Swedish Healthcare Service - Health Condition Description - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

GetAlertInformation

GetAlertInformation

Version: 2.0
Contract: urn:riv:clinicalprocess:healthcond:description:GetAlertInformation:2

Description

GetAlertInformation returns alert information (uppmärksamhetsinformation) for a patient, including allergies, serious conditions, and other information requiring healthcare attention. The message format is based on NPÖ RIV 2.2.0 and is compatible with HL7 v. 3 CDA v. 2.

Alert information includes circumstances where lack of knowledge could constitute a serious threat to the patient's life or health.

Request Structure

See the GetAlertInformationRequest logical model for complete structure.

Key Request Parameters

Time Period Filtering (Rule 2)

The search returns alerts where the validity period overlaps with the search interval. The validity period is formed from:

• Start: validityTimePeriod.start
• End: obsoleteTime OR validityTimePeriod.end (if set), otherwise open-ended

An alert is returned if:

• Validity start date falls within search interval, OR
• Validity end date falls within search interval, OR
• Validity period completely encompasses search interval

Response Structure

See the GetAlertInformationResponse logical model for complete structure.

Alert Information Structure

Each alert entry contains:

Header

Standard PatientSummaryHeader with same structure as GetDiagnosis

Body - Common Fields

• typeOfAlertInformation (required) - Type of alert from KV Uppmärksamhetstyp or KV Informationstyp
• ascertainedDate (optional) - Date condition was confirmed
• verifiedTime (optional) - When verified in local system
• validityTimePeriod (required) - Time interval when alert is valid
  • start (required)
  • end (optional) - for predictable end time
• alertInformationComment (optional) - Professional's comment
• obsoleteTime (optional) - When marked as no longer current
• obsoleteComment (optional) - Why marked obsolete

Body - Type-Specific Content

Exactly one of the following must be specified:

1. Hypersensitivity

For medication or other allergies/hypersensitivities:

• typeOfHypersensitivity - ICD-10/SNOMED preferred
  • Medication hypersensitivity
  • Food hypersensitivity
  • Animal hypersensitivity
  • Plant hypersensitivity
  • Chemical hypersensitivity
• degreeOfSeverity - KV Allvarlighetsgrad (severity grade)
• degreeOfCertainty - KV Visshetsgrad (certainty degree)

Pharmaceutical Hypersensitivity:

• atcSubstance (required for serious reactions) - ATC code min 3-digit level
  • code (required)
  • displayName (required)
  • codeSystem: 1.2.752.129.2.2.3.1.1
• nonATCSubstance - When ATC code unavailable
• nonATCSubstanceComment - Why no ATC code
• pharmaceuticalProductId - NPL-id for specific products

Other Hypersensitivity:

• hypersensitivityAgent - Description of agent
• hypersensitivityAgentCode - Code (e.g., LMK for food, CAS for chemicals)

2. Serious Disease

Serious illness requiring attention:

• disease (required) - ICD-10/SNOMED preferred

3. Treatment

Significant ongoing treatment:

• treatmentDescription (required) - Treatment description
• treatmentCode - KVÅ-kod preferred
• pharmaceuticalTreatment (0..*) - ATC codes for medications

Interaction Flow

The GetAlertInformation service follows the standard request-response pattern with optional aggregation:

Consumer          Aggregator           EI          Source Systems
   |                  |                 |              |
   |-- GetAlert ------>|                 |              |
   |                  |-- Query EI ---->|              |
   |                  |<- HSA-IDs ------|              |
   |                  |                                |
   |                  |--------- Parallel Queries ---->|
   |                  |                 |         System A
   |                  |                 |         System B
   |                  |<-------- Responses ------------|
   |                  |                 |              |
   |<- Aggregated ----|                 |              |
   |    Response      |                 |              |

