Breast Screening NZ FHIR Implementation Guide - Local Development build (v1.1.4) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Business View

Purpose of Te Puna

Te Puna is the core technology platform that supports the delivery and operation of the BreastScreen Aotearoa (BSA) national breast screening programme. Its purpose is to provide a single, integrated source of information for managing participants, screening activities, clinical workflows, imaging, assessments, reporting, and programme administration.

Te Puna enables BreastScreen Aotearoa to:

• Manage participant enrolment and eligibility.

• Maintain participant demographic and screening history information.

• Support the end-to-end screening pathway, from invitation through to screening, assessment, and outcome management.

• Coordinate activities between screening providers, assessment services, radiology providers, and programme administrators.

• Record and manage screening episodes and associated clinical information.

• Store and provide access to screening results, reports, and related diagnostic information.

• Support programme monitoring, reporting, quality assurance, and population health activities.

• Enable information sharing with authorised internal and external systems

Te Puna's Role in the Screening Journey

At a high level, Te Puna acts as the system of record for key BreastScreen Aotearoa information, supporting the participant journey:

Te Puna maintains information associated with each stage of this journey and makes relevant information available to authorised users and systems.

The Te Puna FHIR API exposes selected information held within Te Puna enabling authorised consumers to retrieve information such as:

• Screening CarePlan

• Diagnostic findings and reports (DiagnosticReport)

Business Rules

Searching Care Plan

The participant's NHI is usually used to get their Care Plan details, although there are options to include a status parameter to narrow down the results, e.g. draft, active, ended

There is an option to return all plans between a date range or by status. Where a status is used then multiple different status can be entered but must be comma separated. These types of calls will return a large result set.

Searching Diagnostic Report

Diagnostic reports are usually searched by the NHI. Only one NHI is allowed per search. Searches by NHI and Status and by Date Range are allowed.

Searching on just the Status is allowed, with options to search by Final, or Preliminary being supported. This is likely to return a large number of reports.

Use Cases

Screening Use Case Summary

• Care Plan - the participant's overall participation in the BreastScreen Aotearoa programme.

• Dagnostic Report - a participant's Radiologist report

Care Plan

A Care Plan represents a participant's enrolment and current status in the BreastScreen Aotearoa programme, including their pathway and lead provider information. It is the longitudinal record of programme participation, while Episodes of Care represent individual screening journeys.

The Care Plan remains active while the participant stays in the programme, whereas each Episode of Care starts and finishes for a particular screening event

The Care Plan resource:

• Represents BSA programme enrolment.
• Facilitates reporting on programme participation and outcomes
• Includes
  • Enrolment Date
  • Programme Status
  • Pathway State
  • Pathway Sub State
  • Last screening information
  • Lead Provider responsible for the participant

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

Diagnostic Report

The Diagnostic Report resource provides the clinical findings and outcomes generated during the BreastScreen Aotearoa screening pathway. It represents radiologist reports and related diagnostic information produced from screening and assessment activities.

The report forms part of the participant's screening record and supports the communication of screening outcomes, clinical conclusions, and associated reporting information to internal and external clinical systems.

Diagnostic report attributes include:

• Status
• Issued Date
• Screening Date
• Report content