK_SEDIAAN Kode bentuk sediaan obat
$NAMA_BENTUK_SEDIAAN Nama bentuk sedian obat

5. MedicationRequest

{
    "resourceType": "MedicationStatement",
    "id": "$GENERATED_UUID_MEDICATION_REQUEST",
    "subject": "Patient/$IHS_NUMBER_PASIEN",
    "context": "EpisodeOfCare/$GENERATED_UUID_EPISODEOFCARE",
    "status": "active",
    "category": {
        "coding": [
            {
                "system": "http://hl7.org/fhir/ValueSet/medication-statement-category",
                "code": "outpatient"
            }
        ]
    },
    "medicationReference": {
        "reference": "Medication/$GENERATED_UUID_MEDICATION"
    },
    "basedOn": [
        {
            "reference": "CarePlan/$GENERATED_UUID_CAREPLAN"
        }
    ],
    "dosageInstruction": [
        {
            "sequence": 1,
            "text": "Take a tablet daily for a month starting $TANGGAL_MULAI_PENGOBATAN",
            "timing": {
                "repeat": {
                "boundsPeriod": {
                    "start": "$TANGGAL_MULAI_PENGOBATAN",
                    "end": "$TANGGAL_KUNJNGAN_BULANAN_BERIKUTNYA"
                },
                "frequency": 1,
                "period": 1,
                "periodUnit": "d"
                }
            },
            "route": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "26643006",
                        "display": "Oral Route"
                    }
                ]
            },
            "method": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "421521009",
                        "display": "Swallow - dosing instruction imperative (qualifier value)"
                    }
                ]
            },
            "doseAndRate": [
                {
                    "type": {
                        "coding": [
                            {
                                "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type",
                                "code": "ordered",
                                "display": "Ordered"
                            }
                        ]
                    },
                    "doseQuantity": {
                        "value": 1,
                        "unit": "TAB",
                        "system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
                        "code": "TAB"
                    }
                }
            ]
        }
    ]
}
        
Variabel Deskripsi
$GENERATED_UUID_MEDICATION_REQUEST UUID MedicationRequest yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$GENERATED_UUID_EPISODEOFCARE UUID EpisodeOfCare yang digenerate
$GENERATED_UUID_MEDICATION UUID Medication yang digenerate
$GENERATED_UUID_CAREPLAN UUID CarePlan yang digenerate

6. MedicationDispense

{
    "resourceType": "MedicationDispense",
    "id": "$GENERATED_UUID_MEDICATION_DISPENSE",
    "status": "completed",
    "medicationReference": {
        "reference": "Medication/$GENERATED_UUID_MEDICATION"
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "context": {
        "reference": "EpisodeOfCare/$GENERATED_UUID_EPISODEOFCARE"
    },
    "performer": [
        {
            "actor": {
                "reference": "Practitioner/$IHS_NUMBER_DOKTER"
            }
        }
    ],
    "authorizingPrescription": [
        {
        "reference": "MedicationRequest/$GENERATED_UUID_MEDICATION_REQUEST"
        }
    ],
    "type": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                "code": "RFP",
                "display": "Refill - Part Fill"
            }
        ]
    },
    "quantity": {
        "value": 30,
        "system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
        "code": "TAB"
    },
    "daysSupply": {
        "value": 30,
        "unit": "Day",
        "system": "http://unitsofmeasure.org",
        "code": "d"
    },
    "whenPrepared": "$DATETIME_OBAT_DISIAPKAN",
    "whenHandedOver": "$DATETIME_OBAT_DIBERIKAN",
    "dosageInstruction": [
        {
            "sequence": 1,
            "text": "Take a tablet daily for a month starting $DATE_MULAI_PENGOBATAN",
            "timing": {
                "repeat": {
                    "boundsPeriod": {
                        "start": "$DATE_MULAI_PENGOBATAN",
                        "end": "$DATE_KUNJUNGAN_BULANAN_BERIKUTNYA"
                    },
                    "frequency": 1,
                    "period": 1,
                    "periodUnit": "d"
                }
            },
            "route": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "26643006",
                        "display": "Oral Route"
                    }
                ]
            },
            "method": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "421521009",
                        "display": "Swallow - dosing instruction imperative (qualifier value)"
                    }
                ]
            },
            "doseAndRate": [
                {
                    "type": {
                        "coding": [
                            {
                                "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type",
                                "code": "ordered",
                                "display": "Ordered"
                            }
                        ]
                    },
                    "doseQuantity": {
                        "value": 1,
                        "unit": "TAB",
                        "system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
                        "code": "TAB"
                    }
                }
            ]
        }
    ]
}
        
