Implementasi Use Case HIV
Last Updated: 2024/12/05
A. Pendahuluan
Human Immunodeficiency Virus (HIV) masih menjadi ancaman di Indonesia. Meskipun upaya penanggulangan HIV telah membaik, namun masih terdapat beberapa hal yang dapat dioptimalkan seperti perlunya peningkatan jumlah tes HIV yang dilaksanakan di masyarakat, perlunya layanan HIV yang terintegrasi, perlunya peran swasta, dll. Untuk mewujudkan layanan HIV yang terintegrasi, dibutuhkan sistem pelaporan yang mampu berinteroperasi dengan data kesehatan dari berbagai institusi kesehatan.
Playbook use case Human Immunodeficiency Virus (HIV) dibuat sebagai panduan teknis untuk fasilitas pelayanan kesehatan (fasyankes) atau pengembang rekam medis elektronik lainnya dalam melakukan proses integrasi dan interoperabilitas di dalam SATUSEHAT Platform, khususnya informasi terkait pelayanan penyakit HIV. Playbook ini menjelaskan secara detail mengenai standar tahapan alur integrasi dan format pengiriman data, mulai dari:
- Pendaftaran Identitas Pasien
- Pendaftaran Kunjungan
- Memulai Episode Perawatan HIV
- Pengiriman Data Anamnesis dan Pemeriksaan Fisik
- Pengiriman Data Pemeriksaan Penunjang
- Pengiriman Data Diagnosis
- Pengiriman Data Rencana Tindak Lanjut
- Pengiriman Data Kondisi Saat Meninggalkan Rumah Sakit
- Pengiriman Data Cara Keluar dari Rumah Sakit & Pembaharuan Data Kunjungan
Resource FHIR yang digunakan pada use case ini yaitu:
Category | No | Resource | Entry Mandatory |
---|---|---|---|
Base | 1 | Patient | Required |
2 | Practitioner | Required | |
3 | Organization | Required | |
4 | Location | Required | |
5 | Encounter | Required | |
Clinical | 6 | Condition | Required |
7 | ServiceRequest | Required | |
8 | Specimen | Required | |
9 | Observation | Required | |
10 | DiagnosticReport | Required | |
11 | QuestionnaireResponse | Required | |
12 | EpisodeOfCare | Required |
Notes:
- Required: Entry resource harus dilibatkan setiap kali mengirimkan bundle
- Optional: Entry resource dapat tidak dilibatkan setiap kali mengirimkan bundle
Pada tahap 1 implementasi use case HIV secara umum dapat dibagi menjadi 2 bagian, yaitu:
- Pemeriksaan HIV (Human Immunodeficiency Virus), meliputi pemeriksaan rapid serologis untuk skrining serta pemeriksaan PCR untuk testing.
- Pemeriksaan IMS (Infeksi Menular Seksual), meliputi pemeriksaan rapid untuk sifilis dan pemeriksaan titer.
Tahapan alur integrasi dan resource yang digunakan pada pelayanan HIV dapat dilihat pada gambar di bawah ini.
Gambar 1. Alur Integrasi HIV
Referensi:
Postman HIV (on-progress) | Playbook HIV (on-progress) | Postman Resume Medis Rawat Jalan SATUSEHAT |
B. Strategi Pengiriman Data ke SATUSEHAT
1. Berbasis Resource
Data dapat dikirimkan secara berurutan sesuai resource yang terlibat pada alur pelayanan terkait. Sebagai contoh: ketika mengirimkan data registrasi kunjungan saja yang berisikan resource Encounter dan QuestionnaireResponse, maka implementor mengirimkan resource-resource tersebut ke SATUSEHAT secara berurutan sesuai dependensinya.
2. Berbasis Bundle
Data dapat dikirimkan seluruh resource yang terlibat pada alur pelayanan terkait dengan menggunakan satu langkah pengiriman data ke SATUSEHAT menggunakan profil FHIR bernama Bundle.
C. Langkah-Langkah Pengiriman Data ke SATUSEHAT
Informasi Variabel
Variabel serta pemetaan terhadap resource FHIR untuk Pelaporan HIV yang dipertukarkan dapat dilihat dalam tabel berikut.
No | Variabel | Resource | Elemen Data / Path | Keterangan |
---|---|---|---|---|
Pendaftaran Kunjungan | ||||
1 | Asal Rujukan | Encounter | Encounter.hospitalization.admitSource.coding | Diisi sesuai dengan jenis fasyankes asal perujuk pasien. |
2 | Alasan Kunjungan | Encounter | Encounter.reasonCode.coding | Diisi dengan alasan pasien berkunjung ke fasyankes. |
3 | Pendidikan | Observation | Observation.category.coding | Diisi dengan pendidikan terakhir ketika pasien melakukan tes HIV. |
Observation.code.coding | ||||
Observation.valueCodeableConcept.coding | ||||
4 | Pekerjaan | Observation | Observation.category.coding | Diisi dengan pekerjaan terakhir ketika pasien melakukan tes HIV. |
Observation.code.coding | ||||
Observation.valueCodeableConcept.coding | ||||
Pengiriman Data Anamnesis dan Pemeriksaan Fisik | ||||
1 | Kajian Tingkat Risiko | |||
a. | Kelompok populasi | Observation | Observation.category.coding | Diisi berdasarkan klasifikasi kelompok populasi pasien . |
Observation.code.coding | ||||
Observation.component.code.coding | ||||
Observation.component.valueBoolean | ||||
QuestionnaireResponse | QuestionnaireResponse.questionnaire | |||
QuestionnaireResponse.item.item.linkId | ||||
QuestionnaireResponse.item.item.text | ||||
QuestionnaireResponse.item.item.answer.valueReference | ||||
b. | Hubungan Seks Vaginal Beresiko | Observation | Observation.category.coding | Diisi berdasarkan riwayat hubungan seks vaginal berisiko pasien. |
Observation.code.coding | ||||
Observation.valueBoolean | ||||
QuestionnaireResponse | QuestionnaireResponse.questionnaire | |||
QuestionnaireResponse.item.item.linkId | ||||
QuestionnaireResponse.item.item.text | ||||
QuestionnaireResponse.item.item.answer.valueReference | ||||
c. | Anal Seks Beresiko | Observation | Observation.category.coding | Diisi berdasarkan riwayat hubungan seks anak berisiko pasien. |
Observation.code.coding | ||||
Observation.valueBoolean | ||||
QuestionnaireResponse | QuestionnaireResponse.questionnaire | |||
QuestionnaireResponse.item.item.linkId | ||||
QuestionnaireResponse.item.item.text | ||||
QuestionnaireResponse.item.item.answer.valueReference | ||||
d. | Bergantian Peralatan Suntik | Observation | Observation.category.coding | Diisi berdasarkan riwayat pasien dalam penggunaan peralatan suntik secara bergantian. |
Observation.code.coding | ||||
Observation.valueBoolean | ||||
QuestionnaireResponse | QuestionnaireResponse.questionnaire | |||
QuestionnaireResponse.item.item.linkId | ||||
QuestionnaireResponse.item.item.text | ||||
QuestionnaireResponse.item.item.answer.valueReference | ||||
e. | Transfusi Darah | Observation | Observation.category.coding | Diisi berdasarkan riwayat transfusi darah pasien. |
Observation.code.coding | ||||
Observation.valueBoolean | ||||
QuestionnaireResponse | QuestionnaireResponse.questionnaire | |||
QuestionnaireResponse.item.item.linkId | ||||
QuestionnaireResponse.item.item.text | ||||
QuestionnaireResponse.item.item.answer.valueReference | ||||
f. | Transmisi Ibu ke Anak | Observation | Observation.category.coding | Diisi berdasarkan riwayat transmisi ibu ke anak pasien. |
Observation.code.coding | ||||
Observation.valueBoolean | ||||
QuestionnaireResponse | QuestionnaireResponse.questionnaire | |||
QuestionnaireResponse.item.item.linkId | ||||
QuestionnaireResponse.item.item.text | ||||
QuestionnaireResponse.item.item.answer.valueReference | ||||
g. | Periode Jendela | Observation | Observation.category.coding | Diisi berdasarkan periode jendela pasien. |
Observation.code.coding | ||||
Observation.valueBoolean | ||||
QuestionnaireResponse | QuestionnaireResponse.questionnaire | |||
QuestionnaireResponse.item.item.linkId | ||||
QuestionnaireResponse.item.item.text | ||||
QuestionnaireResponse.item.item.answer.valueReference | ||||
h. | Penyakit terkait Pasien | Condition | Condition.category.coding | Diisi berdasarkan penyakit lain yang sedang diderita pasien. |
Condition.code.coding | ||||
QuestionnaireResponse | QuestionnaireResponse.questionnaire | |||
QuestionnaireResponse.item.item.linkId | ||||
QuestionnaireResponse.item.item.text | ||||
QuestionnaireResponse.item.item.answer.valueReference | ||||
i. | Lainnya | QuestionnaireResponse | QuestionnaireResponse.questionnaire | Diisi berdasarkan risiko HIV lain yang dimiliki oleh pasien. |
QuestionnaireResponse.item.item.linkId | ||||
QuestionnaireResponse.item.item.text | ||||
QuestionnaireResponse.item.item.answer.valueBoolean | ||||
j | Risiko Lainnya | QuestionnaireResponse | QuestionnaireResponse.item.item.answer.item.linkId | |
QuestionnaireResponse.item.item.answer.item.text | ||||
QuestionnaireResponse.item.item.answer.item.answer.valueString | ||||
2 | Tanda Klinis dan Pemeriksaan Fisik | |||
a. | Tanda Klinis IMS | QuestionnaireResponse | QuestionnaireResponse.questionnaire | Diisi berdasarkan tanda klinis IMS yang dialami pasien. |
QuestionnaireResponse.item.item.linkId | ||||
QuestionnaireResponse.item.item.text | ||||
QuestionnaireResponse.item.item.answer.valueBoolean | ||||
b. | Jika Ya, Tanda Klinis | Condition | Condition.category.coding | |
Condition.code.coding | ||||
QuestionnaireResponse | QuestionnaireResponse.item.item.answer.item.linkId | |||
QuestionnaireResponse.item.item.answer.item.text | ||||
QuestionnaireResponse.item.item.answer.item.answer.valueReference | ||||
c. | Pemeriksaan fisik | Observation | Observation.category.coding | Diisi berdasarkan pemeriksaan fisik IMS pada pasien. |
Observation.code.coding | ||||
Observation.valueCodeableConcept.coding | ||||
QuestionnaireResponse | QuestionnaireResponse.questionnaire | |||
QuestionnaireResponse.item.item.linkId | ||||
QuestionnaireResponse.item.item.text | ||||
QuestionnaireResponse.item.item.answer.valueReference | ||||
3 | Status Hamil | Observation | Observation.category.coding | Diisi dengan status kehamilan pasien sesuai dengan pemeriksaan pasien. |
Observation.code.coding | ||||
Observation.valueCodeableConcept.coding | ||||
4 | Usia kehamilan (jika pasien menyatakan hamil) | Observation | Observation.category.coding | Diisi dengan usia kehamilan pasien sesuai dengan pemeriksaan pasien. |
Observation.code.coding | ||||
Observation.valueInteger | ||||
5 | Keluhan | Condition | Condition.category.coding | Diisi dengan keluhan yang dirasakan oleh pasien. |
Condition.code.coding | ||||
Pengiriman Data Pemeriksaan Penunjang | ||||
1 | Alasan Pemeriksaan | ServiceRequest | ServiceRequest.reasonCode.coding | Diisi dengan alasan/tujuan dilakukannya pemeriksaan laboratorium yang diminta. |
ServiceRequest.reasonCode.text | ||||
2 | Jenis Pemeriksaan | ServiceRequest | ServiceRequest.code.coding | Diisi dengan pemeriksaan laboratorium yang diminta. |
ServiceRequest.category.coding | ||||
3 | Jenis spesimen | Specimen | Specimen.type.coding | Diisi dengan jenis spesimen yang dikirimkan sebagai contoh uji untuk dilakukan pemeriksaan. |
4 | Tanggal Pengambilan spesimen | Specimen | Specimen.collectedDateTime | Diisi dengan tanggal pengambilan spesimen yang dikirimkan sebagai contoh uji untuk dilakukan pemeriksaan. |
5 | Jam Pengambilan spesimen | Specimen | Specimen.collectedDateTime | Diisi dengan jam pengambilan spesimen yang dikirimkan sebagai contoh uji untuk dilakukan pemeriksaan. |
6 | Kondisi spesimen | Specimen | Specimen.status | Diisi dengan keadaan specimen pada saat diterima di laboratorium. |
Specimen.condition.coding | ||||
7 | Tanggal Pemeriksaan Lab | Specimen | Specimen.processing.timeDateTime | Diisi dengan tanggal dilakukannya pemeriksaan pada contoh uji. |
8 | Jam Pemeriksaan Lab | Specimen | Specimen.processing.timeDateTime | Diisi dengan jam dilakukannya pemeriksaan pada contoh uji. |
9 | Pemeriksa | Observation | Observation.performer.reference | Diisi dengan tenaga kesehatan yang melakukan pemeriksaan. |
10 | Tanggal Hasil Keluar | Observation | Observation.issued | Berisi data mengenai tanggal hasil pemeriksaan dikeluarkan. |
11 | Jam Hasil Keluar | Observation | Observation.issued | Berisi data mengenai jam hasil pemeriksaan dikeluarkan. |
12 | Dokter Penanggung Jawab (PJ) Pemeriksaan Lab | Observation | Observation.performer.reference | Berisi data penanggung jawab laboratorium yang mempertanggungjawabkan hasil pemeriksaan. |
13 | Hasil Pemeriksaan Rapid Serologis HIV | Observation | Observation.category.coding | Diisi dengan hasil pemeriksaan rapid serologis HIV (R1, R2, dan R3) pada pasien. |
Observation.code.coding | ||||
Observation.valueCodeableConcept.coding | ||||
Observation.interpretation.coding.code | ||||
Observation.dataAbsentReason.coding | ||||
14 | Hasil Pemeriksaan PCR DNA/ EID HIV Kualitatif | Observation | Observation.category.coding | Diisi dengan hasil pemeriksaan PCR DNA kualitatif yang dilakukan untuk pemeriksaan HIV. |
Observation.code.coding | ||||
Observation.component.valueCodeableConcept.coding | ||||
Observation.dataAbsentReason.coding | ||||
15 | Hasil Pemeriksaan PCR DNA/ EID HIV Kuantitatif/ Viral Load | Observation | Observation.category.coding | Diisi dengan hasil pemeriksaan PCR DNA Kuantitatif yang dilakukan untuk pemeriksaan HIV. |
Observation.code.coding | ||||
Observation.valueQuantity.value | ||||
Observation.valueQuantity.code | ||||
Observation.valueQuantity.system | ||||
Observation.valueQuantity.unit | ||||
16 | Hasil Pemeriksaan PCR RNA Kuantitatif/ Viral Load | Observation | Observation.category.coding | Diisi dengan hasil pemeriksaan PCR RNA Kuantitatif yang dilakukan untuk pemeriksaan HIV. |
Observation.code.coding | ||||
Observation.valueQuantity | ||||
17 | Hasil Pemeriksaan Rapid Sifilis/TPHA | Observation | Observation.category.coding | Diisi dengan hasil pemeriksaan Rapid Sifilis/TPHA yang dilakukan untuk pemeriksaan skrining Sifilis. |
Observation.code.coding | ||||
Observation.valueCodeableConcept.coding | ||||
Observation.dataAbsentReason.coding | ||||
18 | Hasil Pemeriksaan RPR/VDRL | Observation | Observation.category.coding | Diisi dengan hasil pemeriksaan RPR/ VDRL yang dilakukan untuk pemeriksaan skrining Sifilis. |
Observation.code.coding | ||||
Observation.valueCodeableConcept.coding | ||||
Observation.dataAbsentReason.coding | ||||
19 | Hasil Pemeriksaan Titer RPR | Observation | Observation.category.coding | Diisi dengan hasil Pemeriksaan Titer RPR jika hasil Pemeriksaan Rapid Sifilis/TPHA reaktif. |
Observation.code.coding | ||||
Observation.valueRatio.numerator | ||||
Observation.valueRatio.denominator | ||||
20 | Hasil Pemeriksaan Rapid Duo (HIV + Sifilis) | Observation | Observation.category.coding | Diisi dengan hasil Pemeriksaan Rapid Duo yang dilakukan untuk pemeriksaan skrining gabungan HIV dan Sifilis. |
Observation.code.coding | ||||
Observation.component.code.coding | ||||
Observation.component.valueCodeableConcept.coding | ||||
Observation.dataAbsentReason.coding | ||||
21 | Laporan Pemeriksaan | DiagnosticReport | DiagnosticReport.category.coding | Berlaku untuk seluruh pemeriksaan lab baik skrining HIV, tes HIV dan skrining Sifilis. |
DiagnosticReport.code.coding | ||||
DiagnosticReport.conclusionCode.coding | ||||
Pengiriman Data Diagnosis | ||||
1 | Diagnosis | Condition | Condition.category.coding | Diisi dengan kode diagnosis ICD-10. |
Condition.code.coding |
Pre-Use Case Requirement
Registrasi Struktur Organisasi
Organisasi merupakan data terkait struktur organisasi yang ada di dalam suatu institusi. Data struktur organisasi ini akan dijadikan referensi saat data pelayanan kesehatan dikirimkan ke SATUSEHAT. Institusi yang akan melakukan integrasi ke SATUSEHAT perlu melakukan registrasi atau mengirimkan data terkait struktur organisasi yang tersedia di dalam institusi tersebut (selanjutnya disebut suborganisasi). Institusi yang termasuk dalam kategori fasilitas pelayanan kesehatan (selanjutnya disebut organisasi induk), akan mendapatkan ID dari Kementerian Kesehatan setelah melakukan registrasi. Organisasi induk selanjutnya akan mengirimkan struktur organisasi/suborganisasi yang ada dalam institusi tersebut. Contoh struktur organisasi dapat dilihat dalam Gambar 1. Setiap suborganisasi di bawah organisasi induk perlu dikirimkan datanya ke SATUSEHAT.
