This page is part of the CH eTOC (R4) (v3.0.0: STU 3) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

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Official URL: http://fhir.ch/ig/ch-etoc/ImplementationGuide/ch.fhir.ig.ch-etoc				Version: 3.0.0
Active as of 2024-12-17				Computable Name: CH_eTOC
Copyright/Legal: CC0-1.0

Purpose

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.

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

Foundation

This Implementation Guide uses FHIR defined resources. For details on HL7 FHIR R4 see http://hl7.org/fhir/r4.

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 a 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 Record (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.

Relation to the International Patient Summary

At the IPAG working group meeting in February 2021, it was decided that a first version of CH eTOC shall be based on the the HL7 IPS-UV specification, especially regarding the structure. See also the table below where the sections of both formats are compared.

However, this version of CH eTOC still allows many free text entries. The reason for this is that, according to IPAG, the items shall be implemented as text in a first step. It can be expected, that users will copy and paste results: it seems reasonable to have multiple entries for the lab, but other findings are usually in free text form and therefore it makes sense to copy all findings in one copy and 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 CH IPS or UV IPS. This decision was made in order to focus on the sections relevant to CH eTOC and to minimize the unexpected effects of future changes within the IPS.

IPS Section	CH eTOC Section	Profile used in CH eTOC	Comments (on differences)
IPS Medication Summary	Medication	CH Core MedicationStatement	-
IPS Allergies and Intolerances	Allergies and intolerances	CH eTOC Allergy Intolerance	-
IPS Problems	Problems	CH eTOC Primary Diagnosis Condition	CH eTOC allows to distinguish between primary and secondary diagnosis, both are referenced in this section.
		CH eTOC Secondary Diagnosis Condition
IPS History of Procedures	History of Procedures	CH eTOC Procedure	-
IPS Immunizations	Immunizations	CH eTOC immunizationstatus	-
IPS Medical Devices	Medical devices	CH eTOC Device	-
IPS Results	Diagnostic results	CH eTOC Lab Observation	-
		CH eTOC Pathology Observation
		CH eTOC Radiology Observation
		CH eTOC Cardiology Observation
IPS Vital Signs		CH eTOC Body Weight Observation	There is no Vital Signs section in CH eTOC, to avoid duplicate content.
		CH eTOC Body Height Observation
IPS History of Past Illness	History of past illness	CH eTOC Past History of Illnesses Condition	-
IPS Functional Status	Functional Status	CH eTOC Functional Status Condition	-
IPS Plan of Care	-	-	This section is omitted in CH eTOC for the following reason: It is assumed that care plans will only be available as PDF files in the foreseeable future at best. Therefore, there is a need to provide care plans as attachments. The Attachments section is provided for this purpose.
IPS Social History	Social history	CH eTOC Social History Condition	-
IPS History of Pregnancy	Pregnancy	CH eTOC Pregnancy Status Observation	-
		CH eTOC Expected Delivery Date Observation
IPS Advance Directives	-	-	Not defined (yet) in CH eTOC.
IPS Alerts Section	-	-	Not defined (yet) in CH eTOC.
IPS Patient Story Section	-	-	Not defined (yet) in CH eTOC.
-	Order and Referral	CH ORF Questionnaire	Additional section in CH eTOC containing the data that supports the order and referral by form.
		CH ORF QuestionnaireResponse
		CH eTOC Service Request
-	Purpose	CH eTOC ServiceRequest	Additional section in CH eTOC to provide information about the purpose/reason.
-	Attachments	CH ORF DocumentReference	Additional section to support multiple attachments (for anything considered important).

^{[Table 1]} Comparison between the sections of IPS and CH eTOC

Terminology

Value sets and codings 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: https://www.hl7.org/FHIR/safety.html.

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.