Variabel Deskripsi
$GENERATED_UUID_MEDICATION_DISPENSE UUID MedicationDispense yang digenerate
$GENERATED_UUID_MEDICATION_REQUEST UUID MedicationRequest yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$GENERATED_UUID_EPISODEOFCARE UUID EpisodeOfCare yang digenerate
$GENERATED_UUID_MEDICATION UUID Medication yang digenerate
$DATETIME_OBAT_DISIAPKAN Tanggal dan jam obat disiapkan
$DATETIME_OBAT_DIBERIKAN Tanggal dan jam obat diberikan
$DATE_MULAI_PENGOBATAN Tanggal mulai pemberian obat
$DATE_KUNJUNGAN_BULANAN_BERIKUTNYA Tanggal kunjungan ulang (kontrol) bulan berikutnya

7. CarePlan

{
    "resourceType": "CarePlan",
    "id": "$GENERATED_UUID_CAREPLAN",
    "contained": [
        {
            "resourceType": "Goal",
            "id": "goal",
            "lifecycleStatus": "planned",
            "description": {
                "text": "Follow-up consultation"
            },
            "subject": {
                "reference": "Patient/$IHS_NUMBER_PASIEN",
                "display": "$NAMA_PASIEN"
            }
        }
    ],
    "status": "active",
    "intent": "plan",
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "addresses": [
        {
        "reference": "Condition/$GENERATED_UUID_DIAGNOSIS"
        }
    ],
    "goal": [
        {
            "reference": "#goal"
        }
    ],
    "activity": [
        {
            "detail": {
                "kind": "Appointment",
                "code": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "281036007"
                    }
                ],
                "text": "Follow-up consultation (procedure)"
                },
                "status": "scheduled",
                "doNotPerform": false,
                "performer": [
                    {
                        "reference": "Practitioner/$IHS_NUMBER_DOKTER",
                        "display": "$NAMA_DOKTER"
                    }
                ]
            }
        }
    ]
}
        
Variabel Deskripsi
$GENERATED_UUID_CAREPLAN UUID CarePlan yang digenerate
$GENERATED_UUID_DIAGNOSIS UUID untuk Diagnosis ICD-10 TB yang digenerate
$GENERATED_UUID_ENCOUNTER UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NAMA_DOKTER Nama Dokter/Nakes

8. QuestionnaireResponse

{
    "resourceType": "QuestionnaireResponse",
    "questionnaire": "https://fhir.kemkes.go.id/Questionnaire/Q0001",
    "status": "completed",
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
      },
    "authored": "$TIMESTAMP_AUTHORED",
    "author": {
        "reference": "Practitioner/$IHS_NUMBER_DOKTER"
    },
    "source": {
        "reference": "Patient/$IHS_NUMBER_PASIEN"
    },
    "item": [
        {
            "linkId": "1",
            "text": "Tipe diagnosis tuberkulosis",
            "answer": [
                {
                    "valueCoding": {
                        "system": "https://terminology.kemkes.go.id/CodeSystem/tb-case-definition",
                        "code": "$CODE_TB_CASE",
                        "display": "$DISPLAY_TB_CASE"
                    }
                }
            ]
        },
        {
            "linkId": "2",
            "text": "Klasifikasi tuberkulosis berdasarkan lokasi anatomis",
            "answer": [
                {
                    "valueCoding": {
                        "system": "https://terminology.kemkes.go.id/CodeSystem/tb-anatomical",
                        "code": "$CODE_TB_ANATOMICAL",
                        "display": "$DISPLAY_TB_ANATOMICAL"
                    }
                }
            ]
        },
        {
            "linkId": "3",
            "text": "Klasifikasi tuberkulosis berdasarkan riwayat pengobatan",
            "answer": [
                {
                    "valueCoding": {
                        "system": "https://terminology.kemkes.go.id/CodeSystem/prev-tb-treatment",
                        "code": "$CODE_TB_TREATMENT",
                        "display": "$DISPLAY_TB_TREATMENT"
                    }
                }
            ]
        }
    ]
}
        