Data suborganisasi dikirimkan menggunakan resource Organization dengan metode POST. Resource Organization digunakan untuk mencatat data sekelompok orang atau organisasi dengan tujuan yang sama. Hal ini ditunjukkan dengan adanya struktur pengurus dari organisasi tersebut. Template pengisian organisasi dapat diakses pada tautan berikut : Template Registrasi Organization & Location
Pemetaan nilai terkait Pengiriman Data Registrasi Struktur Organisasi dapat merujuk ke modul pelayanan yang terkait, baik Modul Rawat Jalan, IGD, maupun Rawat Inap di SATUSEHAT.
Registrasi Struktur Lokasi
Struktur lokasi merupakan lokasi fisik yang dapat berupa bangunan, ruangan yang menjadi tempat dimana layanan kesehatan dilakukan. Institusi yang akan melakukan integrasi ke SATUSEHAT perlu melakukan registrasi atau mengirimkan data terkait struktur lokasi yang tersedia di dalam institusi tersebut. Data struktur lokasi yang dimaksud adalah detail dan informasi posisi untuk tempat fisik di mana layanan disediakan dan sumber daya dan peserta dapat disimpan, ditemukan, ditampung, atau diakomodasi. Contoh struktur lokasi dapat dilihat dalam Gambar 2. Setiap lokasi dari struktur tersebut perlu dikirimkan datanya ke SATUSEHAT untuk keperluan informasi dimana suatu layanan dilakukan.
Data struktur dikirimkan menggunakan resource Location dengan metode POST. Template pengisian struktur lokasi dapat diakses pada link berikut: Template Registrasi Organization & Location
Pemetaan nilai terkait Pengiriman Data Registrasi Struktur Lokasi dapat merujuk ke modul pelayanan yang terkait, baik Modul Rawat Jalan, IGD, maupun Rawat Inap di SATUSEHAT.
Nomor IHS untuk Tenaga Kesehatan
Apabila melakukan pengiriman data kesehatan melalui SATUSEHAT yang memiliki elemen data terkait tenaga kesehatan, maka diperlukan informasi {practitioner-ihs-number} dari tenaga kesehatan yang bersangkutan. {practitioner-ihs-number} seorang tenaga kesehatan didapatkan dari Master Nakes Index (MNI) Kementerian Kesehatan. MNI menyimpan data-data Nakes dari seluruh sumber yang secara resmi menerbitkan daftar tenaga kesehatan. Setelah mendapatkan {practitioner-ihs-number}, ID tersebut dapat disimpan di masing-masing sistem internal fasilitas kesehatan.
Proses pencarian Nomor IHS dari tenaga kesehatan dapat dilakukan melalui FHIR API dengan metode GET. Untuk metode pencarian data nakes di SATUSEHAT secara detail dapat dilihat dalam link berikut.
Proses pencarian data fasyankes dan nakes dapat dilakukan melalui FHIR API dengan metode GET dengan parameter dibawah ini:
No | Data | Resource | Parameter Pencarian |
---|---|---|---|
1 | Fasyankes | Organization | {organization-ihs-number} |
2 | Lokasi | Location | There is no placeholder called 'id-resource-Location' |
3 | Nakes | Practitioner | NIK, {practitioner-ihs-number} |
1. Pendaftaran Identitas Pasien
Jika data kesehatan yang mengandung elemen data terkait pasien dikirimkan melalui SATUSEHAT, maka diperlukan informasi {patient-ihs-number} dari pasien tersebut. {patient-ihs-number} ini diperoleh dari Master Patient Index (MPI) Kementerian Kesehatan, yang menyimpan data demografi pasien skala nasional, seperti nama, tanggal lahir, alamat, dan identitas resmi yang dikeluarkan pemerintah. Setelah mendapatkan {patient-ihs-number}, ID tersebut dapat disimpan dalam sistem internal fasilitas kesehatan maupun mitra non-fasilitas kesehatan. {patient-ihs-number} mempermudah pelaporan layanan kesehatan terkait pasien, karena mitra tidak perlu menyertakan data pribadi pasien setiap kali mengirim data. {patient-ihs-number} juga dapat digunakan untuk mengakses data pasien secara lengkap. Untuk kasus pasien bayi baru lahir gunakan variable NIK Ibu Kandung pada resource Patient.identifier.use dan Nama Ibu Kandung pada resource Patient.contact.name untuk melakukan identifikasi pasien.
Pencarian {patient-ihs-number} dari pasien dapat dilakukan melalui FHIR API dengan metode GET. Panduan lebih rinci tentang pencarian data pasien di SATUSEHAT dapat ditemukan dalam dokumen Petunjuk Teknis SATUSEHAT (Juknis SATSET).
2. Pendaftaran Kunjungan
Kunjungan pasien dapat didefinisikan sebagai interaksi pasien terhadap suatu layanan fasyankes. Sebagai contoh, dalam satu rangkaian rawat jalan, seluruh rangkaian dapat didefinisikan sebagai satu “Encounter”. Data-data kunjungan pasien yang direkam meliputi kapan pertemuan tersebut mulai dan selesai, siapa tenaga kesehatan yang melayani, siapa subjek dari pelayanannya, dan informasi pendukung lainnya. Dalam konteks pelaporan ibu dan bayi, resource Encounter wajib untuk dikirimkan.
➕ Pembuatan Kunjungan Baru
{ "resourceType": "Encounter", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/encounter/{{Org_id}}", "value": "{{Registration_id}}" } ], "status": "arrived", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB", "display": "ambulatory" }, "subject": { "reference": "Patient/{{Patient_id}}", "display": "{{Patient_Name}}" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "ATND", "display": "attender" } ] } ], "individual": { "reference": "Practitioner/{{Practitioner_id}}", "display": "{{Practitioner_Name}}" } } ], "period": { "start": "2023-08-31T00:00:00+00:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "24081000087105", "display": "Human immunodeficiency virus nurse practitioner service" } ] } ], "location": [ { "location": { "reference": "Location/{{Location_Poli_uuid}}", "display": "{{Location_Poli_Name}}" }, "period": { "start": "2023-08-31T00:00:00+00:00" }, "extension": [ { "url": "https://fhir.kemkes.go.id/r4/StructureDefinition/ServiceClass", "extension": [ { "url": "value", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/locationServiceClass-Outpatient", "code": "reguler", "display": "Kelas Reguler" } ] } }, { "url": "upgradeClassIndicator", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/locationUpgradeClass", "code": "kelas-tetap", "display": "Kelas Tetap Perawatan" } ] } } ] } ] } ], "statusHistory": [ { "status": "arrived", "period": { "start": "2023-08-31T00:00:00+00:00" } } ], "serviceProvider": { "reference": "Organization/{{Org_id}}" }, "hospitalization": { "admitSource": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/clinical-term", "code": "EHA000002", "display": "Datang sendiri" } ] } } }
{ "resourceType": "Encounter", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/encounter/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{ENCOUNTER_LOCAL_CODE}}" } ], "status": "arrived", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB", "display": "ambulatory" }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "ATND", "display": "attender" } ] } ], "individual": { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } } ], "period": { "start": "{{ENCOUNTER_PERIOD1_START}}" }, "reasonCode": [ { "coding": [ { "system": "{{ENCOUNTER_REASON}}", "code": "{{ENCOUNTER_REASON}}", "display": "{{ENCOUNTER_REASON}}" } ] } ], "location": [ { "location": { "reference": "Location/{{ID_RESOURCE_LOCATION}}", "display": "{{ENCOUNTER_LOCATION_NAME}}" }, "period": { "start": "{{ENCOUNTER_PERIOD1_START}}" }, "extension": [ { "url": "https://fhir.kemkes.go.id/r4/StructureDefinition/ServiceClass", "extension": [ { "url": "value", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/locationServiceClass-Outpatient", "code": "reguler", "display": "Kelas Reguler" } ] } }, { "url": "upgradeClassIndicator", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/locationUpgradeClass", "code": "kelas-tetap", "display": "Kelas Tetap Perawatan" } ] } } ] } ] } ], "statusHistory": [ { "status": "arrived", "period": { "start": "{{ENCOUNTER_PERIOD1_START}}" } } ], "serviceProvider": { "reference": "Organization/{{ORGANIZATION_IHS_NUMBER}}" }, "hospitalization": { "admitSource": { "coding": [ { "system": "{{ENCOUNTER_ADMITSOURCE}}", "code": "{{ENCOUNTER_ADMITSOURCE}}", "display": "{{ENCOUNTER_ADMITSOURCE}}" } ] } } }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
ENCOUNTER_LOCAL_CODE | ID Lokal untuk Kunjungan/Encounter |
PATIENT_IHS_NUMBER | {patient-ihs-number} pada SATUSEHAT |
PATIENT_NAME | Nama Pasien |
PRACTITIONER_IHS_NUMBER | {practitioner-ihs-number} pada SATUSEHAT |
DOCTOR_NAME | Nama Dokter/Nakes |
ENCOUNTER_PERIOD1_START | Waktu mulai/check-in kunjungan |
ID_RESOURCE_LOCATION | ID Location tempat kunjungan dilakukan |
ENCOUNTER_LOCATION_NAME | Nama Location tempat kunjungan dilakukan |
ENCOUNTER_ADMITSOURCE | (*) Data asal di mana sebelum pasien dirawat/admisia. Reference ke value set "Asal Rujukan" |
ENCOUNTER_REASON | (*) Data kode alasan terjadinya kunjungan. Reference ke value set "Alasan Kunjungan" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Encounter.hospitalization.admitSource.coding.system | Encounter.hospitalization.admitSource.coding.code | Encounter.hospitalization.admitSource.coding.display |
---|---|---|
http://terminology.kemkes.go.id/CodeSystem/clinical-term | EHA000002 | Datang sendiri |
http://terminology.kemkes.go.id | TK000031 | From outpatient department |
http://terminology.kemkes.go.id/CodeSystem/clinical-term | EHA000001 | Kader/ Komunitas |
http://terminology.kemkes.go.id | TK000033 | LSM |
http://snomed.info/sct | 257622000 | Healthcare facility |
Alasan Kunjungan
Encounter.reasonCode.coding.system | Encounter.reasonCode.coding.code | Encounter.reasonCode.coding.display |
---|---|---|
http://snomed.info/sct | 24081000087105 | Human immunodeficiency virus nurse practitioner service |
http://terminology.kemkes.go.id | TK000033 | Tes IMS |
➕ Pendidikan
Informasi pendukung seperti data jenjang pendidikan terakhir ketika pasien melakukan tes HIV perlu diinput di awal pendaftaran kunjungan.
