Te Whatu Ora Shared Care FHIR API - Local Development build (v0.3.9) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Rheumatic Fever Data Models
FHIR data models (pilot phase)
This section provides an overview of the design of the FHIR data representations that authorized applications can use to record and interchange rheumatic fever information.
FHIR resource model
Rheumatic fever FHIR resources (pilot phase) Rheumatic fever bounded context - FHIR resource types Te Whatu Ora national systems Te Whatu Ora NHI/HPI «APPOINTMENT» :Appointment An Appointment is a planned encounter. For example, administration of secondary prophylaxis (preventative)) medication. text "Secondary prophylaxis appointment" status: #booked | #arrived start: instant (UTC) end: instance (UTC) participant: Reference(Practitioner) «CAREPLAN» :RheumaticFeverCarePlan Profiles FHIR CarePlan so it can act as registration for rheumatic fever patients. identifier[NHI] (official): NHI identifier[case] (usual): case Id (salesforce) title "Rheumatic fever care plan for patient X" status: #active etc. period: date range category: SNOMED #tbc "RF secondary prevention care plan" intent: #Plan etc. activity[]: Reference(MedicationRequest or Appointment) only onHoldReason : string closureReason : string extensions «NZPATIENT» :RheumaticFeverPatient Profiles NzPatient so it can define whanau care team members as contacts identifier[NHI] (official): NHI name: HumanName birthDate: date communication.language gender: code deceasedBoolean: boolean telecom: ContactPoint[] address: Address[] iwi: code ethnicity 0..*: code[] nzCitizen: code patient.contact[]. whanauMemberCareRole : Coding whanauMemberCareRelationship : string whanauMemberCarePrimary : boolean interpreterRequired : boolean (extensions) «CARETEAM» :**RheumaticFeverCareTeam Profiles CareTeam to categorize only. Identifies practitioners/providers involved in patient's care (performing RF secondary prevention) category: | Secondary Prophylaxis Team participant[].role «CONSENT» :Consent^ data collection Represents a patient's active or provisional consent to RF Services collection and use of data. status: #proposed | active scope: #patient-privacy dateTime: date period: date range policy: uri «NZCONDITION» :RheumaticFeverCondition Profiles NzCondition (NZ Base) for RF 'case' details. identifier (usual): code: SNOMED diagnosis code severity: #mild | #moderate | #severe clinicalStatus: #active etc. recordedDate: date rhdSeverity : code (in dedicated ValueSet) diagnosticCertainty : code (in dedicated ValueSet) assessmentDate : date (UTC) extensions «MEDICATION» :Medication code: SNOMED (brand) ingredient: SNOMED (type) «NZMEDICATIONREQUEST» :RheumaticFeverMedicationRequest Medication that is planned for RF prevention status: code medicationRequestStatus intent: #plan authoredOn: dateTime (UTC) validityPeriod: dateTime (UTC) dosageInstruction: route: SNOMED site: SNOMED doseAndRate additionalInstruction: SNOMED [frequency] medicationFrequency : code (in dedicated ValueSet) extensions «NZMEDICATIONSTATEMENT» :MedicationStatement Detail of benzathine etc. actually administered status: #completed code: NZMT effectiveDatePeriod: UTC dateTime note: brand of benzathine used «NZMEDICATIONSTATEMENT» :MedicationStatement Strength of lignocaine administered for pain relief medicationCodeableConcept: NZMT «QUESTIONNAIRE» :Questionnaire (definitional) Four canonical instances defined by Te Whatu Ora 1 Patient Medication Allergies 2 Medications and Follow-up Guidance 3 Patient & Whanau Goals and Preferences 4 Secondary Prophylaxis Health Assessment «QUESTIONNAIRERESPONSE» :QuestionnaireResponse Collects form data items as defined by a Questionnaire value[x]: item[].answer «ENCOUNTER» :Encounter Tracks patient's secondary prophylaxis appointment. class: #AMB "ambulatory" status: #planned | #finished participant[]: Reference[Patient, Practitioner] period: datetime range location: Reference[HPI facility] «external data» RFCCS (Salesforce) Salesforce logical resource logical id: CarePlanId «external data» Episurv Notifiable disease surveillance logical id: Episurv number «logical resource» Patient (NHI) logical id: NHI «logical resource» HPI logical identifier formats: NNXXXX - practitioner CPNs GXXNNN-C HPI Org Id - orgs FXXNNN-C HPI Facility Id - locs «logical resource» RelatedPerson logical id: name «logical resource» NZMT terminology medication coding <> supportingInformation 1 appointment 1 addresses <> supportingInfo basedOn subject 1 activity. reference basedOn " Salesforce care plan Id" 1 Identifier[NationalSystem] careTeam activity. reference CarePlan. author identifies Lead Provider author participant.member participant.member subject 1 " Episurv number" 1 Identifier[NationalSystem] patient 1 performer 1 "participant, serviceProvider" 1 medication[x] 1 requester 1 subject 1 partOf context 1 1 basedOn medication Reference 1 code ingredient lignocaine concentration coding Identifier[NHI] 1 encounter questionnaire Notes - Model of data types (FHIR resources) and relations (FHIR references) for national rheumatic fever FHIR data. - Arrows show direction of FHIR reference. - Solid/open dots indicate mandatory/optional data elements. Key to datatype colours colour stereotype ghost white Standard FHIR resource in TWO Shared Care API salmon Profiled FHIR resource orange red Canonical shared resource defined by TWO sky blue Logical identifier reference to records in other national systems Health NZ/Te Whatu Ora. Generated from PlantUML source on 20/06/2024
FHIR careplan instance lifecycle
Typical sequence of rheumatic fever FHIR resource instance creation patient registration care plan setup Medication planning Secondary prophylaxis activity recording ongoing care coordination Consent created and linked Consent CarePlan --> #draft Initial diagnosis completed Condition (updated) CareTeam defined CareTeam Allergies recorded Questionnaire type A Response Medications & Follow-up Guidance captured Questionnaire type B Response Patient / Whanau Goals & Prefs recorded Questionnaire type C Response when all parts ready Plan a period of medication (say 2023 ) Medication Request 2023 Medication (Benzathine) SP medication frequency is set (say every 28 days) Book appointments Appointment (planned encounter) July 11 #booked Appointment (planned encounter) August 8 2023 #booked Appointment (planned encounter) Sept. 5 2023 #booked more appointments... MedicationRequest --> #active & appointments planned When medication planned for a sufficient period First appointment data capture (say August 2023 ) Medication Statement (aug) Questionnaire type D Response (aug) Encounter of aug appointment Appointment (aug) --> #fulfilled Second appointment data capture (say September 2023 ) Medication Statement (sept) Questionnaire type D Response (sept) Encounter of sept appointment Appointment (sept) --> #fulfilled Similar further instance sets ... FHIR resources accumulate as rheumatic fever patient care continues. CarePlan #active CarePlan #on-hold CarePlan cancelled ( #revoked ) CarePlan closed ( #completed ) NzPatient created/updated NzPatient CarePlan created CarePlan Condition On registration, CarePlan moves into #draft state. Other sector health applications can interpret from this that a patient is "registered" with an NZ RF Secondary Prevention Service. CarePlan --> #active Patient not registered /no FHIR records. Patient has an existing FHIR representation. ok ok ok Health NZ/Te Whatu Ora. Generated from PlantUML source on 20/06/2024
Secondary prophylaxis appointment planning and recording instances
