gematik · alexzautke · Sep 17, 2025
diff --git a/Resources/fsh-generated/resources/Composition-CompositionExampleIntensivstation.json b/Resources/fsh-generated/resources/Composition-CompositionExampleIntensivstation.json
@@ -0,0 +1,59 @@
+{
+  "resourceType": "Composition",
+  "id": "CompositionExampleIntensivstation",
+  "meta": {
+    "profile": [
+      "https://gematik.de/fhir/isik/StructureDefinition/ISiKBerichtSubSysteme"
+    ]
+  },
+  "status": "final",
+  "text": {
+    "status": "extensions",
+    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"></div>"
+  },
+  "identifier": {
+    "type": {
+      "coding": [
+        {
+          "code": "FILL",
+          "system": "http://terminology.hl7.org/CodeSystem/v2-0203"
+        }
+      ]
+    },
+    "system": "urn:ietf:rfc:3986",
+    "value": "urn:uuid:54d0804f-c770-4b61-a175-28fa1875b2a9"
+  },
+  "type": {
+    "coding": [
+      {
+        "code": "AD010116",
+        "system": "http://dvmd.de/fhir/CodeSystem/kdl",
+        "display": "Verlegungsbericht"
+      }
+    ]
+  },
+  "subject": {
+    "reference": "Patient/critical-patient"
+  },
+  "date": "2025-07-21T00:00:00+02:00",
+  "author": [
+    {
+      "display": "Dr. Alenia Vogt"
+    }
+  ],
+  "title": "Verlegungsbericht für Patient Herrn Thomas Müller (1234567890) - Intensivstation 0100",
+  "section": [
+    {
+      "title": "Beatmungswerte (Unterstützungsdruck) vom 22.07.2025 - #1",
+      "text": {
+        "status": "generated",
+        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"></div>"
+      },
+      "entry": [
+        {
+          "reference": "Observation/VentilationPressureObservation"
+        }
+      ]
+    }
+  ]
+}
diff --git a/Resources/fsh-generated/resources/Observation-BloodPressureObservation.json b/Resources/fsh-generated/resources/Observation-BloodPressureObservation.json
@@ -0,0 +1,82 @@
+{
+  "resourceType": "Observation",
+  "id": "BloodPressureObservation",
+  "meta": {
+    "profile": [
+      "https://gematik.de/fhir/isik/StructureDefinition/ISiKBlutdruckSystemischArteriell"
+    ]
+  },
+  "category": [
+    {
+      "coding": [
+        {
+          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
+          "code": "vital-signs"
+        }
+      ]
+    }
+  ],
+  "code": {
+    "coding": [
+      {
+        "system": "http://loinc.org",
+        "code": "85354-9"
+      }
+    ]
+  },
+  "component": [
+    {
+      "code": {
+        "coding": [
+          {
+            "system": "http://loinc.org",
+            "code": "8480-6"
+          }
+        ]
+      },
+      "valueQuantity": {
+        "system": "http://unitsofmeasure.org",
+        "code": "mm[Hg]",
+        "value": 210,
+        "unit": "mmHg"
+      }
+    },
+    {
+      "code": {
+        "coding": [
+          {
+            "system": "http://loinc.org",
+            "code": "8462-4"
+          }
+        ]
+      },
+      "valueQuantity": {
+        "system": "http://unitsofmeasure.org",
+        "code": "mm[Hg]",
+        "value": 115,
+        "unit": "mmHg"
+      }
+    },
+    {
+      "code": {
+        "coding": [
+          {
+            "system": "http://loinc.org",
+            "code": "8478-0"
+          }
+        ]
+      },
+      "valueQuantity": {
+        "system": "http://unitsofmeasure.org",
+        "code": "mm[Hg]",
+        "value": 140,
+        "unit": "mmHg"
+      }
+    }
+  ],
+  "status": "final",
+  "subject": {
+    "reference": "Patient/critical-patient"
+  },
+  "effectiveDateTime": "2025-07-22T14:10:00+02:00"
+}
