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

## Careplan Extensions

This Implementation Guide defines a set of extensions to support breast screening programme workflows. These extensions enable tracking of participant enrollment, pathway progression, and screening-specific details that are not captured in the base FHIR CarePlan resource.

## Extensions Overview

The following extensions are defined for use with CarePlan resources in the breast screening context:

Extension | Type | Cardinality | Description
--- | --- | --- | ---
Programme Status | CodeableConcept | 0..1 | Enrollment status in the programme
Pathway State | CodeableConcept | 0..1 | Current state in the screening pathway
Pathway Substate | CodeableConcept | 0..1 | Detailed substate within the pathway
Pathway State Date Last Modified | dateTime | 0..1 | When the pathway state was last changed

## Extension Definitions

### Programme Status

URL: `https://bsa-uat.pinga.health/ig/StructureDefinition/programme-status`
Type: CodeableConcept
Cardinality: 0..1
Binding: Programme Status ValueSet (required)

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

Example Codes:

- `PRE_ENROLLED` - Active participant
- `ENROLLED` - Temporarily suspended
- `NOT_ENROLLED` - Permanently exited from programme

Usage:

    {
      "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/programme-status",
      "valueCodeableConcept": {
        "coding": [{
          "system": "https://bsa-uat.pinga.health/ig/CodeSystem/programme-status",
          "code": "enrolled",
          "display": "Enrolled"
        }]
      }
    }

### Pathway State

URL: pathway-state

Type: CodeableConcept
Cardinality: 0..1 (1..1 in BsaCarePlan profile)
Binding: Pathway State ValueSet (required)

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

Possible Values:

- `available-for-invitation`
- `invited`
- `booked`
- `deferred`
- `screening`
- `reading`
- `returned-to-routine`
- `exited`

Usage:

    {
      "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"
        }]
      }
    }

### Pathway Substate

URL: pathway-substate
Type: CodeableConcept
Cardinality: 0..1 (1..1 in BsaCarePlan profile)
Binding: Pathway Substate ValueSet (required)

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

Usage:

    {
      "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-substate",
      "valueCodeableConcept": {
        "coding": [{
          "system": "https://bsa-uat.pinga.health/ig/CodeSystem/pathway-substate",
          "code": "first-invitation",
          "display": "First Invitation"
        }]
      }
    }

### Pathway State Date Last Modified

URL: `https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-state-date-last-modified`
Type: dateTime
Cardinality: 0..1 (1..1 in BsaCarePlan profile)

Records the date and time when any of the status/state indicators were last updated. This supports audit requirements and enables tracking of participant progression through the screening workflow.

Usage:

    {
      "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-state-date-last-modified",
      "valueDateTime": "2025-11-14T10:30:00+13:00"
    }

## Complete Example

### Breast Screening CarePlan with Extensions

The following example shows a CarePlan for a breast screening participant who has been invited for their screening appointment:

    {
      "resourceType": "CarePlan",
      "id": "example-careplan",
      "meta": {
        "profile": [
          "https://bsa-uat.pinga.health/ig/StructureDefinition/BsaCarePlan"
        ],
        "lastUpdated": "2025-11-14T10:30:00+13:00"
      },
      "extension": [
        {
          "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/programme-status",
          "valueCodeableConcept": {
            "coding": [{
              "system": "https://bsa-uat.pinga.health/ig/CodeSystem/programme-status",
              "code": "enrolled",
              "display": "Enrolled"
            }]
          }
        },
        {
          "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-substate",
          "valueCodeableConcept": {
            "coding": [{
              "system": "https://bsa-uat.pinga.health/ig/CodeSystem/pathway-substate",
              "code": "first-invitation",
              "display": "First Invitation"
            }]
          }
        },
        {
          "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-state-date-last-modified",
          "valueDateTime": "2025-11-14T10:30:00+13:00"
        }
      ],
      "status": "active",
      "intent": "plan",
      "subject": {
        "reference": "Patient/example-patient",
        "display": "Jane Doe"
      },
      "period": {
        "start": "2025-01-15"
      },
      "author": {
        "reference": "Organization/ORG-xxx",
        "display": "Example Lead Provider"
      }
    }

## Usage in BsaCarePlan Profile

When using the BsaCarePlan profile, the following extensions have stricter cardinality requirements:

Extension | Base Cardinality | Profile Cardinality | Required?
--- | --- | --- | ---
Programme Status | 0..1 | 1..1 | Required
Pathway State | 0..1 | 1..1 | Required
Pathway Substate | 0..1 | 0..1 | Optional
Pathway State Date Last Modified | 0..1 | 1..1 | Required

This ensures that CarePlan instances conforming to the breast screening profile always include the essential tracking information needed for programme management and reporting.

## Related Resources

- BsaCarePlan Profile
- Pathway State CodeSystem
- Pathway Substate CodeSystem
- Programme Status CodeSystem
- Profiles and Extensions