Message Examples

Request Example - Allergy Information

<soap:Envelope xmlns:soap="http://www.w3.org/2003/05/soap-envelope"
               xmlns:add="http://www.w3.org/2005/08/addressing"
               xmlns:ns="urn:riv:clinicalprocess:healthcond:description:GetAlertInformationResponder:2">
  <soap:Header>
    <add:To>https://aggregator.example.se/GetAlertInformation/2</add:To>
    <add:Action>urn:riv:clinicalprocess:healthcond:description:GetAlertInformationResponder:2:GetAlertInformation</add:Action>
    <add:MessageID>urn:uuid:23456789-2345-2345-2345-234567890bcd</add:MessageID>
    <urn:LogicalAddress xmlns:urn="urn:riv:itintegration:registry:1">SE2321000016-1234</urn:LogicalAddress>
  </soap:Header>
  <soap:Body>
    <ns:GetAlertInformation>
      <ns:patientId>
        <ns:id>197001011234</ns:id>
        <ns:type>1.2.752.129.2.1.3.1</ns:type>
      </ns:patientId>
      <ns:timePeriod>
        <ns:start>20200101</ns:start>
        <ns:end>20241231</ns:end>
      </ns:timePeriod>
    </ns:GetAlertInformation>
  </soap:Body>
</soap:Envelope>

Response Example - Pharmaceutical Hypersensitivity

<soap:Envelope xmlns:soap="http://www.w3.org/2003/05/soap-envelope"
               xmlns:ns="urn:riv:clinicalprocess:healthcond:description:GetAlertInformationResponder:2">
  <soap:Body>
    <ns:GetAlertInformationResponse>
      <ns:result>
        <ns:resultCode>OK</ns:resultCode>
        <ns:message>Successfully retrieved 1 alert</ns:message>
      </ns:result>
      <ns:alertInformation>
        <ns:alertInformationHeader>
          <ns:documentId>alert-456-2023</ns:documentId>
          <ns:sourceSystemHSAId>SE2321000016-1234</ns:sourceSystemHSAId>
          <ns:documentTime>20230520093000</ns:documentTime>
          <ns:patientId>
            <ns:id>197001011234</ns:id>
            <ns:type>1.2.752.129.2.1.3.1</ns:type>
          </ns:patientId>
          <ns:accountableHealthcareProfessional>
            <ns:healthcareProfessionalHSAId>SE2321000016-B456</ns:healthcareProfessionalHSAId>
            <ns:healthcareProfessionalName>Dr. Bengt Bengtsson</ns:healthcareProfessionalName>
          </ns:accountableHealthcareProfessional>
        </ns:alertInformationHeader>
        <ns:alertInformationBody>
          <ns:typeOfAlertInformation>
            <ns:code>UPP04</ns:code>
            <ns:codeSystem>1.2.752.129.2.2.1.87</ns:codeSystem>
            <ns:displayName>Läkemedelsöverkänslighet</ns:displayName>
          </ns:typeOfAlertInformation>
          <ns:ascertainedDate>20230518</ns:ascertainedDate>
          <ns:verifiedTime>20230520093000</ns:verifiedTime>
          <ns:validityTimePeriod>
            <ns:start>20230518</ns:start>
          </ns:validityTimePeriod>
          <ns:alertInformationComment>Patient utvecklade utslag och andningsbesvär efter penicillinbehandling. Verifierad av läkare.</ns:alertInformationComment>
          <ns:hypersensitivity>
            <ns:typeOfHypersensitivity>
              <ns:code>Z88.0</ns:code>
              <ns:codeSystem>1.2.752.116.1.1.1.1.3</ns:codeSystem>
              <ns:displayName>Allergi mot penicillin</ns:displayName>
            </ns:typeOfHypersensitivity>
            <ns:degreeOfSeverity>
              <ns:code>Svår</ns:code>
              <ns:codeSystem>1.2.752.129.2.2.1.88</ns:codeSystem>
              <ns:displayName>Svår reaktion</ns:displayName>
            </ns:degreeOfSeverity>
            <ns:degreeOfCertainty>
              <ns:code>Säker</ns:code>
              <ns:codeSystem>1.2.752.129.2.2.1.89</ns:codeSystem>
              <ns:displayName>Säkerställd diagnos</ns:displayName>
            </ns:degreeOfCertainty>
            <ns:pharmaceuticalHypersensitivity>
              <ns:atcSubstance>
                <ns:code>J01C</ns:code>
                <ns:codeSystem>1.2.752.129.2.2.3.1.1</ns:codeSystem>
                <ns:displayName>Betalaktamantibiotika, penicilliner</ns:displayName>
              </ns:atcSubstance>
            </ns:pharmaceuticalHypersensitivity>
          </ns:hypersensitivity>
        </ns:alertInformationBody>
      </ns:alertInformation>
    </ns:GetAlertInformationResponse>
  </soap:Body>
</soap:Envelope>

