1059 lines
37 KiB
PL/PgSQL
1059 lines
37 KiB
PL/PgSQL
-- Migration: FHIR-compliant GGZ EPD Schema
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-- Created: 2024-11-21
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-- Description: Core tables for intake, diagnostiek en behandelplan
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-- Based on: FHIR R4, MedMIJ Basisgegevens GGZ 2.0, Koppeltaal
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-- ============================================================================
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-- ENABLE EXTENSIONS
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-- ============================================================================
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CREATE EXTENSION IF NOT EXISTS "uuid-ossp";
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CREATE EXTENSION IF NOT EXISTS "pgcrypto";
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-- ============================================================================
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-- ENUM TYPES (for type safety)
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-- ============================================================================
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-- FHIR Gender
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CREATE TYPE gender_type AS ENUM ('male', 'female', 'other', 'unknown');
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-- FHIR Encounter Status
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CREATE TYPE encounter_status AS ENUM (
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'planned', 'in-progress', 'on-hold', 'completed',
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'cancelled', 'entered-in-error', 'unknown'
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);
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-- FHIR Condition Clinical Status
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CREATE TYPE condition_clinical_status AS ENUM (
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'active', 'recurrence', 'relapse', 'inactive',
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'remission', 'resolved', 'unknown'
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);
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-- FHIR Condition Verification Status
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CREATE TYPE condition_verification_status AS ENUM (
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'unconfirmed', 'provisional', 'differential',
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'confirmed', 'refuted', 'entered-in-error'
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);
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-- FHIR Observation Status
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CREATE TYPE observation_status AS ENUM (
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'registered', 'preliminary', 'final', 'amended',
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'corrected', 'cancelled', 'entered-in-error', 'unknown'
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);
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-- FHIR CarePlan Status
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CREATE TYPE careplan_status AS ENUM (
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'draft', 'active', 'on-hold', 'revoked',
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'completed', 'entered-in-error', 'unknown'
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);
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-- FHIR CarePlan Activity Status
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CREATE TYPE activity_status AS ENUM (
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'not-started', 'scheduled', 'in-progress',
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'on-hold', 'completed', 'cancelled', 'stopped', 'unknown'
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);
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-- FHIR DocumentReference Status
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CREATE TYPE document_status AS ENUM (
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'current', 'superseded', 'entered-in-error'
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);
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-- ============================================================================
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-- TABLE: practitioners (FHIR: Practitioner)
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-- Behandelaren/professionals
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-- ============================================================================
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CREATE TABLE practitioners (
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id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
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-- FHIR Practitioner fields
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identifier_big TEXT UNIQUE, -- BIG-nummer (optioneel voor niet-BIG geregistreerden)
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identifier_agb TEXT, -- AGB-code
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-- Name (HumanName)
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name_prefix TEXT, -- "Drs.", "Dr."
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name_given TEXT[] NOT NULL, -- Voornamen
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name_family TEXT NOT NULL, -- Achternaam
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name_suffix TEXT, -- "PhD", "MSc"
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-- Qualification
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qualification TEXT[], -- ["GZ-psycholoog", "Psychotherapeut"]
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-- Contact
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telecom_phone TEXT,
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telecom_email TEXT,
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-- Active
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active BOOLEAN DEFAULT true,
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-- Link to auth user
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user_id UUID REFERENCES auth.users(id) ON DELETE CASCADE,
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-- Metadata
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created_at TIMESTAMPTZ DEFAULT NOW(),
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updated_at TIMESTAMPTZ DEFAULT NOW()
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);
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-- ============================================================================
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-- TABLE: organizations (FHIR: Organization)
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-- GGZ-instellingen
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-- ============================================================================
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CREATE TABLE organizations (
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id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
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-- FHIR Organization fields
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identifier_agb TEXT UNIQUE, -- AGB-code instelling
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identifier_kvk TEXT, -- KVK-nummer
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-- Name
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name TEXT NOT NULL,
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alias TEXT[], -- Alternative names
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-- Type
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type_code TEXT DEFAULT 'prov', -- healthcare provider
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type_display TEXT DEFAULT 'Healthcare Provider',
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-- Contact
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telecom_phone TEXT,
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telecom_email TEXT,
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telecom_website TEXT,
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-- Address
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address_line TEXT[],
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address_city TEXT,
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address_postal_code TEXT,
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address_country TEXT DEFAULT 'NL',
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-- Active
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active BOOLEAN DEFAULT true,
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-- Metadata
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created_at TIMESTAMPTZ DEFAULT NOW(),
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updated_at TIMESTAMPTZ DEFAULT NOW()
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);
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-- ============================================================================
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-- TABLE: patients (FHIR: Patient / ZIB: Patient)
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-- Cliënten/patiënten
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-- ============================================================================
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CREATE TABLE patients (
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id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
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-- FHIR Patient.identifier
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identifier_bsn TEXT UNIQUE NOT NULL, -- BSN (verplicht in NL)
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identifier_client_number TEXT, -- Interne cliëntnummer
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-- FHIR Patient.name (HumanName)
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name_family TEXT NOT NULL, -- Achternaam
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name_given TEXT[] NOT NULL, -- Voornamen array
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name_prefix TEXT, -- Voorvoegsel (van, de, etc)
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name_use TEXT DEFAULT 'official', -- official, maiden, nickname
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-- FHIR Patient.birthDate
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birth_date DATE NOT NULL,
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-- FHIR Patient.gender
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gender gender_type NOT NULL,
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-- FHIR Patient.telecom (ContactPoint)
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telecom_phone TEXT,
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telecom_email TEXT,
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-- FHIR Patient.address (Address)
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address_line TEXT[], -- Straat + huisnummer
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address_city TEXT,
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address_postal_code TEXT,
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address_country TEXT DEFAULT 'NL',
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-- Insurance (ZIB: Payer)
