German Practice Management FHIR Profiles (R4)
0.71.0 - STU1
DE
German Practice Management FHIR Profiles (R4) - Local Development build (v0.71.0) 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 PVS archive and
system-change interface ("PVS-Archivierungs- und Wechsel-Schnittstelle",
kbv.ita.aws). It is a semantic crosswalk for archive/migration export and
selected onboarding import. It is not an inheritance plan.
fhir-praxis-de does not use KBV_PR_AW_* profiles as parents.
AW-SST is a reference and crosswalk target because it is the closest official FHIR model for PVS archive/change export. It is not a direct dependency or live PVS synchronization contract.
See ADR-003: AW-SST as Crosswalk Target, Not Profile Parent. See ADR-005: Account-Centered Billing Case Model.
Sources last checked: 2026-05-18.
| Source | Finding |
|---|---|
| KBV update directory | Public AW-SST artifacts include FHIR model, bundle/data-area overview, examples, validation service, and FAQ. |
Simplifier kbv.ita.aws |
Public FHIR R4 package kbv.ita.aws version 1.2.0, described as PVS archive/change interface according to SGB V section 371. |
Local package inspection of kbv.ita.aws@1.2.0 |
Package depends on old KBV/base package versions and contains broad KBV_PR_AW_* export profiles. |
| INA/gematik AWST analysis | AWST version 1.3 was analyzed as a gap-analysis target. The working group calls out separation of archive and change use cases, versioning, and reusable information-model needs. |
The local model is optimized for live ambulatory practice workflows, not only archive export:
| Area | Local advantage |
|---|---|
| Billing layers | Separates ChargeItem service lines, Claim submission, Invoice fiscal/tax invoices, ChargeItemDefinition catalog entries, and plan-library templates. |
| Diagnoses | Preserves clinical asserter and evidence.detail links for laboratory, imaging, reports, and AI-assisted review. |
| Encounters | EncounterPraxis models a single clinical contact (AMB/HH). AccountPraxisSchein anchors the billing case (Schein) with ScheinNummer identifier, Scheinart type, and servicePeriod. |
| Imaging | Adds IHE IMR, DICOM identifiers, imaging workflow, and radiation-protection traceability. |
| Tax | Models German invoice tax classification and small-business notice requirements outside AW Claim semantics. |
| PVS operation | Supports queue management, PVS writeback status, private billing review, multi-coverage routing, and local adapter semantics. |
AW-SST is stronger as an archive/migration export map. It is especially useful for Claim structure, archive documents, import/export reports, and a broad list of PVS data areas.
| Topic | Decision |
|---|---|
kbv.ita.aws dependency |
Do not add to sushi-config.yaml. |
KBV_PR_AW_* parent inheritance |
Do not use. |
| AW canonical references | May be referenced in documentation, mapping tables, examples, or adapter code where useful. |
| Validation | Local resources validate against local profiles. Exported AW packages may be validated by export tooling against AW-SST if required. |
| Domain | Local model | AW-SST target(s) | Decision | Implementation consequence |
|---|---|---|---|---|
| Package boundary | sushi-config.yaml dependencies on current local base stack |
kbv.ita.aws package |
Reference only | Keep out of direct dependencies unless a later packaging ADR changes this. |
| Patient | FPDEPatient / German base patient use |
KBV_PR_AW_Patient |
Crosswalk | Keep local profile; export mapper can transform to AW patient shape. |
| Practitioner | PraxisPractitionerDE, PraxisPractitionerRoleDE, KBV base practitioner use |
KBV_PR_AW_Behandelnder, KBV_PR_AW_Mitarbeiter, KBV_PR_AW_BehandelnderFunktion |
