CH eTOC (R4)
3.0.0-ballot - ballot Switzerland flag

This page is part of the CH eTOC (R4) (v3.0.0-ballot: STU 3 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions


Official URL: Version: 3.0.0-ballot
Active as of 2024-05-17 Computable Name: CH_eTOC

Copyright/Legal: CC0-1.0


The CH eTransition of Care (CH eTOC) Implementation Guide defines the content of a referral from a GP to the hospital, to a specialist, from one hospital to another etc.

CH eTOC is intended primarily for use in directional information exchange and for the use in the SWISS EPR. It however may be implemented in other settings too.

This implementation guide is under STU ballot by HL7 Switzerland until September 30th, 2024 midnight.
Please add your feedback via the ‘Propose a change’-link in the footer on the page where you have comments.

Significant changes, open and closed issues.

Download: You can download this implementation guide in npm format from here.


This Implementation Guide uses FHIR defined resources. For details on HL7 FHIR R4 see

Because the Implementation Guide relies heavily on the FHIR Resources Questionnaire and QuestionnaireResponse, forms are addressed here as Questionnaires.

This Implementation Guide is derived from the CH Order & Referral by Form (CH ORF) Implementation Guide (CH ORF) which relies on HL7 Structured Data Capture Implementation Guide, see SDC and uses the Swiss Core Profiles, see CH Core.

April 7, 2022 the HL7 Switzerland Technical Committee discussed #39 and finally voted to set cardinality for the Questionnaire and QuestionnaireResponse to 1.. in the composition resource thus making the use of Questionnaires and QuestionnaireResponses mandatory (see also CH ORF).

Applications claiming for conformance with an CH ORF derived implementation guide shall:

Render (and in case of the Questionnaire Filler allow for data entry) all elements of a questionnaire in the user interface (e.g. on screen, in print). Grouping of items and the order of items within shall be adequately reproduced according to the questionnaire.

Vendors of applications with Questionnaire Filler/Questionnaire Receiver actors are strongly recommended to implement interfaces to other applications (such as HIS and PACS) at least for all data in the generics elements of questionnaires.

In the 3rd report of the Interprofessional Working Group on Electronic Patient Dossiers (IPAG) eDischarge Report, recommendations are formulated that are important for the inter-professional exchange of information during transitions of treatment (transition of care). The information relevant to treatment shall be be described in an exchange format that makes suggestions for structuring the content of interprofessional data content.

At the working group meeting in February 2021, it was decided that a first version of eTOC shall be based on the the FHIR International Patient Summary (IPS).

However, this first version of CH eTOC still allows many free text entries. Reason: According to IPAG, in a first step, the items shall be implemented as text. It can be expected, that users want to copy paste results: it seems sensible, to have multiple entries for lab, but other findings are mostly in freetext and therefore it makes sense to copy all findings in one copy-paste action.

Clinical content uses mostly the same resources as the IPS. The resource definitions are however constrained from FHIR base definitions and CH Core definitions and NOT from UVIPS. This decision was made in order to minimize unexpected impact of future changes in IPS and for compatibility with Swiss Core.

Corresponding section in the IPS Resource / Datatype Derived from
IPS Medication Summary CHCoreMedicationStatement MedicationStatement
CHCoreMedication Medication
CHCoreDosage Dosage
IPS Allergies and Intolerances ChEtocAllergyIntolerance CHCoreAllergyIntolerance
IPS Problem List ChEtocPrimaryDiagnosisCondition CHCoreCondition
ChEtocSecondaryDiagnosisCondition CHCoreCondition
IPS Immunizations ChEtocImmunization CHCoreImmunization
IPS History of Procedures ChEtocProcedure Procedure
IPS Medical Devices ChEtocDevice Device
IPS Diagnostic Results ChEtocLabObservation Observation
ChEtocPathologyObservation Observation
ChEtocRadiologyObservation Observation
ChEtocCardiologyObservation Observation
ChEtocBodyHeightObservation HL7BodyHeight
ChEtocBodyWeightObservation HL7BodyWeight
IPS Past history of illnesses ChEtocPastHistoryofIllnessesCondition CHCoreCondition
IPS Pregnancy ChEtocPregnancyStatusObservation Observation
CH eToc Expected Delivery Date Observation Observation
IPS Social History ChEtocSocialHistoryCondition CHCoreCondition
IPS IFunctional Status ChEtocFunctionalStatusCondition CHCoreCondition
IPS Advance Directives Not supported yet -

[Table 1] Resources and datatypes for clinical content

In addition to the Composition (IPS), the CH eTOC Composition provides a sectionPurpose.

CH eTOC allows to distinguish between primary and secondary diagnosis; both are referenced in sectionProblems. sectionAttachment allows n for attachment (whatever is considered as important).

There is no sectionVitalSigns such as provided by the IPS. This is in order to prevent duplicate content.

