3. FHIR IG

3.1. Introduction

This Implementation Guide (IG) details the HL7 FHIR requirements for exchanging dental care data.

This IG is a technical counterpart of the functional design. The FHIR version used for this IG is HL7 FHIR R4 (4.0.1).

3.2. Actors involved

Actors		Systems		FHIR CapabilityStatements
Name	Description	Name	Description	Description
Patient	The user of a personal healthcare environment	PHR (Dental Care data Consumer)	Personal health record	FHIR client requirements
Healthcare provider	The user of a TIS	TIS (Dental Care Responder)	Healthcare information system	FHIR server requirements

3.3. Boundaries and relationships

This FHIR IG includes use cases for the exchange of Dental Care data between health care providers (e.g. dentists) and patients (e.g. in a PHR setting).

This IG guide assumes that a PHR is able to connect with a TIS. It does not provide information on finding the right source system nor does it provide information about security. These infrastructure and interface specifications are described in the 'MedMij Afsprakenstelsel'.

The dental care information exchange is overlapping with other standards such as the BgZ (Basis Gegevensset Zorg). Dental care uses the same HCIM based FHIR profiles for exchanging information as used in other standards extended with additional dental care specific profiles. These dental care specific profiles are derived from the base HCIM FHIR profiles, for example the dental fitness is in fact an observation with additional specifications such as the Dental Fitness score

3.4. Use cases

Dental care supports the following (types of) use cases

Dental Fitness data for Ministery of Defense oriented exchange
Basic (general) dental care

3.4.1. Use case: Retrieve Dental Fitness

This FHIR implementation guide assumes that the PHR system is able to make a connection to the right TIS, for dental care TIS, that contains the patient's information. It does not provide information on finding the right XIS, for dental care TIS, nor does it provide information about security. Moreover, each transaction is performed in the context of a specific authenticated patient, for whose context (token) has been established using the authentication mechanisms described in the 'MedMij Afsprakenstelsel'. Each TIS or for dental care TIS, Gateway is required to perform filtering based on the patient associated with the context for the request, so only the records associated with the authenticated patient are returned. For this reason, search parameters should not be included for patient identification.

3.4.1.1. PHR: request message

The PHR system requests the dental care data using individual 'Search' interactions. The mouthcare exchange consists of multiple FHIR resources with certain constraints. To obtain the patient's mouthcare data, the client can use multiple individual search operations based on specified search queries. The interactions are performed by an HTTP GET as shown: search interactions. The dental care exchange consists of multiple FHIR resources with certain constraints. To obtain the patient's dental care data, the client can use multiple individual search operations based on specified search queries. The interactions are performed by an HTTP GET as shown:

GET [base]/[type]{?[parameters]}

The table below shows in the first four columns the dental care sections, the HCIMs that constitute those sections and the specific content of dental care specific information. The last column shows the FHIR search queries to obtain the dental care information. These queries and expected responses are based on profiles listed in the functional design.

3.4.1.2. TIS: Response message

The returned data to the PHR should conform to the profiles listed in the table below.

Nette Tabel

Section	ZIB NL	HCIM EN	FHIR Profile	Search URL
1	zib Patiënt	Patient	nl core Patient	GET [base]/Patient
2	zib Zorgverlener	nl core HealthProfessional Practitioner and nl core HealthProfessional PractitionerRole	nl core HealthProfessional Practitioner nl core HealthProfessional PractitionerRole	See observation Dental Fitness
3	zib Zorgaanbieder	HealthcareProvider	nl core HealthcareProvider	See observation Dental Fitness
4	cim Dental Fitness	Dental Fitness	DentalCare - Dental Fitness Score	GET [base]/Observation?code=http://snomed.info/sct\|440271000146100&_include=Observation:performer

3.4.2. Use case: Retrieve Dental care data

This FHIR implementation guide assumes that the PHR system is able to make a connection to the right TIS, for dental care TIS, that contains the patient's information. It does not provide information on finding the right XIS, for dental care TIS, nor does it provide information about security. Moreover, each transaction is performed in the context of a specific authenticated patient, for whose context (token) has been established using the authentication mechanisms described in the 'MedMij Afsprakenstelsel'. Each TIS or for dental care TIS. Gateway is required to perform filtering based on the patient associated with the context for the request, so only the records associated with the authenticated patient are returned. For this reason, search parameters should not be included for patient identification.

3.4.2.1. PHR: request message