4. Communicable Disease

Infectious disease information:

• communicableDiseaseCode (required) - ICD-10 preferred
• routeOfTransmission - KV Smittväg (mandatory if regulated)

5. Restriction of Care

Care restrictions or limitations:

• restrictionOfCareComment (required) - Description of restriction

6. Unstructured Alert Information

Historical warnings not structured per NPÖ:

• unstructuredAlertInformationHeading (required) - Warning heading
• unstructuredAlertInformationContent (required) - Warning content

Related Alert Information

Links to related alerts:

• typeOfAlertInformationRelationship - KV Samband
• relationComment - Comment on relationship
• relatedAlertInformation - Referenced alert document IDs

Business Rules

Rule 1: Access Control Requirements

Elements healthcareProfessionalCareUnitHSAId and healthcareProfessionalCareGiverHSAId required for PDL compliance. Records without these won't display in coherent medical records access.

Rule 2: NPÖ Alert Types

When sending to National Patient Overview (NPÖ), must use these codes from KV Informationstyp or KV Uppmärksamhetstyp:

• upp-ube (Hypersensitivity)
• upp-ube-beh (Hypersensitivity treatment)
• upp-ube-lbe (Medication hypersensitivity)
• upp-ube-kod (Hypersensitivity food)
• upp-uas (Other serious)
• upp-uas-sjd (Serious disease)
• upp-vbe (Care restriction)
• upp-vbe-vbe (Care restriction detail)
• upp-arb (Work environment)
• upp-arb-smf (Communicable disease)
• upp-arb-smf-vag (Transmission route)
• upp-arb-smf-sjd (Communicable disease detail)
• upp-est (Historical)
• upp-est-rub (Historical heading)
• upp-est-inh (Historical content)

Or KV Uppmärksamhetstyp values:

• Överkänslighet
• Allvarlig sjukdom
• Allvarlig behandling
• Smittsam sjukdom
• Vårdbegränsning
• Historisk varningsinformation

Hypersensitivity Guidelines

Serious Reactions

For hypersensitivity with severity "livshotande" (life-threatening) or "skadande" (harmful):

• ATC code at min 3-digit level is REQUIRED
• Example: C09 (ACE inhibitors) rather than specific product

When ATC Unavailable

If ATC code cannot be provided:

• Use nonATCSubstance with substance name
• Provide nonATCSubstanceComment explaining why

Severity Grading

KV Allvarlighetsgrad has two versions - specify which version used in implementation agreements.

Code Systems

Error Handling

SLA Requirements

Engagement Index Updates

Categorization value: "upp"

Update when:

• New alert registered
• Existing alert modified
• Alert validity changes
• Alert obsoleted
• Patient approval status changes

Examples

Example 1: Penicillin Allergy

typeOfAlertInformation:
  code: "upp-ube-lbe"
  codeSystem: "1.2.752.129.2.2.2.1"
  displayName: "Läkemedelsöverkänslighet"

hypersensitivity:
  typeOfHypersensitivity:
    code: "Z88.0"
    codeSystem: "1.2.752.116.1.1.1.1.3"  # ICD-10
    displayName: "Allergi mot penicillin"
  
  degreeOfSeverity:
    code: "SVA"
    displayName: "Svår"
    codeSystem: "1.2.752.129.2.2.3.3"
  
  degreeOfCertainty:
    code: "KON"
    displayName: "Konstaterad"
    codeSystem: "1.2.752.129.2.2.3.11"
  
  pharmaceuticalHypersensitivity:
    atcSubstance:
      code: "J01C"
      displayName: "Betalaktamantibiotika, penicilliner"
      codeSystem: "1.2.752.129.2.2.3.1.1"

validityTimePeriod:
  start: "20200115120000"

Example 2: Diabetes (Serious Disease)

typeOfAlertInformation:
  code: "upp-uas-sjd"
  displayName: "Allvarlig sjukdom"

seriousDisease:
  disease:
    code: "E11"
    codeSystem: "1.2.752.116.1.1.1.1.3"  # ICD-10
    displayName: "Typ 2-diabetes"

validityTimePeriod:
  start: "20180601000000"

References

• NPÖ RIV 2.2.0 Specification
• HL7 CDA v. 2
• KV Uppmärksamhetstyp
• KV Allvarlighetsgrad
• ATC Classification