Variabel Deskripsi
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$GENERATED_UUID_ENCOUNTER UUID Encounter yang digenerate
$TIMESTAMP_AUTHORED Tanggal dan waktu Questionnaire dibuat
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$CODE_TB_CASE Kode Tipe diagnosis TB (lihat ValueSet)
$DISPLAY_TB_CASE Teks display Tipe diagnosis TB (lihat ValueSet)
$CODE_TB_ANATOMICAL Kode klasifikasi Anatomis (lihat ValueSet)
$DISPLAY_TB_ANATOMICAL Teks display klasifikasi Anatomis (lihat ValueSet)
$CODE_TB_TREATMENT Kode riwayat pengobatan (lihat ValueSet)
$DISPLAY_TB_TREATMENT Teks display riwayat pengobatan (lihat ValueSet)

Tipe diagnosis tuberkulosis

Code System https://terminology.kemkes.go.id/CodeSystem/tb-case-definition
Value Set url https://terminology.kemkes.go.id/ValueSet/tb-case-definition
Kode Teks Display
tb-bac Terkonfirmasi bakteriologis
tb-clin Terdiagnosis klinis

Klasifikasi tuberkulosis berdasarkan lokasi anatomis

Code System https://terminology.kemkes.go.id/CodeSystem/tb-anatomical
Value Set url https://terminology.kemkes.go.id/ValueSet/tb-anatomical
Kode Teks Display
PTB TB Paru
EPTB TB Ekstraparu

Klasifikasi tuberkulosis berdasarkan riwayat pengobatan

Code System https://terminology.kemkes.go.id/CodeSystem/prev-tb-treatment
Value Set url https://terminology.kemkes.go.id/ValueSet/prev-tb-treatment
Kode Teks Display
new Kasus Baru
relapse Kasus Kambuh
failure Kasus Pengobatan Setelah Gagal
failure-cat1 Kasus Pengobatan Setelah Gagal Kategori 1
failure-cat2 Kasus Pengobatan Setelah Gagal Kategori 2
failure-2line Kasus Pengobatan Setelah Gagal lini 2
loss-to-follow-up Kasus Setelah Loss To Follow Up
other Kasus lain-lain
unknown Kasus dengan riwayat pengobatan tidak diketahui

D. Kunjungan Pengobatan TB bulanan

Bundle ini digunakan untuk mencatat hasil kunjungan perawatan TB setiap bulannya selama proses pengobatan (sesuai desain integrasi SITB hasil dilaporkan pada bulan 2, 3 dan 5). Setiap kunjungan harus dibungkus dengan Resource Encounter dengan menyebutkan referensi ID EpisodeOfCare pada tiap Encounter tersebut untuk menandakan kunjungan dalam satu episode yang sama.

alt text

Entry Resources yang digunakan

No Resource Entry Mandatory
1 Encounter Required
2 ServiceRequest Required
3 DiagnosticReport Required
4 Condition Required
5 Observation Required
6 MedicationDispense Optional
7 CarePlan Required

1. Encouter

{
    "resourceType": "Encounter",
    "identifier": [
        {
            "use": "official",
            "system": "http://sys-ids.kemkes.go.id/encounter/$IHS_NUMBER_FASKES",
            "value": "$ID_ENCOUNTER_2"
        }
    ],
    "status": "finished",
    "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB",
        "display": "ambulatory"
    },
    "priority": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/ValueSet/v3-ActPriority",
                "code": "R",
                "display": "routine"
            }
        ]
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "participant": [
        {
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                            "code": "ATND"
                        }
                    ]
                }
            ],
            "individual": {
                "reference": "Practitioner/$IHS_NUMBER_DOKTER"
            }
        }
    ],
    "serviceProvider": {
        "reference": "Organization/$IHS_NUMBER_FASYANKES"
    }
}
        
