Download: You can download this Implementation Guide in NPM format from here.

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 hispital to another etc.

CH eTOC is intended for use in directional communiation as well as for the use in the SWISS EPR.

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 Order & Referral by Form (ORF) Implementation Guide CH-ORF which relies on HL7 Structured Data Capture Implementation Guide, see SDC IG and uses the Swiss Core Profiles, see CH Core

There has been a discussion whether population of the resources such as Patient Resource, ServiceRequest Resource etc. with the content of the QuestionnaireResponse Resource should be done by the order placer application or rather by the order filler application. The argument for assigning the task to the order placer is a result of the following consideration: the authors of a particular implementation guide may decide to define a questionnaire and its rendering but to leave it open if in a particular implementation the questionnaire is implemented or if the representation towards the user is made (in accordance to the questionnaire definition) by other technical means. In such a case, there would be no QuestionnaireResponse Resource in the bundle because all content is already in concerning resources. In order to handle all FHIR exchange formats equal (as far as sensible), the authors decided to mandate the order placer application with the task.

Applications claiming for conformance with the ORF 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.
• In case of an implementation without Questionnaire and QuestionnaireResponse, the content of otherwise implemented UIs shall be in accordance to the questionnaire definition.
• Be able to process all codes related to the generic elements in a Questionnaire.

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 based on the the FHIR International Patient Summary (IPS).

However, this first version of eTOC still allows many free text entries. Derivations for use cases in different disciplines are to be defined later. Clinical content uses mostly the same resources as th IPS; some minor differences are explained in comments to the resources affected. The resouce definitions are however constrained from FHIR base definitions and Swiss Core definitions and NOT from UVIPS.

As a consequence, the first version of CH eTOC does not claim to be conformant to IPS.

This decision was made in order to minimize unexpected impact of future changes in IPS and for compatibility with Swiss Core. eToc adds a ServiceReequest 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 preferance etc.). Resources for such purpose are referenced by the ServiceRequest resource. Header information such as sender, receiver etc. are condsidered as Generic Elements (to all sorts of referral, orders etc.) and follow the definition in the ORF Implementation Guide.

This IG follows the Swiss eHealth Exchange Format Handbook Part I: Service Requests V 0.13. The Questionnaire resource gives guidance for the implementation of the user interface.

Actors, transcations and security considerations are covered in the corresponding sections of CH-ORF.

Terminology

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