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social History" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ] }, "subject": { "reference": "Patient/{{Patient_id}}", "display": "{{Patient_Name}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T01:35:00+00:00", "issued": "2023-08-31T01:35:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}", "display": "{{Practitioner_Name}}" } ], "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "224299000", "display": "Received higher education" } ] } }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social History" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "82589-3", "display": "Highest level of education" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "{{VALUE_OBSERVATION}}", "display": "{{VALUE_OBSERVATION}}" } ] } }
Variabel | Deskripsi |
---|---|
FACILITY_IHS_NUMBER | SATUSEHAT ID untuk FASYANKES |
FACILITY_NAME | Nama FASYANKES |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
DOCTOR_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
VALUE_OBSERVATION | (*) Data tingkat pendidikan. Referensi ke value set "Pendidikan" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Observation.valueCodeableConcept.coding.system | Observation.valueCodeableConcept.coding.code | Observation.valueCodeableConcept.coding.display | Pilihan jawaban yang divisualisasikan |
---|---|---|---|
http://snomed.info/sct | 224304004 | Not receiving education | Tidak Pernah Sekolah |
http://snomed.info/sct | 473463000 | Received elementary school education | SD/Sederajat |
http://snomed.info/sct | 603435002 | Educated to junior high school level | SMP/Sederajat |
http://snomed.info/sct | 603434003 | Educated to senior high school level | SMA/Sederajat |
http://snomed.info/sct | 224299000 | Received higher education | Akademi/Perguruan Tinggi/Sederajat |
➕ Pekerjaan
Informasi pendukung seperti data pekerjaan terakhir ketika pasien melakukan tes HIV perlu diinput di awal pendaftaran kunjungan.
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social History" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85658-3", "display": "Occupation [Type]" } ] }, "subject": { "reference": "Patient/{{Patient_id}}", "display": "{{Patient_Name}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T01:35:00+00:00", "issued": "2023-08-31T01:35:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}", "display": "{{Practitioner_Name}}" } ], "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "236297007", "display": "Civil servant" } ] } }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "social-history", "display": "Social History" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "85658-3", "display": "Occupation [Type]" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "{{VALUE_OBSERVATION}}", "display": "{{VALUE_OBSERVATION}}" } ] } }
Variabel | Deskripsi |
---|---|
FACILITY_IHS_NUMBER | SATUSEHAT ID untuk FASYANKES |
FACILITY_NAME | Nama FASYANKES |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
DOCTOR_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
VALUE_OBSERVATION | (*) Kode data jenis pekerjaan. Referensi ke value set "Pekerjaan" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Observation.valueCodeableConcept.coding.system | Observation.valueCodeableConcept.coding.code | Observation.valueCodeableConcept.coding.display | Pilihan jawaban yang divisualisasikan |
---|---|---|---|
http://terminology.kemkes.go.id | TK000030 | Turis | Turis |
http://snomed.info/sct | 106333009 | Manager | Manager/Eksekutif |
http://terminology.kemkes.go.id | TK000040 | Tenaga profesional non medis | Tenaga profesional non medis |
http://snomed.info/sct | 223366009 | Healthcare professional | Tenaga profesional medis |
http://terminology.kemkes.go.id | TK000041 | Pegawai/ karyawan swasta | Pegawai/ karyawan swasta |
http://snomed.info/sct | 160906004 | Self-employed | Wiraswasta/usaha sendiri |
http://snomed.info/sct | 159062006 | Artist | Seniman/artis/aktor/pengrajin |
http://snomed.info/sct | 106388008 | Farmer | Petani |
http://snomed.info/sct | 106540006 | Laborer | Buruh Kasar |
http://snomed.info/sct | 40045004 | Military services member of ground forces | TNI |
http://snomed.info/sct | 236297007 | Civil servant | Pegawai Negeri Sipil (PNS) |
http://snomed.info/sct | 449344001 | Sex worker | Penjaja Seks |
http://snomed.info/sct | 105568001 | In prison | Narapidana |
http://terminology.kemkes.go.id | TK000042 | Pelaut | Pelaut |
http://snomed.info/sct | 236320001 | Vehicle driver | Sopir |
http://snomed.info/sct | 308040008 | Pilot - aircraft | Pilot |
http://snomed.info/sct | 444168002 | Homemaker | Ibu Rumah Tangga |
http://snomed.info/sct | 65853000 | Student | Anak Sekolah/ Mahasiswa |
http://snomed.info/sct | 73438004 | Unemployed | Tidak bekerja |
http://snomed.info/sct | 74964007 | Other | Lain-lain |
http://snomed.info/sct | 106400003 | Fisherman | Nelayan |
http://snomed.info/sct | 52060003 | Livestock farmer | Peternak |
http://snomed.info/sct | 14406004 | Policeman | POLRI |
http://snomed.info/sct | 308208002 | Steward | Pramugara/Pramugari |
➕ Masuk ke ruang pemeriksaan
{ "resourceType": "Encounter", "id": "{{Encounter_id}}", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/encounter/{{Org_id}}", "value": "{{Registration_id}}" } ], "status": "in-progress", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB", "display": "ambulatory" }, "subject": { "reference": "Patient/{{Patient_id}}", "display": "{{Patient_Name}}" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "ATND", "display": "attender" } ] } ], "individual": { "reference": "Practitioner/{{Practitioner_id}}", "display": "{{Practitioner_Name}}" } } ], "period": { "start": "2023-08-31T01:00:00+00:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "24081000087105", "display": "Human immunodeficiency virus nurse practitioner service" } ] } ], "location": [ { "location": { "reference": "Location/{{Location_Poli_uuid}}", "display": "{{Location_Poli_Name}}" }, "period": { "start": "2023-08-31T00:00:00+00:00" }, "extension": [ { "url": "https://fhir.kemkes.go.id/r4/StructureDefinition/ServiceClass", "extension": [ { "url": "value", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/locationServiceClass-Outpatient", "code": "reguler", "display": "Kelas Reguler" } ] } }, { "url": "upgradeClassIndicator", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/locationUpgradeClass", "code": "kelas-tetap", "display": "Kelas Tetap Perawatan" } ] } } ] } ] } ], "statusHistory": [ { "status": "arrived", "period": { "start": "2023-08-31T00:00:00+00:00", "end": "2023-08-31T01:00:00+00:00" } }, { "status": "in-progress", "period": { "start": "2023-08-31T01:00:00+00:00" } } ], "serviceProvider": { "reference": "Organization/{{Org_id}}" }, "hospitalization": { "admitSource": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/clinical-term", "code": "EHA000002", "display": "Datang sendiri" } ] } } }
{ "resourceType": "Encounter", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/encounter/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{ENCOUNTER_LOCAL_CODE}}" } ], "status": "in-progress", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB", "display": "ambulatory" }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "ATND", "display": "attender" } ] } ], "individual": { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } } ], "period": { "start": "{{ENCOUNTER_PERIOD1_START}}" }, "reasonCode": [ { "coding": [ { "system": "{{ENCOUNTER_REASON}}", "code": "{{ENCOUNTER_REASON}}", "display": "{{ENCOUNTER_REASON}}" } ] } ], "location": [ { "location": { "reference": "Location/{{ID_RESOURCE_LOCATION}}", "display": "{{ENCOUNTER_LOCATION_NAME}}" }, "period": { "start": "{{ENCOUNTER_PERIOD1_START}}" }, "extension": [ { "url": "https://fhir.kemkes.go.id/r4/StructureDefinition/ServiceClass", "extension": [ { "url": "value", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/locationServiceClass-Outpatient", "code": "reguler", "display": "Kelas Reguler" } ] } }, { "url": "upgradeClassIndicator", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/locationUpgradeClass", "code": "kelas-tetap", "display": "Kelas Tetap Perawatan" } ] } } ] } ] } ], "statusHistory": [ { "status": "arrived", "period": { "start": "{{ENCOUNTER_PERIOD1_START}}", "end": "{{ENCOUNTER_PERIOD1_END}}" } }, { "status": "in-progress", "period": { "start": "{{ENCOUNTER_PERIOD1_START}}" } } ], "serviceProvider": { "reference": "Organization/{{ORGANIZATION_IHS_NUMBER}}" }, "hospitalization": { "admitSource": { "coding": [ { "system": "{{ENCOUNTER_ADMITSOURCE}}", "code": "{{ENCOUNTER_ADMITSOURCE}}", "display": "{{ENCOUNTER_ADMITSOURCE}}" } ] } } }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
ENCOUNTER_LOCAL_CODE | ID Lokal untuk Kunjungan/Encounter |
PATIENT_IHS_NUMBER | {patient-ihs-number} pada SATUSEHAT |
PATIENT_NAME | Nama Pasien |
PRACTITIONER_IHS_NUMBER | {practitioner-ihs-number} pada SATUSEHAT |
DOCTOR_NAME | Nama Dokter/Nakes |
ENCOUNTER_PERIOD1_START | Waktu mulai/check-in kunjungan |
ENCOUNTER_PERIOD1_END | Waktu mulai/check-out kunjungan |
ID_RESOURCE_LOCATION | ID Location tempat kunjungan dilakukan |
ENCOUNTER_LOCATION_NAME | Nama Location tempat kunjungan dilakukan |
ENCOUNTER_ADMITSOURCE | (*) Data asal di mana sebelum pasien dirawat/admisia. Reference ke value set "Asal Rujukan" |
ENCOUNTER_REASON | (*) Data kode alasan terjadinya kunjungan. Reference ke value set "Alasan Kunjungan" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Encounter.hospitalization.admitSource.coding.system | Encounter.hospitalization.admitSource.coding.code | Encounter.hospitalization.admitSource.coding.display |
---|---|---|
http://terminology.kemkes.go.id/CodeSystem/clinical-term | EHA000002 | Datang sendiri |
http://terminology.kemkes.go.id | TK000031 | From outpatient department |
http://terminology.kemkes.go.id/CodeSystem/clinical-term | EHA000001 | Kader/ Komunitas |
http://terminology.kemkes.go.id | TK000033 | LSM |
http://snomed.info/sct | 257622000 | Healthcare facility |
Alasan Kunjungan
Encounter.reasonCode.coding.system | Encounter.reasonCode.coding.code | Encounter.reasonCode.coding.display |
---|---|---|
http://snomed.info/sct | 24081000087105 | Human immunodeficiency virus nurse practitioner service |
http://terminology.kemkes.go.id | TK000033 | Tes IMS |
3. Memulai Episode Perawatan HIV
Saat pasien mendapatkan hasil tes serologis HIV positif, pasien tersebut dinyatakan sebagai pasien terduga HIV, maka data resource EpisodeOfCare harus dikirimkan. Pembuatan resource EpisodeOfCare cukup dikirimkan satu kali saja melalui POST EpisodeOfCare dengan menggunakan status "waitlist" dan akan mendapat balikan dari SATUSEHAT berupa ID yang kemudian akan digunakan untuk menandai data Encounter.episodeOfCare selama menjalani perawatan dan pengobatan HIV.
Selain itu, akan didapatkan balikan dari SATUSEHAT berupa nomor surveilans penyakit HIV (suspect-id). Episode perawatan HIV dimulai dengan status "waitlist" saat pasien dinyatakan oleh tenaga kesehatan yang berkompetensi sebagai terduga HIV sesuai dengan pedoman dan kriteria diagnosis yang berlaku.
Pada kunjungan berikutnya tidak perlu membuat EpisodeOfCare yang baru, ID EpisodeOfCare yang pertama kali dibuat dapat dicari dengan metode GET menggunakan parameter pencarian dengan patient IHS Number Patient, type EpisodeOfCare yang sesuai dan status "waitlist" untuk mendapatkan ID EpisodeOfCare yang kemudian digunakan untuk menandai data Encounter.episodeOfCare pada kunjungan tersebut dan kunjungan-kunjungan berikutnya. Selain ketiga parameter pencarian tersebut, parameter organization IHS Number Organization juga dapat digunakan apabila hanya ingin melihat EpisodeOfCare di fasyankes yang dikunjungi. Namun, apabila ingin melihat seluruh EpisodeOfCare yang sedang dijalani oleh pasien maka tidak perlu menambahkan parameter organization.
Contoh POST EpisodeOfCare dan pencarian ID EpisodeOfCare dapat dilihat dalam Postman Collection pada Petunjuk Teknis SATUSEHAT (Juknis SATSET).
➕ EpisodeOfCare - Terduga HIV
{ "resourceType": "EpisodeOfCare", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/episode-of-care/{{Org_id}}", "value": "EOC10234567" } ], "status": "waitlist", "statusHistory": [ { "status": "waitlist", "period": { "start": "2023-08-31T04:10:00+00:00" } } ], "type": [ { "coding": [ { "system": "http://terminology.kemkes.go.id", "code": "HIV", "display": "Human Immunodeficiency Virus" } ] } ], "patient": { "reference": "Patient/{{Patient_id}}", "display": "{{Patient_Name}}" }, "managingOrganization": { "reference": "Organization/{{Org_id}}" }, "period": { "start": "2023-08-31T04:10:00+00:00" } }
{ "resourceType": "EpisodeOfCare", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/episode-of-care/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{EOC_LOCAL_CODE}}" } ], "status": "waitlist", "statusHistory": [ { "status": "waitlist", "period": { "start": "{{EOC_PERIOD1_START}}" } } ], "type": [ { "coding": [ { "system": "http://terminology.kemkes.go.id", "code": "HIV", "display": "Human Immunodeficiency Virus" } ] } ], "patient": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "managingOrganization": { "reference": "Organization/{{ORGANIZATION_IHS_NUMBER}}" }, "period": { "start": "{{EOC_PERIOD1_START}}" } }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
EOC_LOCAL_CODE | ID Lokal untuk Episode perawatan HIV |
EOC_PERIOD1_START | Waktu mulai episode perawatan HIV |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
4. Pengiriman Data Anamnesis dan Pemeriksaan Fisik
Data Anamnesis mencakup keluhan utama, riwayat penyakit, riwayat pengobatan, riwayat alergi. Data yang dimiliki pasien tersebut dapat dikirimkan menggunakan resource Condition, AllergyIntolerance, MedicationStatement dan Observation.
Selain itu pada use case HIV juga dibutuhkan informasi tambahan seperti status kehamilan dan usia kehamilan, kelompok populasi, kajian tingkat risiko, tanda klinis dan pemeriksaan fisik. Data-data tersebut dapat dikirimkan menggunakan resource Condition, Observation, dan QuestionnaireResponse.