Rheumatic fever -- secondary prophylaxis medication planning and appointment recording Medication definition Planning and recording of secondary prophylaxis medication activity <CarePlan.activity[].reference> July 2023 completed appointment detail August 2023 completed appointment detail medication ingredient NZMT ..6105 -benzathine penicillin NZMT ..6107 -amoxicillin NZMT ..6109 -penicillin VK NZMT ..6100 -erythromycin Benzathine brand NZMT ..6108 -Bicillin L-A NZMT tbc -Tardocillin NZMT tbc -Lentocillin Med. route SNOMED..1000 -Intramuscular route SNOMED..3006 -Oral route Med. site SNOMED..10101 -Left ventrogluteal .. ... -etc. «Medication» : Medication Planned secondary prophylaxis medication brand and ingredient «CarePlan» :RheumaticFeverCarePlan FHIR CarePlans contain a list of (references to) activities. FHIR activity types shown here are Appointments and MedicationRequests. These three instances, added to the original Appointment instance, capture detail from a completed secondary prophylaxis appointment: - Encounter the who / what / where etc. - MedicationStatement the actual meds given - QuestionnaireResponse health assessment The next planned patient secondary prophylaxis encounter is represented by this Appointment instance in #booked status. Its main purpose is to convey the due date, to which adherence is important for effective RF care. After the care encounter, the status updates to #fulfilled. The medication administered and assessmention question responses are captured in other FHIR resource instances, as shown above for July and August. «MedicationRequest» : RheumaticFeverMedicationRequest text: "Benzathine medication plan 2023" status: #active intent: #plan dosageInstruction -route:SNOMED -site:SNOMED -additionalInstruction [frequency] -doseAndRate:Dosage performer: Ref(Practitioner) validityPeriod: eg. 2023-01 to 2023-12 medicationFrequency: Every twenty eight days - extension - July2023: Appointment completed care encounter identifier[case] (usual): case Id (salesforce) status: #fulfilled start: 2023-07-11 supportingInfo: service provider Ref(HPI org) participant: Reference(Practitioner) August2023: Appointment completed care encounter identifier: type #CarePlanActivityId (SF) status: #fulfilled start: 2023-08-08 supportingInfo: service provider Ref(HPI org) participant: Reference(Practitioner) September2023: Appointment planned next care encounter identifier: type #CarePlanActivityId (SF) status: #booked start: 2023-09-05 supportingInfo: service provider Ref(HPI org) participant: Reference(Practitioner) july2023:Encounter status: #finished period: 2023-07-11 participant: Ref(Practitioner) serviceProvider: Ref(Organisation) :MedicationStatement (Benzathine) status: #completed effectiveDateTime: 2023-07-11 dosage: Dosage // actual dose quantity,site,route :QuestionnaireResponse (health assessment) questionnaire: Canonical(SPHA) status: #completed authored: 2023-07-11 item.*: responses august2023:Encounter status: #finished period: 2023-08-08 participant: Ref(Practitioner) serviceProvider: Ref(Organisation) :MedicationStatement (Benzathine) status: #completed effectiveDateTime: 2023-08-08 dosage: Dosage // actual dose quantity,site,route :QuestionnaireResponse (health assessment) questionnaire: Canonical(SPHA) status: #completed authored: 2023-08-08 item.*: responses ingredient code context encounter context encounter activity supportingInfo appointment supportingInfo appointment medication[x] 1 1 route site basedOn basedOn medicationReference medication Reference Legend 1) Arrows indicate direction of FHIR reference 2) Object colour shading reflects colours used in Data Dictionary mapping. FHIR resource instances object model
Secondary prophylaxis appointment planning and recording states model
Secondary prophylaxis recording: FHIR instance lifecycles Planned Appointment PROPOSED FINISHED CANCELLED ENTERED-IN-ERROR Patient's next SP treatment due date is represented in FHIR by an Appointment instance in their CarePlan secondary prophylaxis treatment records Encounter MedicationStatement QuestionnaireResponse FINISHED ENTERED-IN-ERROR COMPLETED ENTERED-IN-ERROR COMPLETED ENTERED-IN-ERROR After the treatment encounter takes place, 3 more FHIR resources record the details. Typically these three instances are created directly in their terminal state. state colour meaning lime green starting state (if applicable) orange terminal state (if applicable) Health NZ/Te Whatu Ora. Generated from PlantUML source on 20/06/2024
