German Practice Management FHIR Profiles (R4)
0.90.0 - STU1
Germany
German Practice Management FHIR Profiles (R4) - Local Development build (v0.90.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
This page records how fhir-praxis-de relates to the KBV Wechselschnittstelle
(WeST) — the FHIR successor of the older PVS archive and change interface
("PVS-Archivierungs- und Wechsel-Schnittstelle", AW-SST, kbv.ita.aws). WeST
(kbv.mio.west, 371 SGB V) is on track to become the 371 SGB V) is on track to become the KBV_PR_AW_*) remain listed as an archive/migration reference only.
This is a semantic crosswalk for migration export and selected onboarding import. It is not an inheritance plan and not a live synchronization contract.
fhir-praxis-de does not inherit from WeST or AW-SST profiles.
Per the KBV-base alignment decision (ADR-008), WeST profiles (KBV_PR_WEST_*)
inherit from KBV_PR_Base_*; where KBV base has no target (ServiceRequest,
generic/anamnesis Observation, MedicationStatement) WeST stays on core R4. Our
Praxis*DE profiles are therefore siblings of WeST on the KBV base, not
children of WeST. We stay export/import compatible, adopt WeST terminology
(Diagnoseart / Diagnosekategorie / Leistungsart, istDauerdiagnose), and treat
WeST as the primary crosswalk target.
WeST is a migration snapshot (draft, pre-binding); adopting it as a parent
would import migration-completeness constraints and a divergent transitive base
version. So kbv.mio.west stays out of sushi-config.yaml dependencies, and no
Parent: KBV_PR_WEST_* appears in input/fsh/.
Normative architecture outcomes:
KBV_PR_WEST_* or KBV_PR_AW_*, and neither
kbv.mio.west nor kbv.ita.aws is a direct package dependency.AccountPraxisSchein as the Schein anchor. Clinical contacts
use EncounterPraxis (class AMB or HH) and remain billing-agnostic. Care
programs such as HZV, HVG, and DMP use base R4 EpisodeOfCare.WeST adds its own profiles only where KBV base has no target; elsewhere it uses the KBV base profile directly. The concrete WeST artifacts this crosswalk targets:
| WeST artifact | Shape | Local counterpart |
|---|---|---|
KBV_PR_WEST_ServiceRequest |
Order (referral / remedy / lab request) | PraxisReferralDE, PraxisTherapeuticRemedyDE |
KBV_PR_WEST_MedicationStatement |
Medication history statement | PraxisMedicationAdministration (resource type differs) |
KBV_PR_WEST_Observation-Anamnese |
Anamnesis observation | PraxisAnamneseFreeTextObservationDE, SmokingStatusDE |
KBV_EX_WEST_Diagnose_istDauerdiagnose |
Boolean Dauerdiagnose marker | local DauerdiagnoseExt (1:1 crosswalk) |
KBV_CS_WEST_Diagnoseart / _Diagnosekategorie / _Leistungsart |
Terminology | adopt-when-needed (see MIO Crosswalks) |
| everything else (Patient, Practitioner, Condition, Organization, Encounter, Procedure, AllergyIntolerance) | inherits KBV_PR_Base_* |
our profiles are siblings on the same KBV base |
The WeST target column names the WeST profile where one exists, otherwise the KBV base profile WeST inherits (our sibling target). The legacy AW-SST column retains the archive-export reference.