SectionPlanOfCare is omitted for the following reason: It can be assumed that careplans will be available at best as pdf files for the foreseeable future. There is therefore a need to provide careplans as an attachment. This is what the Attachment section is for.

All other sections for clinical content use the same wording for section titles as the Composition (IPS):


As a consequence of the above CH eTOC does not claim to be conformant to IPS for now.

Derivations for use cases in different disciplines are to be defined later.

eTOC adds a ServiceRequest resource to the clinical content (according to the IPS) in order to depict the reason for a referral, the requested service and some additional information (e.g. coverage, room preference etc.).

Header information such as sender, receiver etc. are considered as Generic Elements (to all sorts of referral, orders etc.) and follow the definition in the ORF Implementation Guide.

Copy receiver is meant to receive a copy from the order and all evolving results thereof.

Actors, transactions and security considerations are covered in the corresponding sections of CH ORF


Value sets and coding are preliminary and not yet approved by eHealth Suisse.

Safety Considerations

This implementation guide defines data elements, resources, formats, and methods for exchanging healthcare data between different participants in the healthcare process. As such, clinical safety is a key concern. Additional guidance regarding safety for the specification’s many and various implementations is available at:

Although the present specification does gives users the opportunity to observe data protection and data security regulations, its use does not guarantee compliance with these regulations. Effective compliance must be ensured by appropriate measures during implementation projects and in daily operations. The corresponding implementation measures are explained in the standard. In addition, the present specification can only influence compliance with the security regulations in the technical area of standardization. It cannot influence organizational and contractual matters.

IP Statements

This document is licensed under Creative Commons “No Rights Reserved” (CC0).

HL7®, HEALTH LEVEL SEVEN®, FHIR® and the FHIR ® are trademarks owned by Health Level Seven International, registered with the United States Patent and Trademark Office.

This implementation guide contains and references intellectual property owned by third parties (“Third Party IP”). Acceptance of these License Terms does not grant any rights with respect to Third Party IP. The licensee alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize Third Party IP in connection with the specification or otherwise.

This publication includes IP covered under the following statements.

Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 ( and R4B ( are available.

Dependency Table

.. CH eTOC (R4)
... FHIR Extensions Packhl7.fhir.uv.extensions.r4#5.1.0R4Automatically added as a dependency - all IGs depend on the HL7 Extension Pack
... HL7 Terminology (THO)hl7.terminology#5.5.0R4
.... FHIR Extensions Packhl7.fhir.uv.extensions.r4#1.0.0R4
... CH ORF (R4)
.... CH Core (R4)
..... CH Term (R4)
...... IHE FormatCode Vocabularyihe.formatcode.fhir#1.2.0R4
....... HL7 Terminology (THO)hl7.terminology.r4#5.3.0R4
.... Structured Data Capturehl7.fhir.uv.sdc#3.0.0R4
..... FHIR R4 package : Exampleshl7.fhir.r4.examples#4.0.1R4
... CH RAD-Order (R4)
.... HL7 Terminology (THO)hl7.terminology.r4#5.5.0R4
... International Patient Summary Implementation Guidehl7.fhir.uv.ips#1.1.0R4
.... HL7 Terminology (THO)hl7.terminology.r4#5.0.0R4
.... fhir.dicom#2022.4.20221006R4

Package hl7.fhir.uv.extensions.r4#5.1.0

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00)

Package hl7.fhir.uv.extensions.r4#1.0.0

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00)

Package ihe.formatcode.fhir#1.2.0

Implementation Guide for IHE defined FormatCode vocabulary. (built Tue, Mar 12, 2024 16:59-0500-05:00)


Implementation Guide for Swiss Terminology (built Thu, May 16, 2024 10:33+0000+00:00)


FHIR implementation guide CH Core (built Thu, May 16, 2024 16:08+0000+00:00)

Package hl7.fhir.r4.examples#4.0.1

Example resources in the R4 version of the FHIR standard

Package hl7.fhir.uv.sdc#3.0.0

The SDC specification provides an infrastructure to standardize the capture and expanded use of patient-level data collected within an EHR.
This includes two components:
* Support more sophisticated questionnaire/form use-cases such as those needed for research, oncology, pathology and other clinical domains.
*Support pre-population and auto-population of EHR data into forms/questionnaires for uses outside direct clinical care (patient safety, adverse event reporting, public health reporting, etc.). (built Tue, Mar 8, 2022 18:32+0000+00:00)


Order & Referral by Form - Implementation Guide (CH ORF) (built Fri, May 17, 2024 06:30+0000+00:00)


Implementation guide CH RAD-Order (R4) (built Fri, May 17, 2024 11:21+0000+00:00)

Package hl7.fhir.uv.ips#1.1.0

International Patient Summary (IPS) FHIR Implementation Guide (built Tue, Nov 22, 2022 03:24+0000+00:00)

Globals Table

There are no Global profiles defined