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insurance_company TEXT, -- Zorgverzekeraar
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insurance_number TEXT, -- Polisnummer
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-- FHIR Patient.contact (naasten)
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emergency_contact_name TEXT,
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emergency_contact_relationship TEXT,
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emergency_contact_phone TEXT,
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-- FHIR Patient.active
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active BOOLEAN DEFAULT true,
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-- FHIR Patient.generalPractitioner (huisarts)
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general_practitioner_name TEXT,
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general_practitioner_agb TEXT,
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-- Metadata
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created_at TIMESTAMPTZ DEFAULT NOW(),
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updated_at TIMESTAMPTZ DEFAULT NOW()
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);
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-- ============================================================================
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-- TABLE: encounters (FHIR: Encounter / ZIB: Contact)
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-- Contactmomenten (intake, behandelsessie, etc)
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-- ============================================================================
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CREATE TABLE encounters (
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id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
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-- FHIR Encounter.identifier
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identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
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-- FHIR Encounter.status
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status encounter_status NOT NULL DEFAULT 'planned',
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-- FHIR Encounter.class
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class_code TEXT NOT NULL, -- AMB (ambulatory), IMP (inpatient), EMER (emergency)
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class_display TEXT NOT NULL,
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-- FHIR Encounter.type
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type_code TEXT NOT NULL, -- intake, diagnostiek, behandeling, follow-up
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type_display TEXT NOT NULL,
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-- FHIR Encounter.priority
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priority_code TEXT, -- routine, urgent, emergency
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priority_display TEXT,
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-- FHIR Encounter.subject (patient)
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patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
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-- FHIR Encounter.participant (behandelaar)
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practitioner_id UUID REFERENCES practitioners(id),
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-- FHIR Encounter.serviceProvider (instelling)
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organization_id UUID REFERENCES organizations(id),
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-- FHIR Encounter.period
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period_start TIMESTAMPTZ NOT NULL,
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period_end TIMESTAMPTZ,
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-- FHIR Encounter.reasonCode
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reason_code TEXT[], -- DSM-5 codes, SNOMED codes
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reason_display TEXT[], -- Human-readable reason
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-- FHIR Encounter.hospitalization (indien opname)
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admission_source TEXT,
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discharge_disposition TEXT,
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-- Free text notes
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notes TEXT,
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-- Metadata
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created_at TIMESTAMPTZ DEFAULT NOW(),
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updated_at TIMESTAMPTZ DEFAULT NOW()
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);
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-- ============================================================================
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-- TABLE: conditions (FHIR: Condition / ZIB: Problem)
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-- DSM-5 diagnoses en problemlijst
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-- ============================================================================
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CREATE TABLE conditions (
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id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
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-- FHIR Condition.identifier
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identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
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-- FHIR Condition.clinicalStatus
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clinical_status condition_clinical_status NOT NULL DEFAULT 'active',
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-- FHIR Condition.verificationStatus
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verification_status condition_verification_status NOT NULL DEFAULT 'provisional',
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-- FHIR Condition.category
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category TEXT NOT NULL DEFAULT 'encounter-diagnosis', -- of 'problem-list-item'
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-- FHIR Condition.severity
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severity_code TEXT, -- mild, moderate, severe
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severity_display TEXT,
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-- FHIR Condition.code (DSM-5 / ICD-10)
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code_system TEXT NOT NULL DEFAULT 'http://hl7.org/fhir/sid/icd-10',
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code_code TEXT NOT NULL, -- "F32.2", "F41.1"
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code_display TEXT NOT NULL, -- "Depressieve episode, ernstig"
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-- FHIR Condition.bodySite (indien relevant)
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body_site_code TEXT,
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body_site_display TEXT,
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-- FHIR Condition.subject (patient)
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patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
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-- FHIR Condition.encounter (wanneer gesteld)
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encounter_id UUID REFERENCES encounters(id),
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-- FHIR Condition.onsetDateTime / abatementDateTime
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onset_datetime TIMESTAMPTZ,
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onset_age INTEGER, -- Leeftijd bij ontstaan (optioneel)
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abatement_datetime TIMESTAMPTZ,
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abatement_age INTEGER,
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-- FHIR Condition.recordedDate
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recorded_date TIMESTAMPTZ NOT NULL DEFAULT NOW(),
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-- FHIR Condition.recorder (wie legde vast)
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recorder_id UUID REFERENCES practitioners(id),
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-- FHIR Condition.asserter (wie stelde diagnose)
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asserter_id UUID REFERENCES practitioners(id),
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-- FHIR Condition.note
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note TEXT,
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-- Metadata
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created_at TIMESTAMPTZ DEFAULT NOW(),
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updated_at TIMESTAMPTZ DEFAULT NOW()
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);
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-- ============================================================================
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-- TABLE: observations (FHIR: Observation)
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-- ROM-scores, risico's, klachten, metingen
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-- ============================================================================
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CREATE TABLE observations (
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id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
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-- FHIR Observation.identifier
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identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
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-- FHIR Observation.status
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status observation_status NOT NULL DEFAULT 'final',
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-- FHIR Observation.category
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category TEXT NOT NULL, -- vital-signs, social-history, exam, survey, therapy
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-- FHIR Observation.code (wat werd geobserveerd)
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code_system TEXT NOT NULL, -- SNOMED, LOINC, custom
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code_code TEXT NOT NULL,
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code_display TEXT NOT NULL,
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-- FHIR Observation.subject (patient)
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patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
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-- FHIR Observation.encounter
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encounter_id UUID REFERENCES encounters(id),
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-- FHIR Observation.effectiveDateTime
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effective_datetime TIMESTAMPTZ NOT NULL,
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-- FHIR Observation.issued
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issued TIMESTAMPTZ DEFAULT NOW(),
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-- FHIR Observation.performer (wie deed observatie)
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performer_id UUID REFERENCES practitioners(id),
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-- FHIR Observation.value[x] (polymorf!)