| Domain | Local model | WeST target | Legacy AW-SST archive reference |
|---|---|---|---|
| Patient | KBV_PR_Base_Patient (used directly) |
WeST inherits KBV_PR_Base_Patient |
KBV_PR_AW_Patient |
| Practitioner / role | KBV_PR_Base_Practitioner (used directly), PraxisPractitionerRoleDE |
WeST inherits KBV_PR_Base_Practitioner / KBV_PR_Base_PractitionerRole |
KBV_PR_AW_Behandelnder, _Mitarbeiter, _BehandelnderFunktion |
| Organization / location | PraxisOrganizationDE |
WeST inherits KBV_PR_Base_Organization (WeST adds a Betriebsstätte hierarchy) |
KBV_PR_AW_Betriebsstaette, _Organisation, _Betriebsstaette_Ort |
| Coverage | FPDECoverageGKV, FPDECoveragePrivat, multi-coverage Account pattern |
KBV base Coverage (de.basisprofil.r4); WeST carries VSDM data |
KBV_PR_AW_Krankenversicherungsverhaeltnis |
| Selective contracts | Contract, HZV/HVG extensions, InsurancePlanDE |
no WeST profile (core Contract) |
KBV_PR_AW_Selektivvertrag |
| Encounter contact | EncounterPraxis (clinical contact, class AMB/HH; billing-agnostic) |
WeST inherits KBV_PR_Base_Encounter |
KBV_PR_AW_Begegnung; home visit KBV_PR_AW_Hausbesuch |
| Billing case (Schein) | AccountPraxisSchein (R4 Account) |
no WeST equivalent; WeST plans a Claim container (Schein/Abrechnungsfall) plus an istAbrechnungsrelevant flag |
no KBV_PR_AW_Account; export decomposes into per-area Claims |
| Home visit Wegegeld | EncounterPraxis class HH + WegegeldHausbesuchExt |
no dedicated WeST profile | KBV_EX_AW_Hausbesuch_Entfernungsinformationen, KBV_PR_AW_Hausbesuch |
| Diagnosis | KBV_PR_Base_Condition_Diagnosis (used directly); Dauerdiagnose via local DauerdiagnoseExt |
WeST inherits KBV_PR_Base_Condition_Diagnosis; KBV_EX_WEST_Diagnose_istDauerdiagnose for Dauerdiagnose |
KBV_PR_AW_Diagnose |
| Accident | Local BG/accident context and Procedure/Condition links |
WeST inherits KBV base | KBV_PR_AW_Unfall, _Unfall_Ort |
| Anamnesis freetext | PraxisAnamneseFreeTextObservationDE |
KBV_PR_WEST_Observation-Anamnese |
KBV_PR_AW_Observation_Anamnese |
| Finding freetext | PraxisBefundFreeTextObservationDE |
no WeST anamnesis-style finding profile; crosswalks to KHE finding observations | KBV_PR_AW_Observation_Befund |
| Vital signs / simple observations | PraxisLabObservation, HbA1cObservationDE, SmokingStatusDE, other Observation profiles |
WeST inherits the KBV base vital-sign Observations; smoking → KBV_PR_WEST_Observation-Anamnese |
KBV_PR_AW_Observation_Blutdruck, _Puls, _Raucherstatus, … |
| Lab observations | PraxisLabObservation, PraxisLabDiagnosticReport, PraxisSpecimen |
MIO Laborbefund form (see MIO Crosswalks); WeST lab requests via KBV_PR_WEST_ServiceRequest |
AW selected Observation/DiagnosticReport profiles |
| Allergy | KBV_PR_Base_AllergyIntolerance (used directly), PraxisFlag for CAVE |
WeST inherits KBV_PR_Base_AllergyIntolerance |
KBV_PR_AW_Allergie |
| Immunization | PraxisImmunization with KBV MIO vaccine vocabulary, no MIO parent |
crosswalk to MIO Impfpass (see MIO Crosswalks) | KBV_PR_AW_Impfung |
| Procedures | KBV_PR_Base_Procedure (used directly), RoentgenProcedurePraxisDe |
WeST inherits KBV_PR_Base_Procedure |
KBV_PR_AW_Untersuchung, _Therapie, _Ambulante_Operation |
| Imaging | IHE IMR ServiceRequest, ImagingStudy, DiagnosticReport, Appointment, Device, radiation-dose extensions | no WeST imaging model (complementary; eBild is Composition-only) | no AW imaging workflow model |
