Breast Screening NZ FHIR Implementation Guide
1.1.0 - Release

Breast Screening NZ FHIR Implementation Guide - Local Development build (v1.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Profiles and Extensions

This page provides a list of the FHIR profiles and extensions defined in this Implementation Guide.

## Profiles

The following profiles have been defined for this implementation guide.

### CarePlan Profile

​CarePlan - Breast Screening

This profile defines constraints on the CarePlan resource for representing a participant's enrollment and progression through the breast screening programme. It tracks the participant's pathway state, programme status, and key dates throughout their screening journey.

Key Features:

- Required subject (Patient reference)
- Fixed intent of "plan"
- Enrollment period tracking
- Managing organization reference
- Support for programme and pathway tracking extensions

Must Support Elements:

- `status` - Current status of the care plan
- `intent` - Always set to "plan"
- `subject` - The patient enrolled in screening
- `period` - Enrollment and exit dates
- `author` - Managing organization

## Extensions

The following extensions have been defined for this implementation guide. These extensions are used to capture breast screening-specific data that is not part of the base FHIR specification.

### Programme Status Extension

Programme Status

Indicates the participant's enrollment status in the breast screening programme.

- Context of Use: CarePlan
- Type: CodeableConcept
- Cardinality: 0..1
- Binding: Programme Status ValueSet (required)

This extension captures whether a participant is actively enrolled, suspended, or has exited the programme.

### Pathway State Extension

Pathway State

Represents the current state of the participant within the screening pathway.

- Context of Use: CarePlan
- Type: CodeableConcept
- Cardinality: 0..1 (Required in CarePlan-BreastScreening profile: 1..1)
- Binding: Pathway State ValueSet (required)

This extension tracks where the participant is in the screening workflow (e.g., invited, booked, screening, reading).

Possible Values:

- Available for invitation
- Invited
- Booked
- Deferred
- Screening
- Reading
- Returned to routine screening
- Exited

### Pathway Substate Extension

Pathway Substate

Provides additional detail about the participant's current pathway state.

- Context of Use: CarePlan
- Type: CodeableConcept
- Cardinality: 0..1 (Required in CarePlan-BreastScreening profile: 1..1)
- Binding: Pathway Substate ValueSet (required)

This extension captures more granular status information that provides context to the main pathway state.

### Pathway State Date Last Modified Extension

Pathway State Date Last Modified

Records when the pathway state was last updated.

- Context of Use: CarePlan
- Type: dateTime
- Cardinality: 0..1 (Required in CarePlan-BreastScreening profile: 1..1)

This extension enables tracking of when the participant's pathway state changed, supporting audit and reporting requirements.

## Terminology

### Code Systems

The following code systems are defined in this implementation guide:

- Pathway State CodeSystem - Codes representing states in the screening pathway
- Pathway Substate CodeSystem - Codes for pathway substates
- Programme Status CodeSystem - Codes for programme enrollment status

### Value Sets

The following value sets are defined in this implementation guide:

- Pathway State ValueSet - Valid pathway state codes
- Pathway Substate ValueSet - Valid pathway substate codes
- Programme Status ValueSet - Valid programme status codes

## Usage Notes

### Using Extensions with the CarePlan Profile

When creating a CarePlan resource that conforms to the Breast Screening profile, the extensions should be populated as follows:

    {
      "resourceType": "CarePlan",
      "meta": {
        "profile": [
          "https://bsa-uat.pinga.health/ig/StructureDefinition/CarePlan-BreastScreening"
        ]
      },
      "extension": [
        {
          "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-state",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "https://bsa-uat.pinga.health/ig/CodeSystem/pathway-state",
                "code": "invited",
                "display": "Invited"
              }
            ]
          }
        },
        {
          "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-state-date-last-modified",
          "valueDateTime": "2025-11-14T10:30:00Z"
        }
      ],
      "status": "active",
      "intent": "plan",
      "subject": {
        "reference": "Patient/example"
      }
    }

### Extension Cardinality in Profile vs Base Definition

Note that while the base extension definitions allow cardinality of 0..1, the CarePlan-BreastScreening profile constrains certain extensions to be required (1..1):

- pathwayState - Required (1..1)
- pathwaySubstate - Required (1..1)
- pathwayStateLastModified - Required (1..1)
- programmeStatus - Optional (0..1)