Variabel Deskripsi
$ID_ENCOUNTER_1 UUID Encounter yang digenerate
$ID_ENCOUNTER_2 UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES

2. ServiceRequest

{
    "resourceType": "ServiceRequest",
    "identifier": [
        {
            "system": "http://sys-ids.kemkes.go.id/servicerequest/$IHS_NUMBER_FASKES",
            "use": "official",
            "value": "$GENERATED_LOCALID_SERVICEREQUEST"
        }
    ],
    "status": "completed",
    "intent": "directive",
    "priority": "routine",
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "647-8",
                "display": "Microscopic observation [Identifier] in Sputum by Acid fast stain.Ziehl-Neelsen"
            }
        ]
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN"
    },
    "encounter": {
        "reference": "Encounter/$ID_ENCOUNTER_1"
    },
    "occurrenceDateTime": "2022-02-01T08:00:00+07:00",
    "requester": {
        "reference": "Organization/$IHS_NUMBER_FASYANKES"
    },
    "performer": [
        {
            "reference": "Organization/$IHS_NUMBER_FASYANKES"
        }
    ]
}
        
Variabel Deskripsi
$GENERATED_UUID_SERVICE_REQUEST_NUMBER_1 UUID ServiceRequest yang digenerate untuk permintaan pemeriksaan mikroskopis
$ID_ENCOUNTER_1 UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES

3. DiagnosticReport

{
    "resourceType": "DiagnosticReport",
    "identifier": [
        {
            "system": "http://sys-ids.kemkes.go.id/diagnostic/$IHS_NUMBER_FASKES/lab",
            "use": "official",
            "value": "$GENERATED_UUID_DIAGNOSTIC_REPORT"
        }
    ],
    "status": "final",
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "????"
            }
        ],
        "text": "????"
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN"
    },
    "effectiveDateTime": "2022-07-07",
    "issued": "2022-07-07T00:00:00+07:00",
    "performer": [
        {
            "reference": "Organization/$IHS_NUMBER_FASYANKES",
            "display": "$NAMA_FASYANKES"
        }
    ],
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "result": [
        {
            "reference": "Observation/$GENERATED_UUID_OBSERVATION_1"
        }
    ]
}
        
Variabel Deskripsi
$GENERATED_UUID_DIAGNOSTIC_REPORT UUID DiagnosticReport yang digenerate
$GENERATED_UUID_OBSERVATION_1 UUID pemeriksaan mikroskopis yang digenerate
$GENERATED_UUID_ENCOUNTER UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES
$NAMA_FASYANKES Nama FASYANKES

4. Condition

Keluhan(anamnesis) pasien saat berkunjung (jika ada)

{
  "id": "$GENERATED_UUID_CONDITION1",
  "subject": {
    "reference": "Patient/$IHS_NUMBER_PASIEN",
    "display": "$NAMA_PASIEN"
  },
  "encounter": {
    "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
  },
  "code": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/sid/icd-10",
        "code": "$ICD10_CODE_R00_R99_SIGN_SYMPTOPM",
        "display": "$ICD10_DISPLAY_R00_R99_SIGN_SYMPTOPM"
      }
    ]
  },
  "category": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/condition-category",
        "code": "problem-list-item",
        "display": "Problem List Item"
      }
    ]
  },
  "bodySite": [
    {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "38266002",
          "display": "Entire body as a whole"
        }
      ]
    }
  ],
  "clinicalStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
        "code": "active"
      }
    ]
  }
}
        
Variabel Deskripsi
$GENERATED_UUID_DIAGNOSIS UUID untuk Diagnosis ICD-10 TB yang digenerate
$ICD10_CODE_R00_R99_SIGN_SYMPTOPM Kode ICD-10 untuk diagnosis Tuberculosis
$ICD10_DISPLAY_R00_R99_SIGN_SYMPTOPM Teks ICD-10 untuk diagnosis Tuberculosis