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value_type TEXT NOT NULL, -- quantity, string, boolean, codeableConcept
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value_quantity_value NUMERIC,
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value_quantity_unit TEXT,
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value_quantity_comparator TEXT, -- <, <=, >=, >
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value_string TEXT,
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value_boolean BOOLEAN,
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value_codeable_concept JSONB, -- {system, code, display}
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-- FHIR Observation.interpretation
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interpretation_code TEXT, -- H (high), L (low), N (normal)
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interpretation_display TEXT,
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-- FHIR Observation.note
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note TEXT,
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-- FHIR Observation.bodySite
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body_site TEXT,
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-- FHIR Observation.method
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method_code TEXT,
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method_display TEXT,
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-- Reference range (normaalwaarden)
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reference_range_low NUMERIC,
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reference_range_high NUMERIC,
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reference_range_text TEXT,
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-- Metadata
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created_at TIMESTAMPTZ DEFAULT NOW()
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);
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-- ============================================================================
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-- TABLE: medication_statements (FHIR: MedicationStatement)
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-- Huidige medicatie van patiënt
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-- ============================================================================
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CREATE TABLE medication_statements (
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id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
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-- FHIR MedicationStatement.identifier
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identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
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-- FHIR MedicationStatement.status
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status TEXT NOT NULL DEFAULT 'active', -- active, completed, entered-in-error, stopped
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-- FHIR MedicationStatement.medicationCodeableConcept
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medication_code TEXT NOT NULL, -- PRK, GPK, HPK code
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medication_display TEXT NOT NULL, -- "Sertraline 50mg tablet"
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medication_system TEXT DEFAULT 'http://www.whocc.no/atc', -- ATC codes
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-- FHIR MedicationStatement.subject
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patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
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-- FHIR MedicationStatement.context
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encounter_id UUID REFERENCES encounters(id),
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-- FHIR MedicationStatement.effectiveDateTime / effectivePeriod
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effective_datetime TIMESTAMPTZ,
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effective_period_start TIMESTAMPTZ,
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effective_period_end TIMESTAMPTZ,
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-- FHIR MedicationStatement.dateAsserted
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date_asserted TIMESTAMPTZ DEFAULT NOW(),
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-- FHIR MedicationStatement.informationSource
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information_source_id UUID REFERENCES practitioners(id),
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-- FHIR MedicationStatement.dosage
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dosage_text TEXT, -- "1 tablet 's ochtends"
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dosage_route TEXT, -- oraal, intraveneus, etc
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dosage_timing TEXT, -- frequency
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dosage_dose_quantity NUMERIC,
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dosage_dose_unit TEXT,
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-- FHIR MedicationStatement.reasonCode
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reason_code TEXT[],
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reason_display TEXT[],
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-- FHIR MedicationStatement.note
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note TEXT,
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-- Metadata
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created_at TIMESTAMPTZ DEFAULT NOW(),
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updated_at TIMESTAMPTZ DEFAULT NOW()
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);
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-- ============================================================================
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-- TABLE: care_plans (FHIR: CarePlan)
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-- Behandelplannen
