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 register closes the source-review gate for the Praxis-DE Foundation v1.0
epic (fpde-shp). It records repository evidence for each foundation slice and
marks claims that still depend on external standards or legal interpretation.
The register is intentionally conservative. It uses repository artifacts and
bead close evidence as the source of truth. It does not renew legal, tax, or
package-version assertions from memory. When an assertion depends on current
external material and is not proven by this repository, the status is
external verification unresolved.
The foundation layer is cross-specialty. Billing and coverage features that were
first discovered through dental workflows remain valid in fhir-praxis-de when
they model ambulatory-practice primitives rather than specialty-specific
clinical content.
This is especially relevant for non-dental self-pay and supplemental-insurance workflows, such as gynecology self-pay services, private invoices, additional private insurance, mixed payer routing, and external billing services. Dental examples in this IG are examples of those primitives; they do not make the primitive dental-only.
| Status | Meaning |
|---|---|
| Repository evidence | Local FSH, pagecontent, tests, or workflow files demonstrate the claim. |
| Bead evidence | bd close reasons record implementation, review, and verification status. |
| External verification unresolved | The repository contains the model, but this review did not independently re-check the current external legal, regulatory, or standards source. |
| Slice | Repository evidence | Source status | Downstream consequence |
|---|---|---|---|
| KBV base and inheritance boundary | sushi-config.yaml pins kbv.basis: 1.8.0; input/pagecontent/inheritance-architecture.md; surviving wrappers input/fsh/profiles/EncounterPraxis.fsh, PraxisOrganizationDE.fsh, care-team.fsh; .github/actions/generate-kbv-basis-snapshots/README.md |
Repository evidence for the current dependency and, post-ADR-008, the direct-KBV-inheritance strategy. External verification unresolved for broad claims about everything KBV base does or does not cover. | Per ADR-008, inherit KBV_PR_Base_* directly; keep a Praxis* wrapper only where a justified, locally-populated field exists (Encounter, Organization, CareTeam). Do not add wrapper profiles solely to mirror KBV. |
| Tax and VAT classification | de.gematik.dipag#1.0.8; input/pagecontent/steuer-compliance.md; input/fsh/extensions/tax-category.fsh; input/fsh/extensions/tax-exemption-reason.fsh; input/fsh/extensions/kleinunternehmer.fsh; input/fsh/valuesets/tax-category-de.fsh; input/fsh/codesystems/ust-befreiungsgrund.fsh; input/fsh/examples/example-invoice-tax.fsh; input/fsh/examples/example-chargeitemdef-tax.fsh |
The official DiPag package is used directly as the invoice contract. Repository examples prove its gross-line and included-tax convention; local UNECE-5305 and exemption extensions remain only as non-binding ChargeItemDefinition catalog defaults. External verification remains necessary for current tax-law interpretation. | Keep cross-specialty tax defaults in Praxis-DE, but do not define a parallel Invoice profile or payload. Final classification stays with the invoicing system, practice, and tax advisor. |
| Multi-coverage routing | input/pagecontent/multi-coverage.md; input/fsh/examples/example-multi-coverage.fsh; input/fsh/profiles/coverage.fsh; sushi-config.yaml page entry |
Repository evidence for the local Account-based pattern and examples. Bead evidence from fpde-shp.2 records SUSHI 0/0 and notes that Coverage.order was confirmed unavailable in the German base profiles. External verification unresolved for future changes in de.basisprofil.r4. |
This is relevant for any GKV plus supplemental-insurance or PKV plus Beihilfe workflow, including non-dental self-pay and gynecology supplemental-insurance cases. |
| Condition diagnosis modelling | input/fsh/examples/example-condition-constraints-bundle.fsh; input/pagecontent/claim-diagnosis-contract.md; input/pagecontent/inheritance-architecture.md |
Repository evidence that diagnoses use KBV_PR_Base_Condition_Diagnosis directly. External verification unresolved for the WeST istDauerdiagnose binding until WeST is released. |
Per ADR-008 the earlier asserter-restriction wrapper was dropped: asserter/evidence are not sourced from the PVS (the recorder is set instead) and Dauerdiagnose tracks WeST istDauerdiagnose. Do not collapse diagnoses into AW archive profile inheritance. |
| Risk modifier observations | input/fsh/profiles/lab-observation.fsh; input/fsh/examples/example-condition-constraints-bundle.fsh; input/pagecontent/aw-sst-crosswalk.md; input/pagecontent/profiles.md |
Repository evidence for HbA1cObservationDE, SmokingStatusDE, and their use as Condition evidence. External verification unresolved for any clinical guideline claim about risk scoring thresholds. |
