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This FHIR Implementation Guide (IG) describes a proposal to how NAV’s SMART on FHIR form-filler application can integrate with an Electronic Health Record (EHR) system and what capabilities that are required by the EHR’s FHIR API.

Actors

The primary actors in context of this IG are:

1. EHRs, “Elektronisk Pasient Journal (EPJ)”, are systems that contains and manages health information related to a patient and the tools used by healthcare professionals to interact with this data.
2. SMART App is a SMART on FHIR web application provided by NAV that allows healthcare professionals to report events, and to respond to request for information from NAV.
3. NAV APIs is a set of APIs provided by NAV that the SMART app uses to interact with NAV.

Workflow Overview

Figure 1 shows a simplified diagram of the steps involved in capturing data for NAV forms. This workflow is based on the Structure Data Capture FHIR IG.

Dotted-lines are used to represent optional sequences.

Figure 1

[1] In order to discover and launch the SMART app the EHR SHALL support the SMART Application Launch Framework. The launch-context SHALL specify the Patient, Practitioner (user) and optionally the Questionnaire (form).

[2-5] Once launched the SMART app SHALL be able to connect to the NAV back-end services to fetch the required definition resources: Questionnaire, ValueSet, CodeSystem etc. These resources are not static and will be continuously developed and improved by NAV teams in response to feedback from healthcare and social work professionals.

[6-9] The EHR SHOULD implement capabilities to access context relevant data as FHIR resources. This data can be used by the SMART app to auto-fill forms, thereby lessen the work required by the user. These resources SHALL conform to the Norwegian base profiles, specifically regarding norwegian identifiers (FNR, HPR, HER-id, ORGNR).

[10] The form answers will be sent to NAV as FHIR QuestionnaireResponse resources with a status (in-progress, competed etc.).

[11-13] Depending on the requirements of the EHR, notably archiving, they MAY implement capabilities that allows the SMART app to send completed or intermediate representations of the forms back to the EHR. This can either be as a raw QuestionnaireResponse, or as a human-readable PDF with associated metadata (Binary + DocumentReference).