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-- ============================================================================
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CREATE TABLE care_plans (
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id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
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-- FHIR CarePlan.identifier
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identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
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-- FHIR CarePlan.status
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status careplan_status NOT NULL DEFAULT 'draft',
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-- FHIR CarePlan.intent
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intent TEXT NOT NULL DEFAULT 'plan', -- proposal, plan, order, option
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-- FHIR CarePlan.category
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category_code TEXT DEFAULT 'ggz-behandelplan',
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category_display TEXT DEFAULT 'GGZ Behandelplan',
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-- FHIR CarePlan.title
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title TEXT NOT NULL,
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-- FHIR CarePlan.description
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description TEXT,
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-- FHIR CarePlan.subject (patient)
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patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
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-- FHIR CarePlan.encounter (intake waar uit voortkomt)
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encounter_id UUID REFERENCES encounters(id),
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-- FHIR CarePlan.period
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period_start DATE,
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period_end DATE,
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-- FHIR CarePlan.created
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created_date TIMESTAMPTZ DEFAULT NOW(),
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-- FHIR CarePlan.author (regiebehandelaar)
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author_id UUID REFERENCES practitioners(id),
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-- FHIR CarePlan.contributor
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contributor_ids UUID[], -- Array van practitioner IDs
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-- FHIR CarePlan.careTeam
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care_team_ids UUID[], -- Array van practitioner IDs
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-- FHIR CarePlan.addresses (welke diagnoses)
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addresses_condition_ids UUID[], -- Array van condition IDs
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-- FHIR CarePlan.goal (behandeldoelen als array)
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goals JSONB, -- [{description: "...", target: {...}}]
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-- FHIR CarePlan.note
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note TEXT,
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-- Metadata
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created_at TIMESTAMPTZ DEFAULT NOW(),
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updated_at TIMESTAMPTZ DEFAULT NOW()
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);
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-- ============================================================================
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-- TABLE: care_plan_activities (FHIR: CarePlan.activity)
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-- Behandelactiviteiten binnen een behandelplan
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-- ============================================================================
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CREATE TABLE care_plan_activities (
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id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
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-- Reference to parent CarePlan
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care_plan_id UUID REFERENCES care_plans(id) ON DELETE CASCADE NOT NULL,
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-- FHIR CarePlan.activity.outcomeCodeableConcept
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outcome_code TEXT,
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outcome_display TEXT,
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-- FHIR CarePlan.activity.outcomeReference
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outcome_observation_ids UUID[], -- References to observations
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-- FHIR CarePlan.activity.progress
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progress TEXT[], -- Array van voortgangsnotities
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-- FHIR CarePlan.activity.reference (ServiceRequest, Task, etc)
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reference_type TEXT, -- ServiceRequest, Appointment, Task
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reference_id UUID,
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-- FHIR CarePlan.activity.detail
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detail_kind TEXT, -- ServiceRequest, Appointment, etc
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detail_code_code TEXT,
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detail_code_display TEXT NOT NULL, -- "Individuele CGT", "ROM-meting"
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detail_status activity_status NOT NULL DEFAULT 'not-started',
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detail_status_reason TEXT,
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detail_do_not_perform BOOLEAN DEFAULT false,
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-- Scheduling
