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input/IKNL_PZP_IG.xml

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xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
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xsi:schemaLocation="http://hl7.org/fhir ../input-cache/schemas/R3/fhir-single.xsd">
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<id value="iknl.fhir.stu3.pzp" />
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<url value="https://fhir.iknl.nl/fhir/ImplementationGuide/iknl.fhir.stu3.pzp" />
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<version value="0.1.3-beta3" />
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<url value="https://api.iknl.nl/docs/pzp/stu3/ImplementationGuide/iknl.fhir.stu3.pzp" />
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<version value="1.0.0-alpha1" />
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<name value="PZP" />
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<title value="IKNL PZP STU3" />
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<status value="active" />
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<dependsOn>
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<uri value="https://simplifier.net/packages/nictiz.fhir.nl.stu3.zib2017/2.2.20" />
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<packageId value="nictiz.fhir.nl.stu3.zib2017" />
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<version value="2.2.20" />
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<version value="2.3.2" />
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</dependsOn>
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<definition>
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<page>

input/ignoreWarnings.txt

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@@ -97,14 +97,14 @@ ERROR: QuestionnaireResponse/HendrikHartman-20221108: QuestionnaireResponse.item
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# Manual check in latest version of SNOMED does find the code '1351964001'. The error might be due to a older version of SNOMED available in tx.fhir.org/r4
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ERROR: Goal/F1-ACP-Medical-Policy-Goal: Goal.description.coding[0].code: Unknown code '1351964001' in the CodeSystem 'http://snomed.info/sct' version 'http://snomed.info/sct/11000146104/version/20240930'
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ERROR: Goal/F1-ACP-Medical-Policy-Goal: Goal.description: None of the codings provided are in the value set 'Most Important Agreed-upon Goal of Medical Policy' (https://fhir.iknl.nl/fhir/ValueSet/ACP-MedicalPolicyGoal|0.1.0), and a coding from this value set is required) (codes = http://snomed.info/sct#1351964001)
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ERROR: Goal/F1-ACP-Medical-Policy-Goal: Goal.description: None of the codings provided are in the value set 'Most Important Agreed-upon Goal of Medical Policy' (https://api.iknl.nl/docs/pzp/stu3/ValueSet/ACP-MedicalPolicyGoal|0.1.0), and a coding from this value set is required) (codes = http://snomed.info/sct#1351964001)
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ERROR: ValueSet/ACP-MedicalPolicyGoal: ValueSet.compose.include[0].concept[1]: The code '1351964001' is not valid in the system http://snomed.info/sct (Unknown code '1351964001' in the CodeSystem 'http://snomed.info/sct' version 'http://snomed.info/sct/11000146104/version/20240930')
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ERROR: Questionnaire/ACP-zib2020: Questionnaire.item[6].item[1].answerOption[1].value.ofType(Coding).code: Unknown code '1351964001' in the CodeSystem 'http://snomed.info/sct' version 'http://snomed.info/sct/11000146104/version/20240930'
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ERROR: QuestionnaireResponse/HendrikHartman-20201001: QuestionnaireResponse.item[6].item[1].answer[0].value.ofType(Coding).code: Unknown code '1351964001' in the CodeSystem 'http://snomed.info/sct' version 'http://snomed.info/sct/11000146104/version/20240930'
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# Manually checked: 72506001 is in the ValueSet, even in the expansion. The ValueSet in the profile bound is allowed as it restricts the zib's required binding. 72506001 zit in "Include codes from SNOMED_CT where concept DescendentOf 260787004"
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ERROR: Device/P1-ACP-MedicalDevice.Product-ICD: Device.type: None of the codings provided are in the value set 'MedicalDevice ProductType ICD' (https://fhir.iknl.nl/fhir/ValueSet/ACP-MedicalDeviceProductType-ICD|0.1.0), and a coding from this value set is required) (codes = http://snomed.info/sct#72506001)
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ERROR: Device/P2-ACP-MedicalDevice.Product-ICD: Device.type: None of the codings provided are in the value set 'MedicalDevice ProductType ICD' (https://fhir.iknl.nl/fhir/ValueSet/ACP-MedicalDeviceProductType-ICD|0.1.0), and a coding from this value set is required) (codes = http://snomed.info/sct#72506001)
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ERROR: Device/P1-ACP-MedicalDevice.Product-ICD: Device.type: None of the codings provided are in the value set 'MedicalDevice ProductType ICD' (https://api.iknl.nl/docs/pzp/stu3/ValueSet/ACP-MedicalDeviceProductType-ICD|0.1.0), and a coding from this value set is required) (codes = http://snomed.info/sct#72506001)
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ERROR: Device/P2-ACP-MedicalDevice.Product-ICD: Device.type: None of the codings provided are in the value set 'MedicalDevice ProductType ICD' (https://api.iknl.nl/docs/pzp/stu3/ValueSet/ACP-MedicalDeviceProductType-ICD|0.1.0), and a coding from this value set is required) (codes = http://snomed.info/sct#72506001)
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# Definition can be found in the Nictiz package. Not sure why the IG publisher cannot access it. Also not a big deal for this IG.
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WARNING: Practitioner/F1-ACP-HealthProfessional-Practitioner-DrVanHuissen: Practitioner.identifier[0].system: No definition could be found for URL value 'http://fhir.nl/fhir/NamingSystem/agb-z'