Crosswalk | Preserve local practitioner/role semantics; map LANR/role data on export. |
| Organization and location | PraxisOrganizationDE, local identifiers and PVS organization types |
KBV_PR_AW_Betriebsstaette, KBV_PR_AW_Organisation, KBV_PR_AW_Betriebsstaette_Ort, KBV_PR_AW_Hausbesuch_Ort, KBV_PR_AW_Unfall_Ort |
Crosswalk | Keep local organization profile; add export mappings for BSNR/IK/location roles. |
| Coverage | FPDECoverageGKV, FPDECoveragePrivat, multi-coverage Account pattern |
KBV_PR_AW_Krankenversicherungsverhaeltnis |
Crosswalk | Preserve local multi-coverage routing and private billing assignment; map to AW coverage when exporting. |
| Selective contracts | Contract, HZV/HVG extensions, InsurancePlanDE where needed |
KBV_PR_AW_Selektivvertrag |
Crosswalk | Keep contract identifier and tariff model; export to AW selective-contract representation. |
| EncounterPraxis contact | EncounterPraxis (clinical contact, class AMB/HH; billing-agnostic) |
KBV_PR_AW_Begegnung; home-visit contacts also crosswalk to KBV_PR_AW_Hausbesuch where export requires the AW home-visit profile |
Clean crosswalk, no parent | EncounterPraxis is now the clinical contact and crosswalks cleanly to AW Begegnung. Do not parent: live contacts must not inherit archive-completeness constraints, and kbv.ita.aws@1.2.0 adds old base-package pressure. Keep Scheinart and coverage on Account. |
| AccountPraxisSchein billing case | AccountPraxisSchein (R4 Account; Schein billing-case anchor) |
No KBV_PR_AW_Account equivalent. Export decomposes into AW encounter context (KBV_PR_AW_Begegnung / KBV_PR_AW_Hausbesuch), KBV_PR_AW_Krankenversicherungsverhaeltnis, and KBV_PR_AW_Abrechnung_* Claim resources. |
Local operational layer, no AW parent | Account carries ScheinNummer, Scheinart, servicePeriod, coverage, and open/closed case status. AW export materializes the relevant coverage and per-area Claims rather than exporting Account directly. |
| Home visit Wegegeld | EncounterPraxis with class HH plus WegegeldHausbesuchExt distance and zone |
KBV_EX_AW_Hausbesuch_Entfernungsinformationen; KBV_VS_AW_Hausbesuch_Besuchszonen; KBV_PR_AW_Hausbesuch export target |
Crosswalk, no separate local profile | Distance comes from Patient.EntfernungZurPraxis in km. Zone comes from per-case Schein.Zonenkennzeichen, falling back to Patient.Zonenkennzeichen. Downstream editors may edit the extension and write back per ADR-002. Wegegeld billing codes such as WT2 remain ChargeItem / Claim.item. |
| Stationary treatment | Local administrative workflow where present | KBV_PR_AW_Stationaere_Behandlung |
Adapter/export crosswalk | No immediate local parent/profile change. |
| Diagnosis | PraxisConditionDE, older PraxisCondition, DauerdiagnoseExt; quarterly billing projection on Claim.diagnosis |
KBV_PR_AW_Diagnose |
Crosswalk, no parent | Keep asserter and evidence.detail. Confirmed by fpde-mub: KBV-AWS Diagnosesicherheit maps to Condition.verificationStatus/clinicalStatus as A -> refuted, G -> confirmed/active, V -> provisional or differential/active, Z -> confirmed/resolved. Claim diagnosis dedupe is exact billing tuple only. |
| Accident | Local BG/accident context and Procedure/Condition links |
KBV_PR_AW_Unfall, KBV_PR_AW_Unfall_Ort |
Crosswalk | Use AW as export target; do not collapse accident handling into diagnosis profile inheritance. |
| Anamnesis freetext | PraxisAnamneseFreeTextObservationDE |
KBV_PR_AW_Observation_Anamnese |
Implemented | PraxisAnamneseFreeTextObservationDE — lightweight Observation.valueString (category=survey, LOINC 10164-2) for card-file anamnesis lines. Structured questionnaire responses remain in PraxisAnamneseQuestionnaireResponse. |