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detail_scheduled_timing TEXT, -- "1x per week", "daily"
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detail_scheduled_period_start DATE,
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detail_scheduled_period_end DATE,
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-- Location
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detail_location TEXT, -- "Polikliniek", "Online"
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-- Performer (wie voert uit)
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detail_performer_id UUID REFERENCES practitioners(id),
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-- Description
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detail_description TEXT,
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-- Metadata
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created_at TIMESTAMPTZ DEFAULT NOW(),
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updated_at TIMESTAMPTZ DEFAULT NOW()
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);
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-- ============================================================================
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-- TABLE: goals (FHIR: Goal / ZIB: TreatmentObjective)
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-- Behandeldoelen
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-- ============================================================================
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CREATE TABLE goals (
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id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
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-- FHIR Goal.identifier
|
|
identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
|
|
|
|
-- FHIR Goal.lifecycleStatus
|
|
lifecycle_status TEXT NOT NULL DEFAULT 'proposed', -- proposed, planned, accepted, active, on-hold, completed, cancelled, entered-in-error, rejected
|
|
|
|
-- FHIR Goal.achievementStatus
|
|
achievement_status TEXT, -- in-progress, improving, worsening, no-change, achieved, sustaining, not-achieved, no-progress, not-attainable
|
|
|
|
-- FHIR Goal.category
|
|
category_code TEXT DEFAULT 'treatment',
|
|
category_display TEXT DEFAULT 'Behandeldoel',
|
|
|
|
-- FHIR Goal.priority
|
|
priority_code TEXT, -- high-priority, medium-priority, low-priority
|
|
priority_display TEXT,
|
|
|
|
-- FHIR Goal.description (het doel zelf)
|
|
description_code TEXT,
|
|
description_text TEXT NOT NULL, -- "PHQ-9 score < 10", "Herstel dagelijks functioneren"
|
|
|
|
-- FHIR Goal.subject (patient)
|
|
patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
|
|
|
|
-- FHIR Goal.startDate / target.dueDate
|
|
start_date DATE,
|
|
target_due_date DATE,
|
|
|
|
-- FHIR Goal.target (meetbaar doel)
|
|
target_measure_code TEXT, -- bijv. PHQ-9 code
|
|
target_measure_display TEXT,
|
|
target_detail_quantity NUMERIC, -- bijv. < 10
|
|
target_detail_unit TEXT,
|
|
target_detail_comparator TEXT, -- <, <=, >=, >
|
|
|
|
-- FHIR Goal.expressedBy (wie stelde doel)
|
|
expressed_by_id UUID REFERENCES practitioners(id),
|
|
|
|
-- FHIR Goal.addresses (welke conditions/observations)
|
|
addresses_condition_ids UUID[], -- Array van condition IDs
|
|
addresses_observation_ids UUID[], -- Array van observation IDs
|
|
|
|
-- FHIR Goal.note
|
|
note TEXT,
|
|
|
|
-- FHIR Goal.outcomeCode / outcomeReference
|
|
outcome_code TEXT,
|
|
outcome_display TEXT,
|
|
outcome_observation_ids UUID[], -- Metingen die outcome aantonen
|
|
|
|
-- Metadata
|
|
created_at TIMESTAMPTZ DEFAULT NOW(),
|
|
updated_at TIMESTAMPTZ DEFAULT NOW()
|
|
);
|
|
|
|
-- ============================================================================
|
|
-- TABLE: consents (FHIR: Consent / ZIB: AdvanceDirective)
|
|
-- Toestemmingen, wilsverklaringen, AVG consent
|
|
-- ============================================================================
|
|
CREATE TABLE consents (
|
|
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
|
|
|
|
-- FHIR Consent.identifier
|
|
identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
|
|
|
|
-- FHIR Consent.status
|
|
status TEXT NOT NULL DEFAULT 'active', -- draft, proposed, active, rejected, inactive, entered-in-error
|
|
|
|
-- FHIR Consent.scope
|
|
scope_code TEXT NOT NULL, -- patient-privacy, research, treatment, advance-directive
|
|
scope_display TEXT NOT NULL,
|
|
|
|
-- FHIR Consent.category
|
|
category_code TEXT NOT NULL, -- acd (advance directive), dnr (do not resuscitate), emrgonly, etc
|
|
category_display TEXT NOT NULL,
|
|
|
|
-- FHIR Consent.patient
|
|
patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
|
|
|
|
-- FHIR Consent.dateTime
|
|
date_time TIMESTAMPTZ NOT NULL DEFAULT NOW(),
|
|
|
|
-- FHIR Consent.performer (wie gaf toestemming)
|
|
performer_ids UUID[], -- Patient zelf of wettelijk vertegenwoordiger
|
|
|
|
-- FHIR Consent.organization
|
|
organization_id UUID REFERENCES organizations(id),
|
|
|
|
-- FHIR Consent.sourceAttachment / sourceReference
|
|
source_attachment_data TEXT, -- PDF van ondertekende wilsverklaring
|
|
source_attachment_url TEXT,
|
|
source_document_id UUID REFERENCES document_references(id),
|
|
|
|
-- FHIR Consent.policy
|
|
policy_rule_code TEXT, -- GDPR, NL-wetgeving, etc
|
|
policy_rule_text TEXT,
|
|
|
|
-- FHIR Consent.provision (wat is toegestaan/verboden)
|
|
provision_type TEXT NOT NULL DEFAULT 'permit', -- deny, permit
|
|
provision_period_start TIMESTAMPTZ,
|
|
provision_period_end TIMESTAMPTZ,
|
|
|
|
-- Provision details (wat mag wel/niet)
|
|
provision_action TEXT[], -- access, correct, disclose, etc
|
|
provision_purpose TEXT[], -- TREAT (behandeling), ETREAT (spoedeisend), etc
|
|
|
|
-- FHIR Consent.provision.actor (wie mag)
|
|
provision_actor_ids UUID[], -- Practitioner IDs die toegang hebben
|
|
|
|
-- FHIR Consent.provision.data (welke data)
|
|
provision_data_meaning TEXT, -- instance, related, dependents, authoredby
|
|
provision_data_reference_ids UUID[], -- Specifieke resources
|
|
|
|
-- Metadata
|
|
created_at TIMESTAMPTZ DEFAULT NOW(),
|
|
updated_at TIMESTAMPTZ DEFAULT NOW()
