Stream: europe
Topic: EHIC + FHIR
Kevin Mayfield (Apr 06 2021 at 07:47):
Do we have any standards for E111 as FHIR. Presume it would be a FHIR Coverage profile? (I know UK now has it's own card but it appears to be a paint job)
Giorgio Cangioli (Apr 06 2021 at 08:34):
@Kevin Mayfield not yet , but it is a topic in the wish list of HL7 EU (see e.g. https://confluence.hl7.org/pages/viewpage.action?pageId=86966581#Ideasforcollaboration-Commonartifactsdevelopment)
Giorgio Cangioli (Apr 08 2021 at 16:24):
@Kevin Mayfield I drafted an initial proposal for stimulating the discussion:
- https://build.fhir.org/ig/hl7-eu/base/StructureDefinition-EHIC.html (logical model)
- https://build.fhir.org/ig/hl7-eu/base/StructureDefinition-Coverage-eu-ehic.html (FHIR profile)
Giorgio Cangioli (Apr 08 2021 at 16:25):
(ignore the look & feel ;-) )
Giorgio Cangioli (Apr 08 2021 at 16:33):
A first question might be to convey the country code should we rely on the payer.address or should we consider an extension (Coding) at the Coverage level ?
Kevin Mayfield (Apr 09 2021 at 06:32):
I think I need a better handle on insurance, we only have limited use in uk.
My gut feeling is it may be useful to know which country, identifiers come from. In uk for insurance two main patient insurance identifiers are ehic/ghic and social security.
Patient health identifiers are at home nation level.
So Patient/Organisation identifiers have country codes extension to make handling easier. Ehic/ghic has a single system uri.
Giorgio Cangioli (Apr 09 2021 at 06:47):
Kevin Mayfield said:
Ehic/ghic has a single system uri.
not sure to have understood this point .. focusing on the ehic there are two kinds of identifiers:
the Identification number of the card (field #8) and the Personal identification number (field #6)
Giorgio Cangioli (Apr 09 2021 at 06:48):
for the card number we need to agree / list the uri used
Kevin Mayfield (Apr 09 2021 at 06:48):
They would also serve as hints to where they are used. For example covid cert patient could use ehic identifier. For main use its just a cross border patient identifier, if we do need to know country of origin - its in the extension.
Giorgio Cangioli (Apr 09 2021 at 06:49):
.. I don't think the card number is unique at the Eu level :-)
Giorgio Cangioli (Apr 09 2021 at 06:50):
the Personal identification number (field #6) (that is the identifier of the person) is assigned locally
Giorgio Cangioli (Apr 09 2021 at 06:50):
for Italy is the fiscal code (unique nationally) used as identifier also for health services
Giorgio Cangioli (Apr 09 2021 at 06:52):
I've started capturing the system used for EHIC#6 here https://build.fhir.org/ig/hl7-eu/base/ValueSet-uri-ehicPersonalId.html
Giorgio Cangioli (Apr 09 2021 at 06:52):
(for the time being there is only the Italian one)
Giorgio Cangioli (Apr 09 2021 at 06:52):
in https://build.fhir.org/ig/hl7-eu/base/ValueSet-oid-ehicPersonalId.html you can find the correspondent OIDs
Giorgio Cangioli (Apr 09 2021 at 06:54):
feel free to add those used in UK ( or send to me and I'll do) :-)
Kevin Mayfield (Apr 09 2021 at 07:16):
Easier to show an example. Which is English Patients: health id, ehic and social security.
"identifier": [
{
"extension": [
{
"url": "http://hl7.eu/Id/country-code",
"valueCodeableConcept": {
"coding": [
{
"system": "{iso 3166}",
"code": "GB-ENG",
"display": "England"
}
]
}
}
],
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9912003888"
},
{
"extension": [
{
"url": "http://hl7.eu/Id/country-code",
"valueCodeableConcept": {
"coding": [
{
"system": "{iso 3166}",
"code": "GB",
"display": "United Kingdom"
}
]
}
}
],
"system": "http://hl7.eu/Id/ehic",
"value": "{add in country code at start}-GHIC/EHIC Number"
},
{
"extension": [
{
"url": "http://hl7.eu/Id/country-code",
"valueCodeableConcept": {
"coding": [
{
"system": "{iso 3166}",
"code": "GB",
"display": "United Kingdom"
}
]
}
}
],
"system": "https://fhir.hl7.org.uk/Id/national-insurance",
"value": "NI Number"
}
],
Kevin Mayfield (Apr 09 2021 at 07:16):
Easier to show an example. Which is English Patients: health id, ehic and social security.
"identifier": [
{
"extension": [
{
"url": "http://hl7.eu/Id/country-code",
"valueCodeableConcept": {
"coding": [
{
"system": "{iso 3166}",
"code": "GB-ENG",
"display": "England"
}
]
}
}
],
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9912003888"
},
{
"extension": [
{
"url": "http://hl7.eu/Id/country-code",
"valueCodeableConcept": {
"coding": [
{
"system": "{iso 3166}",
"code": "GB",
"display": "United Kingdom"
}
]
}
}
],
"system": "http://hl7.eu/Id/ehic",
"value": "{add in country code at start}-GHIC/EHIC Number"
},
{
"extension": [
{
"url": "http://hl7.eu/Id/country-code",
"valueCodeableConcept": {
"coding": [
{
"system": "{iso 3166}",
"code": "GB",
"display": "United Kingdom"
}
]
}
}
],
"system": "https://fhir.hl7.org.uk/Id/national-insurance",
"value": "NI Number"
}
],
Kevin Mayfield (Apr 09 2021 at 07:19):
Not sure country code is correct, maybe this should be domain where it is used?
so in UK case the ehic entry becomes something like:
{
"extension": [
{
"url": "http://hl7.eu/Id/country-code",
"valueCodeableConcept": {
"coding": [
{
"system": "{iso 3166}",
"code": "EU",
"display": "European Union"
}
]
}
}
],
"system": "https://fhir.hl7.org.uk/Id/ghic",
"value": "{GHIC Number}"
},
Kevin Mayfield (Apr 09 2021 at 07:19):
The domain is now EU and uses the 'brexit' version of the EHIC compatible code system.
Kevin Mayfield (Apr 09 2021 at 07:20):
Domain = EU implies this system+code can be used for EHIC purposes.
Simone Heckmann (Jun 10 2021 at 12:12):
Giorgio Cangioli said:
Kevin Mayfield I drafted an initial proposal for stimulating the discussion:
I took a quick look at the Coverage Profile and I think it needs a fixed type code in order for it to be distinguishable from other types of coverage information and also to provide a unique search parameter when looking for a Patient's EHIC information.
e.g. /Coverage?type=EHIC
Giorgio Cangioli (Jun 14 2021 at 13:41):
Simone Heckmann said:
I took a quick look at the Coverage Profile and I think it needs a fixed type code in order for it to be distinguishable from other types of coverage information and also to provide a unique search parameter when looking for a Patient's EHIC information.
e.g. /Coverage?type=EHIC
I totally agree with you @Simone Heckmann ... it should be fixed and required.
Giorgio Cangioli (Jun 14 2021 at 13:41):
other suggestions ?
Christof Gessner (Nov 26 2021 at 12:03):
Update: recent statement of European Parliament on "Introduction of a European Social Security pass for improving the digital enforcement of social security rights and fair mobility", https://www.europarl.europa.eu/doceo/document/TA-9-2021-0473_EN.pdf
Mentions EHIC in the context of eID and social security data exchange.
Last updated: Apr 12 2022 at 19:14 UTC