➕ Keluhan Utama
{ "resourceType": "Condition", "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active", "display": "Active" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "problem-list-item", "display": "Problem List Item" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "49650001", "display": "Dysuria" } ] }, "subject": { "reference": "Patient/{{Patient_id}}", "display": "{{Patient_Name}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "onsetDateTime": "2023-02-02T00:00:00+00:00", "recordedDate": "2023-08-31T01:00:00+00:00", "recorder": { "reference": "Practitioner/{{Practitioner_id}}", "display": "{{Practitioner_Name}}" } }
{ "resourceType": "Condition", "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active", "display": "Active" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "problem-list-item", "display": "Problem List Item" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "{{CONDITION_VALUE_CODE}}", "display": "{{CONDITION_VALUE_DISPLAY}}" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "onsetDateTime": "{{CONDITION_ONSET_DATETIME}}", "recordedDate": "{{CONDITION_RECORDED_DATETIME}}", "recorder": { "reference": "Practitioner/{{DOCTOR_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } }
Variabel | Deskripsi |
---|---|
CONDITION_VALUE | (*) Value data keluhan utama. Referensi ke value set "Keluhan Utama" |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
CONDITION_ONSET_DATETIME | Tanggal perkiraan atau tanggal aktual atau tanggal-waktu kondisi mulai, menurut pendapat dokter. |
CONDITION_RECORDED_DATETIME | Tanggal kapan kondisi/keluhan ini tercatat dalam sistem (tanggal yang dibuat oleh sistem) |
DOCTOR_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Condition.code.coding.system | Condition.code.coding.code | Condition.code.coding.display |
---|---|---|
http://snomed.info/sct | 271939006 | Vaginal discharge |
http://snomed.info/sct | 267802000 | Pruritus of genital organs |
http://snomed.info/sct | 49650001 | Dysuria |
http://snomed.info/sct | 21522001 | Abdominal pain |
http://snomed.info/sct | 283096002 | Scratch of genitalia |
http://snomed.info/sct | 339008 | Blister |
http://snomed.info/sct | 56208002 | Ulcer |
➕ Status Kehamilan
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "82810-3", "display": "Pregnancy status" } ] }, "subject": { "reference": "Patient/{{Patient_id}}", "display": "{{Patient_Name}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T01:35:00+00:00", "issued": "2023-08-31T01:35:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}" } ], "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "77386006", "display": "Pregnancy" } ] } }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "82810-3", "display": "Pregnancy status" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "{{VALUE_OBSERVATION}}", "display": "{{VALUE_OBSERVATION}}" } ] } }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
PRACTITIONER_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
VALUE_OBSERVATION | (*) Kode data status hamil. Referensi ke value set "Status Hamil" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Condition.code.coding.system | Condition.code.coding.code | Condition.code.coding.display |
---|---|---|
http://snomed.info/sct | 77386006 | Pregnancy |
http://snomed.info/sct | 60001007 | Not pregnant |
➕ Usia Kehamilan
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "32418-6", "display": "Obstetric trimester Stated" }, { "system": "http://terminology.kemkes.go.id/CodeSystem/anc-custom-codes", "code": "ANC.SS.DE13", "display": "Trimester ke" } ] }, "subject": { "reference": "Patient/{{Patient_id}}", "display": "{{Patient_Name}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T01:35:00+00:00", "issued": "2023-08-31T01:35:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}", "display": "{{Practitioner_Name}}" } ], "valueInteger": 1 }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "32418-6", "display": "Obstetric trimester Stated" }, { "system": "http://terminology.kemkes.go.id/CodeSystem/anc-custom-codes", "code": "ANC.SS.DE13", "display": "Trimester ke" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "valueInteger": "{{VALUE_OBSERVATION}}" }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
PRACTITIONER_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
VALUE_OBSERVATION | Data usia kehamilan trisemester ke berapa (format integer dengan value 1-3) |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
➕ Kajian Faktor Risiko dan Tanda Klinis
{ "resourceType": "QuestionnaireResponse", "questionnaire": "https://fhir.kemkes.go.id/Questionnaire/Q0023", "status": "completed", "subject": { "reference": "Patient/{{Patient_id}}", "display": "{{Patient_Name}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "authored": "2023-06-22T14:30:00+00:00", "author": { "reference": "Practitioner/{{Practitioner_id}}" }, "source": { "reference": "Patient/{{Patient_id}}" }, "item": [ { "linkId": "1", "text": " Kajian Tingkat Risiko", "item": [ { "linkId": "1.1", "text": "Kelompok Populasi", "answer": [ { "valueReference": { "reference": "Observation/{{Observation_1_1}}" } } ] }, { "linkId": "1.2", "text": "Hubungan Seks Vaginal Beresiko", "answer": [ { "valueReference": { "reference": "Observation/{{Observation_1_2}}" } } ] }, { "linkId": "1.3", "text": "Anal Seks Beresiko", "answer": [ { "valueReference": { "reference": "Observation/{{Observation_1_3}}" } } ] }, { "linkId": "1.4", "text": "Bergantian Peralatan Suntik", "answer": [ { "valueReference": { "reference": "Observation/{{Observation_1_4}}" } } ] }, { "linkId": "1.5", "text": "Transfusi Darah", "answer": [ { "valueReference": { "reference": "Observation/{{Observation_1_5}}" } } ] }, { "linkId": "1.6", "text": "Transmisi Ibu ke Anak", "answer": [ { "valueReference": { "reference": "Observation/{{Observation_1_6}}" } } ] }, { "linkId": "1.7", "text": "Periode Jendela", "answer": [ { "valueReference": { "reference": "Observation/{{Observation_1_7}}" } } ] }, { "linkId": "1.8", "text": "Penyakit Terkait Pasien", "answer": [ { "valueReference": { "reference": "Condition/{{Condition_Penyakit}}" } } ] }, { "linkId": "1.9", "text": "Lainnya", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "1.9.1", "text": "Risiko Lainnya", "answer": [ { "valueString": "Hipertensi" } ] } ] } ] } ] }, { "linkId": "2", "text": "Tanda Klinis IMS dan Pemeriksaan Fisik", "item": [ { "linkId": "2.1", "text": "Tanda Klinis IMS", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "2.1.1", "text": "Jika ya, Tanda Klinis IMS", "answer": [ { "valueReference": { "reference": "Condition/{{Condition_TandaKlinis_1}}" } }, { "valueReference": { "reference": "Condition/{{Condition_TandaKlinis_2}}" } } ] } ] } ] }, { "linkId": "2.2", "text": "Pemeriksaan Fisik", "answer": [ { "valueReference": { "reference": "Observation/{{Observation_2_2_1}}" } }, { "valueReference": { "reference": "Observation/{{Observation_2_2_2}}" } } ] } ] } ] }
{ "resourceType": "QuestionnaireResponse", "questionnaire": "https://fhir.kemkes.go.id/Questionnaire/Q0023", "status": "completed", "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}" "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "authored": "{{AUTHORED_DATETIME}}", "author": { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}" }, "source": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}" }, "item": [ { "linkId": "1", "text": "Kajian Tingkat Risiko", "item": [ { "linkId": "1.1", "text": "Kelompok Populasi", "answer": [ { "valueReference": { "reference": "Observation/{{ANSWER_1_1}}" } } ] }, { "linkId": "1.2", "text": "Hubungan Seks Vaginal Beresiko", "answer": [ { "valueReference": { "reference": "Observation/{{ANSWER_1_2}}" } } ] }, { "linkId": "1.3", "text": "Anal Seks Beresiko", "answer": [ { "valueReference": { "reference": "Observation/{{ANSWER_1_3}}" } } ] }, { "linkId": "1.4", "text": "Bergantian Peralatan Suntik", "answer": [ { "valueReference": { "reference": "Observation/{{ANSWER_1_4}}" } } ] }, { "linkId": "1.5", "text": "Transfusi Darah", "answer": [ { "valueReference": { "reference": "Observation/{{ANSWER_1_5}}" } } ] }, { "linkId": "1.6", "text": "Transmisi Ibu ke Anak", "answer": [ { "valueReference": { "reference": "Observation/{{ANSWER_1_6}}" } } ] }, { "linkId": "1.7", "text": "Periode Jendela", "answer": [ { "valueReference": { "reference": "Observation/{{ANSWER_1_7}}" } } ] }, { "linkId": "1.8", "text": "Penyakit Terkait Pasien", "answer": [ { "valueReference": { "reference": "Condition/{{ANSWER_1_8}}" } } ] }, { "linkId": "1.9", "text": "Lainnya", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "1.9.1", "text": "Risiko Lainnya", "answer": [ { "valueString": "{{ANSWER_1_9_1}}" } ] } ] } ] } ] }, { "linkId": "2", "text": "Tanda Klinis IMS dan Pemeriksaan Fisik", "item": [ { "linkId": "2.1", "text": "Tanda Klinis IMS", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "2.1.1", "text": "Jika ya, Tanda Klinis IMS", "answer": [ { "valueReference": { "reference": "Condition/{{ANSWER_2_1}}" } }, { "valueReference": { "reference": "Condition/{{ANSWER_2_2}}" } } ] } ] } ] }, { "linkId": "2.2", "text": "Pemeriksaan Fisik", "answer": [ { "valueReference": { "reference": "Observation/{{ANSWER_2_2_1}}" } }, { "valueReference": { "reference": "Observation/{{ANSWER_2_2_2}}" } } ] } ] } ] }
Variabel | Deskripsi |
---|---|
PATIENT_IHS_NUMBER | {patient-ihs-number} pada SATUSEHAT |
PATIENT_NAME | Nama pasien |
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
AUTHORED_DATETIME | Waktu di mana jawaban kuesioner didapatkan dengan tipe data dateTime, dengan format yang diperbolehkan YYYY-MM-DDThh:mm:ss+zz:zz |
PRACTITIONER_IHS_NUMBER | {practitioner-ihs-number} pada SATUSEHAT |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
ANSWER_1_1 | {id-resource-Observation} pada SATUSEHAT untuk data Kelompok Populasi |
ANSWER_1_2 | {id-resource-Observation} pada SATUSEHAT untuk data Hubungan Seks Vaginal Beresiko |
ANSWER_1_3 | {id-resource-Observation} pada SATUSEHAT untuk data Anal Seks Beresiko |
ANSWER_1_4 | {id-resource-Observation} pada SATUSEHAT untuk data Bergantian Peralatan Suntik |
ANSWER_1_5 | {id-resource-Observation} pada SATUSEHAT untuk data Transfusi Darah |
ANSWER_1_6 | {id-resource-Observation} pada SATUSEHAT untuk data Transmisi Ibu ke Anak |
ANSWER_1_7 | {id-resource-Observation} pada SATUSEHAT untuk data Periode Jendela |
ANSWER_1_8 | {id-resource-Condition} pada SATUSEHAT untuk data Penyakit Terkait Pasien |
ANSWER_1_9_1 | Data Risiko Lainnya (format freetext) |
ANSWER_2_1 | {id-resource-Condition} pada SATUSEHAT untuk data Tanda Klinis IMS |
ANSWER_2_2 | {id-resource-Observation} pada SATUSEHAT untuk data Tanda Klinis IMS (apabila lebih dari 1) |
ANSWER_2_2_1 | {id-resource-Observation} pada SATUSEHAT untuk data Pemeriksaan Fisik |
ANSWER_2_2_2 | {id-resource-Observation} pada SATUSEHAT untuk data Pemeriksaan Fisik (apabila lebih dari 1) |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
5. Pengiriman Data Terkait Pemeriksaan Penunjang
Pengiriman Data terkait Pemeriksaan Penunjang khususnya Laboratorium dimulai dari skema pemeriksaan, permintaan pemeriksaan penunjang melalui ServiceRequest, pengiriman spesimen untuk Laboratorium melalui Specimen, data hasil pemeriksaan penunjang melalui Observation, dan data laporan pemeriksaan penunjang melalui DiagnosticReport dapat merujuk ke Modul Rawat Jalan, IGD, maupun Rawat Inap di SATUSEHAT. Pemeriksaan penunjang pada pelayanan HIV dan skrining Sifilis mencakup Pemeriksaan Serologis HIV (R1, R2, R3), PCR DNA HIV, PCR RNA HIV, RPR/VDRL, Rapid Sifilis/TPHA.
