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

HealthcareService Contract

HealthcareService Contract

This page defines the canonical ambulatory HealthcareService contract for fhir-praxis-de.

Profile Decision Summary

fhir-praxis-de does not inherit ISiKMedizinischeBehandlungseinheit directly because the de.gematik.isik-terminplanung package is not resolvable from the public FHIR package registry. Instead, this IG publishes PraxisHealthcareServiceDE, structurally aligned with ISiK Stufe 5 cardinalities. Hospital ISiK consumers treat https://gematik.de/fhir/isik/StructureDefinition/ISiKMedizinischeBehandlungseinheit as the compatibility mapping target.

Field Requirements

Organization

providedBy MUST reference a PraxisOrganizationDE instance. This anchors the offering to the practice organization responsible for billing, configuration, and staff assignment.

Location

location references base FHIR Location resources. Co-located offerings (e.g. general medicine and radiology at one MVZ site) share the same Location reference. PractitionerRole.location SHOULD align with the same Location when the role serves that site.

Specialty and Type

• type: PVS-agnostic service category (general-practice, internal-medicine, radiology, psychosomatic-basic-care). Do not use GenehmigungenLeistungsbereichCS codes on HealthcareService.type.
• specialty: Ambulatory Fachgruppe via KBV BAR2-WBO (PraxisHealthcareServiceSpecialtyVS).

Active / Status

Only active is constrained (boolean, mandatory). There is no separate operational status element beyond base FHIR HealthcareService.active.

Identifiers

Systems SHOULD provide at least one stable business identifier (e.g. https://fhir.cognovis.de/praxis/NamingSystem/service-offering-id). BSNR on the organization covers Betriebsstaette identity; service-offering identifiers distinguish multiple offerings under one organization.

Provenance

This profile does not add provenance elements. AI or configuration provenance for published offerings uses base Provenance resources per AI Provenance when applicable.

Resource Relationships

graph TD
    Org["PraxisOrganizationDE"]
    HS["PraxisHealthcareServiceDE"]
    Loc["Location"]
    PR["PraxisPractitionerRoleDE"]
    Pract["Practitioner (KBV_PR_Base_Practitioner)"]
    Gen["Basic Genehmigung"]

    Org -->|providedBy| HS
    Loc -->|location| HS
    PR -->|healthcareService| HS
    PR -->|organization| Org
    PR -->|location| Loc
    PR -->|practitioner| Pract
    Gen -->|subject| Pract
    Pract -->|qualification.code BAR2-WBO| HS

PractitionerRole link

PraxisPractitionerRoleDE.healthcareService references PraxisHealthcareServiceDE (0..* MS). Use this to connect staff roles to publishable service offerings.

Qualification vs Genehmigung vs Service offering

Genehmigung leistungsbereich codes (e.g. psychosomatik-grundversorgung) evidence authorization; they are not copied to HealthcareService.type. Align offerings to Genehmigung via shared BAR2-WBO specialty and practitioner subject linkage.

Shared-location example

ExampleSharedPracticeLocation is referenced by:

• ExampleHealthcareServiceGeneral and ExampleHealthcareServiceRadiology (same providedBy organization ExamplePraxisOrganizationHs)
• ExamplePractitionerRoleGeneral and ExamplePractitionerRoleRadiology (each links its healthcareService and location)

Psychosomatic scenario (ExampleHealthcareServicePsychosomatik) adds ExampleGenehmigungPsychosomatik on ExamplePractitionerPsychosomatik with leistungsbereich = psychosomatik-grundversorgung.

ISiK / IHE Specialty Mapping

ISiK ISiKMedizinischeBehandlungseinheit binds specialty to IHE XDS practice setting (http://ihe-d.de/ValueSets/IHEXDSpracticeSettingCode). fhir-praxis-de uses KBV BAR2-WBO for ambulatory Fachgruppe. When exchanging with ISiK hospital systems, add IHE coding alongside KBV or apply this mapping at the integration boundary:

Exact IHE codes depend on the target ISiK implementation; consult the hospital ValueSet expansion.

Downstream Handoff

Mandatory profile URL

https://fhir.cognovis.de/praxis/StructureDefinition/praxis-healthcare-service-de

Mandatory ValueSet URLs

Mandatory mapping rules

1. Publish offerings as HealthcareService instances conforming to PraxisHealthcareServiceDE.
2. Set type from PraxisHealthcareServiceTypeCS — never from Genehmigung leistungsbereich codes.
3. Set specialty from KBV BAR2-WBO (PraxisHealthcareServiceSpecialtyVS).
4. Set providedBy to the owning PraxisOrganizationDE.
5. Link staff via PraxisPractitionerRoleDE.healthcareService + location + organization.
6. Store KV Genehmigung on Basic (BasicResourceTypeCS#genehmigung) with GenehmigungenExt; correlate to offerings by practitioner + specialty, not by duplicating codes on HealthcareService.
7. Persist identifier with stable service-offering ids for idempotent downstream sync.

PractitionerRole profile URL

https://fhir.cognovis.de/praxis/StructureDefinition/praxis-practitioner-role-de

Examples