HPI Practitioner - New Zealand HPI Implementation Guide v1.3.1

New Zealand HPI Implementation Guide
1.3.1 - Release

New Zealand HPI Implementation Guide - Local Development build (v1.3.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: HPI Practitioner

Official URL: http://hl7.org.nz/fhir/StructureDefinition/HPIPractitioner				Version: 1.3.1
Active as of 2024-03-04				Computable Name: HpiPractitioner

The practitioner exposed by the HPI. This is the person who delivers healthcare or healthcare related services.

Describe the Practitioner that will be returned by the HPI

The Practitioner resource represents any provider of healthcare - not restricted to those with formal qualifications.

The current HPI contains practitioners covered by the Health Practitioners Competence Assurance Amendment Act 2019. This includes all:

Chiropractors,
Dentists,
Dental hygienist and Dental and Oral health therapist,
Dietitians,
Medical Laboratory Scientist and Technicians including phlebotomists and mortuary technicians,
Anaesthetic Technologists,
Medical Radiation Technologists,
Medical Practitioners (all doctors and specialists),
Midwifes,
Nurses,
Occupational Therapists,
Optometrists and optical dispensers,
Osteopaths,
Paramedics,
Pharmacists,
Physiotherapists,
Podiatrists, and
Psychologists.

It is intended with the upgraded capabilities that other professional groups may supply their members eg Social Workers, Acupuncturists, Audiologists, Counsellors, Cardiac Physiologists, Nutritionist.

Other groups of health workers will need a CPN to be identified in digital records eg Allied Health assistants, Aged care, Personal Care and support workers, administrative staff, practice managers, students working in healthcare setting.

Consideration is being given to ‘self-asserted’ data.

Key differences from spec

DeathDate extension
Ethnicity extension
Qualification has a status (see more differences below)
Initial date of registration extension
Additional Authorizations extension (complex)
Scope of Practice extension (complex)
Conditions on Practice extension (complex)

Registration Authority (RA)

A registration authority is an organization that asserts the information about a practitioner’s competence to perform a particular health role. This includes the Responsible Authorities named under the Act and Professional bodies who require a level of education and professional development to be registered as a member and be issued a certificate to practice. - Information supplied by the Registration Authority can only be changed by the Registration Authority. Health provider organisations may add their workers to the HPI with personal identity details ie name, date of birth, gender, ethnicity and the languages they speak in order to get a CPN. At a later stage a Responsible Authority or a Professional body may add information about their registration with that body ie Annual Practicing Certificate dates, scopes of practice etc.

Resource identifiers

There are 2 levels of identifier in the practitioner resource.

Practitioner.identifier is the top level identifier assigned by the HPI (and the source of the resource id as described in the background section). There can be multiple identifiers for any given resource as part of managing the Practitioner (for example removal of duplicate identifiers). The current identifier will have a use value of ‘official’, others will have a use value of ‘old’. The HPI identifier will always have a system value of ‘\https://standards.digital.health.nz/ns/hpi-person-id’ It is the client’s responsibility to check the value of the use element.

Practitioner.qualification.identifier is the identifier assigned by the Registration authority - for example the Medical Council Number, or Nursing Council number. This will also be found under the Practitioner.identifier but with a system value related to the Registration authority who issued it, for nursing council this will be ‘https://standards.digital.health.nz/ns/nursing-council-id’.

Qualifications

To practice in NZ, practitioners must gain registration with a Responsible Authority (RA). The RA ensures practitioners are competent and fit to practice. Practitioners may provide evidence of educational qualifications attained that are considered by the RA when granting registrations, however the educational qualifications alone do not give a practitioner the right to practice in NZ.

In order to clearly distinguish a person’s licence to practice and their educational qualifications the HpiPractitioner profile uses the Practitioner.qualification element to represent the practitioner’s registration and the extension Practitioner.educational.qualification element to represent a person’s educational qualifications.

Other health providers (not considered Practitioners in NZ) are recorded in the HPI. They may not have a registration but will supply educational qualifications as part of their profile. In the HPI educational qualifications are an element of practitioner not a sub element of practitioner.qualification (ie registration).