| Finding freetext | PraxisBefundFreeTextObservationDE |
KBV_PR_AW_Observation_Befund |
Implemented | PraxisBefundFreeTextObservationDE — lightweight Observation.valueString (category=exam, LOINC 11506-3) for unstructured finding notes. Structured reports (lab, imaging) remain in separate profiles. |
| Vital signs and simple observations | PraxisLabObservation, HbA1cObservationDE, SmokingStatusDE, other Observation profiles as needed |
KBV_PR_AW_Observation_Blutdruck, _Puls, _Koerpertemperatur, _Bauchumfang, _Hueftumfang, _Raucherstatus, _Schwangerschaft |
Crosswalk | Preserve standard categories such as social-history for smoking; add AW coding as mapping/export detail where useful. |
| Lab observations | PraxisLabObservation, PraxisLabDiagnosticReport, PraxisSpecimen |
AW has selected Observation/DiagnosticReport profiles and ring trial/certificate support | Crosswalk | Keep lab profiles; map only overlapping findings and certificates to AW export. |
| Allergy | PraxisAllergyIntoleranceDE, PraxisFlag for CAVE/workflow flags |
KBV_PR_AW_Allergie |
Implemented | PraxisAllergyIntoleranceDE — real AllergyIntolerance profile with clinicalStatus, verificationStatus, type, category, criticality, code (SNOMED), and reaction. PraxisFlag kept for broader CAVE, notes, risks, and workflow warnings. |
| Immunization | PraxisImmunization with KBV MIO vaccine vocabulary, no MIO parent |
KBV_PR_AW_Impfung |
Crosswalk | Keep local profile; AW is export target. Do not inherit from AW or MIO profile. |
| Procedures | ProcedureAmbulantDE, RoentgenProcedurePraxisDe, specialty profiles |
KBV_PR_AW_Untersuchung, _Therapie, _Ambulante_Operation, _Genetische_Untersuchung, _Kur |
Crosswalk | Local procedure profiles stay richer for OPS, imaging, and radiation protection. Export to AW procedure family as needed. |
| Imaging | IHE IMR ServiceRequest, ImagingStudy, DiagnosticReport, Appointment, Device, radiation-dose extensions | No equivalent AW imaging workflow model | Local better | Keep local model. AW may receive generic Procedure/DocumentReference exports only. |
| Referrals and follow-up | ServiceRequest, referral extensions, imaging request profiles |
KBV_PR_AW_Weiterbehandlung_durch, KBV_PR_AW_Behandlung_im_Auftrag_Ueberweisung, KBV_PR_AW_Ueberweisung_KH_Einweisung |
Crosswalk | Map local ServiceRequest variants to AW request profiles at export boundary. |
| Prescriptions | Local medication code systems and MedicationAdministration; prescription profiles not yet complete | KBV_PR_AW_Verordnung_Arzneimittel, KBV_PR_AW_Medikament, KBV_PR_AW_Dauermedikation |
Gap/crosswalk | Use AW to guide future prescription profiles if needed; keep in-practice administration separate. |
| Heilmittel/Hilfsmittel | Local authorization/workflow structures where present | KBV_PR_AW_Verordnung_Heilmittel, KBV_PR_AW_Verordnung_Hilfsmittel, KBV_PR_AW_Hilfsmittel |
Crosswalk | Map ServiceRequest/Device semantics on export; no broad profile cloning. |
| AU / incapacity | Local administrative extensions/workflow where present | KBV_PR_AW_Verordnung_Arbeitsunfaehigkeit |
Crosswalk | Map local AU workflow to AW request when exporting. |
| Krankenbefoerderung | Local ServiceRequest workflow where present | KBV_PR_AW_Krankenbefoerderung, _42019, _Befoerderungsmittel |
Crosswalk | Export mapping only unless local workflow requires a dedicated profile. |
| Sprechstundenbedarf | No central local profile yet | KBV_PR_AW_Anforderung_Sprechstundenbedarf, bundle profile |
Crosswalk | Use AW as reference if demand/order support is added. |
| Prior authorization | PASClaimDE, PASClaimResponseDE, PASTaskDE |