input/pagecontent/data-exchange.md

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This approach provides granular access to the individual clinical statements that constitute the ACP. It allows applications to query for specific data points without processing an entire form.
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This approach is useful for applications that need to query specific parts of a patient's ACP, like treatment wishes or stated goals. While it requires multiple API calls, it provides more granular control and returns the ACP in usable resources. The below client requests are in scope of a Patient's context for which an initial request may be needed to match the Patient resource id with a identifier (e.g. BSN).
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This approach is useful for applications that need to query specific parts of a patient's ACP, like treatment wishes or stated goals. While it requires multiple API calls, it provides more granular control and returns the ACP in usable resources. The below listed client requests are in scope of a Patient's context for which an initial request may be needed to match the Patient resource id with an identifier (e.g. BSN).
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#### Client Requests
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The below listed search request show how all the ACP agreements, procedural information and relevant clinical context can be retrieved. Information on individuals involved in the ACP process are referenced from these resources and can be retrieved using the `_include` statement as defined below, or by resolving the references. Standard FHIR rules apply on the search syntax.
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The below listed search requests show how all the ACP agreements, procedural information and relevant clinical context can be retrieved. Information on individuals involved in the ACP process are referenced from these resources and can be retrieved using the `_include` statement as defined below, or by resolving the references. Standard FHIR rules apply on the search syntax.
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```
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1a GET [base]/Procedure?patient=[id]&code=http://snomed.info/sct|713603004&_include:Procedure:encounter
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3 GET [base]/Consent?patient=[id]&category=http://snomed.info/sct|11341000146107&_include=Consent:actor
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4 GET [base]/Goal?patient=[id]&description:in=https://fhir.iknl.nl/fhir/ValueSet/ACP-MedicalPolicyGoal
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4 GET [base]/Goal?patient=[id]&description:in=https://api.iknl.nl/docs/pzp/stu3/ValueSet/ACP-MedicalPolicyGoal
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5 GET [base]/Observation?patient=[id]&code=http://snomed.info/sct|153851000146100,395091006,340171000146104,247751003
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6 GET [base]/DeviceUseStatement?patient=[id]&device.type:in=https://fhir.iknl.nl/fhir/ValueSet/ACP-MedicalDeviceProductType-ICD&_include:DeviceUseSatement:device
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6 GET [base]/DeviceUseStatement?patient=[id]&device.type:in=https://api.iknl.nl/docs/pzp/stu3/ValueSet/ACP-MedicalDeviceProductType-ICD&_include:DeviceUseSatement:device
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7 GET [base]/Communication?patient=[id]&reason-code=http://snomed.info/sct|713603004
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```
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A client retrieves the `QuestionnaireResponse` by performing a `GET` search operation. The search is scoped to a specific patient and is filtered by the canonical URL of the <a href="Questionnaire-ACP-zib2017.html">ACP Questionnaire</a> to ensure that only the correct form is returned.
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> GET [base]/QuestionnaireResponse?subject=Patient/[id]&questionnaire=https://fhir.iknl.nl/fhir/Questionnaire/ACP-zib2017
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> GET [base]/QuestionnaireResponse?subject=Patient/[id]&questionnaire=https://api.iknl.nl/docs/pzp/stu3/Questionnaire/ACP-zib2017
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#### Server Response

input/pagecontent/data-model.md

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This page provides an overview of the FHIR resources used to represent the ACP dataset, many of which are based on nl-core profiles.
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This page provides an overview of the FHIR profiles used to represent the ACP dataset, many of which are based on nl-core profiles.
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### ACP Questionnaire
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input/pagecontent/index.md