|
|
);
|
|
|
|
-- ============================================================================
|
|
-- TABLE: flags (FHIR: Flag / ZIB: Alert)
|
|
-- Waarschuwingen en belangrijke alerts in dossier
|
|
-- ============================================================================
|
|
CREATE TABLE flags (
|
|
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
|
|
|
|
-- FHIR Flag.identifier
|
|
identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
|
|
|
|
-- FHIR Flag.status
|
|
status TEXT NOT NULL DEFAULT 'active', -- active, inactive, entered-in-error
|
|
|
|
-- FHIR Flag.category
|
|
category_code TEXT NOT NULL, -- safety, clinical, administrative, behavioral, infection, drug
|
|
category_display TEXT NOT NULL,
|
|
|
|
-- FHIR Flag.code (wat is de alert)
|
|
code_code TEXT NOT NULL,
|
|
code_display TEXT NOT NULL, -- "Suïciderisico", "Agressie naar hulpverleners", "Allergie"
|
|
|
|
-- FHIR Flag.subject (patient)
|
|
patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
|
|
|
|
-- FHIR Flag.period (hoe lang geldig)
|
|
period_start TIMESTAMPTZ NOT NULL DEFAULT NOW(),
|
|
period_end TIMESTAMPTZ,
|
|
|
|
-- FHIR Flag.encounter
|
|
encounter_id UUID REFERENCES encounters(id),
|
|
|
|
-- FHIR Flag.author (wie maakte alert)
|
|
author_id UUID REFERENCES practitioners(id),
|
|
|
|
-- Priority (custom extension - niet standaard FHIR)
|
|
priority TEXT, -- high, medium, low
|
|
|
|
-- FHIR Flag.code details
|
|
alert_type TEXT NOT NULL, -- suicide-risk, aggression, allergy, infection, fall-risk, etc
|
|
|
|
-- Extra context
|
|
description TEXT, -- Vrije tekst toelichting
|
|
|
|
-- Gerelateerde resources
|
|
related_condition_ids UUID[], -- Conditions die deze alert veroorzaken
|
|
related_observation_ids UUID[], -- Observations die deze alert ondersteunen
|
|
|
|
-- Metadata
|
|
created_at TIMESTAMPTZ DEFAULT NOW(),
|
|
updated_at TIMESTAMPTZ DEFAULT NOW()
|
|
);
|
|
|
|
-- ============================================================================
|
|
-- TABLE: document_references (FHIR: DocumentReference)
|
|
-- Documenten (intakeverslagen, behandelplannen, etc)
|
|
-- ============================================================================
|
|
CREATE TABLE document_references (
|
|
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
|
|
|
|
-- FHIR DocumentReference.identifier
|
|
identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
|
|
|
|
-- FHIR DocumentReference.status
|
|
status document_status NOT NULL DEFAULT 'current',
|
|
|
|
-- FHIR DocumentReference.docStatus
|
|
doc_status TEXT, -- preliminary, final, amended
|
|
|
|
-- FHIR DocumentReference.type
|
|
type_code TEXT NOT NULL, -- intake-verslag, behandelplan, etc
|
|
type_display TEXT NOT NULL,
|
|
|
|
-- FHIR DocumentReference.category
|
|
category TEXT DEFAULT 'clinical-note',
|
|
|
|
-- FHIR DocumentReference.subject (patient)
|
|
patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
|
|
|
|
-- FHIR DocumentReference.context.encounter
|
|
encounter_id UUID REFERENCES encounters(id),
|
|
|
|
-- FHIR DocumentReference.date
|
|
date TIMESTAMPTZ NOT NULL DEFAULT NOW(),
|
|
|
|
-- FHIR DocumentReference.author
|
|
author_id UUID REFERENCES practitioners(id),
|
|
|
|
-- FHIR DocumentReference.authenticator (wie ondertekende)
|
|
authenticator_id UUID REFERENCES practitioners(id),
|
|
|
|
-- FHIR DocumentReference.custodian (organisatie die beheert)
|
|
custodian_id UUID REFERENCES organizations(id),
|
|
|
|
-- FHIR DocumentReference.content
|
|
content_attachment_content_type TEXT DEFAULT 'text/markdown',
|
|
content_attachment_data TEXT, -- Markdown of base64
|
|
content_attachment_url TEXT, -- Of link naar storage
|
|
content_attachment_title TEXT,
|
|
content_attachment_creation TIMESTAMPTZ DEFAULT NOW(),
|
|
|
|
-- FHIR DocumentReference.context.period
|
|
context_period_start TIMESTAMPTZ,
|
|
context_period_end TIMESTAMPTZ,
|
|
|
|
-- FHIR DocumentReference.context.related (gerelateerde conditions, etc)
|
|
context_related_ids UUID[],
|
|
|
|
-- Security labels
|
|
security_label TEXT[], -- restricted, normal, unrestricted
|
|
|
|
-- Metadata
|
|
created_at TIMESTAMPTZ DEFAULT NOW(),
|
|
updated_at TIMESTAMPTZ DEFAULT NOW()
|
|
);
|
|
|
|
-- ============================================================================
|
|
-- INDEXES (voor performance)
|
|
-- ============================================================================
|
|
|
|
-- Practitioners
|
|
CREATE INDEX idx_practitioners_user_id ON practitioners(user_id);
|
|
CREATE INDEX idx_practitioners_active ON practitioners(active);
|
|
|
|
-- Patients
|
|
CREATE INDEX idx_patients_bsn ON patients(identifier_bsn);
|
|
CREATE INDEX idx_patients_active ON patients(active);
|
|
|
|
-- Encounters
|
|
CREATE INDEX idx_encounters_patient_id ON encounters(patient_id);
|
|
CREATE INDEX idx_encounters_practitioner_id ON encounters(practitioner_id);
|
|
CREATE INDEX idx_encounters_status ON encounters(status);
|
|
CREATE INDEX idx_encounters_period_start ON encounters(period_start DESC);
|
|
|
|
-- Conditions
|
|
CREATE INDEX idx_conditions_patient_id ON conditions(patient_id);
|
|
CREATE INDEX idx_conditions_encounter_id ON conditions(encounter_id);
|
|
CREATE INDEX idx_conditions_clinical_status ON conditions(clinical_status);
|
|
CREATE INDEX idx_conditions_code ON conditions(code_code);
|
|
|
|
-- Observations
|
|
CREATE INDEX idx_observations_patient_id ON observations(patient_id);
|
|
CREATE INDEX idx_observations_encounter_id ON observations(encounter_id);
|
|
CREATE INDEX idx_observations_category ON observations(category);
|
|
CREATE INDEX idx_observations_effective_datetime ON observations(effective_datetime DESC);
|
|
|
|
-- Medication Statements
|
|
CREATE INDEX idx_medication_statements_patient_id ON medication_statements(patient_id);
|
|
CREATE INDEX idx_medication_statements_status ON medication_statements(status);
|
|
|
|
-- Care Plans
|
|
CREATE INDEX idx_care_plans_patient_id ON care_plans(patient_id);
|
|
CREATE INDEX idx_care_plans_status ON care_plans(status);
|
|
CREATE INDEX idx_care_plans_author_id ON care_plans(author_id);
|
|
|
|
-- Care Plan Activities
|
|
CREATE INDEX idx_care_plan_activities_care_plan_id ON care_plan_activities(care_plan_id);
|
|
