HL7 FHIR documents

FHIR documents

FHIR resources can be used to build documents that represent a composition: a set of coherent information that is a statement of healthcare information. A document is an immutable set of resources with a fixed presentation that is authored and/or attested by humans, organizations and devices.

Document Content

All documents have the same structure: a Bundle of resources that has a Composition resource as the first resource in the Bundle, followed by a series of other resources, referenced from the Composition resource. The Bundle gathers all the content of the document into a single XML- or JSON-document. The resources include both human readable and computer processable portions. In addition, the Bundle may include CSS stylesheets.

The Composition resource is the foundation of the clinical document. It:

• provides identity and its purpose, sets the context of the document
• carries key information such as the subject and author, and who attests to the document
• divides the document up into a series of sections, each with their own narrative

Any resource referenced directly in the Composition SHALL be included in the Bundle.

The ZorgDomein document has two key identifiers on the document:

• The document identifier (mandatory). This is found in Bundle.id and is unique for this instance of the document, and is never re-used
• The composition identifier contains a ZD-Number

Once assembled into a bundle, the document is immutable - its content can never be changed, and the document id can never be reused.

Document types

For the different transactions that ZorgDomein supports, ZorgDomein will send different document types. The type of document is captured in the composition.type element of the FHIR document.  This element can contain the following values: 

• Aanvraagformulier: request form for specific research, procedure or service, e.g. diagnostic research, operation request ("uitvoeringsverzoek"), delivery request ("leveringsverzoek") or placement request ("plaatsingsverzoek")
• Afnameformulier: laboratory collection form (only relevant for laboratory order management systems)
• Afspraakbericht: appointment request message
• Annuleringsbericht: cancellation message
• Nazending: document containing supplemental attachments for the referral letter
• Rapportage: copy of a report that was sent by the care provider
• Teleconsultatie aanvraagformulier: request for teleconsultation
• Verwijsbrief: referral letter or document containing attachments for the referral letter
• Vragenlijst: questionnaire accomplishing a referral or request
• Patiëntoverleg: export of a conversation in ZorgDomein Patiëntoverleg (the ZorgDomein messenger app)

Not all document type will be relevant for all systems, or some systems will not be able to process specific document types. Please contact us at the start of the development of the interface to discuss which document types should be implemented. If at any point you receive a document type that is unknown to you or cannot be processed, you must return a HTTP 422 response. 

Sending Documents

Assembled documents will be sent by ZorgDomein to the Bundle-endpoint of the receiving XIS. This is done by the HTTP POST-method, so a Document with id 123-456 will be POST to /Bundle/ with the XML- or JSON-representation of the document in the body of the HTTP-call.

Diagram