AW CoverageEligibilityRequest/Response for Kur, Heilmittel, Psychotherapie | Parallel patterns | Keep PAS for prior authorization. Map to AW eligibility resources only when the use case requires AW archive export. |
| Billing claim | PraxisPreliminaryBillingClaimDE, PraxisGKVClaimDE, PraxisPrivateClaimDE, PraxisBGClaimDE, PraxisSelectiveContractClaimDE; PASClaimDE remains prior-auth only; ChargeItemPraxisDe; PraxisInvoiceDE |
KBV_PR_AW_Abrechnung_Vorlaeufig, _vertragsaerztlich, _privat, _BG, _HzV_BesondereVersorgung_Selektiv |
Implemented | Five local billing Claim profiles added. Preliminary claim carries item lines (use=predetermination). Final claims (GKV/private/BG/selective, use=claim) reference the preliminary claim via Claim.related. |
| Billing service lines | ChargeItemPraxisDe, billing extensions, ChargeItemDefinition catalog |
AW preliminary Claim item lines and item categories | Crosswalk | Keep ChargeItem as operational source. Export service lines into preliminary AW-style Claim items. |
| Fiscal invoice | PraxisInvoiceDE with tax categories, exemption reason, small-business notice |
AW private/BG/final Claim with invoice-like metadata | Intentional divergence | Keep Invoice separate. Link or map to private/BG Claim where needed; do not treat AW Claim as tax invoice. |
| Billing patterns | PraxisBillingPattern, PraxisBillingActivity, ChargeItemDefinition |
KBV_PR_AW_Behandlungsbaustein_Definition, _Leistungsziffern, _Diagnose, _Verordnung, _Textvorlage, _OMIMCode, _Sonstige |
Crosswalk, no parent | Keep plan-library/rule-execution boundary from ADR-001. Export or import AW Behandlungsbaustein semantics through mapping. |
| Documents and attachments | PraxisComposition; no broad local DocumentReference profile yet |
KBV_PR_AW_Anlage, KBV_PR_AW_Gesundheitspass |
Gap/crosswalk | Add archive-oriented DocumentReference profile only if examples/export need attachment metadata beyond Composition. |
| Consents and directives | Local Consent extensions | KBV_PR_AW_Patientenverfuegung, KBV_PR_AW_Vorsorgevollmacht, KBV_PR_AW_Notfallbenachrichtigter |
Crosswalk | Keep local consent model; map directive/notification use cases on export. |
| Provenance and audit | Local AI Provenance extensions and Provenance usage | KBV_PR_AW_Provenienz, KBV_PR_AW_Report_Import, KBV_PR_AW_Report_Export, KBV_PR_AW_Hersteller_Software |
Crosswalk/gap | Add AW archive import/export AuditEvent support if the export pipeline needs explicit reports. |
| Appointment / scheduling | ImagingAppointmentPraxisDe, queue management extensions |
KBV_PR_AW_Termin, KBV_PR_AW_Bundle_Termin |
Crosswalk | Keep local scheduling profiles; export simple appointment data to AW Termin where needed. |
| Devices and materials | ImagingDevicePraxisDe, material/medication coding where present |
KBV_PR_AW_Hersteller_Software, KBV_PR_AW_Hilfsmittel, KBV_PR_AW_Material_Sache, KBV_PR_AW_Ringversuchszertifikat |
Crosswalk | Map only relevant devices/materials. Imaging device profile remains local workflow model. |
| Specialist cancer screening | No general local coverage for all AW screening modules | Many KBV_PR_AW_Krebsfrueherkennung_* profiles |
Out of current scope | Do not implement unless a concrete fhir-praxis-de workflow requires it. Record as AW-covered domain. |
| Bundles | IG examples and local bundles | KBV_PR_AW_Bundle_Patientenakte, _Adressbuch, _Termin, _Sprechstundenbedarf, _Behandlungsbaustein |
Export packaging | Bundle shape belongs to export tooling, not local profile inheritance. |
The AW Claim split is the strongest finding of the crosswalk. Local billing Claim
profiles have been added rather than reusing PASClaimDE.