➕ Permintaan Pemeriksaan Laboratorium - Pemeriksaan Rapid Combo
{ "resourceType": "ServiceRequest", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/servicerequest/{{Org_id}}", "value": "{{Lab_SRID}}" } ], "status": "active", "intent": "original-order", "priority": "routine", "category": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "108252007", "display": "Laboratory procedure" } ] } ], "code": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/examination", "code": "X099420", "display": "Pemeriksaan HIV + Sifilis" } ] }, "subject": { "reference": "Patient/{{Patient_id}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "occurrenceDateTime": "2023-08-31T16:30:00+00:00", "authoredOn": "2023-08-31T19:30:00+00:00", "requester": { "reference": "Practitioner/{{Practitioner_id}}", "display": "{{Practitioner_Name}}" }, "performer": [ { "reference": "Practitioner/N10000005", "display": "Fatma" } ], "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "171128005", "display": "Venereal disease screening" } ] } ] }
{ "resourceType": "ServiceRequest", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/servicerequest/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{SERVICEREQUEST_LOCAL_CODE}}" } ], "status": "active", "intent": "original-order", "priority": "routine", "category": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "108252007", "display": "Laboratory procedure" } ] } ], "code": { "coding": [ { "system": "{{SERVICEREQUEST_TYPE}}", "code": "{{SERVICEREQUEST_TYPE}}", "display": "{{SERVICEREQUEST_TYPE}}" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}" "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "occurrenceDateTime": "{{SERVICEREQUEST_OCCURRENCE_DATETIME}}", "authoredOn": "{{SERVICEREQUEST_AUTHOREDON_DATETIME}}", "requester": { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" }, "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "reasonCode": [ { "coding": [ { "system": "{{REASON_FOR_SERVICEREQUEST}}", "code": "{{REASON_FOR_SERVICEREQUEST}}", "display": "{{REASON_FOR_SERVICEREQUEST}}" } ] } ] }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | ID organisasi induk yang didapatkan dari master sarana indeks |
SERVICEREQUEST_LOCAL_CODE | Kode atau ID lokal/nomor service request lokal yang disimpan di sistem internal masing-masing organisasi |
PATIENT_IHS_NUMBER | ID Patient yang didapatkan dari master pasien indeks |
PATIENT_NAME | Nama Pasien |
SERVICEREQUEST_TYPE | (*) Jenis pemeriksaan lab. Referensi ke value set "Kode Jenis Pemeriksaan" |
ID_RESOURCE_ENCOUNTER | pada SATUSEHAT untuk data kunjungan |
SERVICEREQUEST_OCCURRENCE_DATETIME | Berisi data informasi kapan kontrol harus terlaksana dengan tipe data dateTime, dengan format yang diperbolehkan YYYY-MM-DDThh:mm:ss+zz:zz |
ID_RESOURCE_LOCATION | pada SATUSEHAT untuk data lokasi faskes |
REASON_FOR_SERVICEREQUEST | (*) Berisi data yang berkaitan dengan penjelasan atau justifikasi mengenai mengapa pelayanan ini diminta dalam bentuk kode. Referensi ke value set "Alasan Pemeriksaan" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
ServiceRequest.code.coding.system | ServiceRequest.code.coding.code | ServiceRequest.code.coding.display |
---|---|---|
http://terminology.kemkes.go.id/CodeSystem/examination | X099420 | Pemeriksaan HIV + Sifilis |
http://terminology.kemkes.go.id/CodeSystem/examination | X099419 | Pemeriksaan HIV Diagnostik |
http://loinc.org | 7918-6 | HIV 1+2 Ab [Presence] in Serum |
http://loinc.org | 31201-7 | HIV 1+2 Ab [Presence] in Serum or Plasma by Immunoassay |
http://loinc.org | 80387-4 | HIV 1+2 Ab [Presence] in Serum, Plasma or Blood by Rapid immunoassay |
http://loinc.org | 95524-5 | HIV 1 and 2 Ab [Identifier] in Serum or Plasma by Immunoassay |
http://loinc.org | 69668-2 | HIV 1 and 2 Ab [Identifier] in Serum or Plasma by Rapid immunoassay |
http://loinc.org | 7917-8 | HIV 1 Ab [Presence] in Serum |
http://loinc.org | 7919-4 | HIV 2 Ab [Presence] in Serum |
http://loinc.org | 44871-2 | HIV 1 proviral DNA [Presence] in Blood by NAA with probe detection |
http://loinc.org | 25841-8 | HIV 2 proviral DNA [Presence] in Blood by NAA with probe detection |
http://loinc.org | 74854-1 | HIV 1 proviral DNA [#/volume] (viral load) in Blood by NAA with probe detection |
http://loinc.org | 59419-2 | HIV 1 RNA [#/volume] (viral load) in Plasma by Probe with signal amplification |
http://loinc.org | 86548-5 | HIV 2 RNA [#/volume] (viral load) in Plasma by NAA with probe detection |
http://loinc.org | 29539-4 | HIV 1 RNA [Log #/volume] (viral load) in Plasma by Probe with signal amplification |
http://loinc.org | 62469-2 | HIV 1 RNA [Units/volume] (viral load) in Serum or Plasma by NAA with probe detection |
http://loinc.org | 69354-9 | HIV 2 RNA [Units/volume] (viral load) in Serum or Plasma by NAA with probe detection |
http://loinc.org | 22587-0 | Treponema pallidum Ab [Presence] in Serum |
http://loinc.org | 8041-6 | Treponema pallidum Ab [Presence] in Serum by Hemagglutination |
http://loinc.org | 5393-4 | Treponema pallidum Ab [Presence] in Serum by Immunofluorescence |
http://loinc.org | 31147-2 | Reagin Ab [Titer] in Serum by RPR |
http://loinc.org | 5292-8 | Reagin Ab [Presence] in Serum by VDRL |
http://loinc.org | 20507-0 | Reagin Ab [Presence] in Serum by RPR |
Alasan Pemeriksaan
ServiceRequest.reasonCode.coding.system | ServiceRequest.reasonCode.coding.code | ServiceRequest.reasonCode.coding.display |
---|---|---|
http://snomed.info/sct | 171128005 | Venereal disease screening |
http://terminology.kemkes.go.id/CodeSystem/clinical-term | SRR000007 | Pemeriksaan Diagnosis |
http://terminology.kemkes.go.id/CodeSystem/clinical-term | SRR000008 | Follow Up |
➕ Pengambilan Spesimen - Darah
{ "resourceType": "Specimen", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/specimen/{{Org_id}}", "value": "00001", "assigner": { "reference": "Organization/{{Org_id}}" } } ], "status": "available", "type": { "coding": [ { "system": "http://snomed.info/sct", "code": "258580003", "display": "Whole blood specimen" } ] }, "collection": { "collectedDateTime": "2023-08-31T15:15:00+00:00" }, "processing": [ { "procedure": { "coding": [ { "system": "http://snomed.info/sct", "code": "9265001", "display": "Specimen processing" } ] }, "timeDateTime": "2023-08-31T15:15:00+00:00" } ], "subject": { "reference": "Patient/{{Patient_id}}", "display": "{{Patient_Name}}" }, "request": [ { "reference": "ServiceRequest/{{ServiceRequest_Lab}}" } ], "receivedTime": "2023-08-31T08:25:00+00:00" }
{ "resourceType": "Specimen", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/specimen/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{SPECIMEN_LOCAL_CODE}}" "assigner": { "reference": "Organization/{{ORGANIZATION_IHS_NUMBER}}" } } ], "status": "available", "type": { "coding": [ { "system": "{{SPECIMEN_TYPE}}", "code": "{{SPECIMEN_TYPE}}", "display": "{{SPECIMEN_TYPE}}" } ] }, "collection": { "collectedDateTime": "{{SPECIMEN_COLLECTED_DATETIME}}" }, "processing": [ { "procedure": { "coding": [ { "system": "http://snomed.info/sct", "code": "9265001", "display": "Specimen processing" } ] }, "timeDateTime": "{{SPECIMEN_PROCESSED_DATETIME}}" } ], "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "request": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "receivedTime": "{{SPECIMEN_RECEIVED_DATETIME}}" }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
SPECIMEN_LOCAL_CODE | id spesimen lokal dari masing-masing institusi |
SPECIMEN_TYPE | (*) Jenis spesimen. Referensi ke value set "Jenis Spesimen" |
SPECIMEN_COLLECTED_DATETIME | Tanggal dan jam pengambilan sample spesimen |
SPECIMEN_PROCESSED_DATETIME | Tanggal dan jam spesimen diproses di dept lab |
SPECIMEN_RECEIVED_DATETIME | Tanggal dan jam spesimen diterima di dept lab |
PATIENT_IHS_NUMBER | {patient-ihs-number} pada SATUSEHAT |
PATIENT_NAME | Nama pasien |
PRACTITIONER_IHS_NUMBER | {practitioner-ihs-number} pada SATUSEHAT |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Specimen.type.coding.system | Specimen.type.coding.code | Specimen.type.coding.display |
---|---|---|
http://snomed.info/sct | 119297000 | Blood specimen |
http://snomed.info/sct | 119361006 | Plasma |
http://snomed.info/sct | 119364003 | Serum |
http://snomed.info/sct | 258580003 | Whole blood specimen |
➕ Hasil Pemeriksaan Lab
KETERANGAN:
|
➕ Rapid Serologis HIV (R1, R2, dan R3)
Pemeriksaan rapid serologis HIV dapat dilakukan hingga 3x sebagai bentuk konfirmasi jika ditemukan hasil reaktif. Pemeriksaan pertama (R1) dapat menggunakan reagen single yang hanya mendeteksi virus HIV atau reagen duo/combo yang dapat mendeteksi virus HIV dan Sifilis. Reagen duo/combo biasanya digunakan untuk pemeriksaan pada ibu hamil dan triple eliminasi. Jika reagen duo/combo digunakan, pengiriman data dilakukan dengan elemen Observation.component dengan pemetaan terminologi untuk kode pemeriksaan dan hasil pemeriksaan mengacu pada jenis masing-masing pemeriksaan.
Hasil pemeriksaan rapid serologis HIV dapat dikirimkan dengan menggunakan resource Observation berdasarkan jenisnya:
1. Pemeriksaan Rapid HIV (Rapid Single)
Pemeriksaan Rapid HIV (Rapid Single) merupakan pemeriksaan yang paling umum dilakukan untuk proses skrining HIV.
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "69668-2", "display": "HIV 1 and 2 Ab [Identifier] in Serum or Plasma by Rapid immunoassay" } ] }, "subject": { "reference": "Patient/{{Patient_id}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T15:25:00+00:00", "issued": "2023-08-31T15:25:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}" }, { "reference": "Organization/{{Org_id}}" } ], "specimen": { "reference": "Specimen/{{Specimen_Lab}}" }, "basedOn": [ { "reference": "ServiceRequest/{{ServiceRequest_Lab}}" } ], "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA18330-3", "display": "HIV-1 reactive" } ] }, "interpretation": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation", "code": "RR", "display": "Reactive" } ] } ] }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "{{OBSERVATION_TYPE}}", "code": "{{OBSERVATION_TYPE}}", "display": "{{OBSERVATION_TYPE}}" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "specimen": { "reference": "Specimen/{{SPECIMEN_IHS_NUMBER}}" }, "basedOn": { "reference": "ServiceRequest/{{SERVICEREQUEST_IHS_NUMBER}}" }, "valueCodeableConcept": { "coding": [ { "system": "{{VALUE_OBSERVATION}}", "code": "{{VALUE_OBSERVATION}}", "display": "{{VALUE_OBSERVATION}}" } ] }, "interpretation": [ { "coding": [ { "system": "{{OBSERVATION_INTERPRETATION}}", "code": "{{OBSERVATION_INTERPRETATION}}", "display": "{{OBSERVATION_INTERPRETATION}}" } ] } ] }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_TYPE | (*) Jenis pemeriksaan lab. Referensi ke value set "Jenis Pemeriksaan" |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
PRACTITIONER_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
SPECIMEN_IHS_NUMBER | {id-resource-Specimen} pada SATUSEHAT untuk data sample specimen |
SERVICEREQUEST_IHS_NUMBER | {id-resource-ServiceRequest} pada SATUSEHAT untuk data permintaan pemeriksaan lab |
VALUE_OBSERVATION | (*) Hasil pemeriksaan lab. Referensi ke value set "Hasil Pemeriksaan" |
OBSERVATION_INTERPRETATION | (*) Hasil interpretasi pemeriksaan lab. Referensi ke value set "Hasil Interpretasi" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Observation.code.coding.system | Observation.code.coding.code | Observation.code.coding.display |
---|---|---|
http://loinc.org | 7918-6 | HIV 1+2 Ab [Presence] in Serum |
http://loinc.org | 31201-7 | HIV 1+2 Ab [Presence] in Serum or Plasma by Immunoassay |
http://loinc.org | 80387-4 | HIV 1+2 Ab [Presence] in Serum, Plasma or Blood by Rapid immunoassay |
http://loinc.org | 95524-5 | HIV 1 and 2 Ab [Identifier] in Serum or Plasma by Immunoassay |
http://loinc.org | 69668-2 | HIV 1 and 2 Ab [Identifier] in Serum or Plasma by Rapid immunoassay |
http://loinc.org | 7917-8 | HIV 1 Ab [Presence] in Serum |
http://loinc.org | 7919-4 | HIV 2 Ab [Presence] in Serum |
Hasil Pemeriksaan
Jenis Pemeriksaan Lab dengan Observation.code | Observation.valueCodeableConcept.coding.system | Observation.valueCodeableConcept.coding.code | Observation.valueCodeableConcept.coding.display |
---|---|---|---|
7918-6 31201-7 80387-4 |
http://loinc.org | LA18332-9 | HIV Reactive (Undifferentiated) |
http://loinc.org | LA15256-3 | Nonreactive | |
95524-5 69668-2 |
http://loinc.org | LA18332-9 | HIV Reactive (Undifferentiated) |
http://loinc.org | LA18330-3 | HIV-1 reactive | |
http://loinc.org | LA18331-1 | HIV-2 reactive | |
http://loinc.org | LA15256-3 | Nonreactive | |
7917-8 7919-4 |
http://loinc.org | LA15255-5 | Reactive |
http://loinc.org | LA15256-3 | Nonreactive |
Hasil Interpretasi
Observation.code.coding.system | Observation.code.coding.code | Observation.code.coding.display |
---|---|---|
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | RR | Reactive |
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | NR | Nonreactive |
2. Pemeriksaan Rapid HIV Sifilis (Rapid Duo/Combo)
Pada hasil pemeriksaan Rapid Combo, terdapat 2 hasil pemeriksaan yaitu hasil pemeriksaan HIV dan hasil pemeriksaan Sifilis. Pengiriman data dilakukan dalam 1 payload dengan array pada path Observation.component. Ketentuan mengenai pemetaan terminologi kode pemeriksaan, hasil pemeriksaan, dan interpretasi pemeriksaan mengacu pada ketentuan masing-masing pemeriksaan, baik untuk pemeriksaan rapid serologis HIV maupun sifilis. Namun, terdapat perubahan pemetaan variabel dengan ketentuan sebagai berikut:
- Untuk variabel kode pemeriksaan, path Observation.code menjadi Observation.component.code
- Untuk variabel hasil pemeriksaan, Observation.valueCodeableConcept menjadi Observation.component.valueCodeableConcept
- Untuk variabel interpretasi pemeriksaan, Observation.interpretation menjadi Observation.component.interpretation
➕ PCR DNA/EID HIV
1. PCR DNA/EID HIV Kualitatif