diff --git a/Resources/fsh-generated/resources/Observation-VentilationPressureObservation.json b/Resources/fsh-generated/resources/Observation-VentilationPressureObservation.json
@@ -0,0 +1,40 @@
+{
+  "resourceType": "Observation",
+  "id": "VentilationPressureObservation",
+  "partOf": [
+    {
+      "reference": "Procedure/VentilationProcedure"
+    }
+  ],
+  "status": "final",
+  "category": [
+    {
+      "coding": [
+        {
+          "code": "40617009",
+          "system": "http://snomed.info/sct",
+          "display": "Artificial ventilation (regime/therapy)"
+        }
+      ]
+    }
+  ],
+  "code": {
+    "coding": [
+      {
+        "code": "20079-0",
+        "system": "http://loinc.org",
+        "display": "Pressure support setting Ventilator"
+      }
+    ]
+  },
+  "subject": {
+    "reference": "Patient/critical-patient"
+  },
+  "effectiveDateTime": "2025-07-21T00:00:00+02:00",
+  "valueQuantity": {
+    "value": 6,
+    "code": "cm[H2O]",
+    "system": "http://unitsofmeasure.org",
+    "unit": "cm[H2O]"
+  }
+}
diff --git a/Resources/fsh-generated/resources/Patient-critical-patient.json b/Resources/fsh-generated/resources/Patient-critical-patient.json
@@ -0,0 +1,34 @@
+{
+  "resourceType": "Patient",
+  "id": "critical-patient",
+  "meta": {
+    "profile": [
+      "https://gematik.de/fhir/isik/StructureDefinition/ISiKPatient"
+    ]
+  },
+  "identifier": [
+    {
+      "type": {
+        "coding": [
+          {
+            "code": "MR",
+            "system": "http://terminology.hl7.org/CodeSystem/v2-0203"
+          }
+        ]
+      },
+      "system": "https://example.org/fhir/sid/pid",
+      "value": "1234567890"
+    }
+  ],
+  "name": [
+    {
+      "use": "official",
+      "family": "Müller",
+      "given": [
+        "Thomas"
+      ]
+    }
+  ],
+  "gender": "male",
+  "birthDate": "1965-04-11"
+}
diff --git a/Resources/fsh-generated/resources/Procedure-VentilationProcedure.json b/Resources/fsh-generated/resources/Procedure-VentilationProcedure.json
@@ -0,0 +1,29 @@
+{
+  "resourceType": "Procedure",
+  "id": "VentilationProcedure",
+  "category": {
+    "coding": [
+      {
+        "code": "40617009",
+        "system": "http://snomed.info/sct",
+        "display": "Artificial ventilation (regime/therapy)"
+      }
+    ]
+  },
+  "code": {
+    "coding": [
+      {
+        "code": "4764004",
+        "system": "http://snomed.info/sct",
+        "display": "Jet ventilation procedure (procedure)"
+      }
+    ]
+  },
+  "status": "completed",
+  "subject": {
+    "reference": "Patient/critical-patient"
+  },
+  "performedPeriod": {
+    "start": "2025-07-21"
+  }
+}
diff --git a/Resources/input/fsh/Basis/ISiKBerichtSubSysteme.fsh b/Resources/input/fsh/Basis/ISiKBerichtSubSysteme.fsh
@@ -212,3 +212,89 @@ Invariant: kdl-1
 Description: "KDL-Code ungültig"
 Severity: #warning
 Expression: "matches('^[A-Z]{2}[0-9]{6}$')"
+
+Instance: CriticalPatient
+InstanceOf: ISiKPatient
+Title: "Patient Thomas Müller"
+Description: "Patient mit hypertensivem Notfall, vorbereitet zur Verlegung auf die ICU"
+Usage: #example
+* id = "critical-patient"
+* meta.profile = "https://gematik.de/fhir/isik/StructureDefinition/ISiKPatient"
+* identifier[Patientennummer].system = "https://example.org/fhir/sid/pid"
+* identifier[Patientennummer].value = "1234567890"
+* name[Name].family = "Müller"
+* name[Name].given = "Thomas"
+* gender = #male
+* birthDate = "1965-04-11"
+
+Instance: BloodPressureObservation
+InstanceOf: ISiKBlutdruckSystemischArteriell
+Usage: #example
+Title: "Hypertensiver Blutdruck - ICU-Aufnahme"
+Description: "Kritischer Blutdruckwert (Systole 210 / Diastole 115 / MAP 140) vor Verlegung auf Intensivstation."