| Local profile | File | AW target | Status | Key behavior |
|---|---|---|---|---|
PraxisPreliminaryBillingClaimDE |
praxis-preliminary-billing-claim.fsh |
KBV_PR_AW_Abrechnung_Vorlaeufig |
Implemented | Carries the actual billable item lines. Claim.use = predetermination. |
PraxisGKVClaimDE |
praxis-gkv-claim.fsh |
KBV_PR_AW_Abrechnung_vertragsaerztlich |
Implemented | Final GKV claim. use=claim. References preliminary claim via Claim.related; item lines stay in preliminary claim. |
PraxisPrivateClaimDE |
praxis-private-claim.fsh |
KBV_PR_AW_Abrechnung_privat |
Implemented | Final private claim. use=claim. References preliminary claim. Private payer/routing semantics distinct from PraxisInvoiceDE. |
PraxisBGClaimDE |
praxis-bg-claim.fsh |
KBV_PR_AW_Abrechnung_BG |
Implemented | Final BG claim. use=claim. References preliminary claim. Carries BG accident context. |
PraxisSelectiveContractClaimDE |
praxis-selective-contract-claim.fsh |
KBV_PR_AW_Abrechnung_HzV_BesondereVersorgung_Selektiv |
Implemented | Final HZV/selective-contract claim. use=claim. References preliminary claim and contract context. |
PASClaimDE remains a prior-authorization/preauthorization profile (use=preauthorization).
It must not become the submitted billing Claim profile.
Bead fpde-7eg has been completed. All gap profiles from the crosswalk have been implemented:
| Gap profile | File | Status |
|---|---|---|
PraxisPreliminaryBillingClaimDE |
input/fsh/profiles/praxis-preliminary-billing-claim.fsh |
Done |
PraxisGKVClaimDE |
input/fsh/profiles/praxis-gkv-claim.fsh |
Done |
PraxisPrivateClaimDE |
input/fsh/profiles/praxis-private-claim.fsh |
Done |
PraxisBGClaimDE |
input/fsh/profiles/praxis-bg-claim.fsh |
Done |
PraxisSelectiveContractClaimDE |
input/fsh/profiles/praxis-selective-contract-claim.fsh |
Done |
PraxisAnamneseFreeTextObservationDE |
input/fsh/profiles/praxis-anamnese-freetext-observation.fsh |
Done |
PraxisBefundFreeTextObservationDE |
input/fsh/profiles/praxis-befund-freetext-observation.fsh |
Done |
PraxisAllergyIntoleranceDE |
input/fsh/profiles/praxis-allergy-intolerance.fsh |
Done |
Invariants maintained:
kbv.ita.aws not in sushi-config.yaml dependenciesParent: KBV_PR_AW_* anywhere in input/fsh/PASClaimDE unchanged (prior-auth only)ChargeItem, Claim, and Invoice remain separate layersAccountPraxisSchein and EncounterPraxis remain local profiles, not AW
children; AW vocabulary and codes are reused where they fit local semantics.docs/adr/ADR-003-aw-sst-crosswalk.mddocs/adr/ADR-005-account-centered-billing-case-model.mdfpde-cj3: AccountPraxisSchein profile and EncounterPraxis clinical-contact re-scopefpde-mub: Claim.diagnosis quarterly Behandlungsdiagnosen and KBV-AWS diagnosis certainty mapping59tj / ADR-039: downstream Account-centered billing-case decision