EHDS, EHRxF and national alignment

DigiDOT is a Norwegian dental FHIR model. It is not a full EHDS/EHRxF implementation, but the test profiles are designed so dental information can be used in an EHDS/EHRxF-oriented architecture.

The correct maturity statement is:

DigiDOT is FHIR R4 based, reuses no-basis and SFM, and is prepared for later EHDS/EHRxF mapping. It should not be described as fully EHDS/EHRxF conformant until mapping, access, audit, source/provenance, imaging and export/import requirements have been made explicit.

EHDS/EHRxF priority categories

EHRxF category DigiDOT relevance Current direction
Patient summaries Dental conditions, procedures, observations, devices, allergies, medication context, alerts and relevant medical history. Use a Composition/summary view that assembles DigiDOT and external FHIR resources without making DigiDOT the master for all patient data.
Electronic prescriptions Dental prescribing context, contraindications and medication risk. Reuse SFM/PLL and reference relevant medication context. Do not create DigiDOT medication profiles.
Electronic dispensations Dispensed medication that affects dental treatment. Consume from SFM/national medication sources when relevant.
Medical imaging studies and reports Dental X-ray, OPG, CBCT, clinical images and image reports. Use ImagingStudy, DocumentReference and optionally DiagnosticReport for metadata and reports. Store large images in PACS/VNA/DICOMweb/object storage, not primarily in HAPI.
Medical test results and diagnostic reports Dental measurements, diagnostic observations and grouped reports. Use DigiDOT Observation for individual dental observations; use DiagnosticReport when observations are reported together.
Discharge reports External hospital/healthcare reports that affect dental care. Consume as DocumentReference/Composition when relevant.

Helse-NIM mapping

Helse-NIM for oppsummerende helseopplysninger is especially relevant because it uses Patient Summary and EHDS-oriented thinking. DigiDOT should map to these categories:

Helse-NIM category DigiDOT/FHIR direction
Tilstander DigiDOT Condition for dental conditions; external Condition for relevant medical history.
Overfolsomhet / allergies no-basis-AllergyIntolerance or Kjernejournal AllergyIntolerance.
Prosedyrehistorikk DigiDOT Procedure for completed dental procedures; external Procedure where relevant.
Medisinsk utstyr DigiDOT Device; DeviceUseStatement for active patient device/implant context.
Behandlingsbegrensninger External Consent from Kjernejournal/critical information when relevant.
Varslinger Flag for alerts; it does not replace the underlying allergy, condition or consent.

Modelling guidance

  • Patient is the main anchor for retrieving patient context, but opening a patient should return more than demographics.
  • Encounter is the completed dental contact. It should not be used as a container for the entire patient history.
  • ServiceRequest is the planning anchor. Use reasonCode/reasonReference for why the treatment is planned, and supportingInfo for relevant decision context such as allergy, SFM medication, critical information or medical history.
  • External information should remain source-aware. Keep source identifier, source system, last fetched, last changed, cache status and provenance.
  • Use Provenance and operational audit/logging for external lookups, transformations, exports and clinical decision snapshots.
  1. Formalize mapping from DigiDOT resources and examples to EHDS/EHRxF and Helse-NIM categories.
  2. Decide export/import packaging for patient summary, imaging/report metadata and relevant dental history.
  3. Define source, provenance, audit and cache freshness rules for external data used in clinical decisions.
  4. Complete terminology governance and Snowstorm/Snowstorm-X validation.
  5. Finalize CapabilityStatement and $digidot-context behavior, including security, consent and authorization expectations.
  6. Add KPR TANN mapping from Encounter, Condition, Observation, Procedure, ChargeItem and Claim.
  7. Keep all promoted artifacts consistently on canonical base https://novari.no/fhir/digidot.

Sources