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

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.