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

Proposal Provenance

Proposal Provenance

This page defines a vendor-neutral Provenance pattern for structured clinical proposals. A proposal is a structured clinical resource that may have been suggested by software, extracted from free text, linked to an existing record, confirmed by a clinician, or entered manually.

The proposed clinical resource remains a normal FHIR resource such as Condition, Observation, AllergyIntolerance, ServiceRequest, or ChargeItem. The proposal lifecycle is recorded with one or more PraxisProposalProvenance resources.

Contribution Roles

The ProposalContributionRoleCS CodeSystem classifies how a Provenance agent contributed to the proposal lifecycle.

Code Meaning Typical agent
software-suggested A deterministic parser or rule engine suggested the structured resource from source data. Device
llm-suggested A large-language-model component suggested the structured resource from free text or unstructured source data. Device
clinician-confirmed A clinician reviewed and confirmed a previously suggested resource. Practitioner
linked-existing A proposed entry was resolved by linking to an existing clinical record instead of creating a duplicate. Practitioner or Device
manual-entry A clinician created the structured resource directly without an intermediate proposal source. Practitioner

The ValueSet ProposalContributionRoleVS is bound with required strength to Provenance.agent.role in the profile.

Event Model

Use separate Provenance resources for separate lifecycle events. A software or LLM suggestion and a clinician confirmation are different events and should not be collapsed into a single all-purpose Provenance resource.

Suggestion Event

For a derived proposal, use a CREATE activity and reference the source material through Provenance.entity.

{
  "resourceType": "Provenance",
  "meta": {
    "profile": [
      "https://fhir.cognovis.de/praxis/StructureDefinition/praxis-proposal-provenance"
    ]
  },
  "target": [
    { "reference": "Condition/example-diagnosis" }
  ],
  "recorded": "2026-05-18T10:15:00+01:00",
  "activity": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-DataOperation",
        "code": "CREATE"
      }
    ]
  },
  "agent": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
            "code": "assembler"
          }
        ]
      },
      "role": [
        {
          "coding": [
            {
              "system": "https://fhir.cognovis.de/praxis/CodeSystem/proposal-contribution-role",
              "code": "llm-suggested"
            }
          ]
        }
      ],
      "who": { "reference": "Device/example-proposal-engine" }
    }
  ],
  "entity": [
    {
      "role": "source",
      "what": { "reference": "Composition/example-card-entry" }
    }
  ]
}

Confirmation Event

For clinician confirmation, use a separate UPDATE Provenance that references the previously suggested resource version as a revision source.

{
  "resourceType": "Provenance",
  "meta": {
    "profile": [
      "https://fhir.cognovis.de/praxis/StructureDefinition/praxis-proposal-provenance"
    ]
  },
  "target": [
    { "reference": "Condition/example-diagnosis" }
  ],
  "recorded": "2026-05-18T10:20:00+01:00",
  "activity": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-DataOperation",
        "code": "UPDATE"
      }
    ]
  },
  "agent": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
            "code": "verifier"
          }
        ]
      },
      "role": [
        {
          "coding": [
            {
              "system": "https://fhir.cognovis.de/praxis/CodeSystem/proposal-contribution-role",
              "code": "clinician-confirmed"
            }
          ]
        }
      ],
      "who": { "reference": "Practitioner/example-practitioner" }
    }
  ],
  "entity": [
    {
      "role": "revision",
      "what": { "reference": "Condition/example-diagnosis/_history/1" }
    }
  ]
}

Manual Entry

Manual entry is valid without a source entity. The authoring clinician is represented as the Provenance agent.

{
  "resourceType": "Provenance",
  "meta": {
    "profile": [
      "https://fhir.cognovis.de/praxis/StructureDefinition/praxis-proposal-provenance"
    ]
  },
  "target": [
    { "reference": "Condition/example-diagnosis" }
  ],
  "recorded": "2026-05-18T10:25:00+01:00",
  "activity": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-DataOperation",
        "code": "CREATE"
      }
    ]
  },
  "agent": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
            "code": "author"
          }
        ]
      },
      "role": [
        {
          "coding": [
            {
              "system": "https://fhir.cognovis.de/praxis/CodeSystem/proposal-contribution-role",
              "code": "manual-entry"
            }
          ]
        }
      ],
      "who": { "reference": "Practitioner/example-practitioner" }
    }
  ]
}

Source Requirement

The profile keeps Provenance.entity optional so that direct manual entry can be represented without inventing a synthetic source. It also defines an invariant: when any agent role is software-suggested, llm-suggested, or linked-existing, entity must be present. Derived proposals must always identify their source or linked record.