Inera Core Implementation Guide
0.2.0 - ci-build Sweden

Inera Core Implementation Guide - Local Development build (v0.2.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Introduction

Introduction to Inera Core FHIR IG

Purpose

The Inera Core Implementation Guide provides Swedish national FHIR profiles and conformance resources for healthcare information exchange in Sweden. This IG serves as the foundation for:

  • NPÖ (Nationell Patientöversikt) - National Patient Overview
  • Regional healthcare information exchange
  • Cross-organizational patient data sharing
  • Integration with Swedish national healthcare infrastructure

Scope

This implementation guide covers:

  1. Base Profiles for core FHIR resources adapted to Swedish healthcare context
  2. Swedish Identifiers (personnummer, samordningsnummer, HSA-ID)
  3. Terminology Bindings to Swedish code systems (ICD-10-SE, SNOMED CT SE, ATC, NPL, KVÅ)
  4. TKB Service Mappings from legacy RIVTA/TKB services to FHIR REST APIs
  5. Security and Privacy patterns for Swedish healthcare regulations (PDL, GDPR)

Target Audience

  • System Developers implementing FHIR-based healthcare systems in Sweden
  • Integration Architects designing cross-organizational data exchange
  • Standards Coordinators at regional and national levels
  • Terminology Specialists mapping Swedish healthcare terminologies

Design Principles

1. International Alignment

This IG builds upon internationally recognized standards:

  • FHIR R4 (4.0.1) as the base specification
  • IPA (International Patient Access) 1.1.0 for patient-facing APIs
  • US Core 7.0.0 for metadata patterns and extensibility approaches

Swedish-specific constraints and extensions are added only where necessary to support national requirements.

2. Progressive Conformance

Implementations can adopt this IG at different levels:

Level Description Use Cases
Basic Core profiles with Swedish identifiers Read-only access, simple queries
Intermediate + Terminology bindings, basic search Regional exchange, care summaries
Advanced + Provenance, Consent, full security NPÖ integration, cross-regional
Complete + All TKB mappings, audit trails National infrastructure

3. TKB Compatibility

Sweden has a large installed base of RIVTA/TKB (Tjänstekontrakt) SOAP-based services. This IG provides:

  • ConceptMaps documenting element-by-element mappings from TKB to FHIR
  • Logical Models representing TKB service structures
  • Migration guidance for transitioning systems

See the Mapping Strategy page for technical details and the Migration Guide for architectural transition patterns.

4. Swedish Healthcare Context

The IG addresses specific Swedish requirements:

  • HSA (Hälso- och Sjukvårdens Adressregister) for organization and practitioner identification
  • Vårdgivare/Vårdenhet hierarchy (care provider → care unit)
  • PDL (Patientdatalagen) compliance for privacy and consent
  • Inre/yttre spärr (inner/outer blocks) for patient-directed access control

For detailed security and privacy implementation, see the Security and Privacy page.

Key Resources and Profiles

Patient and Demographics

  • PatientBaseInera: Swedish patient with personnummer, samordningsnummer, and reservnummer support
  • RelatedPerson: Family members and representatives

Providers and Organizations

  • PractitionerBaseInera: Healthcare professionals with HSA-ID
  • PractitionerRoleBaseInera: Roles linking practitioners to organizations
  • OrganizationBaseInera: Vårdgivare and vårdenhet with HSA-ID

Clinical Content

  • ConditionBaseInera: Diagnoses and health conditions with ICD-10-SE/SNOMED CT SE
  • ObservationBaseInera: Laboratory results, vital signs, assessments
  • AllergyIntoleranceBaseInera: Drug allergies and hypersensitivities
  • MedicationStatementBaseInera: Current and historical medications with ATC/NPL codes
  • ProcedureBaseInera: Surgical procedures, examinations, interventions with KVÅ codes

Provenance and Security

  • ProvenanceBaseInera: TKB header mapping, authorship, organizational context
  • ConsentBaseInera: Patient consent and access control (spärr)
  • AuditEventBaseInera: Audit trails for PDL compliance

Swedish Terminology Systems

This IG uses Swedish national code systems including ICD-10-SE, SNOMED CT SE, ATC, NPL, KVÅ, and HSA-ID.

​For detailed OID to URI mappings and terminology integration, see the Mapping Strategy page.

Relationship to Other IGs

Dependencies

  • IPA 1.1.0: Core patient access patterns
  • US Core 7.0.0: Metadata and extensibility patterns

This Core IG is complemented by domain-specific IGs:

  • Inera Medications IG: Detailed prescription and dispensation workflows
  • Inera Laboratory IG: Laboratory orders and results
  • Inera Imaging IG: Radiology and imaging reports
  • Regional IGs: Region-specific extensions and constraints

Getting Started

For System Developers

  1. Review the Mapping Strategy to understand TKB→FHIR transformation
  2. Study the ConceptMaps for specific TKB services you're implementing
  3. Review the Migration Guide for architectural patterns appropriate to your system type
  4. Implement base profiles starting with Patient, Practitioner, Organization
  5. Add clinical content profiles (Condition, Observation, MedicationStatement)
  6. Implement Provenance for TKB header metadata (see TKB Header Mapping)
  7. Add Consent for spärr/access control (see Security and Privacy)

For Integration Architects

  1. Review the Migration Guide for transition architecture patterns (Façade, Dual-Native, Mirror, FHIR-Native)
  2. Review the Security and Privacy guidance for PDL/GDPR compliance
  3. Understand the TKB Header Mapping for metadata and Provenance patterns
  4. Design your capability statement based on supported TKB services
  5. Plan security implementation including OAuth2/SMART, consent, and audit logging

For Terminology Specialists

  1. Review terminology bindings in value sets
  2. Map local code systems to ICD-10-SE, SNOMED CT SE, ATC, NPL
  3. Coordinate with national terminology initiatives
  4. Provide feedback on terminology coverage gaps

Support and Feedback

Status and Roadmap

Current Status: Draft / CI Build

This IG is under active development. See the Change Log for version history.

Upcoming Milestones:

  • Q1 2026: Beta release with all core profiles
  • Q2 2026: Complete TKB service ConceptMaps
  • Q3 2026: Reference implementation and conformance testing
  • Q4 2026: Version 1.0 release