CREATE INDEX idx_care_plan_activities_status ON care_plan_activities(detail_status);
|
|
|
|
-- Document References
|
|
CREATE INDEX idx_document_references_patient_id ON document_references(patient_id);
|
|
CREATE INDEX idx_document_references_encounter_id ON document_references(encounter_id);
|
|
CREATE INDEX idx_document_references_type ON document_references(type_code);
|
|
|
|
-- Goals
|
|
CREATE INDEX idx_goals_patient_id ON goals(patient_id);
|
|
CREATE INDEX idx_goals_lifecycle_status ON goals(lifecycle_status);
|
|
CREATE INDEX idx_goals_achievement_status ON goals(achievement_status);
|
|
|
|
-- Consents
|
|
CREATE INDEX idx_consents_patient_id ON consents(patient_id);
|
|
CREATE INDEX idx_consents_status ON consents(status);
|
|
CREATE INDEX idx_consents_scope ON consents(scope_code);
|
|
CREATE INDEX idx_consents_category ON consents(category_code);
|
|
|
|
-- Flags
|
|
CREATE INDEX idx_flags_patient_id ON flags(patient_id);
|
|
CREATE INDEX idx_flags_status ON flags(status);
|
|
CREATE INDEX idx_flags_category ON flags(category_code);
|
|
CREATE INDEX idx_flags_alert_type ON flags(alert_type);
|
|
CREATE INDEX idx_flags_priority ON flags(priority);
|
|
|
|
-- ============================================================================
|
|
-- ROW LEVEL SECURITY (RLS) - basis setup
|
|
-- ============================================================================
|
|
|
|
-- Enable RLS on all tables
|
|
ALTER TABLE practitioners ENABLE ROW LEVEL SECURITY;
|
|
ALTER TABLE organizations ENABLE ROW LEVEL SECURITY;
|
|
ALTER TABLE patients ENABLE ROW LEVEL SECURITY;
|
|
ALTER TABLE encounters ENABLE ROW LEVEL SECURITY;
|
|
ALTER TABLE conditions ENABLE ROW LEVEL SECURITY;
|
|
ALTER TABLE observations ENABLE ROW LEVEL SECURITY;
|
|
ALTER TABLE medication_statements ENABLE ROW LEVEL SECURITY;
|
|
ALTER TABLE care_plans ENABLE ROW LEVEL SECURITY;
|
|
ALTER TABLE care_plan_activities ENABLE ROW LEVEL SECURITY;
|
|
ALTER TABLE document_references ENABLE ROW LEVEL SECURITY;
|
|
ALTER TABLE goals ENABLE ROW LEVEL SECURITY;
|
|
ALTER TABLE consents ENABLE ROW LEVEL SECURITY;
|
|
ALTER TABLE flags ENABLE ROW LEVEL SECURITY;
|
|
|
|
-- Voor MVP: practitioners kunnen alles zien/bewerken van hun eigen patiënten
|
|
-- Later verfijnen met teams, roles, etc.
|
|
|
|
-- Practitioners: can read/update their own record
|
|
CREATE POLICY "Practitioners can view own record" ON practitioners
|
|
FOR SELECT USING (user_id = auth.uid());
|
|
|
|
CREATE POLICY "Practitioners can update own record" ON practitioners
|
|
FOR UPDATE USING (user_id = auth.uid());
|
|
|
|
-- Patients: practitioners can view all (voor MVP - later verfijnen)
|
|
CREATE POLICY "Authenticated users can view patients" ON patients
|
|
FOR SELECT USING (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can insert patients" ON patients
|
|
FOR INSERT WITH CHECK (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can update patients" ON patients
|
|
FOR UPDATE USING (auth.role() = 'authenticated');
|
|
|
|
-- Encounters: authenticated users can view/create
|
|
CREATE POLICY "Authenticated users can view encounters" ON encounters
|
|
FOR SELECT USING (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can insert encounters" ON encounters
|
|
FOR INSERT WITH CHECK (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can update encounters" ON encounters
|
|
FOR UPDATE USING (auth.role() = 'authenticated');
|
|
|
|
-- Conditions: authenticated users can view/create
|
|
CREATE POLICY "Authenticated users can view conditions" ON conditions
|
|
FOR SELECT USING (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can insert conditions" ON conditions
|
|
FOR INSERT WITH CHECK (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can update conditions" ON conditions
|
|
FOR UPDATE USING (auth.role() = 'authenticated');
|
|
|
|
-- Observations: authenticated users can view/create
|
|
CREATE POLICY "Authenticated users can view observations" ON observations
|
|
FOR SELECT USING (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can insert observations" ON observations
|
|
FOR INSERT WITH CHECK (auth.role() = 'authenticated');
|
|
|
|
-- Medication Statements: authenticated users can view/create
|
|
CREATE POLICY "Authenticated users can view medications" ON medication_statements
|
|
FOR SELECT USING (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can insert medications" ON medication_statements
|
|
FOR INSERT WITH CHECK (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can update medications" ON medication_statements
|
|
FOR UPDATE USING (auth.role() = 'authenticated');
|
|
|
|
-- Care Plans: authenticated users can view/create
|
|
CREATE POLICY "Authenticated users can view care plans" ON care_plans
|
|
FOR SELECT USING (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can insert care plans" ON care_plans
|
|
FOR INSERT WITH CHECK (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can update care plans" ON care_plans
|
|
FOR UPDATE USING (auth.role() = 'authenticated');
|
|
|
|
-- Care Plan Activities: authenticated users can view/create
|
|
CREATE POLICY "Authenticated users can view activities" ON care_plan_activities
|
|
FOR SELECT USING (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can insert activities" ON care_plan_activities
|
|
FOR INSERT WITH CHECK (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can update activities" ON care_plan_activities
|
|
FOR UPDATE USING (auth.role() = 'authenticated');
|
|
|
|
-- Document References: authenticated users can view/create
|
|
CREATE POLICY "Authenticated users can view documents" ON document_references
|
|
FOR SELECT USING (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can insert documents" ON document_references
|
|
FOR INSERT WITH CHECK (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can update documents" ON document_references
|
|
FOR UPDATE USING (auth.role() = 'authenticated');
|
|
|
|
-- Goals: authenticated users can view/create
|
|
CREATE POLICY "Authenticated users can view goals" ON goals
|
|
FOR SELECT USING (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can insert goals" ON goals
|
|
FOR INSERT WITH CHECK (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can update goals" ON goals