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### Project Description and Scope
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This Implementation Guide (IG) supports the Advance Care Planning (ACP) information standard (Dutch: Palliatieve Zorg Planning) and is intended for use within the palliative care domain in the Netherlands. This domain involves care for patients with an incurable illness or condition from which they are expected to die.
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This Implementation Guide (IG) supports the Advance Care Planning (ACP) information standard (Dutch: Proactieve Zorgplanning) and is intended for use within the palliative care domain in the Netherlands. This domain involves care for patients with an incurable illness or condition from which they are expected to die.
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Developed by the <a href="https://iknl.nl/en">Netherlands Comprehensive Cancer Organisation</a> (Dutch: Integraal kankercentrum Nederland (IKNL)), this guide provides technical direction for using FHIR to exchange ACP data. It is based on <a href="http://hl7.org/fhir/R4/index.html">HL7 FHIR R4</a> and builds on top of the <a href="https://simplifier.net/packages/nictiz.fhir.nl.r4.nl-core">Dutch Core R4 profiles</a>.
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Developed by the <a href="https://iknl.nl/en">Netherlands Comprehensive Cancer Organisation</a> (Dutch: Integraal Kankercentrum Nederland (IKNL)), this guide provides technical direction for using FHIR to exchange ACP data. It is based on <a href="http://hl7.org/fhir/STU3/index.html">HL7 FHIR STU3</a> and builds on top of the <a href="https://simplifier.net/packages/nictiz.fhir.nl.stu3.zib2017">Dutch STU3 zib2017 profiles</a>.
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This guide assumes that readers are familiar with the functional specifications of ACP and the **STU3** version of FHIR.
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1. The <a href="StructureDefinition-ext-EncounterReference.html">EncounterReference extension</a> is an optional extension that enables linking the Consent, Goal, and DeviceUseStatement resources to a relevant Encounter. We invite feedback on whether this extension is truly necessary.
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2. The <a href="StructureDefinition-ACP-Communication.html">Communication profile</a> has been developed to capture all communication events related to advance care planning. It specifically documents whether the patient has been informed about their responsibility discuss treatment agreements with relatives. As this profile is newly created rather than derived from zib/nl-core profiles, we welcome input on its structure and modeling approach.
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2. The <a href="StructureDefinition-ACP-Communication.html">Communication profile</a> has been developed to capture all communication events related to advance care planning. It specifically documents whether the patient has been informed about their responsibility to discuss treatment agreements with relatives. As this profile is newly created rather than derived from zib/nl-core profiles, we welcome input on its structure and modeling approach.
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3. The <a href="Questionnaire-ACP-zib2017.html">ACP Questionnaire</a> has been developed based on the ACP form dataset and aims to preserve the zib structure as much as possible. We welcome any feedback on its design and implementation.
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input/pagecontent/information-standard.md

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### Information Standard: Documentation and Artifacts
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The advance care planning (ACP) information standard defines both the functional and technical design. This implementation guide (IG) specifies how the technical design of the ACP information standard should be applied in practice. To clarify the coherence of the different documents involved, we outline their roles here.
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The advance care planning (ACP) information standard defines both the functional and technical design. This implementation guide (IG) is the technical design and specifies how the ACP information standard should be implemented in HL7 FHIR in practice. To clarify the coherence of the different documents involved, we outline their roles here.
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#### Functional design (FD)
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The functional design forms the basis for this IG. It entails:
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[Functioneel Ontwerp](https://palliaweb.nl/overzichtspagina-hulpmiddelen/uniform-vastleggen-proactieve-zorgplanning-2025)
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##### Datasets, Terminology and scenarios
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Inside the functional design there are links towards [ART-DECOR](https://decor.nictiz.nl/ad/#/pall-izppz-/project/overview).
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On Art Decor the following information is published:
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- **Datasets**PZP dataset and ACP form describing the structure of the information.
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Inside the functional design there are links directing to [ART-DECOR](https://decor.nictiz.nl/ad/#/pall-izppz-/project/overview).
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On ART-DECOR the following information is published:
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- **Datasets**ACP dataset and ACP form describing the structure of the information.
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- **Terminology & code systems** – Description of the used value sets with mappings to SNOMED CT, or domain specific codes.
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- **Scenarios & sequence diagrams** – Explanation and visualization of how actors and systems exchange information.
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- FHIR profiles and extensions;
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- Use of terminology (SNOMED CT, local codes);
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- Constraints and business rules;
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- containing a traceable mapping to the dataset;
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- ACP Form Questionaire and Questionaire response example;
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- A traceable mapping to the dataset;
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- ACP Form Questionnaire and Questionnaire response example;
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- Examples – to support suppliers with implementation and conformance assessment.
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#### Test Scripts
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#### Test scripts
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To ensure correct implementation and interoperability, test scripts are provided.
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These artefacts support vendors and implementers in validating their systems against the requirements defined in the functional and technical design.
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[Testscripts](https://palliaweb.nl/overzichtspagina-hulpmiddelen/uniform-vastleggen-proactieve-zorgplanning-2025)
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[Test scripts](https://palliaweb.nl/overzichtspagina-hulpmiddelen/uniform-vastleggen-proactieve-zorgplanning-2025)
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