5. Observation

{
    "resourceType": "Observation",
    "identifier": [
        {
            "system": "http://sys-ids.kemkes.go.id/observation/$IHS_NUMBER_FASKES",
            "value": "$GENERATED_LOCALID_OBSERVATION"
        }
    ],
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "647-8",
                "display": "Microscopic observation [Identifier] in Sputum by Acid fast stain.Ziehl-Neelsen"
            }
        ]
    },
    "category": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                "code": "laboratory",
                "display": "Laboratory"
            }
        ]
    },
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "value": {
        "coding": [
            {
                "system": "$CODE_OBSERVATION_1",
                "code": "$VALUE_OBSERVATION_1"
            }
        ]
    },
    "dataAbsentReason": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/data-absent-reason",
                "code": "not-performed",
                "display": "Not Performed"
            }
        ]
    }
}
        
Variabel Deskripsi
$GENERATED_UUID_ENCOUNTER UUID Encounter yang digenerate
$CODE_OBSERVATION_1 CodeSystem pemeriksaan mikroskopis
$VALUE_OBSERVATION_1 Value pemeriksaan mikroskopis

6. MedicationDispense

{
    "resourceType": "MedicationDispense",
    "id": "$GENERATED_UUID_MEDICATION_DISPENSE",
    "status": "completed",
    "medicationReference": {
        "reference": "Medication/$GENERATED_UUID_MEDICATION"
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "context": {
        "reference": "EpisodeOfCare/$GENERATED_UUID_EPISODEOFCARE"
    },
    "performer": [
        {
            "actor": {
                "reference": "Practitioner/$IHS_NUMBER_DOKTER"
            }
        }
    ],
    "authorizingPrescription": [
        {
        "reference": "MedicationRequest/$GENERATED_UUID_MEDICATION_REQUEST"
        }
    ],
    "type": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                "code": "RFP",
                "display": "Refill - Part Fill"
            }
        ]
    },
    "quantity": {
        "value": 30,
        "system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
        "code": "TAB"
    },
    "daysSupply": {
        "value": 30,
        "unit": "Day",
        "system": "http://unitsofmeasure.org",
        "code": "d"
    },
    "whenPrepared": "$DATETIME_OBAT_DISIAPKAN",
    "whenHandedOver": "$DATETIME_OBAT_DIBERIKAN",
    "dosageInstruction": [
        {
            "sequence": 1,
            "text": "Take a tablet daily for a month starting $DATE_MULAI_PENGOBATAN",
            "timing": {
                "repeat": {
                    "boundsPeriod": {
                        "start": "$DATE_MULAI_PENGOBATAN",
                        "end": "$DATE_KUNJUNGAN_BULANAN_BERIKUTNYA"
                    },
                    "frequency": 1,
                    "period": 1,
                    "periodUnit": "d"
                }
            },
            "route": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "26643006",
                        "display": "Oral Route"
                    }
                ]
            },
            "method": {
                "coding": [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "421521009",
                        "display": "Swallow - dosing instruction imperative (qualifier value)"
                    }
                ]
            },
            "doseAndRate": [
                {
                    "type": {
                        "coding": [
                            {
                                "system": "http://terminology.hl7.org/CodeSystem/dose-rate-type",
                                "code": "ordered",
                                "display": "Ordered"
                            }
                        ]
                    },
                    "doseQuantity": {
                        "value": 1,
                        "unit": "TAB",
                        "system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
                        "code": "TAB"
                    }
                }
            ]
        }
    ]
}
        