+* status = #final
+* subject = Reference(CriticalPatient)
+* effectiveDateTime = "2025-07-22T14:10:00+02:00"
+* component[SystolicBP]
+  * valueQuantity = 210 'mm[Hg]' "mmHg"
+* component[DiastolicBP]
+  * valueQuantity = 115 'mm[Hg]' "mmHg"
+* component[meanBP]
+  * valueQuantity = 140 'mm[Hg]' "mmHg"
+
+Instance: VentilationProcedure
+InstanceOf: Procedure
+Usage: #example
+Title: "Beatmung - ICU-Aufnahme"
+* category = $sct#40617009 "Artificial ventilation (regime/therapy)"
+* code = $sct#4764004 "Jet ventilation procedure (procedure)"
+* status = #completed
+* subject = Reference(CriticalPatient)
+* performedPeriod
+  * start = "2025-07-21"
+
+Instance: VentilationPressureObservation
+InstanceOf: Observation
+Usage: #example
+Title: "Unterstützungsdruck Beatmung - ICU-Aufnahme"
+* partOf = Reference(VentilationProcedure)
+* status = #final
+* category = $sct#40617009 "Artificial ventilation (regime/therapy)"
+* code = $loinc#20079-0 "Pressure support setting Ventilator"
+* subject = Reference(CriticalPatient)
+* effectiveDateTime = "2025-07-21T00:00:00+02:00"
+* valueQuantity = 6 'cm[H2O]' "cm[H2O]"
+
+Instance: CompositionExampleIntensivstation
+InstanceOf: ISiKBerichtSubSysteme
+Usage: #example
+* text.div = "<div xmlns=\"http://www.w3.org/1999/xhtml\"></div>"
+* identifier[0].type = $v2-0203#FILL
+* identifier[=].system = "urn:ietf:rfc:3986"
+* identifier[=].value = "urn:uuid:54d0804f-c770-4b61-a175-28fa1875b2a9"
+* type = $kdl#AD010116 "Verlegungsbericht"
+* subject = Reference(CriticalPatient)
+* date = "2025-07-21T00:00:00+02:00"
+* author
+  * display = "Dr. Alenia Vogt"
+* title = "Verlegungsbericht für Patient Herrn Thomas Müller (1234567890) - Intensivstation 0100"
+* section
+  * title = "Patient - Herrn Thomas Müller (1965-04-11)"
+  * text[0].status = #generated
+  * text[=].div = "<div xmlns=\"http://www.w3.org/1999/xhtml\"></div>"
+  * entry = Reference(CriticalPatient)
+* section
+  * title = "Blutdruckmessung vom 22.07.2025 - #1"
+  * text[0].status = #generated
+  * text[=].div = "<div xmlns=\"http://www.w3.org/1999/xhtml\"></div>"
+  * entry = Reference(BloodPressureObservation)
+* section
+  * title = "Beatmungswerte vom 22.07.2025 - #1"
+  * text[0].status = #generated
+  * text[=].div = "<div xmlns=\"http://www.w3.org/1999/xhtml\"></div>"
+  * entry = Reference(VentilationProcedure)
+* section
+  * title = "Beatmungswerte (Unterstützungsdruck) vom 22.07.2025 - #1"
+  * text[0].status = #generated
+  * text[=].div = "<div xmlns=\"http://www.w3.org/1999/xhtml\"></div>"
+  * entry = Reference(VentilationPressureObservation)
diff --git a/guides/ICU-5/Einfuehrung/ProzesseUndWorkflows.page.md b/guides/ICU-5/Einfuehrung/ProzesseUndWorkflows.page.md
@@ -38,7 +38,8 @@ Denkbar sind auch Workflows, bei denen erhobene Daten aus einem System vor der V
 
 Eine Abfrage per HTTP GET allein reicht nicht aus, um die benötigten Daten rechtzeitig zu übermitteln. Stattdessen muss eine Vorab-Übermittlung durch einen anderen Mechanismus erfolgen. Sobald diese angestoßen wurde, kann das PDMS die vollständigen Daten per GET abrufen. An dieser Stelle werden keine weiteren Festlegungen zur vorgelagerten Übermittlung der  Daten erhoben und es wird keine direkte Schreiboperation auf FHIR-Basis des KIS im PDMS für diesen Fall gefordert. Die Vorab-Übermittlung könnte durch verschiedene Mechanismen unterstützt werden:
 
-- FHIR Subscription (vgl. im ISiK Kontext [Patient merge Notification](https://simplifier.net/guide/isik-subscription-stufe-5/Einfuehrung/UseCases/Patientenzusammenf%C3%BChrung.page.md))
-- Create-Interaktion (POST) (vgl. im ISiK Kontext [REST-API](https://simplifier.net/guide/isik-basis-stufe-5/Einfuehrung/Festlegungen/UebergreifendeFestlegungen_Rest.page.md))
+- FHIR Subscription (vgl. im ISiK Kontext [Patient merge Notification](https://simplifier.net/guide/isik-subscription-stufe-5/Einfuehrung/Spezifikation/Patientenzusammenführung?version=5.0.0))
+- Create-Interaktion (POST) (vgl. im ISiK Kontext [REST-API](https://simplifier.net/guide/isik-basis-stufe-5/Einfuehrung/Festlegungen/UebergreifendeFestlegungen_Rest?version=5.0.0))
 - HL7 v2 Messaging
+- Rückübermittelung als FHIR Document per [ISiKBerichtSubSysteme](https://simplifier.net/guide/isik-basis-stufe-5/Einfuehrung/Artefakte/Datenobjekte_BerichtSubsystem?version=5.0.0)
 - etc.