Establishing a Citizen as a Patient

The Patient resource is a central resource in the eHealth Infrastructure. It plays a number of 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 Patient 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 episode of cares and other clinical resources.

Ensuring Match Between CRN and Citizen

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

Establishing the Patient

Example Create Patient Request in HAPI FHIR Client Framework

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();

Example Create Patient HTTP Request and Response

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 introduction to use and elements.

Creating the EpisodeOfCare

The EpisodeOfCare is created by invoking $create-episode-of-care.

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 Update.

Setting EpisodeOfCare Status

EpisodeOfCare.status must be set manually by EpisodeOfCare Update.

Allowed status changes:

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

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 a number of ways:

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

CareTeam Handover and Unhandled Tasks

The CareTeams involved in an EpisodeOfCare have access to the EpisodeOfCare, all CarePlan related to it, and all measurements related to ServiceRequest related to the CarePlan and so on (provided the appropriate Role-based access privileges are present for a user using the CareTeam). For Task resources currently created automatically by the infrastructure, the set of CareTeam involved in an EpisodeOfCare are not designated as Task responsible.

There might, however, still exist Task created by other means, for instance Task created on user initiative in a solution. For these, it should be considered whether a change in the set of CareTeam involved in the EpisodeOfCare should also result in adjusting of Task.taskResponsible (by adding CareTeam added to the EpisodeOfCare).

Adjusting the Period

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

The EpisodeOfCare.status and EpisodeOfCare.period are set independently. Setting either causes no automatic change of the other.

Enrolling a Patient in an Episode Of Care