• CC0-1.0
  Show Usage
  • BFS Medizinische Statistik - 21 1.3.V02 - Klasse / Classe / Classe: Bundle/DocumentEtoc, QuestionnaireEtoc and QuestionnaireResponse/QuestionnaireResponseEtocTransCare
  • BFS Medizinische Statistik - 25 1.4.V02 - Hauptkostenträger für Grundversicherungsleistungen / Prise en charge des soins de base / Unità d’imputazione principale per le prestazioni dell’assicurazione di base: Bundle/DocumentEtoc and Coverage/CoverageKVG
  • eCH-011 MaritalStatus: Bundle/DocumentEtoc, QuestionnaireEtoc, QuestionnaireResponse/QuestionnaireResponseEtocRequestPrevious and QuestionnaireResponse/QuestionnaireResponseEtocTransCare
  • Condition Category: Bundle/DocumentEtoc, ChEtocFunctionalStatusCondition... Show 8 more, ChEtocPastHistoryofIllnessesCondition, ChEtocPrimaryDiagnosisCondition, ChEtocSecondaryDiagnosisCondition, ChEtocSocialHistoryCondition, Condition/PastHistoryofIllnessesConditionEtoc, Condition/PrimaryDiagnosis, Condition/SecondaryDiagnosis1 and Condition/SecondaryDiagnosis2
  • Consent Status: Bundle/DocumentEtoc, QuestionnaireEtoc, QuestionnaireResponse/QuestionnaireResponseEtocRequestPrevious and QuestionnaireResponse/QuestionnaireResponseEtocTransCare
  • Coverage Identifier Type: Bundle/DocumentEtoc and Coverage/CoverageKVG
• ISO maintains the copyright on the country codes, and controls its use carefully. For further details see the ISO 3166 web page: https://www.iso.org/iso-3166-country-codes.html
  Show Usage
  • ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code: Bundle/DocumentEtoc, CH_eTOC... Show 32 more, ChEtocAllergyIntolerance, ChEtocBodyHeightObservation, ChEtocBodyWeightObservation, ChEtocCardiologyObservation, ChEtocComposition, ChEtocDevice, ChEtocDocument, ChEtocFunctionalStatusCondition, ChEtocImmunization, ChEtocLabObservation, ChEtocPastHistoryofIllnessesCondition, ChEtocPathologyObservation, ChEtocPregnancyExpectedDeliveryDateObservation, ChEtocPregnancyStatusObservation, ChEtocPrimaryDiagnosisCondition, ChEtocProcedure, ChEtocRadiologyObservation, ChEtocSecondaryDiagnosisCondition, ChEtocServiceRequest, ChEtocSocialHistoryCondition, ModuleQuestionnaireAttachment, ModuleQuestionnaireEtocAnamnesis, ModuleQuestionnaireEtocDiagnosis, ModuleQuestionnaireEtocImaging, ModuleQuestionnaireEtocLab, ModuleQuestionnaireEtocMedication, ModuleQuestionnaireEtocPathology, ModuleQuestionnaireEtocPurpose, ModuleQuestionnaireImmunization, ModuleQuestionnaireallergyIntolerance, QuestionnaireEtoc and QuestionnaireEtoc-modular
• The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
  Show Usage
  • Unified Code for Units of Measure (UCUM): Bundle/DocumentEtoc, Observation/BodyHeight and Observation/BodyWeight
• This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
  Show Usage
  • LOINC: Bundle/DocumentEtoc, ChEtocCardiologyObservation... Show 13 more, ChEtocComposition, ChEtocLabObservation, ChEtocPathologyObservation, ChEtocPregnancyStatusObservation, ChEtocRadiologyObservation, Composition/CompositionEtoc, Observation/Biopsy, Observation/BodyHeight, Observation/BodyWeight, Observation/Electrocardiogram, Observation/HbA1c, Observation/Hemoglobin and Observation/Imaging
• This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
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  • SNOMED Clinical Terms® (SNOMED CT®): Bundle/DocumentEtoc, ChEtocComposition, ChEtocServiceRequest, Composition/CompositionEtoc and QuestionnaireEtoc
• This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
  Show Usage
  • AllergyIntolerance Clinical Status Codes: AllergyIntolerance/AllergyIntolerance
  • Observation Category Codes: Bundle/DocumentEtoc, Observation/BodyHeight and Observation/BodyWeight
  • identifierType: Bundle/DocumentEtoc, ChEtocServiceRequest and ServiceRequest/ServiceRequestEtoc
  • ActCode: Bundle/DocumentEtoc, QuestionnaireEtoc and QuestionnaireResponse/QuestionnaireResponseEtocTransCare

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 (ch.fhir.ig.ch-etoc.r4) and R4B (ch.fhir.ig.ch-etoc.r4b) are available.

Dependency Table

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 ch.fhir.ig.ch-core#5.0.0 FHIR implementation guide CH Core (built Tue, Dec 17, 2024 19:54+0000+00:00)

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 18:36+0000+00:00)

Package ch.fhir.ig.ch-orf#3.0.0 Order & Referral by Form - Implementation Guide (CH ORF) (built Wed, Dec 18, 2024 08:31+0000+00:00)

Package ihe.formatcode.fhir#1.3.0 Implementation Guide for IHE defined FormatCode vocabulary. (built Fri, May 17, 2024 12:02-0500-05:00)

Package ch.fhir.ig.ch-term#3.1.0 Implementation Guide for Swiss Terminology (built Tue, Dec 17, 2024 13:13+0000+00:00)

Package ch.fhir.ig.ch-rad-order#2.0.0 Implementation guide CH RAD-Order (R4) (built Wed, Dec 18, 2024 10:01+0000+00:00)

Globals Table

There are no Global profiles defined