A registration is made up of

Element	Description	Profile element
Type	the type of registration – nurse, physiotherapist, doctor etc.	Practitioner.qualification.code
Identifier	an identifier issued by the responsible authority eg medical council number	Practitioner.qualification.identifier
Status	indicates whether the registration is current	Practitioner.qualification.extension:registration-status-code
Initial registration date	date the practitioner was first registered with the responsible authority	Practitioner.qualification.extension:registration-initial-date
Annual practicing certificate	the period of the most recently issued APC	Practitioner.qualification.period
Issuer	HPI Identifier of the responsible authority	Practitioner.qualification.issuer
Scope of practice	range of health services a practitioner is authorised to perform	Practitioner.qualification.extension:scope-of-practice
Condition on practice	conditions the health practitioner is subject to in relation to their scope of practice	Practitioner.qualification.extension:condition-on-practice
Additional Authorisation	additional services that a practitioner is authorised to perform	Practitioner.qualification.extension:additional-authorisation

An education qualification is made up of

Element	Profile element
Fullname	Practitioner.extension:educational-qualification.extension:fullname
Shortname	Practitioner.extension:educational-qualification.extension:shortname
Year	Practitioner.extension:educational-qualification.extension:year
Institution	Practitioner.extension:educational-qualification.extension:institution
City	Practitioner.extension:educational-qualification.extension:city
Country	Practitioner.extension:educational-qualification.extension:country

Redacted Practitioner details

A person can make a request to their council to make their record confidential. When this is the case the person’s name and other personal details will not be returned in any search or get response. Identifiers and registration details are returned. See Confidentiality.

A practitioner’s Date of birth, Gender and Ethnicity are supplied when a practitioner is added and maintained by their Responsible Authority, but they are withheld on a Get Practitioner response. Admin permissions are required to get all the practitioner details in a response.

The Practitioner resources will contain a security element of “REDACTED” in the meta data when data items within the practitioner resource have been withheld.

HPI Practitioner security labels

Confidentiality level	Code	HPI Use	Information that is redacted with a read scope
Low	L	All Registered Practitioner records with no confidentiality flag set	Gender, birthDate and ethnicity
Moderate	M	All Non-registered Practitioner records with no confidentiality flag set	Gender, birthDate and ethnicity
Restricted and, Redacted	R, and REDACTED	All Practitioner records with confidentiality set (Registered and Non-registered Practitioners)	Name Official Name Usual Name(s) Old Gender Date of Birth Date of death Language(s) Ethnicity ConditionOnPractice (Applies to Registered Practitioner only)

Example of Practitioner with confidentiality flag set

{
    "resourceType": "Practitioner",
    "id": "90ZZLP",
    "meta": {
        "versionId": "9971",
        "lastUpdated": "2022-04-07T09:12:26.000+12:00",
        "profile": [
            "http://hl7.org.nz/fhir/StructureDefinition/HPIPractitioner"
        ],
        "security": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationValue",
                "code": "REDACTED"
            },
            {
                "system": "http://terminology.hl7.org/CodeSystem/v3-Confidentiality",
                "code": "R"
            }
        ]
…
}

Usage:

Refer to this Resource Profile: HPI Practitioner role
Examples for this Resource Profile: Practitioner/90ZZLP, Practitioner/91ZABY, Practitioner/92ZZRE and Practitioner/98ZZQJ

