EFA XDS Document Metadata Binding

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|Realm    = Deutschland
 
|Realm    = Deutschland
 
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''Anmerkung: Die Kürzel unter den einzelnen Überschriften dienen der Unterstützung des Kommentierungsverfahrens. Bitte geben Sie bei einem Kommentar oder einem Verbesserungsvorschlag zu dieser Spezifikation immer das Kürzel des Abschnitts an, auf den sich Ihr Kommentar bezieht. Alle Kommentare werden in der Lasche "Diskussion" zu der kommentierten Seite gesammelt und gegenkommentiert.<br>Hinweise zum Kommentierungsverfahren einschließlich aller Formulare und Kontaktadressen finden Sie auf der Seite "[[cdaefa:Kommentierung EFAv2.0|Kommentierung EFAv2.0]]".''
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----
  
 
== Document Metadata ==
 
== Document Metadata ==
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<tt>Bitte markieren Sie [[cdaefa:Kommentierung_EFAv2.0|Kommentare]] zu diesem Abschnitt mit dem Code {EDoct.01}</tt>
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Unless stated otherwise in the following sub-sections, document metadata MUST be used as defined in table 4.1-5 of [IHE ITI TF Vol3 v9.0]. Further constraints MAY apply for EFA national profiles (see below for the German profile).
 
Unless stated otherwise in the following sub-sections, document metadata MUST be used as defined in table 4.1-5 of [IHE ITI TF Vol3 v9.0]. Further constraints MAY apply for EFA national profiles (see below for the German profile).
  
 
=== classCode ===
 
=== classCode ===
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The document class shall be taken from a national catalogue. It should be provided as a LOINC code.
  
The document class SHALL be provided as a LOINC code.
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=== typeCode ===
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The document type shall be provided as a LOINC code. Document types shall be more specific than document classes. They may be defined per [[cdaefa:EFA_Provider|Care Domain]].
  
 
'''Example:'''
 
'''Example:'''
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</syntaxhighlight>
 
</syntaxhighlight>
  
=== typeCode ===
 
The typeCode SHOULD be identical to the classCode.
 
  
 
=== Comments ===
 
=== Comments ===
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</syntaxhighlight>
 
</syntaxhighlight>
  
=== patientID ===
 
 
Only the following identification schemes MUST be used. If multiple schemes are available for a practice, the order in the table denotes the order of preference.
 
 
{|class="wikitable" style="text-align: left; cellpadding: 10;"
 
!Person&nbsp;Role
 
!Scheme
 
!Root OID
 
|-
 
|Patient
 
|Fixed part of unique health insurance number (KVNR).
 
|1.2.276.0.76.4.8
 
|-
 
|Patient
 
|Full health insurance number (KVNR)
 
|1.2.276.0.76.4.1
 
|-
 
|Patient
 
|Local identifier within the healthcare organization. Local identifiers MUST NOT be directly derived from personal id numbers that are assigned by non-healthcare authorities.
 
|Local Root OID
 
|}
 
  
 
=== sourcePatientInfo ===
 
=== sourcePatientInfo ===
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=== Querverweise und Referenzen ===
  
* zurück zur [[cdaefa:EFA_Spezifikation_v2.0|EFA-2.0-Spezifikation]]
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* [[cdaefa:EFA_Spezifikation_v2.0|EFA-2.0-Spezifikation]]

Version vom 2. Mai 2013, 17:11 Uhr


Anmerkung: Die Kürzel unter den einzelnen Überschriften dienen der Unterstützung des Kommentierungsverfahrens. Bitte geben Sie bei einem Kommentar oder einem Verbesserungsvorschlag zu dieser Spezifikation immer das Kürzel des Abschnitts an, auf den sich Ihr Kommentar bezieht. Alle Kommentare werden in der Lasche "Diskussion" zu der kommentierten Seite gesammelt und gegenkommentiert.
Hinweise zum Kommentierungsverfahren einschließlich aller Formulare und Kontaktadressen finden Sie auf der Seite "Kommentierung EFAv2.0".


Document Metadata

Bitte markieren Sie Kommentare zu diesem Abschnitt mit dem Code {EDoct.01}

Unless stated otherwise in the following sub-sections, document metadata MUST be used as defined in table 4.1-5 of [IHE ITI TF Vol3 v9.0]. Further constraints MAY apply for EFA national profiles (see below for the German profile).

classCode

The document class shall be taken from a national catalogue. It should be provided as a LOINC code.

typeCode

The document type shall be provided as a LOINC code. Document types shall be more specific than document classes. They may be defined per Care Domain.