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "44871-2", "display": "HIV 1 proviral DNA [Presence] in Blood by NAA with probe detection" } ] }, "subject": { "reference": "Patient/{{Patient_id}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T15:25:00+00:00", "issued": "2023-08-31T15:25:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}" }, { "reference": "Organization/{{Org_id}}" } ], "specimen": { "reference": "Specimen/{{Specimen_Lab}}" }, "basedOn": [ { "reference": "ServiceRequest/{{ServiceRequest_Lab}}" } ], "valueCodeableConcept": { "coding": [ { "system": "http://loinc.org", "code": "LA11882-0", "display": "Detected" } ] } }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "{{OBSERVATION_TYPE}}", "code": "{{OBSERVATION_TYPE}}", "display": "{{OBSERVATION_TYPE}}" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "specimen": { "reference": "Specimen/{{SPECIMEN_IHS_NUMBER}}" }, "basedOn": { "reference": "ServiceRequest/{{SERVICEREQUEST_IHS_NUMBER}}" }, "valueCodeableConcept": { "coding": [ { "system": "{{VALUE_OBSERVATION}}", "code": "{{VALUE_OBSERVATION}}", "display": "{{VALUE_OBSERVATION}}" } ] }, "interpretation": [ { "coding": [ { "system": "{{OBSERVATION_INTERPRETATION}}", "code": "{{OBSERVATION_INTERPRETATION}}", "display": "{{OBSERVATION_INTERPRETATION}}" } ] } ] }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_TYPE | (*) Jenis pemeriksaan lab. Referensi ke value set "Jenis Pemeriksaan" |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
PRACTITIONER_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
SPECIMEN_IHS_NUMBER | {id-resource-Specimen} pada SATUSEHAT untuk data sample specimen |
SERVICEREQUEST_IHS_NUMBER | {id-resource-ServiceRequest} pada SATUSEHAT untuk data permintaan pemeriksaan lab |
VALUE_OBSERVATION | (*) Hasil pemeriksaan lab. Referensi ke value set "Hasil Pemeriksaan" |
OBSERVATION_INTERPRETATION | (*) Hasil interpretasi pemeriksaan lab. Referensi ke value set "Hasil Interpretasi" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Observation.code.coding.system | Observation.code.coding.code | Observation.code.coding.display |
---|---|---|
http://loinc.org | 44871-2 | HIV 1 proviral DNA [Presence] in Blood by NAA with probe detection |
http://loinc.org | 25841-8 | HIV 2 proviral DNA [Presence] in Blood by NAA with probe detection |
Hasil Pemeriksaan
Observation.valueCodeableConcept.coding.system | Observation.valueCodeableConcept.coding.code | Observation.valueCodeableConcept.coding.display |
---|---|---|
http://loinc.org | LA11882-0 | Detected |
http://loinc.org | LA11883-8 | Not detected |
Hasil Interpretasi
Observation.interpretation.coding.system | Observation.interpretation.coding.code | Observation.interpretation.coding.display |
---|---|---|
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | POS | Positive |
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | NEG | Negative |
2. PCR DNA/EID HIV Kuantitatif
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "74854-1", "display": "HIV 1 proviral DNA [#/volume] (viral load) in Blood by NAA with probe detection" } ] }, "subject": { "reference": "Patient/{{Patient_id}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T15:25:00+00:00", "issued": "2023-08-31T15:25:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}" }, { "reference": "Organization/{{Org_id}}" } ], "specimen": { "reference": "Specimen/{{Specimen_Lab}}" }, "basedOn": [ { "reference": "ServiceRequest/{{ServiceRequest_Lab}}" } ], "valueQuantity": { "value": 18, "unit": "{copies}/mL", "system": "http://unitsofmeasure.org", "code": "{copies}/mL" }, "interpretation": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation", "code": "POS", "display": "Positive" } ] } ] }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "{{OBSERVATION_TYPE}}", "code": "{{OBSERVATION_TYPE}}", "display": "{{OBSERVATION_TYPE}}" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "specimen": { "reference": "Specimen/{{SPECIMEN_IHS_NUMBER}}" }, "basedOn": { "reference": "ServiceRequest/{{SERVICEREQUEST_IHS_NUMBER}}" }, "valueQuantity": { "value": {{VALUE_OBSERVATION}}, "unit": "{copies}/mL", "system": "http://unitsofmeasure.org", "code": "{copies}/mL" }, "interpretation": [ { "coding": [ { "system": "{{OBSERVATION_INTERPRETATION}}", "code": "{{OBSERVATION_INTERPRETATION}}", "display": "{{OBSERVATION_INTERPRETATION}}" } ] } ] }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_TYPE | (*) Jenis pemeriksaan lab. Referensi ke value set "Jenis Pemeriksaan" |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
PRACTITIONER_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
SPECIMEN_IHS_NUMBER | {id-resource-Specimen} pada SATUSEHAT untuk data sample specimen |
SERVICEREQUEST_IHS_NUMBER | {id-resource-ServiceRequest} pada SATUSEHAT untuk data permintaan pemeriksaan lab |
VALUE_OBSERVATION | Hasil pemeriksaan lab dengan tipe data decimal |
OBSERVATION_INTERPRETATION | (*) Hasil interpretasi pemeriksaan lab. Referensi ke value set "Hasil Interpretasi" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Observation.code.coding.system | Observation.code.coding.code | Observation.code.coding.display |
---|---|---|
http://loinc.org | 74854-1 | HIV 1 proviral DNA [#/volume] (viral load) in Blood by NAA with probe detection |
http://loinc.org | 25841-8 | HIV 2 proviral DNA [Presence] in Blood by NAA with probe detection |
Hasil Interpretasi
Observation.interpretation.coding.system | Observation.interpretation.coding.code | Observation.interpretation.coding.display |
---|---|---|
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | POS | Positive |
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | NEG | Negative |
➕ PCR RNA HIV
1. PCR RNA HIV Kuantitatif/ Viral Load - [#/volume]
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "59419-2", "display": "HIV 1 RNA [#/volume] (viral load) in Plasma by Probe with signal amplification" } ] }, "subject": { "reference": "Patient/{{Patient_id}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T15:25:00+00:00", "issued": "2023-08-31T15:25:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}" }, { "reference": "Organization/{{Org_id}}" } ], "specimen": { "reference": "Specimen/{{Specimen_Lab}}" }, "basedOn": [ { "reference": "ServiceRequest/{{ServiceRequest_Lab}}" } ], "valueQuantity": { "value": 18, "unit": "{copies}/mL", "system": "http://unitsofmeasure.org", "code": "{copies}/mL" }, "interpretation": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation", "code": "POS", "display": "Positive" } ] } ] }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "{{OBSERVATION_TYPE}}", "code": "{{OBSERVATION_TYPE}}", "display": "{{OBSERVATION_TYPE}}" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "specimen": { "reference": "Specimen/{{SPECIMEN_IHS_NUMBER}}" }, "basedOn": { "reference": "ServiceRequest/{{SERVICEREQUEST_IHS_NUMBER}}" }, "valueQuantity": { "value": {{VALUE_OBSERVATION}}, "unit": "{copies}/mL", "system": "http://unitsofmeasure.org", "code": "{copies}/mL" }, "interpretation": [ { "coding": [ { "system": "{{OBSERVATION_INTERPRETATION}}", "code": "{{OBSERVATION_INTERPRETATION}}", "display": "{{OBSERVATION_INTERPRETATION}}" } ] } ] }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_TYPE | (*) Jenis pemeriksaan lab. Referensi ke value set "Jenis Pemeriksaan" |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
PRACTITIONER_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
SPECIMEN_IHS_NUMBER | {id-resource-Specimen} pada SATUSEHAT untuk data sample specimen |
SERVICEREQUEST_IHS_NUMBER | {id-resource-ServiceRequest} pada SATUSEHAT untuk data permintaan pemeriksaan lab |
VALUE_OBSERVATION | (*) Hasil pemeriksaan lab. Referensi ke value set "Hasil Pemeriksaan" |
OBSERVATION_INTERPRETATION | (*) Hasil interpretasi pemeriksaan lab. Referensi ke value set "Hasil Interpretasi" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Observation.code.coding.system | Observation.code.coding.code | Observation.code.coding.display |
---|---|---|
http://loinc.org | 59419-2 | HIV 1 RNA [#/volume] (viral load) in Plasma by Probe with signal amplification |
http://loinc.org | 86548-5 | HIV 2 RNA [#/volume] (viral load) in Plasma by NAA with probe detection |
Hasil Interpretasi
Observation.interpretation.coding.system | Observation.interpretation.coding.code | Observation.interpretation.coding.display |
---|---|---|
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | POS | Positive |
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | NEG | Negative |
2. PCR RNA HIV Kuantitatif/ Viral Load - [Log#/volume]
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "29539-4", "display": "HIV 1 RNA [Log #/volume] (viral load) in Plasma by Probe with signal amplification" } ] }, "subject": { "reference": "Patient/{{Patient_id}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T15:25:00+00:00", "issued": "2023-08-31T15:25:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}" }, { "reference": "Organization/{{Org_id}}" } ], "specimen": { "reference": "Specimen/{{Specimen_Lab}}" }, "basedOn": [ { "reference": "ServiceRequest/{{ServiceRequest_Lab}}" } ], "valueQuantity": { "value": 18, "unit": "{Log_copies}/mL", "system": "http://unitsofmeasure.org", "code": "{Log_copies}/mL" }, "interpretation": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation", "code": "POS", "display": "Positive" } ] } ] }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org ", "code": "29539-4", "display": "HIV 1 RNA [Log #/volume] (viral load) in Plasma by Probe with signal amplification" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "specimen": { "reference": "Specimen/{{SPECIMEN_IHS_NUMBER}}" }, "basedOn": { "reference": "ServiceRequest/{{SERVICEREQUEST_IHS_NUMBER}}" }, "valueQuantity": { "value": {{VALUE_OBSERVATION}}, "unit": "{Log_copies}/mL", "system": "http://unitsofmeasure.org", "code": "{Log_copies}/mL" }, "interpretation": [ { "coding": [ { "system": "{{OBSERVATION_INTERPRETATION}}", "code": "{{OBSERVATION_INTERPRETATION}}", "display": "{{OBSERVATION_INTERPRETATION}}" } ] } ] }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
PRACTITIONER_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
SPECIMEN_IHS_NUMBER | {id-resource-Specimen} pada SATUSEHAT untuk data sample specimen |
SERVICEREQUEST_IHS_NUMBER | {id-resource-ServiceRequest} pada SATUSEHAT untuk data permintaan pemeriksaan lab |
VALUE_OBSERVATION | Hasil pemeriksaan lab dengan tipe data decimal |
OBSERVATION_INTERPRETATION | (*) Hasil interpretasi pemeriksaan lab. Referensi ke value set "Hasil Interpretasi" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Observation.interpretation.coding.system | Observation.interpretation.coding.code | Observation.interpretation.coding.display |
---|---|---|
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | POS | Positive |
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | NEG | Negative |
3. PCR RNA HIV Kuantitatif/ Viral Load - [Units/volume]
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "69354-9", "display": "HIV 2 RNA [Units/volume] (viral load) in Serum or Plasma by NAA with probe detection" } ] }, "subject": { "reference": "Patient/{{Patient_id}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T15:25:00+00:00", "issued": "2023-08-31T15:25:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}" }, { "reference": "Organization/{{Org_id}}" } ], "specimen": { "reference": "Specimen/{{Specimen_Lab}}" }, "basedOn": [ { "reference": "ServiceRequest/{{ServiceRequest_Lab}}" } ], "valueQuantity": { "value": 18, "unit": "[IU]/mL", "system": "http://unitsofmeasure.org", "code": "[IU]/mL" }, "interpretation": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation", "code": "POS", "display": "Positive" } ] } ] }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "{{OBSERVATION_TYPE}}", "code": "{{OBSERVATION_TYPE}}", "display": "{{OBSERVATION_TYPE}}" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "specimen": { "reference": "Specimen/{{SPECIMEN_IHS_NUMBER}}" }, "basedOn": { "reference": "ServiceRequest/{{SERVICEREQUEST_IHS_NUMBER}}" }, "valueQuantity": { "value": {{VALUE_OBSERVATION}}, "unit": "[IU]/mL", "system": "http://unitsofmeasure.org", "code": "[IU]/mL" }, "interpretation": [ { "coding": [ { "system": "{{OBSERVATION_INTERPRETATION}}", "code": "{{OBSERVATION_INTERPRETATION}}", "display": "{{OBSERVATION_INTERPRETATION}}" } ] } ] }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_TYPE | (*) Jenis pemeriksaan lab. Referensi ke value set "Jenis Pemeriksaan" |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
PRACTITIONER_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
SPECIMEN_IHS_NUMBER | {id-resource-Specimen} pada SATUSEHAT untuk data sample specimen |
SERVICEREQUEST_IHS_NUMBER | {id-resource-ServiceRequest} pada SATUSEHAT untuk data permintaan pemeriksaan lab |
VALUE_OBSERVATION | (*) Hasil pemeriksaan lab. Referensi ke value set "Hasil Pemeriksaan" |
OBSERVATION_INTERPRETATION | (*) Hasil interpretasi pemeriksaan lab. Referensi ke value set "Hasil Interpretasi" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Observation.code.coding.system | Observation.code.coding.code | Observation.code.coding.display |
---|---|---|
http://loinc.org | 62469-2 | HIV 1 RNA [Units/volume] (viral load) in Serum or Plasma by NAA with probe detection |
http://loinc.org | 69354-9 | HIV 2 RNA [Units/volume] (viral load) in Serum or Plasma by NAA with probe detection |
Hasil Interpretasi
Observation.interpretation.coding.system | Observation.interpretation.coding.code | Observation.interpretation.coding.display |
---|---|---|
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | POS | Positive |
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | NEG | Negative |
➕ Pemeriksaan Rapid Sifilis/TPHA
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "8041-6", "display": "Treponema pallidum Ab [Presence] in Serum by Hemagglutination" } ] }, "subject": { "reference": "Patient/{{Patient_id}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T15:25:00+00:00", "issued": "2023-08-31T15:25:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}" }, { "reference": "Organization/{{Org_id}}" } ], "specimen": { "reference": "Specimen/{{Specimen_Lab}}" }, "basedOn": [ { "reference": "ServiceRequest/{{ServiceRequest_Lab}}" } ], "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "11214006", "display": "Reactive" } ] } }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "{{OBSERVATION_TYPE}}", "code": "{{OBSERVATION_TYPE}}", "display": "{{OBSERVATION_TYPE}&rc]ub;" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "specimen": { "reference": "Specimen/{{SPECIMEN_IHS_NUMBER}}" }, "basedOn": { "reference": "ServiceRequest/{{SERVICEREQUEST_IHS_NUMBER}}" }, "valueCodeableConcept": { "coding": [ { "system": "{{VALUE_OBSERVATION}}", "code": "{{VALUE_OBSERVATION}}", "display": "{{VALUE_OBSERVATION}}" } ] }, "interpretation": [ { "coding": [ { "system": "{{OBSERVATION_INTERPRETATION}}", "code": "{{OBSERVATION_INTERPRETATION}}", "display": "{{OBSERVATION_INTERPRETATION}&rc]ub;" } ] } ] }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_TYPE | (*) Jenis pemeriksaan lab. Referensi ke value set "Jenis Pemeriksaan" |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