Variabel Deskripsi
$GENERATED_UUID_MEDICATION_DISPENSE UUID MedicationDispense yang digenerate
$GENERATED_UUID_MEDICATION_REQUEST UUID MedicationRequest yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$GENERATED_UUID_EPISODEOFCARE UUID EpisodeOfCare yang digenerate
$GENERATED_UUID_MEDICATION UUID Medication yang digenerate
$DATETIME_OBAT_DISIAPKAN Tanggal dan jam obat disiapkan
$DATETIME_OBAT_DIBERIKAN Tanggal dan jam obat diberikan
$DATE_MULAI_PENGOBATAN Tanggal mulai pemberian obat
$DATE_KUNJUNGAN_BULANAN_BERIKUTNYA Tanggal kunjungan ulang (kontrol) bulan berikutnya

7. CarePlan

{
    "resourceType": "CarePlan",
    "id": "$GENERATED_UUID_CAREPLAN",
    "contained": [
        {
            "resourceType": "Goal",
            "id": "goal",
            "lifecycleStatus": "planned",
            "description": {
                "text": "Follow-up consultation"
            },
            "subject": {
                "reference": "Patient/$IHS_NUMBER_PASIEN",
                "display": "$NAMA_PASIEN"
            }
        }
    ],
    "status": "active",
    "intent": "plan",
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "addresses": [
        {
        "reference": "Condition/$GENERATED_UUID_DIAGNOSIS"
        }
    ],
    "goal": [
        {
            "reference": "#goal"
        }
    ],
    "activity": [
        {
            "detail": {
                "kind": "Appointment",
                "code": {
                "coding": [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "281036007",
                            "display": "Follow-up consultation (procedure)"
                        }
                    ]
                },
                "status": "scheduled",
                "doNotPerform": false,
                "performer": [
                    {
                        "reference": "Practitioner/$IHS_NUMBER_DOKTER",
                        "display": "$NAMA_DOKTER"
                    }
                ]
            }
        }
    ]
}
        
Variabel Deskripsi
$GENERATED_UUID_CAREPLAN UUID CarePlan yang digenerate
$GENERATED_UUID_DIAGNOSIS UUID untuk Diagnosis ICD-10 TB yang digenerate
$GENERATED_UUID_ENCOUNTER UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NAMA_DOKTER Nama Dokter/Nakes

E. Kunjungan Akhir Pengobatan TB

Bundle ini digunakan untuk mencatat hasil akhir dari perawatan TB. diharapkan pada akhir proses pengobatan TB dikirimkan bundle yang berisi update dari informasi periode EpisodeOfCare serta Resource Encounter yang menyatakan hasil pemeriksaan pada akhir periode tersebut. Resource Encounter diberlakukan sama seperti bundle lainnya yaitu tetap menyebutkan referensi ID EpisodeOfCare.

alt text

Entry Resources yang digunakan

No Resource Entry Mandatory
1 EpisodeOfCare Required
2 Encounter Required
3 ServiceRequest Required
4 DiagnosticReport Required
5 Observation Required
6 CarePlan Optional
7 QuestionnaireResponse Required

1. EpisodeOfCare

{
    "fullUrl": "urn:uuid:$GENERATED_UUID_EPISODEOFCARE",
    "resource": {
        "resourceType": "EpisodeOfCare",
        "id": "$GENERATED_UUID_EPISODEOFCARE",
        "status": "finished",
        "patient": {
            "reference": "Patient/$IHS_NUMBER_PASIEN",
            "display": "$NAMA_PASIEN"
        },
        "managingOrganization": {
            "reference": "Organization/$IHS_NUMBER_FASYANKES"
        },
        "period": {
            "start": "$DATETIME_MULAI_PENGOBATAN",
            "end": "$DATETIME_AKHIR_PENGOBATAN"
        }
    },
    "request": {
        "method": "PUT",
        "url": "EpisodeOfCare"
    }
}
        
Variabel Deskripsi
$GENERATED_UUID_EPISODEOFCARE UUID EpisodeOfCare
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES

2. Encounter

{
    "resourceType": "Encounter",
    "identifier": [
        {
            "use": "official",
            "system": "http://sys-ids.kemkes.go.id/encounter/$IHS_NUMBER_FASKES",
            "value": "$ID_ENCOUNTER_2"
        }
    ],
    "status": "finished",
    "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB",
        "display": "ambulatory"
    },
    "priority": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/ValueSet/v3-ActPriority",
                "code": "R",
                "display": "routine"
            }
        ]
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "participant": [
        {
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                            "code": "ATND"
                        }
                    ]
                }
            ],
            "individual": {
                "reference": "Practitioner/$IHS_NUMBER_DOKTER"
            }
        }
    ],
    "serviceProvider": {
        "reference": "Organization/$IHS_NUMBER_FASYANKES"
    }
}
        
Variabel Deskripsi
$ID_ENCOUNTER_1 UUID Encounter yang digenerate
$ID_ENCOUNTER_2 UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES

3. ServiceRequest

{
    "resourceType": "ServiceRequest",
    "identifier": [
        {
            "system": "http://sys-ids.kemkes.go.id/servicerequest/$IHS_NUMBER_FASKES",
            "use": "official",
            "value": "$GENERATED_LOCALID_SERVICEREQUEST"
        }
    ],
    "status": "completed",
    "intent": "directive",
    "priority": "routine",
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "647-8",
                "display": "Microscopic observation [Identifier] in Sputum by Acid fast stain.Ziehl-Neelsen"
            }
        ]
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN"
    },
    "encounter": {
        "reference": "Encounter/$ID_ENCOUNTER_1"
    },
    "occurrenceDateTime": "2022-02-01T08:00:00+07:00",
    "requester": {
        "reference": "Organization/$IHS_NUMBER_FASYANKES"
    },
    "performer": [
        {
            "reference": "Organization/$IHS_NUMBER_FASYANKES"
        }
    ]
}
        
Variabel Deskripsi
$GENERATED_UUID_SERVICE_REQUEST_NUMBER_1 UUID ServiceRequest yang digenerate untuk permintaan pemeriksaan mikroskopis
$ID_ENCOUNTER_1 UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES

4. DiagnosticReport

{
    "resourceType": "DiagnosticReport",
    "identifier": [
        {
            "system": "http://sys-ids.kemkes.go.id/diagnostic/$IHS_NUMBER_FASKES/lab",
            "use": "official",
            "value": "$GENERATED_UUID_DIAGNOSTIC_REPORT"
        }
    ],
    "status": "final",
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "????"
            }
        ],
        "text": "????"
    },
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN"
    },
    "effectiveDateTime": "2022-07-07",
    "issued": "2022-07-07T00:00:00+07:00",
    "performer": [
        {
            "reference": "Organization/$IHS_NUMBER_FASYANKES",
            "display": "$NAMA_FASYANKES"
        }
    ],
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "result": [
        {
            "reference": "Observation/$GENERATED_UUID_OBSERVATION_1"
        }
    ]
}
        
Variabel Deskripsi
$GENERATED_UUID_DIAGNOSTIC_REPORT UUID DiagnosticReport yang digenerate
$GENERATED_UUID_OBSERVATION_1 UUID pemeriksaan mikroskopis yang digenerate
$GENERATED_UUID_ENCOUNTER UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$IHS_NUMBER_FASYANKES SATUSEHAT ID Number untuk FASYANKES
$NAMA_FASYANKES Nama FASYANKES

5. Observation

{
    "resourceType": "Observation",
    "identifier": [
        {
            "system": "http://sys-ids.kemkes.go.id/observation/$IHS_NUMBER_FASKES",
            "value": "$GENERATED_LOCALID_OBSERVATION"
        }
    ],
    "code": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "647-8",
                "display": "Microscopic observation [Identifier] in Sputum by Acid fast stain.Ziehl-Neelsen"
            }
        ]
    },
    "category": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                "code": "laboratory",
                "display": "Laboratory"
            }
        ]
    },
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "value": {
        "coding": [
            {
                "system": "$CODE_OBSERVATION_1",
                "code": "$VALUE_OBSERVATION_1",
                "display": "$DISPLAY_OBSERVATION_1"
            }
        ]
    },
    "dataAbsentReason": {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/data-absent-reason",
                "code": "not-performed",
                "display": "Not Performed"
            }
        ]
    }
}
        