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

Differential Table
Key Elements Table
Snapshot Table
Statistics/References
All

This structure is derived from NzPractitioner

Name	Flags	Card.	Type	Description & Constraints
Practitioner		0..*	NzPractitioner	A person with a formal responsibility in the provisioning of healthcare or related services
extension:death-date		0..1	Death_date	The date this person died
extension:source		0..0
extension:educational-qualification		0..*	EducationalQualification	Extension
extension:country		0..1	Extension	Extension
value[x]		0..1	string	Value of extension Binding: ISO 3166-1:2013 (2-alpha country code) (required)
extension:ethnicity		0..6	Nz_ethnicity	NZ Ethnicity
extension:iwi		0..0
Slices for identifier		0..*	Identifier	An identifier for the person as this agent Slice: Unordered, Open At End by value:use, value:system
identifier:All Slices				Content/Rules for all slices
use		0..1	code	official \| old Binding: IdentifierUse (required)
identifier:HPI	S	0..1	Identifier	The currently active CPN (Common Person Name)
use		1..1	code	fixed to official Fixed Value: official
type		0..0
system		1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/hpi-person-id
period		0..0
assigner		0..1	Reference(HPI Organization)	Organization that issued id (may be just text)
identifier:dormant	S	0..*	Identifier	CPN (Common Person Name) identifiers that have been deprecated for this Person
use		1..1	code	fixed to old Fixed Value: old
type		0..0
system		1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/hpi-person-id
period		0..0
assigner		0..1	Reference(HPI Organization)	Organization that issued id (may be just text)
identifier:RA	S	0..*	Identifier	The RA Identifier
use		1..1	code	fixed to official Fixed Value: official
type		0..0
system		0..1	uri	The namespace for the identifier value Binding: RaIdentifier (required)
period		0..0
assigner		0..1	Reference(HPI Organization)	Organization that issued id (may be just text)
active		0..0
name
use		0..1	code	usual \| official \| old Binding: Use values for a HumanName (required)
text		0..0
prefix		0..*	string	Parts that come before the name Binding: Name Prefix Codes (required)
suffix		0..0
period		0..0
telecom		0..0
address		0..0
photo		0..0
qualification
id		0..0
extension:additional-authorisation		0..*	AdditionalAuthorisation	Additional things the person is authorized to do
extension:condition-on-practice		0..*	ConditionOnPractice	Conditions that have been applied to the ability of the person to practice
extension:registration-initial-date		0..1	RegistrationInitialDate	The date that the person was originally registered
extension:registration-status-code		0..1	RegistrationStatusCode	Status of the registration, and the date it was set
extension:scope-of-practice		0..*	ScopeOfPractice	the health services a practitioner is authorised to perform eg Nurse Practitioner
identifier		0..*	Identifier	The practitioner's identifier issued by the Responsible Authority eg medical council number, nursing council number
code		1..1	CodeableConcept	Coded representation of the Responsible Authority that issues the registration Binding: HPI Registration Type (required)
period		0..1	Period	The period of the annual practicing certificate issued by the Responsible Authority
issuer		0..1	Reference(HPI Organization)	The HPI Organisation ID of the Responsible Authority that issues the registration
communication
coding		0..*	Coding	Code defined by a terminology system Binding: ISO 639-3:2007 (3-alpha language code) (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Practitioner.extension:educational-qualification.extension:country.value[x]	required	Hpi_country_code_iso_3166_1 `https://nzhts.digital.health.nz/fhir/ValueSet/country-code`
Practitioner.identifier.use	required	Hpi_IdentfierUse `https://nzhts.digital.health.nz/fhir/ValueSet/hpi-identifier-use-code`
Practitioner.identifier:RA.system	required	Hpi_Ra_Identifier `https://nzhts.digital.health.nz/fhir/ValueSet/hpi-ra-identifier-code`
Practitioner.name.use	required	Hpi_HumanNameUse `https://nzhts.digital.health.nz/fhir/ValueSet/hpi-human-name-use-code`
Practitioner.name.prefix	required	Hpi_name_prefix `https://nzhts.digital.health.nz/fhir/ValueSet/name-prefix-code`
Practitioner.qualification.code	required	Hpi_registration_type `https://nzhts.digital.health.nz/fhir/ValueSet/practitioner-registration-authority-code`
Practitioner.communication.coding	required	Hpi_language_code_iso_639_3 `https://nzhts.digital.health.nz/fhir/ValueSet/language-code`

