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

Vererbungsarchitektur

Vererbungsarchitektur (Inheritance Architecture)

This page documents the 3-layer profile inheritance chain used in de.cognovis.fhir.praxis and its downstream Implementation Guides.

3-Layer-Chain Overview

German FHIR IGs for ambulatory practice management follow a three-tier inheritance hierarchy:

graph TD
    subgraph L1["Layer 1 — KBV Base (kbv.basis 1.8.0)"]
        KBV_C["KBV_PR_Base_Condition_Diagnosis"]
        KBV_P["KBV_PR_Base_Patient"]
        KBV_PR["KBV_PR_Base_Practitioner"]
        KBV_O["KBV_PR_Base_Organization"]
    end

    subgraph L2["Layer 2 — praxis-de Middle Layer (de.cognovis.fhir.praxis — THIS IG)"]
        PC["PraxisConditionDE"]
        PP["PraxisPatientDE"]
        PPR["PraxisPractitionerDE"]
        PO["PraxisOrganizationDE"]
    end

    subgraph L3["Layer 3 — Specialty IGs (e.g. de.cognovis.fhir.dental)"]
        DC["DentalConditionDE"]
        DP["DentalPatientDE"]
        DPR["DentalPractitionerDE"]
        DO["DentalOrganizationDE"]
    end

    KBV_C --> PC
    KBV_P --> PP
    KBV_PR --> PPR
    KBV_O --> PO

    PC --> DC
    PP --> DP
    PPR --> DPR
    PO --> DO

This design means:

• KBV Base profiles define the German regulatory minimum (GKV identifiers, KV-specific codings).
• praxis-de wrapper profiles add cross-specialty constraints shared by all German ambulatory practices (asserter restriction, Telematik-ID MS, Kleinunternehmerregelung, AI provenance marker).
• Specialty IGs extend the middle layer with domain-specific rules (e.g. dental: ZE/KB/KFO billing codes, ZANR identifier).

Wrapper Profiles in This IG

Profile Name	Profile ID	KBV Parent	Key Constraints Added
PraxisConditionDE	praxis-condition-de	KBV_PR_Base_Condition_Diagnosis	asserter restricted to KBV_PR_Base_Practitioner (Arzt/Zahnarzt-Vorbehalt); AI Provenance Marker
PraxisPatientDE	praxis-patient-de	KBV_PR_Base_Patient	AI Provenance Marker
PraxisPractitionerDE	praxis-practitioner-de	KBV_PR_Base_Practitioner	identifier[Telematik-ID] promoted to Must Support
PraxisOrganizationDE	praxis-organization-de	KBV_PR_Base_Organization	KleinunternehmerregelungExt (§ 19 UStG); AI Provenance Marker

Praxis-Specific Constraints

Asserter Restriction (PraxisConditionDE)

German law (BÄO, ZHG § 1 Abs. 5) requires that diagnoses be made by qualified physicians or dentists. The asserter field in PraxisConditionDE is restricted to KBV_PR_Base_Practitioner to enforce this:

• Medical assistants (MFA/ZFA) may be recorder but not asserter.
• This constraint is inherited by all Layer-3 profiles extending PraxisConditionDE.

Telematik-ID Must Support (PraxisPractitionerDE)

The KBV base profile defines identifier[Telematik-ID] as optional. PraxisPractitionerDE promotes it to Must Support per gematik Telematikinfrastruktur requirements. Any system implementing this profile SHOULD support reading and writing the Telematik-ID.

Kleinunternehmerregelung (PraxisOrganizationDE)

Practices below the 19 UStG thresholds (since 2025: EUR 25,000 prior year / EUR 100,000 current year) are exempt from VAT. The KleinunternehmerregelungExt on PraxisOrganizationDE records this status. When active, invoices must carry the statutory notice "gemäß 19 UStG wird keine Umsatzsteuer berechnet". Full billing logic is implemented in bead fpde-47a.

AI Provenance Marker

All four wrapper profiles carry the AiProvenanceApplicableExt boolean marker (Context: DomainResource). When set to true, a corresponding Provenance resource with the AI-specific extensions (AiGeneratedExt, AiProviderExt, AiModelExt, HumanReviewedExt, etc.) SHOULD be present. This satisfies EU AI Act Art. 13 transparency requirements for AI-assisted clinical documentation.

The marker enables fast filtering (e.g. "show me all AI-assisted diagnoses") without requiring a Provenance join on every query.

KBV Snapshot Generation

KBV publishes kbv.basis without snapshots (a known KBV publishing oversight). The CI pipeline runs the generate-kbv-basis-snapshots composite action (.github/actions/generate-kbv-basis-snapshots/) before SUSHI to inject snapshots, enabling inheritance from KBV base profiles. See bead fpde-shp.5.

CI Test Profiles

The directory input/fsh/tests/ contains CI-only test profiles (IDs prefixed with test-); these are included in the published package tarball as tripwires to verify profile inheritance compiles correctly end-to-end. Downstream consumers of de.cognovis.fhir.praxis should filter out any profile IDs matching test-* — they are not intended for clinical use.

Cross-Reference: fhir-dental-de (fdde-pax)

The downstream IG de.cognovis.fhir.dental (fhir-dental-de) depends on this IG's middle-layer profiles. Bead fdde-pax in that project implements the Layer-3 dental profiles:

• DentalConditionDE extends PraxisConditionDE → adds ICNCP/ICD-10-GM dental specifics
• DentalPatientDE extends PraxisPatientDE → adds dental-specific patient identifiers
• DentalPractitionerDE extends PraxisPractitionerDE → adds ZANR Must Support
• DentalOrganizationDE extends PraxisOrganizationDE → adds KZV-specific organization identifiers

When updating the middle-layer profiles in this IG, check for breaking changes that affect fhir-dental-de. The dental IG pins de.cognovis.fhir.praxis in its sushi-config.yaml and must be updated when a new version of this IG is published.