Establishing a Citizen as a Patient

The Patient resource is a central resource in the eHealth Infrastructure. It plays several different roles:

Conveys basic information about the patient (name, address, birth date, gender, civil registration number, demographics information, etc.)
Conveys extended information about the patient
- Contact information
- Language / Need for an interpreter
- Temporary addresses
- General practitioner

A Patient is considered a 'singleton' in the eHealth Infrastructure. The patient is primarily a container for demographic information. While it is allowed according to the FHIR specification to have multiple different logical Patients for the same person, it does not fit the case for the infrastructure and the Danish modelling of patient information. As such, the patient resource is shared across different episodes of care and other clinical resources.

Ensuring a Match Between CRN and Citizen

To verify the correspondence between the Citizen name and CRN, a lookup can be made with a Person name lookup, based on the CRN given in the input Person resource.

Establishing the Patient

Parameters in = new Parameters().addParameter()
  .setName("crn").setValue(new Identifier().setSystem("urn:oid:1.2.208.176.1.2").setValue("2810887020"));
Parameters result = client.operation().onType(Patient.class).named("createPatient").withParameters(in).execute();

POST /Patient/$createPatient
Content-Type: text/xml; extended-operation-type
Accept: */*
Host: localhost:8080
accept-encoding: gzip, deflate
content-length: 689
<Parameters xmlns="http://hl7.org/fhir">
    <parameter>
        <name value="crn"/>
        <valueIdentifier>
            <system value="urn:oid:1.2.208.176.1.2"/>
            <value value="2810887020"/>
        </valueIdentifier>
    </parameter>
</Parameters>

Example HTTP Response:

HTTP/1.1 200
status: 200
Date: Wed, 20 Feb 2019 09:00:35 GMT
X-Powered-By: Trifork
Content-Type: application/fhir+xml;charset=utf-8
Content-Encoding: gzip
Transfer-Encoding: chunked
Server: Jetty(9.4.14.v20181114)
<Parameters xmlns="http://hl7.org/fhir">
    <parameter>
        <resource>
            <Patient xmlns="http://hl7.org/fhir">
                <id value="9952"/>
                <meta>
                    <versionId value="1"/>
                    <lastUpdated value="2019-03-29T11:22:34.053+01:00"/>
                    <profile value="http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-patient"/>
                </meta>
                <text>...</text>
                <identifier>
                    <system value="urn:oid:1.2.208.176.1.2"/>
                    <value value="2810887020"/>
                </identifier>
                <name>
                    <family value="Møller"/>
                    <given value="Anne"/>
                    <given value="Holm"/>
                </name>
                <birthDate value="1988-10-28"/>
                <address>
                    <extension url="http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-municipality-code">
                        <valueCoding>
                            <system value="urn:oid:1.2.208.176.8.1.100"/>
                            <code value="370"/>
                            <display value="Næstved"/>
                        </valueCoding>
                    </extension>
                    <use value="home"/>
                    <type value="postal"/>
                    <line value="Bjergagervej 110"/>
                    <city value="Karrebæksminde"/>
                    <postalCode value="4736"/>
                    <country value="DK"/>
                </address>
                <generalPractitioner>
                    <reference value="http://organization.exttest.ehealth.sundhed.dk/fhir/Organization/1"/>
                </generalPractitioner>
            </Patient>
        </resource>
    </parameter>
</Parameters>

Adding a Related Person

Creating and Maintaining an EpisodeOfCare

See EpisodeOfCare for an introduction to use and elements.

Creating the EpisodeOfCare

The EpisodeOfCare is created by invoking $create-episode-of-care on the CarePlan Service.

Preparing Conditions

An EpisodeOfCare relates to one or more conditions. These must be created as part of the $create-episode-of-care operation by including them in the input bundle.

Creating a Consent

Prerequisite to activating the EpisodeOfCare, the citizen’s consent to undergo/be enrolled to the EpisodeOfCare and comprised CarePlan resources must be registered in a Consent. The Consent is created through Consent Create and must contain details as described in the Consent introduction.

Activating the EpisodeOfCare

An EpisodeOfCare is activated by:

Setting the status to active through an EpisodeOfCare HTTP-Patch.
Setting a status change to active in the EpisodeOfCare.ehealth-statusschedule resulting in an automatic status change in the future.

Maintaining EpisodeOfCare Status

EpisodeOfCare.status can be adjusted in two ways through the use of EpisodeOfCare HTTP-Patch (Update is not exposed):

Setting EpisodeOfCare.status directly
Setting a scheduled status change by updating EpisodeOfCare.ehealth-statusschedule
- scheduled changes are applied when the ApplyPlannedChangesJob is run. (see Automated Processing | AutomatedProcessing AutomatedApplicationofPlannedChanges(EpisodeOfCare,CarePlan... )

Allowed status changes:

From planned to active, onhold, waitlist, cancelled, or entered-in-error
From active to onhold, finished, cancelled, or entered-in-error
From waitlist to planned, active, onhold, cancelled, or entered-in-error
From onhold to active, finished, cancelled, or entered-in-error
From finished to entered-in-error or active

See implementation guide: EpisodeOfCare.status

Maintaining the set of CareTeam involved in the EpisodeOfCare

Over the lifecycle of an EpisodeOfCare, the set of CareTeam involved might change. Adjustment of CareTeam involved can be performed in several ways:

Through EpisodeOfCare Patch
- Setting the EpisodeOfCare.team
- Setting the scheduled team changes in EpisodeOfCare.ehealth-teamschedule
Through EpisodeOfCare$update-care-teams

Adjusting the Period

The period in which the EpisodeOfCare is applicable is reflected in the EpisodeOfCare.period. Adjustment of EpisodeOfCare.period is performed through EpisodeOfCare Patch.

eHealth Infrastructure Wiki

Enrolling a Patient in an Episode Of Care