Variabel Deskripsi
$GENERATED_UUID_ENCOUNTER UUID Encounter yang digenerate
$CODE_OBSERVATION_1 CodeSystem pemeriksaan mikroskopis
$VALUE_OBSERVATION_1 Value pemeriksaan mikroskopis

6. CarePlan

{
    "resourceType": "CarePlan",
    "id": "$GENERATED_UUID_CAREPLAN",
    "contained": [
        {
            "resourceType": "Goal",
            "id": "goal",
            "lifecycleStatus": "planned",
            "description": {
                "text": "Follow-up consultation"
            },
            "subject": {
                "reference": "Patient/$IHS_NUMBER_PASIEN",
                "display": "$NAMA_PASIEN"
            }
        }
    ],
    "status": "active",
    "intent": "plan",
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
    },
    "addresses": [
        {
        "reference": "Condition/$GENERATED_UUID_DIAGNOSIS"
        }
    ],
    "goal": [
        {
            "reference": "#goal"
        }
    ],
    "activity": [
        {
            "detail": {
                "kind": "Appointment",
                "code": {
                "coding": [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "281036007",
                            "display": "Follow-up consultation (procedure)"
                        }
                    ]
                },
                "status": "scheduled",
                "doNotPerform": false,
                "performer": [
                    {
                        "reference": "Practitioner/$IHS_NUMBER_DOKTER",
                        "display": "$NAMA_DOKTER"
                    }
                ]
            }
        }
    ]
}
        
Variabel Deskripsi
$GENERATED_UUID_CAREPLAN UUID CarePlan yang digenerate
$GENERATED_UUID_DIAGNOSIS UUID untuk Diagnosis ICD-10 TB yang digenerate
$GENERATED_UUID_ENCOUNTER UUID Encounter yang digenerate
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$IHS_NAMA_DOKTER Nama Dokter/Nakes

7. QuestionnaireResponse

{
    "resourceType": "QuestionnaireResponse",
    "questionnaire": "https://fhir.kemkes.go.id/Questionnaire/Q0001",
    "status": "completed",
    "subject": {
        "reference": "Patient/$IHS_NUMBER_PASIEN",
        "display": "$NAMA_PASIEN"
    },
    "encounter": {
        "reference": "Encounter/$GENERATED_UUID_ENCOUNTER"
      },
    "authored": "$TIMESTAMP_AUTHORED",
    "author": {
        "reference": "Practitioner/$IHS_NUMBER_DOKTER"
    },
    "source": {
        "reference": "Patient/$IHS_NUMBER_PASIEN"
    },
    "item": [
        {
            "linkId": "4",
            "text": "Hasil akhir pengobatan tuberkulosis",
            "answer": [
                {
                    "valueCoding": {
                        "system": "https://terminology.kemkes.go.id/CodeSystem/tb-outcome-class",
                        "code": "$CODE_TB_OUTCOME",
                        "display": "$DISPLAY_TB_OUTCOME"
                    }
                }
            ]
        }
    ]
}
        
Variabel Deskripsi
$IHS_NUMBER_PASIEN SATUSEHAT ID Number untuk Pasien
$NAMA_PASIEN Nama Pasien
$GENERATED_UUID_ENCOUNTER UUID Encounter yang digenerate
$TIMESTAMP_AUTHORED Tanggal dan waktu Questionnaire dibuat
$IHS_NUMBER_DOKTER SATUSEHAT ID Number untuk Dokter/Nakes
$CODE_TB_OUTCOME Kode hasil akhir Pengobatan (lihat ValueSet)
$DISPLAY_TB_OUTCOME Teks display hasil akhir Pengobatan (lihat ValueSet)

Hasil akhir pengobatan tuberkulosis

Code System https://terminology.kemkes.go.id/CodeSystem/tb-outcome-class
Value Set url https://terminology.kemkes.go.id/ValueSet/tb-outcome-class
Kode Teks Display
cured Sembuh
cmpl Pengobatan Lengkap
failed Pengobatan Gagal
died Meninggal
loss-to-follow-up Putus Obat
not-eval Tidak dievaluasi