TreatmentDirective2-v1.0(2020EN)

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General information

Name: nl.zorg.TreatmentDirective2
Version: 1.0
HCIM Status:Final
Release: 2020
Release status: Published
Release date: 01-09-2020

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Metadata

DCM::CoderList	Kerngroep Registratie aan de Bron
DCM::ContactInformation.Address	*
DCM::ContactInformation.Name	*
DCM::ContactInformation.Telecom	*
DCM::ContentAuthorList	Projectgroep Generieke Overdrachtsgegevens & Kerngroep Registratie aan de Bron
DCM::CreationDate	17-8-2020
DCM::DeprecatedDate
DCM::DescriptionLanguage	nl
DCM::EndorsingAuthority.Address
DCM::EndorsingAuthority.Name	PM
DCM::EndorsingAuthority.Telecom
DCM::Id	2.16.840.1.113883.2.4.3.11.60.40.3.2.2
DCM::KeywordList	advance directives, behandel aanwijzing, wilsverklaring, behandelbeperking
DCM::LifecycleStatus	Final
DCM::ModelerList	Kerngroep Registratie aan de Bron
DCM::Name	nl.zorg.BehandelAanwijzing2
DCM::PublicationDate	01-09-2020
DCM::PublicationStatus	Published
DCM::ReviewerList	Projectgroep Generieke Overdrachtsgegevens & Kerngroep Registratie aan de Bron
DCM::RevisionDate	21-07-2020
DCM::Supersedes	nl.zorg.BehandelAanwijzing-v3.2
DCM::Version	1.0
HCIM::PublicationLanguage	EN

Revision History

Only available in Dutch

Publicatieversie 1.0 (01-09-2020) .

Concept

A treatment directive contains a joint decision between a health professional (for example a general practitioner) and a patient or his representative(s) about the desirability of performing a certain treatment, such as resuscitation, before this treatment becomes (acute) necessary.
When the need arises and the treatment cannot be discussed with the patient or representative (s), that decision is an important indication for the treating health professional (for example an ER doctor).
The term treatment limit is a synonym of the term treatment directive.

Purpose

A good overview of treatment instructions based on the wishes of the patient or their authorized representative on (un)desired treatments is important in a patient’s care. A concise, orderly list is of particular importance in acute care situations. Due to the large variety of symptoms, the situation concerns not only a CPR setting, but also cases in which the patient’s condition rapidly worsens as a result of existing symptoms.
A healthcare provider consulting this information can discuss these existing treatment instructions with the patient, the patient’s family or the patient’s authorized representative and possibly include the instructions in their policy.

Evidence Base

Explanation for TreatmentCodeList:
In discussions on constraints in the therapeutic treatment of patients with a chronic neurological or respiratory condition, respiration is sometimes included as a separate restriction. The ‘Respiration’ item is to be seen separately from the decisions on CPR.

Information Model

Type	Id	Concept						Card.	Definition	DefinitionCode	Reference
	NL-CM:2.2.1	TreatmentDirective							Root concept of the TreatmentDirective2 information model. This concept contains all data elements of the TreatmentDirective2 information model.	129125009 Procedure with explicit context
	NL-CM:2.2.2		TreatmentDecision					1	The joint decision taken with regard to the desirability of performing the indicated treatment. If the agreement is 'Other', 'Specification Other' shall contain the instructions for whether or not to carry out the treatment.		TreatmentDecisionCodelist
	NL-CM:2.2.3		Treatment					1	The medical treatment to which the treatment instruction applies.	363589002 Associated procedure	TreatmentCodelist
	NL-CM:2.2.4		SpecificationOther					0..1	Specification of the treatment decision when the decision is 'Other'.
	NL-CM:2.2.5		MostRecentReviewDate					1	The date on which the treatment directive has been agreed is with the patient and / or his representative (s). This can be the first time that the treatment directive have been discussed, but an existing treatment directive may also have been discussed again. The content of the treatment directive may have changed or remained the same.
	NL-CM:2.2.6		DateExpired					0..1	The date on which the treatment directive has been withdrawn and therefore no longer applies. An explicit decision must be taken about the 'date expired', in consultation between the responsible care provider and the patient or his representative(s). Any future termination can only be entered as a condition. Often this will be linked to 1 or more events.
	NL-CM:2.2.7		ReasonForEnding					0..1	Reason why the agreement on a treatment directive no longer applies.
	NL-CM:2.2.8		AdvanceDirective					0..*	A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter.	713603004 Advance care planning	AdvanceDirective
	NL-CM:2.2.9		AgreementParty					2..*	Container of the Agreement concept.This container contains all data elements of the Agreement concept.	408730004 Procedure context
	NL-CM:2.2.10			Patient				(0..1)	Patient as the person with whom the agreement was made.		Patient
	NL-CM:2.2.11			Representative::ContactPerson				(0..1)	Person who represents the patient in health care matters and with whom the agreement has been made (too).		ContactPerson
	NL-CM:2.2.12			HealthProfessional				(0..1)	HealthProfessional who has made de agreement regarding the treatement directive.		HealthProfessional
	NL-CM:2.2.13		Comment					0..1	The comment may include further information such as the reason why a treatment directive has been drawn up, persons who assisted the patient in agreeing the treatment directive but who are not otherwise involved in the agreement as a representative, etc.	48767-8 Annotation comment [Interpretation] Narrative

