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Boundaries and Relationships

Over the years, various types of patient summaries have been developed both internationally and within specific countries, each with its own specific focus. These summaries may have different names, but they all aim to provide a healthcare summary of a patient.

The ClinicalReportResearch (CRR) developed by Sciensano is intended to create a clinical patient summary within the research domain of Sciensano. Its goal differs from other patient summaries, which typically focus on providing essential patient data for unplanned care, regardless of location. However, there are essential relationships and differences with other (international) standards that may be relevant for implementers. Therefore, the following sections will identify related standards and provide a high-level overview of similarities and differences with this implementation guide.

Belgium

In Belgium, the transactions Clinical Summary and Summarized Electronic Health Record (Sumehr) are defined by the eHealth Platform. It is a summary of a patient's health designed to ensure the continuity of care, and can also be used in the context of planned care. The Sumehr includes patient, author, and contact information, as well as medical history, risks, current problems, medication, and vaccines. The Sumehr is typically maintained by the general practitioner and is sent as a transaction, using the KMEHR standard.

International Patient Summary

The International Patient Summary (IPS) is minimal, non-exhaustive, specialty-agnostic and condition-independent. The main rationale is to use the IPS in unplanned and cross border care, but it can be used for other cases as well. The initiative started with the 2011/24/EU Cross-Border Directive on which Patient Summary guidelines were based, which resulted in the IPS standard. To read more about the development of the IPS standard, we advise reading the Standards and Specifications of the IPS. Here we focus on comparing the CRR with the FHIR implementation of the IPS.

In FHIR, the International Patient Summary is published by the HL7 International - Patient Care Work Group. The review is based on the v1.1.0 - STU Implementation Guide. The IPS is constructed as a Composition resource and contains a Header and required, recommended, and optional sections. As the rationale differs, the IPS and the CRR differ in content as well. The IPS has a focus on providing information for direct care, which is represented by the three required sections on Medication, Allergies and Problems. The IPS provide guidelines on how to deal with absent and unknown information as well.

Netherlands

The Dutch Patient Summary (BgZ) serves as a minimal healthcare dataset that is constructed by Nictiz. The BgZ is derived from the International Patient Summary and consists of zibs ('zorginformatiebouwstenen' or 'Health and Care Information models' in English). It has two use cases:

  1. Exchange between HealthcareProfessionals for referral/transfer and to request information regarding previous treatments.
  2. Retrieval of a patient's own health information in a Personal Health Environment (PGO).

Both use cases use the same FHIR profiles and the CRR is reviewed against the BgZ based on the BgZ 3.1.7 Implementation Guide. To obtain the BgZ the client performs multiple search operations based on specified queries. This allows for adding functional requirements to the BgZ, such as only including the most recent information or searching for specific codes or categories.

As the purpose of the CRR differs from the BgZ, not all zibs have an equivalent in the CRR. The CRR absents concepts only relevant for direct care, which are Alert, Payer, Planned Care and TreatmentDirective information. Most SocialHistory zibs are not prioritzed in research projects for now and are therefore excluded from the CRR. Furthermore, LaboratoryTestResult is not specified in the CRR as this specification is in the LaboratoryTestResult IG. As the CBBs are based on the zibs, the overlapping zibs and CBBs are very similar, and differences are described in the respective changelogs of the CBBs.

Other initiatives

Here is a non-exhaustive list of other ongoing initiatives regarding healthcare summaries:

Diagram of functional layering

The below diagram offers an overview of the layering of CBBs. A description of the diagram and it's three used colors:

  • The blue box represent the project that forms the basis for this implementation guide. More information is given in the general guidance page of the CBB implementation guide.
  • The green box indicates this implementation guide that contains all the definitions for exchanging the ClinicalReportResearch.
  • The grey box represent projects and use cases based on the ClinicalReportResearch specs.