|
|
FOR UPDATE USING (auth.role() = 'authenticated');
|
|
|
|
-- Consents: authenticated users can view/create
|
|
CREATE POLICY "Authenticated users can view consents" ON consents
|
|
FOR SELECT USING (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can insert consents" ON consents
|
|
FOR INSERT WITH CHECK (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can update consents" ON consents
|
|
FOR UPDATE USING (auth.role() = 'authenticated');
|
|
|
|
-- Flags: authenticated users can view/create
|
|
CREATE POLICY "Authenticated users can view flags" ON flags
|
|
FOR SELECT USING (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can insert flags" ON flags
|
|
FOR INSERT WITH CHECK (auth.role() = 'authenticated');
|
|
|
|
CREATE POLICY "Authenticated users can update flags" ON flags
|
|
FOR UPDATE USING (auth.role() = 'authenticated');
|
|
|
|
-- ============================================================================
|
|
-- FUNCTIONS - updated_at trigger
|
|
-- ============================================================================
|
|
|
|
CREATE OR REPLACE FUNCTION update_updated_at_column()
|
|
RETURNS TRIGGER AS $$
|
|
BEGIN
|
|
NEW.updated_at = NOW();
|
|
RETURN NEW;
|
|
END;
|
|
$$ LANGUAGE plpgsql;
|
|
|
|
-- Apply trigger to all tables with updated_at
|
|
CREATE TRIGGER set_updated_at BEFORE UPDATE ON practitioners
|
|
FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
|
|
|
|
CREATE TRIGGER set_updated_at BEFORE UPDATE ON organizations
|
|
FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
|
|
|
|
CREATE TRIGGER set_updated_at BEFORE UPDATE ON patients
|
|
FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
|
|
|
|
CREATE TRIGGER set_updated_at BEFORE UPDATE ON encounters
|
|
FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
|
|
|
|
CREATE TRIGGER set_updated_at BEFORE UPDATE ON conditions
|
|
FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
|
|
|
|
CREATE TRIGGER set_updated_at BEFORE UPDATE ON medication_statements
|
|
FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
|
|
|
|
CREATE TRIGGER set_updated_at BEFORE UPDATE ON care_plans
|
|
FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
|
|
|
|
CREATE TRIGGER set_updated_at BEFORE UPDATE ON care_plan_activities
|
|
FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
|
|
|
|
CREATE TRIGGER set_updated_at BEFORE UPDATE ON document_references
|
|
FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
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CREATE TRIGGER set_updated_at BEFORE UPDATE ON goals
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FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
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CREATE TRIGGER set_updated_at BEFORE UPDATE ON consents
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FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
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CREATE TRIGGER set_updated_at BEFORE UPDATE ON flags
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FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
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-- ============================================================================
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-- COMMENTS (documentatie in database)
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-- ============================================================================
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COMMENT ON TABLE practitioners IS 'FHIR: Practitioner - Behandelaren en zorgprofessionals';
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COMMENT ON TABLE organizations IS 'FHIR: Organization - GGZ-instellingen';
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COMMENT ON TABLE patients IS 'FHIR: Patient / ZIB: Patient - Cliënten/patiënten';
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COMMENT ON TABLE encounters IS 'FHIR: Encounter / ZIB: Contact - Contactmomenten (intake, behandeling, etc)';
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COMMENT ON TABLE conditions IS 'FHIR: Condition / ZIB: Problem - DSM-5 diagnoses en problemlijst';
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COMMENT ON TABLE observations IS 'FHIR: Observation - ROM-scores, risico-inschattingen, metingen';
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COMMENT ON TABLE medication_statements IS 'FHIR: MedicationStatement - Huidige medicatie van patiënt';
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COMMENT ON TABLE care_plans IS 'FHIR: CarePlan - Behandelplannen';
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COMMENT ON TABLE care_plan_activities IS 'FHIR: CarePlan.activity - Behandelactiviteiten';
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COMMENT ON TABLE document_references IS 'FHIR: DocumentReference - Intakeverslagen, brieven, etc';
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COMMENT ON TABLE goals IS 'FHIR: Goal / ZIB: TreatmentObjective - Behandeldoelen';
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COMMENT ON TABLE consents IS 'FHIR: Consent / ZIB: AdvanceDirective - Toestemmingen en wilsverklaringen';
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COMMENT ON TABLE flags IS 'FHIR: Flag / ZIB: Alert - Waarschuwingen en alerts in dossier';
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-- ============================================================================
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-- SAMPLE DATA (optioneel - voor development/demo)
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-- ============================================================================
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-- Uncomment onderstaande voor demo data:
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-- INSERT INTO organizations (name, identifier_agb) VALUES
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-- ('Demo GGZ Instelling', 'AGB12345678');
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-- Voltooid! Schema is FHIR-compliant en klaar voor MedMIJ/Koppeltaal integratie.
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