Example:

 <rim:Classification 
    id="urn:uuid:c33ca26a-29b4-45be-a9b9-de60adca4c64"
    lid="urn:uuid:c33ca26a-29b4-45be-a9b9-de60adca4c64"
    objectType="urn:oasis:names:tc:ebxml-regrep:ObjectType:RegistryObject:Classification"
    classificationScheme="urn:uuid:41a5887f-8865-4c09-adf7-e362475b143a"
    classifiedObject="urn:uuid:fbf2ea29-3aa3-4bc5-9187-01d7b6b0f481" 
    nodeRepresentation="11520-4">
    <rim:Slot name="codingScheme">
        <rim:ValueList>
            <rim:Value>2.16.840.1.113883.6.1</rim:Value>
        </rim:ValueList>
    </rim:Slot>
    <rim:Name>
        <rim:LocalizedString xml:lang="de" charset="UTF-8" value="EKG Befund"/>
    </rim:Name>
 </rim:Classification>


Comments

This slot is optional. If given, it SHALL hold a summary of the document content.

Example:

<rim:Description>
   <rim:LocalizedString xml:lang="de" charset="UTF-8" value = "Befund zur Magenspiegelung vom 3.3.13"/>
</rim:Description>

German Profile

For using EFA within the German national healthcare IT infrastructure (Telematikinfrastruktur) the constraints listed below MUST be considered.

Author Institution

For the German healthcare system the following identification schemes MUST be used. If multiple schemes are available for an organization, the order in the table denotes the order of preference.

Organization Scheme Code System OID
Practice Telematik ID
This ID scheme MUST be preferred only if the Telematik ID is recorded within the SMC-B AUT certificate of the practice.
not defined yet
Practice ID of the SMC-B AUT Certificate 1.2.276.0.76.4.77
Practice »Institutskennzeichen (IK)« acc. to § 293 SGB V 1.2.276.0.76.4.5
Practice KBV »Arztnummer Praxis« 1.2.276.0.76.4.10
Hospital department or faculty Telematik ID
This ID scheme MUST be preferred only if the Telematik ID is recorded within the SMC-B AUT certificate of the department/faculty.
not defined yet
Hospital department or faculty ID of the SMC-B AUT Certificate 1.2.276.0.76.4.77
Hospital Telematik ID
This ID scheme MUST be preferred only if the Telematik ID is recorded within the SMC-B AUT certificate of the hospital.
not defined yet
Hospital ID of the SMC-B AUT Certificate 1.2.276.0.76.4.77
Hospital »Institutskennzeichen (IK)« acc. to § 293 SGB V 1.2.276.0.76.4.5

Example:

A resident practice with the Institutskennzeichen 260326822 would be encoded as:

<rim:Slot name="authorInstitution">
  <rim:ValueList>
    <rim:Value>Name der Praxis^^^^^&1.2.276.0.76.4.5&ISO^^^^260326822</rim:Value> 
  </rim:ValueList>
</rim:Slot>


Author Person

For the German healthcare system the following identification schemes MUST be used. If mul-tiple schemes are available for a role, the order in the table denotes the order of preference. If multiple IDs are known, at least the two SHOULD be provided.

Person Role Scheme Code System OID
Physician Telematik ID
This ID scheme MUST be preferred only if the Telematik ID is recorded within the HBA AUT certificate of the physician.
not defined yet
Physician ID of the HBA AUT Certificate 1.2.276.0.76.4.75
Physician Lebenslange Arztnummer KV 1.2.276.0.76.4.16
Hospital Staff
Practice Staff
Any internal identification scheme that guarantees a unique identification within the scope of the identified organization. The <representedOrganization> and an <id> for this organization MUST be recorded. local code system


Example:

A physician with the Arztnummer 12345678 would be encoded as:

<rim:Slot name="authorInstitution">
  <rim:ValueList>
    <rim:Value>Name des Arztes^^^^^&1.2.276.0.76.4.16&ISO^^^^12345678</rim:Value> 
  </rim:ValueList>
</rim:Slot>


HealthcareFacilityTypeCode

The healthcare facility type code SHALL be encoded as a coded value acc to the KBV Schlüsseltabelle S_VDX_PRAXISTYP ([1]). The root OID 1.2.276.0.76.3.1.1.5.1.4 SHALL be used.

Example:

A hospital facility type would be encoded as:

<rim:Classification classificationScheme="urn:uuid:f33fb8ac-18af-42cc-ae0e-ed0b0bdb91e1"
                    classifiedObject="theDocument" id=”ID_050"
                    objectType="urn:oasis:names:tc:ebxml-regrep:ObjectType:RegistryObject:Classification"
                    nodeRepresentation="50">
    <rim:Name>
        <rim:LocalizedString xml:lang="de" value="Krankenhaus"/>
    </rim:Name>
    <rim:Slot name="codingScheme">
       <rim:ValueList>
           <rim:Value>1.2.276.0.76.3.1.1.5.1.4</rim:Value>
       </rim:ValueList>
    </rim:Slot>
</rim:Classification>


sourcePatientInfo

This slot SHALL NOT be used for protecting the confidentiality of personal medical information.


Querverweise und Referenzen