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
Domain Overview
Domain Overview
Domain Identity
Domain URN: urn:riv:clinicalprocess:healthcond:description
Swedish Name: Vård- och omsorg kärnprocess: hantera hälsorelaterade tillstånd: tillståndsbeskrivning
Short Name: Tillståndsbeskrivning (Health Condition Description)
Version: 3.0.5
Purpose and Scope
This service domain handles information that describes a patient's health status. The domain serves two primary purposes:
- Healthcare Professional Access - Supporting the profession's need for direct access to patient care information (sammanhållen journalföring - coherent medical records)
- Patient Access - Enabling patient access to their own care information
The domain encompasses four main categories of health status information:
| Category |
Swedish Term |
Description |
| Care Documentation |
Vårdanteckningar |
Clinical notes, treatment plans, summaries |
| Diagnoses |
Diagnoser |
Registered medical diagnoses with codes |
| Alert Information |
Uppmärksamhetsinformation |
Allergies, serious conditions, warnings |
| Functional Status |
Funktionsstatus |
Disability and activity assessments |
Service Contracts
GetCareDocumentation v3.0
Returns journal entries for a patient, including:
- Investigation notes (utredning)
- Treatment/intervention records (åtgärd/behandling)
- Summary notes (sammanfattning)
- Coordination notes (samordning)
- Admission notes (inskrivning)
- Discharge notes with epicrisis (slutanteckning)
- Notes without physical encounter
- Inpatient notes (slutenvårdsanteckning)
- Visit notes (besöksanteckning)
Key Features:
- DocBook v5.0 formatted text support
- Binary attachments (embedded or referenced)
- Dissenting opinions
- Partial data retrieval for large datasets
- JoL-header v2.2
GetDiagnosis v2.0
Returns registered diagnoses with one diagnosis code per diagnostic occasion.
Key Features:
- Primary and secondary diagnosis types
- Chronic diagnosis indication
- Related diagnosis linking
- ICD-10/SNOMED CT coding
- Diagnosis time tracking
Returns alert information requiring healthcare attention:
- Medication hypersensitivity
- Other hypersensitivities (food, animals, plants, chemicals)
- Serious diseases
- Ongoing treatments
- Communicable diseases
- Care restrictions
- Historical alert information
Key Features:
- Structured hypersensitivity information (ATC codes)
- Severity and certainty grading
- Validity time periods
- Related alert information linking
GetFunctionalStatus v2.0
Returns documented functional status assessments:
- Personal ADL (Activities of Daily Living) assessments
- Disability assessments (ICF-based)
Key Features:
- PADL assessments per ADL Taxonomy
- ICF-coded disability assessments
- Flexible text descriptions when codes unavailable
Architecture Pattern
Service Interaction Model
[Consumer] → [Aggregating Service] → [Engagement Index]
↓
[Source System 1]
[Source System 2]
[Source System N]
Or direct addressing:
[Consumer] → [Source System]
Aggregating Services
Aggregating services provide:
- National view - Consolidates information across all care givers
- Regional view - Consolidates information within region/authority
- Engagement index consultation - Queries only relevant source systems
- Parallel queries - Efficient multi-system retrieval
Source Systems
Source systems:
- Store original patient information
- Respond to direct queries
- Update engagement index on data changes
- Apply access controls per organizational policy
Engagement Index
The engagement index (EI) enables efficient queries by:
- Maintaining registry of which systems have patient information
- Categorizing information by type
- Tracking most recent content timestamps
- Supporting change notifications
Use Cases
Use Case 1: Healthcare Professional Review
Actors: Healthcare professional, EMR system, aggregating service, multiple source systems
Flow:
- Professional opens patient record in EMR
- EMR queries aggregating service for care documentation
- Aggregating service consults engagement index
- Parallel queries sent to relevant source systems
- Results aggregated and returned to EMR
- Professional reviews consolidated information
Security: Access control per PDL, blocking check, audit logging
Use Case 2: Patient Portal Access
Actors: Patient, patient portal, aggregating service, source systems
Flow:
- Patient logs into portal with strong authentication
- Portal queries for patient's approved information
- Aggregating service filters based on approvedForPatient flag
- Only approved information returned
- Patient views their health information
Security: Only information with approvedForPatient=true shown, audit logging
Use Case 3: Notification-Driven Update
Actors: EMR system, engagement index, source system
Flow:
- Source system updates patient diagnosis
- Source system updates engagement index
- Engagement index notifies subscribers (ProcessNotification)
- EMR receives notification with source system HSA-ID
- EMR directly queries source system for updated information
Benefit: Efficient updates, reduced unnecessary queries
Use Case 4: Partial Data Retrieval
Actors: Consumer, source system with large dataset
Flow:
- Consumer queries for all patient documentation
- Source system has 10,000 records
- Source system returns first 1,000 records plus hasMore element
- Consumer displays initial results
- On user request, consumer uses hasMoreReference for next batch
- Process repeats until all data retrieved or user stops
Benefit: Meets response time requirements, progressive loading
Integration Patterns
Pattern 1: National Coherent Medical Records
- Consumer: National portal/service
- Logical address: Inera HSA-ID (5565594230)
- Aggregation: National aggregating service
- Sources: All care givers nationally
- Consumer: Regional EMR system
- Logical address: Regional authority HSA-ID
- Aggregation: Regional aggregating service
- Sources: Care givers within region
Pattern 3: Direct Source System Access
- Consumer: Specialized application
- Logical address: Source system HSA-ID
- Aggregation: None (direct)
- Sources: Single specified system
All information includes:
- Identity - Unique, persistent record identifier
- Provenance - Author, source system, organization
- Timestamps - Creation, modification, signature times
- Access control - Care giver, care unit, patient approval
- Clinical context - Care contact, care process (where applicable)
Version 2.2 of the JoL (Journal) header provides:
- Access Control Header
- Information owner identification
- Patient identity
- Blocking comparison time
- Patient approval flag
- Record Metadata
- Unique identifier
- Creation timestamp
- Authorship
- Healthcare professional
- Professional role
- Organization unit
- Timestamp
- Signature (when signed)
- Signing person
- Signature timestamp
- Professional role at signing
Body Content
Each service contract defines specific body content:
- GetCareDocumentation - Text content (plain or DocBook), multimedia
- GetDiagnosis - Diagnosis code, type, chronicity
- GetAlertInformation - Type-specific structured data
- GetFunctionalStatus - Assessment category and structured evaluations
Standards Compliance
RIV Technical Framework
- RIV 2.1 compliant
- SOAP/XML messaging
- WS-Security for authentication
- HTTP transport
Healthcare Standards
- NPÖ RIV 2.2.0 - National Patient Overview message formats (where applicable)
- HL7 CDA v2 - Clinical Document Architecture compatibility (where applicable)
- ICD-10 - Diagnosis coding
- SNOMED CT - Clinical terminology
- ICF - Functional status classification
- ATC - Medication classification
Document Standards
- DocBook v5.0 - Structured text formatting
- ISO 8601 - Date and time formats
Swedish Healthcare Standards
- HSA - Hälso- och sjukvårdens adressregister (Healthcare Address Registry)
- KV Befattning - Professional role code system
- KV Anteckningstyp - Document type code system
- SOSFS 2016:40 - Journal keeping regulations
Data Quality Requirements
All responses must include:
- Unique record identifier
- Source system identifier
- Patient identifier
- Timestamp information
- Result status
Services should provide when available:
- Healthcare professional identification
- Organization unit details
- Professional role information
- Care unit and care giver HSA-IDs
Data Consistency
- Record identifiers must be persistent across queries
- Same identifier across different service contracts where applicable
- Timestamps in Swedish time zone (CET/CEST)
- Date format consistency (YYYYMMDD)
Versioning Strategy
Major Version Changes
Major version increments indicate breaking changes:
- GetCareDocumentation 2.x → 3.0 (breaking changes)
Minor Version Changes
Minor version increments maintain backward compatibility:
- GetCareDocumentation 3.0 → 3.1 (if future compatible changes)
Domain Version
Domain version (3.0.5) indicates:
- Major version of newest contract (3)
- Minor revision level (0.5)
Governance
Specification Owner
Inera AB - Swedish national eHealth organization
Standards Body
RIV TA - RIV Technical Architecture board
Change Process
- Requirement identification
- Impact analysis
- Specification update
- Review and approval
- Publication
- Implementation window
- Mandatory upgrade (if breaking)
Support Resources
- Technical specifications at rivta.se
- Code systems at Inera's terminology service
- Implementation guidance documents
- Test suites and validators
- Reference implementations
Scope Boundaries
In Scope
- Reading patient health condition information
- Structured and unstructured clinical data
- Historical information retrieval
- Cross-organizational information access
Out of Scope
- Creating or updating patient information
- Ordering services or treatments
- Real-time monitoring data
- Administrative/financial information
- Medication dispensation (separate domain)
- Laboratory results (separate domain)
- Imaging studies (separate domain)
Related Domains
Other clinicalprocess domains provide:
- medication - Medication information
- activity - Activities and planning
- logistics - Logistics and resource management
- activityprescription - Activity prescriptions
Future Directions
Potential future enhancements:
- Enhanced search capabilities
- Subscription/notification patterns
- FHIR-based alternatives
- Real-time data streaming
- Enhanced structured data models
- International standard alignment