PRACTITIONER_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
SPECIMEN_IHS_NUMBER | {id-resource-Specimen} pada SATUSEHAT untuk data sample specimen |
SERVICEREQUEST_IHS_NUMBER | {id-resource-ServiceRequest} pada SATUSEHAT untuk data permintaan pemeriksaan lab |
VALUE_OBSERVATION | (*) Hasil pemeriksaan lab. Referensi ke value set "Hasil Pemeriksaan" |
OBSERVATION_INTERPRETATION | (*) Hasil interpretasi pemeriksaan lab. Referensi ke value set "Hasil Interpretasi" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Observation.code.coding.system | Observation.code.coding.code | Observation.code.coding.display |
---|---|---|
http://loinc.org | 8041-6 | Treponema pallidum Ab [Presence] in Serum by Hemagglutination |
http://loinc.org | 22587-0 | Treponema pallidum Ab [Presence] in Serum |
http://loinc.org | 5393-4 | Treponema pallidum Ab [Presence] in Serum by Immunofluorescence |
Hasil Interpretasi
Observation.valueCodeableConcept.coding.system | Observation.valueCodeableConcept.coding.code | Observation.valueCodeableConcept.coding.display |
---|---|---|
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | LA15255-5 | Reactive |
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | LA15256-3 | Non-Reactive |
➕ Pemeriksaan Titer RPR
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "31147-2", "display": "Reagin Ab [Titer] in Serum by RPR" } ] }, "subject": { "reference": "Patient/{{Patient_id}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T15:25:00+00:00", "issued": "2023-08-31T15:25:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}" }, { "reference": "Organization/{{Org_id}}" } ], "specimen": { "reference": "Specimen/{{Specimen_Lab}}" }, "basedOn": [ { "reference": "ServiceRequest/{{ServiceRequest_Lab}}" } ], "valueRatio": { "numerator": { "value": 1, "unit": "{titer}", "system": "http://unitsofmeasure.org", "code": "{titer}" }, "denominator": { "value": 16, "unit": "{titer}", "system": "http://unitsofmeasure.org", "code": "{titer}" } } }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "31147-2", "display": "Reagin Ab [Titer] in Serum by RPR" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "specimen": { "reference": "Specimen/{{SPECIMEN_IHS_NUMBER}}" }, "basedOn": { "reference": "ServiceRequest/{{SERVICEREQUEST_IHS_NUMBER}}" }, "valueRatio": { "numerator": { "value": {{VALUE_OBSERVATION_NUMERATOR}}, "unit": "{titer}", "system": "http://unitsofmeasure.org", "code": "{titer}" }, "denominator": { "value": {{VALUE_OBSERVATION_DENOMINATOR}}, "unit": "{titer}", "system": "http://unitsofmeasure.org", "code": "{titer}" } }, "interpretation": [ { "coding": [ { "system": "{{OBSERVATION_INTERPRETATION}}", "code": "{{OBSERVATION_INTERPRETATION}}", "display": "{{OBSERVATION_INTERPRETATION}&rc]ub;" } ] } ] }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_TYPE | (*) Jenis pemeriksaan lab. Referensi ke value set "Jenis Pemeriksaan" |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
PRACTITIONER_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
SPECIMEN_IHS_NUMBER | {id-resource-Specimen} pada SATUSEHAT untuk data sample specimen |
SERVICEREQUEST_IHS_NUMBER | {id-resource-ServiceRequest} pada SATUSEHAT untuk data permintaan pemeriksaan lab |
VALUE_OBSERVATION_NUMERATOR | Hasil pemeriksaan lab numerator dengan tipe data decimal |
VALUE_OBSERVATION_DENOMINATOR | Hasil pemeriksaan lab denominator dengan tipe data decimal |
OBSERVATION_INTERPRETATION | (*) Hasil interpretasi pemeriksaan lab. Referensi ke value set "Hasil Interpretasi" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Observation.valueCodeableConcept.coding.system | Observation.valueCodeableConcept.coding.code | Observation.valueCodeableConcept.coding.display |
---|---|---|
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | POS | Positive |
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | NEG | Negative |
➕ Pemeriksaan RPR/VDRL
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{Org_id}}", "value": "O111111" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "20507-0", "display": "Reagin Ab [Presence] in Serum by RPR" } ] }, "subject": { "reference": "Patient/{{Patient_id}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T15:25:00+00:00", "issued": "2023-08-31T15:25:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}" }, { "reference": "Organization/{{Org_id}}" } ], "specimen": { "reference": "Specimen/{{Specimen_Lab}}" }, "basedOn": [ { "reference": "ServiceRequest/{{ServiceRequest_Lab}}" } ], "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "11214006", "display": "Reactive" } ] } }
{ "resourceType": "Observation", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/observation/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{OBSERVATION_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "{{OBSERVATION_TYPE}}", "code": "{{OBSERVATION_TYPE}}", "display": "{{OBSERVATION_TYPE}}" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{OBSERVATION_EFFECTIVE_DATETIME}}", "issued": "{{OBSERVATION_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "specimen": { "reference": "Specimen/{{SPECIMEN_IHS_NUMBER}}" }, "basedOn": { "reference": "ServiceRequest/{{SERVICEREQUEST_IHS_NUMBER}}" }, "valueCodeableConcept": { "coding": [ { "system": "{{VALUE_OBSERVATION}}", "code": "{{VALUE_OBSERVATION}}", "display": "{{VALUE_OBSERVATION}}" } ] } }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
OBSERVATION_LOCAL_CODE | ID Lokal untuk Observasi |
PATIENT_IHS_NUMBER | SATUSEHAT ID Number untuk Pasien |
PATIENT_NAME | Nama Pasien |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
OBSERVATION_TYPE | (*) Jenis pemeriksaan lab. Referensi ke value set "Jenis Pemeriksaan" |
OBSERVATION_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
OBSERVATION_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
PRACTITIONER_IHS_NUMBER | SATUSEHAT ID untuk Dokter/Nakes |
DOCTOR_NAME | Nama Dokter/Nakes |
SPECIMEN_IHS_NUMBER | {id-resource-Specimen} pada SATUSEHAT untuk data sample specimen |
SERVICEREQUEST_IHS_NUMBER | {id-resource-ServiceRequest} pada SATUSEHAT untuk data permintaan pemeriksaan lab |
VALUE_OBSERVATION | (*) Hasil pemeriksaan lab. Referensi ke value set "Hasil Pemeriksaan" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Observation.code.coding.system | Observation.code.coding.code | Observation.code.coding.display |
---|---|---|
http://loinc.org | 20507-0 | Reagin Ab [Presence] in Serum by RPR |
http://loinc.org | 5292-8 | Reagin Ab [Presence] in Serum by VDRL |
Hasil Pemeriksaan
Observation.valueCodeableConcept.coding.system | Observation.valueCodeableConcept.coding.code | Observation.valueCodeableConcept.coding.display |
---|---|---|
http://loinc.org | LA15255-5 | Reactive |
http://loinc.org | LA15256-3 | Non-Reactive |
➕ Laporan Pemeriksaan Lab
{ "resourceType": "DiagnosticReport", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/diagnostic/{{Org_id}}/lab", "use": "official", "value": "5234342" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/examination", "code": "X099418", "display": "Rapid HIV + Sifilis" } ] }, "subject": { "reference": "Patient/{{Patient_id}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "effectiveDateTime": "2023-08-31T15:25:00+00:00", "issued": "2023-08-31T15:25:00+00:00", "performer": [ { "reference": "Practitioner/{{Practitioner_id}}" }, { "reference": "Organization/{{Org_id}}" } ], "result": [ { "id": "1", "reference": "Observation/{{Observation_Lab_Result_1}}" }, { "id": "2", "reference": "Observation/{{Observation_Lab_Result_2}}" }, { "id": "3", "reference": "Observation/{{Observation_Lab_Result_3}}" } ], "specimen": [ { "reference": "Specimen/{{Specimen_Lab}}" } ], "basedOn": [ { "reference": "ServiceRequest/{{ServiceRequest_Lab}}" } ], "conclusionCode": [ { "coding": [ { "system": "http://loinc.org", "code": "LA6576-8", "display": "Positive" } ], "text": "Hasil Pemeriksaan HIV" }, { "coding": [ { "system": "http://loinc.org", "code": "LA15256-3", "display": "Nonreactive" } ], "text": "Hasil Pemeriksaan Sifilis" } ] }
{ "resourceType": "DiagnosticReport", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/diagnostic/{{ORGANIZATION_IHS_NUMBER}}/lab", "use": "official", "value": "{{DIAGNOSTIC_LOCAL_CODE}}" } ], "status": "final", "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0074", "code": "LAB", "display": "Laboratory" } ] } ], "code": { "coding": [ { "system": "{{DIAGNOSTIC_TYPE}}", "code": "{{DIAGNOSTIC_TYPE}}", "display": "{{DIAGNOSTIC_TYPE}}" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "effectiveDateTime": "{{DIAGNOSTIC_EFFECTIVE_DATETIME}}", "issued": "{{DIAGNOSTIC_ISSUED}}", "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}" } { "reference": "Organization/{{ORGANIZATION_IHS_NUMBER}}" } ], "result": [ { "reference": "Observation/{{ID_RESOURCE_OBSERVATION}}" } ], "specimen": [ { "reference": "Specimen/{{ID_RESOURCE_SPECIMEN}}" } ], "basedOn": [ { "reference": "ServiceRequest/{{ID_RESOURCE_SERVICEREQUEST}}" } ] }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
DIAGNOSTIC_LOCAL_CODE | ID Lokal untuk Report Lab |
DIAGNOSTIC_TYPE | (*) Jenis Laporan Pemeriksaan Lab. Referensi ke value set "Lampiran Terminologi Laboratorium" |
PATIENT_IHS_NUMBER | {patient-ihs-number} pada SATUSEHAT |
ID_RESOURCE_ENCOUNTER | {id-resource-Encounter} pada SATUSEHAT untuk data kunjungan |
DIAGNOSTIC_EFFECTIVE_DATETIME | Tanggal dan waktu nilai observasi yang diamati dinyatakan benar |
DIAGNOSTIC_ISSUED | Tanggal dan waktu versi observasi ini tersedia, biasanya setelah hasilnya ditinjau/direview dan diverifikasi |
ID_RESOURCE_OBSERVATION | {id-resource-Observation} pada SATUSEHAT untuk data hasil pemeriksaan lab |
ID_RESOURCE_SPECIMEN | {id-resource-Specimen} pada SATUSEHAT |
ID_RESOURCE_SERVICEREQUEST | {id-resource-ServiceRequest} pada SATUSEHAT |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Jenis Pemeriksaan | DiagnosticReport.code.coding.system | DiagnosticReport.code.coding.code | DiagnosticReport.code.coding.display |
---|---|---|---|
Rapid Serologis HIV Single (R1, R2, R3) | http://terminology.kemkes.go.id/CodeSystem/examination | X099419 | Pemeriksaan HIV Diagnostik |
Rapid Serologis HIV Combo (R1, R2, R3) | http://terminology.kemkes.go.id/CodeSystem/examination | X099420 | Pemeriksaan HIV + Sifilis |
PCR DNA/EID HIV Kualitatif | http://loinc.org | 44871-2 | HIV 1 proviral DNA [Presence] in Blood by NAA with probe detection |
PCR DNA/EID HIV Kualitatif | http://loinc.org | 25841-8 | HIV 2 proviral DNA [Presence] in Blood by NAA with probe detection |
Rapid Sifilis/TPHA | http://loinc.org | 8041-6 | Treponema pallidum Ab [Presence] in Serum by Hemagglutination |
Rapid Sifilis/TPHA | http://loinc.org | 22587-0 | Treponema pallidum Ab [Presence] in Serum |
Rapid Sifilis/TPHA | http://loinc.org | 5393-4 | Treponema pallidum Ab [Presence] in Serum by Immunofluorescence |
Titer RPR |
http://loinc.org | 31147-2 | Reagin Ab [Titer] in Serum by RPR |
RPR/VDRL | http://loinc.org | 20507-0 | Reagin Ab [Presence] in Serum by RPR |
RPR/VDRL | http://loinc.org | 5292-8 | Reagin Ab [Presence] in Serum by VDRL |
Hasil Laporan Pemeriksaan
Jenis Pemeriksaan Lab dengan Observation.code | DiagnosticReport.conclusionCode.coding.system | DiagnosticReport.conclusionCode.coding.code | DiagnosticReport.conclusionCode.coding.display |
---|---|---|---|
X099419 X099420 |
http://loinc.org | LA6577-6 | Negative |
http://loinc.org | LA6576-8 | Positive | |
http://loinc.org | LA9663-1 | Inconclusive | |
X099420 8041-6 22587-0 5393-4 20507-0 5292-8 |
http://loinc.org | LA15255-5 | Reactive |
http://loinc.org | LA15256-3 | Nonreactive | |
44871-2 25841-8 |
http://loinc.org | LA11882-0 | Detected |
http://loinc.org | LA11883-8 | Not detected | |
31147-2 | http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | POS | Positive |
http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation | NEG | Negative |
6. Diagnosis
Data diagnosis pasien dapat dikirimkan menggunakan resource Condition.
➕ Pencatatan Diagnosis
{ "resourceType": "Condition", "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active", "display": "Active" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://hl7.org/fhir/sid/icd-10", "code": "U11.9", "display": "Need for immunization against COVID-19, unspecified" } ] }, "subject": { "reference": "Patient/100000030009", "display": "Budi Santoso" }, "encounter": { "reference": "Encounter/447222f4-32bc-4ec0-9a53-3be1506a8e8a" }, "onsetDateTime": "2022-12-21T07:00:00+00:00", "recordedDate": "2022-12-26T07:00:00+00:00" }
{ "resourceType": "Condition", "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active", "display": "Active" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "encounter-diagnosis", "display": "Encounter Diagnosis" } ] } ], "code": { "coding": [ { "system": "http://hl7.org/fhir/sid/icd-10", "code": "{{CONDITION_VALUE}}", "display": "{{CONDITION_VALUE}}" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "onsetDateTime": "{{CONDITION_ONSET_DATETIME}}", "recordedDate": "{{CONDITION_RECORDED_DATETIME}}" }
Variabel | Deskripsi |
---|---|
PATIENT_IHS_NUMBER | {patient-ihs-number} pada SATUSEHAT |
PATIENT_NAME | Nama Pasien |
CONDITION_VALUE | Berisi data diagnosis menggunakan ICD-10 tahun 2010 |
CONDITION_ONSET_DATETIME | Tanggal perkiraan atau tanggal aktual atau tanggal-waktu kondisi mulai, menurut pendapat dokter. |
CONDITION_RECORDED_DATETIME | Tanggal kapan kondisi/keluhan ini tercatat dalam sistem (tanggal yang dibuat oleh sistem) |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
7. Rencana Tindak Lanjut
Data rencana tindak lanjut menunjukkan rencana perawatan selanjutnya yang akan diterima oleh pasien setelah pulang dan dikirimkan dengan menggunakan resource ServiceRequest.