Columns Concept and DefinitionCode: hover over the values for more information
For explanation of the symbols, please see the legend page

Example Instances

Only available in Dutch

Behandeling	Behandeling Besluit	SpecificatieAnders	AfspraakPartij	Recentste Bespreek Datum
			Vertegenwoordiger
Opname op Intensive Care	Wel uitvoeren		H.J. Jansen	11-9-2012
Behandeling	Behandeling Besluit	SpecificatieAnders	AfspraakPartij	Recentste Bespreek Datum
			Patiënt
Cardiopulmonaire resuscitatie	Anders	eerst overleg met echtgenote	D. de Jong	11-9-2012

Valuesets

TreatmentCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.2.2.1

Binding: Required

Conceptname	Conceptcode	Codesystem name	Codesystem OID	Description
Admission to intensive care unit	305351004	SNOMED CT	2.16.840.1.113883.6.96	Opname op intensive care
Cardiopulmonary resuscitation	89666000	SNOMED CT	2.16.840.1.113883.6.96	Cardiopulmonaire resuscitatie
Artificial respiration	40617009	SNOMED CT	2.16.840.1.113883.6.96	Kunstmatige beademing
Administration of blood product	116762002	SNOMED CT	2.16.840.1.113883.6.96	Toediening van een bloedproduct
Antibiotic therapy	281789004	SNOMED CT	2.16.840.1.113883.6.96	Toediening van antibiotica
Hospital admission	32485007	SNOMED CT	2.16.840.1.113883.6.96	Opname in ziekenhuis
Other	OTH	NullFlavor	2.16.840.1.113883.5.1008	Overige behandelingen

TreatmentDecisionCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.2.2.2

Binding: Required

Conceptname	Conceptcode	Codesystem name	Codesystem OID	Description
Wel uitvoeren	0	BehandelBesluiten	2.16.840.1.113883.2.4.3.11.60.40.4.25.1	Wel uitvoeren
Anders	1	BehandelBesluiten	2.16.840.1.113883.2.4.3.11.60.40.4.25.1	Anders
Niet uitvoeren	2	BehandelBesluiten	2.16.840.1.113883.2.4.3.11.60.40.4.25.1	Niet uitvoeren

This information model in other releases

• Prerelease 2021-2, (Version 1.0)
• Prerelease 2022-1, (Version 2.0)
• Prerelease 2023-1, (Version 2.0.1)
• Prerelease 2024-1, (Version 2.0.1)

Information model references

This information model refers to

• AdvanceDirective-v3.1.1
• ContactPerson-v3.4
• HealthProfessional-v3.5
• Patient-v3.2

This information model is used in

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Technical specifications in HL7v3 CDA and HL7 FHIR

To exchange information based on health and care information models, additional, more technical specifications are required.
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:

• HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment
• HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR

Downloads

This information model is also available as pdf file or as spreadsheet

About this information

The information in this wikipage is based on Release 2020
SNOMED CT and LOINC codes are based on:

• SNOMED Clinical Terms version: 20200309 [R] (March 2020 Interim Release)
• LOINC version 2.67

Conditions for use are located on the mainpage
This page is generated on 19/09/2020 21:07:00 with ZibExtraction v. 4.0.7556.18438

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