Name	Flags	Card.	Type	Description & Constraints
Practitioner		0..*	NzPractitioner	A person with a formal responsibility in the provisioning of healthcare or related services
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
death-date		0..1	(Complex)	The date this person died URL: http://hl7.org.nz/fhir/StructureDefinition/death-date
extension:date		0..1	Extension	The date of death
extension		0..0
url		1..1	uri	"date"
url		1..1	uri	"http://hl7.org.nz/fhir/StructureDefinition/death-date"
educational-qualification		0..*	(Complex)	Extension URL: http://hl7.org.nz/fhir/StructureDefinition/educational-qualification
extension:fullname		0..1	Extension	The full name of the educational qualification
extension		0..0
url		1..1	uri	"fullname"
extension:shortname		0..1	Extension	A short name of the educational qualification for when space is limited
extension		0..0
url		1..1	uri	"shortname"
extension:year		0..1	Extension	The year in which the qualification was granted
extension		0..0
url		1..1	uri	"year"
extension:institution		0..1	Extension	The institution that granted the qualification
extension		0..0
url		1..1	uri	"institution"
extension:city		0..1	Extension	The city where the institution is located
extension		0..0
url		1..1	uri	"city"
extension:country		0..1	Extension	Extension
extension		0..0
url		1..1	uri	"country"
value[x]		0..1	string	Value of extension Binding: ISO 3166-1:2013 (2-alpha country code) (required)
url		1..1	uri	"http://hl7.org.nz/fhir/StructureDefinition/educational-qualification"
ethnicity		0..6	CodeableConcept	NZ Ethnicity URL: http://hl7.org.nz/fhir/StructureDefinition/nz-ethnicity Binding: Ethnicity of a person (preferred)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	An identifier for the person as this agent Slice: Unordered, Open At End by value:use, value:system
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	official \| old Binding: IdentifierUse (required)
identifier:HPI	SΣ	0..1	Identifier	The currently active CPN (Common Person Name)
use	?!Σ	1..1	code	fixed to official Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Fixed Value: official
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/hpi-person-id
assigner	Σ	0..1	Reference(HPI Organization)	Organization that issued id (may be just text)
identifier:dormant	SΣ	0..*	Identifier	CPN (Common Person Name) identifiers that have been deprecated for this Person
use	?!Σ	1..1	code	fixed to old Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Fixed Value: old
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/hpi-person-id
assigner	Σ	0..1	Reference(HPI Organization)	Organization that issued id (may be just text)
identifier:RA	SΣ	0..*	Identifier	The RA Identifier
use	?!Σ	1..1	code	fixed to official Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Fixed Value: official
system	Σ	0..1	uri	The namespace for the identifier value Binding: RaIdentifier (required) Example General: http://www.acme.com/identifiers/patient
assigner	Σ	0..1	Reference(HPI Organization)	Organization that issued id (may be just text)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Practitioner.extension:death-date.extension:source.value[x]:valueCodeableConcept	preferred	Nhi_date_of_death_source `https://nzhts.digital.health.nz/fhir/ValueSet/dod-information-source-code`
Practitioner.extension:educational-qualification.extension:country.value[x]	required	Hpi_country_code_iso_3166_1 `https://nzhts.digital.health.nz/fhir/ValueSet/country-code`
Practitioner.identifier.use	required	Hpi_IdentfierUse `https://nzhts.digital.health.nz/fhir/ValueSet/hpi-identifier-use-code`
Practitioner.identifier:HPI.use	required	Fixed Value: official `http://hl7.org/fhir/ValueSet/identifier-use\|4.0.1` from the FHIR Standard
Practitioner.identifier:dormant.use	required	Fixed Value: old `http://hl7.org/fhir/ValueSet/identifier-use\|4.0.1` from the FHIR Standard
Practitioner.identifier:RA.use	required	Fixed Value: official `http://hl7.org/fhir/ValueSet/identifier-use\|4.0.1` from the FHIR Standard
Practitioner.identifier:RA.system	required	Hpi_Ra_Identifier `https://nzhts.digital.health.nz/fhir/ValueSet/hpi-ra-identifier-code`