| Referrals / follow-up | PraxisReferralDE, ServiceRequest variants, imaging request profiles |
KBV_PR_WEST_ServiceRequest |
KBV_PR_AW_Weiterbehandlung_durch, _Ueberweisung_KH_Einweisung |
| Prescriptions / medication | PraxisMedicationAdministration; medication code systems |
KBV_PR_WEST_MedicationStatement (resource type differs — statement vs administration) |
KBV_PR_AW_Verordnung_Arzneimittel, _Dauermedikation |
| Heilmittel / Hilfsmittel | PraxisTherapeuticRemedyDE (Muster 13 ServiceRequest); Device semantics |
KBV_PR_WEST_ServiceRequest |
KBV_PR_AW_Verordnung_Heilmittel, _Verordnung_Hilfsmittel |
| Documents / attachments | PraxisComposition |
document-specific MIO Composition (see MIO Crosswalks) | KBV_PR_AW_Anlage, KBV_PR_AW_Gesundheitspass |
| Care plan | PraxisCarePlanDE |
ULB/KHE CarePlan; WeST plans a CarePlan surface | no direct AW target |
| Prior authorization | PASClaimDE, PASClaimResponseDE, PASTaskDE |
no WeST profile | AW CoverageEligibilityRequest/Response |
| Billing claim | PraxisPreliminaryBillingClaimDE, PraxisGKVClaimDE, PraxisPrivateClaimDE, PraxisBGClaimDE, PraxisSelectiveContractClaimDE; ChargeItemPraxisDe; gematik DiPagRechnung used directly |
planned WeST Claim container (Schein/Abrechnungsfall) — future crosswalk at the Schein level |
KBV_PR_AW_Abrechnung_Vorlaeufig, _vertragsaerztlich, _privat, _BG, _HzV_BesondereVersorgung_Selektiv |
| Provenance / audit | Official HL7 AI Transparency lineage and base Provenance usage | WeST inherits KBV_PR_Base_Provenance |
KBV_PR_AW_Provenienz, _Report_Import, _Report_Export |
| Appointment / scheduling | ImagingAppointmentPraxisDe, queue management extensions |
WeST inherits KBV base Appointment | KBV_PR_AW_Termin |
WeST is not a billing-settlement interface: it carries an istAbrechnungsrelevant
flag and plans a Claim container for the Schein/Abrechnungsfall, but the
operational EBM/GOÄ settlement stack stays local. Our five billing Claim profiles
plus ChargeItem, Invoice, and ChargeItemDefinition remain separate layers.
The future WeST Claim container is the intended crosswalk anchor at the
Schein/Abrechnungsfall level; per-service settlement is out of WeST scope.
| Local profile | File | Role |
|---|---|---|
PraxisPreliminaryBillingClaimDE |
praxis-preliminary-billing-claim.fsh |
Carries the billable item lines (use = predetermination). |
PraxisGKVClaimDE |
praxis-gkv-claim.fsh |
Final GKV claim (use = claim); references the preliminary claim via Claim.related. |
PraxisPrivateClaimDE |
praxis-private-claim.fsh |
Final private claim (use = claim). |
PraxisBGClaimDE |
praxis-bg-claim.fsh |
Final BG claim (use = claim). |
PraxisSelectiveContractClaimDE |
praxis-selective-contract-claim.fsh |
Final HZV/selective-contract claim (use = claim). |
PASClaimDE remains prior-authorization only (use = preauthorization); it must
not become the submitted billing Claim profile.
| Topic | Decision |
|---|---|
kbv.mio.west dependency |
Do not add to sushi-config.yaml. |
kbv.ita.aws dependency |
Do not add to sushi-config.yaml. |
KBV_PR_WEST_* / KBV_PR_AW_* parent inheritance |
Do not use. Our profiles are siblings on kbv.basis. |
| WeST / AW canonical references | May appear in documentation, mapping tables, ConceptMaps, examples, or adapter code. |
| Terminology | Adopt WeST code systems directly when a source field appears (adopt-when-needed); do not mint divergent local equivalents. |