Risk modifiers are modeled as normal Observations linked from Conditions; downstream systems should not hard-code them into diagnosis codes. |
| ImagingStudy foundation | input/fsh/profiles/imaging-study-praxis-de.fsh; KBV_PR_Base_Condition_Diagnosis (diagnoses, used directly); input/fsh/examples/example-imaging-study-praxis-de.fsh; input/fsh/examples/example-condition-constraints-bundle.fsh; input/pagecontent/imaging-billing-architecture.md |
Repository evidence for the local ImagingStudy profile and for allowing ImagingStudy as diagnosis evidence. External verification unresolved for any claim that KBV has no current ImagingStudy profile outside the pinned package context. | Imaging remains a local operational model for PACS/RIS workflow and diagnosis evidence. Archive/export tooling may map only generic documents or procedures where needed. |
| AI lineage | sushi-config.yaml; input/fsh/profiles/ai-provenance-compatibility.fsh; input/pagecontent/ai-provenance.md; packaged dependency metadata |
The exact hl7.fhir.uv.aitransparency#1.0.0-ballot dependency supplies the official AI lineage profiles, devices, prompts, model cards, and terminology. The local compatibility profile preserves the accepted-resource agent and AI-Device target contract while avoiding the unsupported nested Reference-profile discriminator. |
Target the accepted FHIR resource with the bounded compatibility profile until its documented removal conditions are met; keep pre-acceptance proposal state outside FHIR and use base Provenance for non-AI audit events. |
| AW-SST billing crosswalk | input/pagecontent/aw-sst-crosswalk.md; input/pagecontent/architecture.md; input/fsh/profiles/praxis-preliminary-billing-claim.fsh; input/fsh/profiles/praxis-gkv-claim.fsh; input/fsh/profiles/praxis-private-claim.fsh; input/fsh/profiles/praxis-bg-claim.fsh; input/fsh/profiles/praxis-selective-contract-claim.fsh |
Repository evidence for the local AW-aligned Claim split and for the no-parent/no-dependency decision. External verification unresolved for future AW-SST package changes after the inspected package version. | Downstream adapters must not stamp existing itemized Claims as final AW Claims. They must either emit a preliminary/final pair or keep PAS/unprofiled flows where the semantics are not submitted billing. |
All fpde-shp child beads are closed. The important close evidence is:
| Child bead | Evidence summary |
|---|---|
fpde-shp.2 |
Multi-coverage page and three example bundles; SUSHI 0/0; Account coverage priority selected over unavailable Coverage.order. |
fpde-shp.5 |
KBV basis snapshot pre-generator action; SUSHI 0 errors; all acceptance criteria verified. |
fpde-shp.6 |
KBV wrapper profiles (later reduced per ADR-008), KleinunternehmerregelungExt, inheritance page; SUSHI 0 errors. The former local provenance marker added here was subsequently removed. |
fpde-shp.7 |
Tax/VAT bundle, invoice tax examples, compliance documentation; SUSHI 0 errors. |
fpde-shp.8 |
Condition constraints, HbA1c and smoking profiles, evidence detail examples; SUSHI 0 errors. |
fpde-shp.9 |
Tax extension context expanded to ChargeItemDefinition and UNECE-5305 migration; SUSHI 0 errors and 0 warnings. |
Legacy child beads consolidated into the bundle beads above:
| Consolidated bead | Bundle |
|---|---|
fpde-47a, fpde-49o, fpde-d18, fpde-shp.1 |
fpde-shp.7 |
fpde-6xf, fpde-shp.3, fpde-shp.4 |
fpde-shp.8 |
| Downstream area | Source-backed conclusion | Follow-up handling |
|---|---|---|
| AW billing adapters | Local AW Claim profiles are available in the Praxis package. Existing itemized adapter Claims require a semantic migration decision before profile assignment. | Track AW billing adoption separately from package pin/codegen work. |
| AI lineage consumers | Official HL7 AI Transparency artifacts are available through the pinned package dependency. | Consume the official profiles and terminology through the package graph; do not recreate local wrappers or proposal lifecycle vocabularies. |
| Specialty IG reuse | Specialty reuse assumptions are limited to cross-specialty primitives: tax, multi-coverage, ImagingStudy evidence, and package dependency behavior. | Specialty-specific billing/material work remains separate and should not block AW adoption in general practice adapters. |
| Non-dental self-pay | Self-pay gynecology, private billing, supplemental-insurance, and mixed payer workflows validate keeping tax, multi-coverage, private Claim, and Invoice patterns in Praxis-DE. | Treat dental-origin billing examples as reusable cross-specialty patterns when the FHIR primitive is not dental-specific. |
Before closing fpde-shp, run a current SUSHI build and record the result in the
bead close reason or notes. If Aidbox or IG Publisher QA is not rerun locally,
record the latest available CI or release signal instead of implying fresh local
validation.