➕ Pencatatan Rencana Tindak Lanjut
{ "resourceType": "ServiceRequest", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/servicerequest/{{Org_id}}", "value": "00001" } ], "status": "active", "intent": "original-order", "priority": "routine", "category": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "3457005", "display": "Patient referral" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "185389009", "display": "Follow-up visit" } ] }, "subject": { "reference": "Patient/{{Patient_id}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}", "display": "Kunjungan {{Patient_Name}} di hari Kamis, 31 Agustus 2023" }, "occurrenceDateTime": "2023-08-31T04:25:00+00:00", "authoredOn": "2023-08-31T04:25:00+00:00", "requester": { "reference": "Practitioner/{{Practitioner_id}}", "display": "{{Practitioner_Name}}" }, "performer": [ { "reference": "Practitioner/{{Practitioner_id}}", "display": "{{Practitioner_Name}}" } ], "locationReference": [ { "reference": "Location/{{Location_Poli_uuid}}", "display": "{{Location_Poli_Name}}" } ], "reasonCode": [ { "coding": [ { "system": "http://hl7.org/fhir/sid/icd-10", "code": "Z11.4", "display": "Special screening examination for human immunodeficiency virus [hiv]" } ], "text": "Kontrol rutin bulanan" } ], "patientInstruction": "Kontrol rutin setelah 7 hari. Dalam keadaan darurat dapat menghubungi hotline Fasyankes di nomor 14045" }
{ "resourceType": "ServiceRequest", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/servicerequest/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{SERVICEREQUEST_LOCAL_CODE}}" } ], "status": "active", "intent": "original-order", "priority": "routine", "category": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "3457005", "display": "Patient referral" } ] } ], "code": { "coding": [ { "system": "{{SERVICEREQUEST_TYPE}}", "code": "{{SERVICEREQUEST_TYPE}}", "display": "{{SERVICEREQUEST_TYPE}}" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}" "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" }, "occurrenceDateTime": "{{SERVICEREQUEST_OCCURRENCE_DATETIME}}", "authoredOn": "{{SERVICEREQUEST_AUTHOREDON_DATETIME}}", "requester": { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" }, "performer": [ { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } ], "locationReference": [ { "reference": "Location/{{ID_RESOURCE_LOCATION}}", "display": "{{LOCATION_NAME}}" } ], "reasonCode": [ { "coding": [ { "system": "{{REASON_FOR_SERVICEREQUEST}}", "code": "{{REASON_FOR_SERVICEREQUEST}}", "display": "{{REASON_FOR_SERVICEREQUEST}}" } ] } ], "patientInstruction": "{{PATIENT_INSTRUCTION}}" }
Variabel | Deskripsi |
---|---|
ORGANIZATION_IHS_NUMBER | ID organisasi induk yang didapatkan dari master sarana indeks |
SERVICEREQUEST_LOCAL_CODE | Kode atau ID lokal/nomor service request lokal yang disimpan di sistem internal masing-masing organisasi |
PATIENT_IHS_NUMBER | ID Patient yang didapatkan dari master pasien indeks |
PATIENT_NAME | Nama Pasien |
SERVICEREQUEST_TYPE | Jenis rencana tindak lanjut. Terminologi spesifik yang digunakan referensi ke portal SATUSEHAT RME - Pemetaan Variabel dan Terminologi Spesifik |
ID_RESOURCE_ENCOUNTER | There is no placeholder called 'id-resource-Encounter' pada SATUSEHAT untuk data kunjungan |
SERVICEREQUEST_OCCURRENCE_DATETIME | Berisi data informasi kapan kontrol harus terlaksana dengan tipe data dateTime, dengan format yang diperbolehkan YYYY-MM-DDThh:mm:ss+zz:zz |
ID_RESOURCE_LOCATION | There is no placeholder called 'id-resource-Location' pada SATUSEHAT untuk data lokasi faskes |
LOCATION_NAME | Data nama lokasi di mana permintaan seharusnya terjadi |
REASON_FOR_SERVICEREQUEST | (*) Berisi data yang berkaitan dengan penjelasan atau justifikasi mengenai mengapa pelayanan ini diminta dalam bentuk kode. Referensi ke value set "Alasan Pemeriksaan" |
PATIENT_INSTRUCTION | Data instruksi untuk pasien dalam format freetext |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Alasan Pemeriksaan
ServiceRequest.reasonCode.coding.system | ServiceRequest.reasonCode.coding.code | ServiceRequest.reasonCode.coding.display |
---|---|---|
http://snomed.info/sct | 171128005 | Venereal disease screening |
http://terminology.kemkes.go.id/CodeSystem/clinical-term | SRR000007 | Pemeriksaan Diagnosis |
http://terminology.kemkes.go.id/CodeSystem/clinical-term | SRR000008 | Follow Up |
8. Kondisi Saat Meninggalkan Rumah Sakit
Data kondisi saat meninggalkan rumah sakit menunjukkan keadaan pasien saat meninggalkan rumah sakit dan dilakukan dengan resource Encounter dan Condition.
➕ Kondisi Saat Meninggalkan Rumah Sakit
{ "resourceType": "Condition", "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active", "display": "Active" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "problem-list-item", "display": "Problem List Item" } ] } ], "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "359746009", "display": "Patient's condition stable" } ] }, "subject": { "reference": "Patient/{{Patient_id}}", "display": "{{Patient_Name}}" }, "encounter": { "reference": "Encounter/{{Encounter_id}}" }, "recordedDate": "2023-08-31T04:10:00+00:00" }
{ "resourceType": "Condition", "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-clinical", "code": "active", "display": "Active" } ] }, "category": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/condition-category", "code": "problem-list-item", "display": "Problem List Item" } ] } ], "code": { "coding": [ { "system": "{{CONDITION_VALUE}}", "code": "{{CONDITION_VALUE}}", "display": "{{CONDITION_VALUE}}" } ] }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "encounter": { "reference": "Encounter/{{ID_RESOURCE_ENCOUNTER}}" } }
Variabel | Deskripsi |
---|---|
PATIENT_IHS_NUMBER | {patient-ihs-number} pada SATUSEHAT |
PATIENT_NAME | Nama Pasien |
CONDITION_VALUE | (*) Berisi data kondisi saat meninggalkan rumah sakit. Referensi ke value set "Kondisi saat meninggalkan rumah sakit" |
CONDITION_ONSET_DATETIME | Tanggal perkiraan atau tanggal aktual atau tanggal-waktu kondisi mulai, menurut pendapat dokter. |
CONDITION_RECORDED_DATETIME | Tanggal kapan kondisi/keluhan ini tercatat dalam sistem (tanggal yang dibuat oleh sistem) |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
No. | Condition.code.coding.system | Condition.code.coding.code | Condition.code.coding.display | Keterangan |
---|---|---|---|---|
1 | http://snomed.info/sct | 359746009 | Patient's condition stable | Stabil |
2 | http://snomed.info/sctc | 162668006 | Patient's condition unstable | Tidak stabil |
3 | http://snomed.info/sctc | 268910001 | Patient's condition improved | Perbaikan |
9. Cara Keluar Dari Rumah Sakit & Pembaharuan Data Kunjungan
Setelah pasien selesai melakukan kunjungan ke fasyankes, maka perlu dilakukan pembaharuan data kunjungan dengan menambahkan informasi seperti diagnosis, periode kunjungan selesai, Rencana Tindak Lanjut, Kondisi Saat Meninggalkan Rumah Sakit, Cara Keluar dari Rumah Sakit, atau informasi lainnya yang belum tersedia di awal kunjungan, dengan metode PUT. Pastikan dalam payload yang akan dilakukan pembaharuan, dimasukkan elemen Encounter.id yang berisi ID balikan dari SATUSEHAT setelah pengiriman data kunjungan di awal.
➕ Update Data Kunjungan
{ "resourceType": "Encounter", "id": "{{Encounter_id}}", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/encounter/{{Org_id}}", "value": "{{Registration_id}}" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB", "display": "ambulatory" }, "subject": { "reference": "Patient/{{Patient_id}}", "display": "{{Patient_Name}}" }, "episodeOfCare": [ { "reference": "EpisodeOfCare/{{EpisodeOfCare_id}}" } ], "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "ATND", "display": "attender" } ] } ], "individual": { "reference": "Practitioner/{{Practitioner_id}}", "display": "{{Practitioner_Name}}" } } ], "period": { "start": "2023-08-31T00:00:00+00:00", "end": "2023-08-31T04:10:00+00:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "24081000087105", "display": "Human immunodeficiency virus nurse practitioner service" } ] } ], "location": [ { "location": { "reference": "Location/{{Location_Poli_uuid}}", "display": "{{Location_Poli_Name}}" }, "period": { "start": "2023-08-31T00:00:00+00:00", "end": "2023-08-31T02:00:00+00:00" }, "extension": [ { "url": "https://fhir.kemkes.go.id/r4/StructureDefinition/ServiceClass", "extension": [ { "url": "value", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/locationServiceClass-Outpatient", "code": "reguler", "display": "Kelas Reguler" } ] } }, { "url": "upgradeClassIndicator", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/locationUpgradeClass", "code": "kelas-tetap", "display": "Kelas Tetap Perawatan" } ] } } ] } ] } ], "diagnosis": [ { "condition": { "reference": "Condition/{{Diagnosis_Primer}}", "display": "{{DiagnosisPrimer_Text}}" }, "use": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/diagnosis-role", "code": "DD", "display": "Discharge diagnosis" } ] }, "rank": 1 } ], "statusHistory": [ { "status": "arrived", "period": { "start": "2023-08-31T00:00:00+00:00", "end": "2023-08-31T01:00:00+00:00" } }, { "status": "in-progress", "period": { "start": "2023-08-31T01:00:00+00:00", "end": "2023-08-31T04:05:00+00:00" } }, { "status": "finished", "period": { "start": "2023-08-31T04:05:00+00:00", "end": "2023-08-31T04:10:00+00:00" } } ], "serviceProvider": { "reference": "Organization/{{Org_id}}" }, "hospitalization": { "admitSource": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/clinical-term", "code": "EHA000002", "display": "Datang sendiri" } ] }, "dischargeDisposition": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/discharge-disposition", "code": "home", "display": "Home" } ], "text": "Anjuran dokter untuk pulang dan kontrol kembali 1 minggu kemudian" } } }
{ "resourceType": "Encounter", "identifier": [ { "system": "http://sys-ids.kemkes.go.id/encounter/{{ORGANIZATION_IHS_NUMBER}}", "value": "{{ENCOUNTER_LOCAL_CODE}}" } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "AMB", "display": "ambulatory" }, "subject": { "reference": "Patient/{{PATIENT_IHS_NUMBER}}", "display": "{{PATIENT_NAME}}" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "ATND", "display": "attender" } ] } ], "individual": { "reference": "Practitioner/{{PRACTITIONER_IHS_NUMBER}}", "display": "{{DOCTOR_NAME}}" } } ], "period": { "start": "{{ENCOUNTER_PERIOD1_START}}", "end": "{{ENCOUNTER_PERIOD1_END}}" }, "location": [ { "location": { "reference": "Location/{{ID_RESOURCE_LOCATION}}", "display": "{{ENCOUNTER_LOCATION_NAME}}" } } ], "diagnosis": [ { "condition": { "reference": "Condition/{{ID_RESOURCE_CONDITION}}", "display": "{{DIAGNOSIS_DISPLAY}}" }, "use": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/diagnosis-role", "code": "DD", "display": "Discharge diagnosis" } ] }, "rank": {{DIAGNOSIS_RANK}} } ], "statusHistory": [ { "status": "arrived", "period": { "start": "{{ENCOUNTER_PERIOD1_START}}", "end": "{{ENCOUNTER_PERIOD1_END}}" } }, { "status": "in-progress", "period": { "start": "{{ENCOUNTER_PERIOD1_START}}", "end": "{{ENCOUNTER_PERIOD1_END}}" } }, { "status": "finished", "period": { "start": "{{ENCOUNTER_PERIOD1_START}}", "end": "{{ENCOUNTER_PERIOD1_END}}" } } ], "serviceProvider": { "reference": "Organization/{{ORGANIZATION_IHS_NUMBER}}" }, "hospitalization": { "admitSource": { "coding": [ { "system": "{{ENCOUNTER_ADMITSOURCE}}", "code": "{{ENCOUNTER_ADMITSOURCE}}", "display": "{{ENCOUNTER_ADMITSOURCE}}" } ] }, "dischargeDisposition": { "coding": [ { "system": "{{ENCOUNTER_DISCHARGE}}", "code": "{{ENCOUNTER_DISCHARGE}}", "display": "{{ENCOUNTER_DISCHARGE}}" } ] } } }
Variabel | Deskripsi |
---|---|
ENCOUNTER_LOCAL_CODE | ID Lokal untuk Kunjungan/Encounter |
PATIENT_IHS_NUMBER | {patient-ihs-number} pada SATUSEHAT |
PATIENT_NAME | Nama Pasien |
PRACTITIONER_IHS_NUMBER | {practitioner-ihs-number} pada SATUSEHAT |
DOCTOR_NAME | Nama Dokter/Nakes |
ORGANIZATION_IHS_NUMBER | {organization-ihs-number} pada SATUSEHAT |
ENCOUNTER_PERIOD1_START | Waktu mulai/check-in kunjungan |
ENCOUNTER_PERIOD1_END | Waktu mulai/check-out kunjungan |
ID_RESOURCE_LOCATION | ID Location tempat kunjungan dilakukan |
ID_RESOURCE_CONDITION | Berisi satu atau lebih data diagnosis dari pasien. Diagnosa bisa berupa diagnosa awal dan/atau pulang dengan tipe data Reference, yang direferensikan ke data yang tersimpan di resource Condition. Di mana isi dari parameter adalah ID Condition yang didapatkan dari server. |
DIAGNOSIS_DISPLAY | Deskripsi diagnosis |
DIAGNOSIS_RANK | Jika ada lebih dari 1 kondisi, maka gunakan elemen rank untuk mengurutkan mana diagnosa yang lebih utama. Semakin kecil angkanya, maka semakin utama, dengan tipe data positiveInt. |
ENCOUNTER_LOCATION_NAME | Nama Location tempat kunjungan dilakukan |
ENCOUNTER_ADMITSOURCE | (*) Data asal di mana sebelum pasien dirawat/admisia. Reference ke value set "Asal Rujukan" |
ENCOUNTER_DISCHARGE | (*) Data kategori atau tipe lokasi setelah pasien dipulangkan. Referensi ke value set "Kategori Pasien Dipulangkan" |
CATATAN:
(*): Jenis data yang memiliki terminologi spesifik. Kamus terminologi bisa ditemukan pada tab "ValueSet"
Asal Rujukan
Encounter.hospitalization.admitSource.coding.system | Encounter.hospitalization.admitSource.coding.code | Encounter.hospitalization.admitSource.coding.display |
---|---|---|
http://terminology.kemkes.go.id/CodeSystem/clinical-term | EHA000002 | Datang sendiri |
http://terminology.kemkes.go.id | TK000031 | From outpatient department |
http://terminology.kemkes.go.id/CodeSystem/clinical-term | EHA000001 | Kader/ Komunitas |
http://terminology.kemkes.go.id | TK000033 | LSM |
http://snomed.info/sct | 257622000 | Healthcare facility |
Kategori Pasien Dipulangkan
Encounter.hospitalization.dischargeDisposition.coding.system | Encounter.hospitalization.dischargeDisposition.coding.code | Encounter.hospitalization.dischargeDisposition.coding.display |
---|---|---|
http://terminology.hl7.org/CodeSystem/discharge-disposition | aadvice | Left against advice |
http://terminology.hl7.org/CodeSystem/discharge-disposition | other-hcf | Other healthcare facility |
http://terminology.kemkes.go.id/CodeSystem/discharge-disposition | exp-lt48h | Meninggal <48 jam |
http://terminology.kemkes.go.id/CodeSystem/discharge-disposition | exp-gt48h | Meninggal >48 jam |