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triqura-ecd/docs/archive/schemas/20241121_fhir_ggz_schema.sql
2025-11-23 10:13:00 +01:00

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PL/PgSQL

-- Migration: FHIR-compliant GGZ EPD Schema
-- Created: 2024-11-21
-- Description: Core tables for intake, diagnostiek en behandelplan
-- Based on: FHIR R4, MedMIJ Basisgegevens GGZ 2.0, Koppeltaal
-- ============================================================================
-- ENABLE EXTENSIONS
-- ============================================================================
CREATE EXTENSION IF NOT EXISTS "uuid-ossp";
CREATE EXTENSION IF NOT EXISTS "pgcrypto";
-- ============================================================================
-- ENUM TYPES (for type safety)
-- ============================================================================
-- FHIR Gender
CREATE TYPE gender_type AS ENUM ('male', 'female', 'other', 'unknown');
-- FHIR Encounter Status
CREATE TYPE encounter_status AS ENUM (
'planned', 'in-progress', 'on-hold', 'completed',
'cancelled', 'entered-in-error', 'unknown'
);
-- FHIR Condition Clinical Status
CREATE TYPE condition_clinical_status AS ENUM (
'active', 'recurrence', 'relapse', 'inactive',
'remission', 'resolved', 'unknown'
);
-- FHIR Condition Verification Status
CREATE TYPE condition_verification_status AS ENUM (
'unconfirmed', 'provisional', 'differential',
'confirmed', 'refuted', 'entered-in-error'
);
-- FHIR Observation Status
CREATE TYPE observation_status AS ENUM (
'registered', 'preliminary', 'final', 'amended',
'corrected', 'cancelled', 'entered-in-error', 'unknown'
);
-- FHIR CarePlan Status
CREATE TYPE careplan_status AS ENUM (
'draft', 'active', 'on-hold', 'revoked',
'completed', 'entered-in-error', 'unknown'
);
-- FHIR CarePlan Activity Status
CREATE TYPE activity_status AS ENUM (
'not-started', 'scheduled', 'in-progress',
'on-hold', 'completed', 'cancelled', 'stopped', 'unknown'
);
-- FHIR DocumentReference Status
CREATE TYPE document_status AS ENUM (
'current', 'superseded', 'entered-in-error'
);
-- ============================================================================
-- TABLE: practitioners (FHIR: Practitioner)
-- Behandelaren/professionals
-- ============================================================================
CREATE TABLE practitioners (
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
-- FHIR Practitioner fields
identifier_big TEXT UNIQUE, -- BIG-nummer (optioneel voor niet-BIG geregistreerden)
identifier_agb TEXT, -- AGB-code
-- Name (HumanName)
name_prefix TEXT, -- "Drs.", "Dr."
name_given TEXT[] NOT NULL, -- Voornamen
name_family TEXT NOT NULL, -- Achternaam
name_suffix TEXT, -- "PhD", "MSc"
-- Qualification
qualification TEXT[], -- ["GZ-psycholoog", "Psychotherapeut"]
-- Contact
telecom_phone TEXT,
telecom_email TEXT,
-- Active
active BOOLEAN DEFAULT true,
-- Link to auth user
user_id UUID REFERENCES auth.users(id) ON DELETE CASCADE,
-- Metadata
created_at TIMESTAMPTZ DEFAULT NOW(),
updated_at TIMESTAMPTZ DEFAULT NOW()
);
-- ============================================================================
-- TABLE: organizations (FHIR: Organization)
-- GGZ-instellingen
-- ============================================================================
CREATE TABLE organizations (
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
-- FHIR Organization fields
identifier_agb TEXT UNIQUE, -- AGB-code instelling
identifier_kvk TEXT, -- KVK-nummer
-- Name
name TEXT NOT NULL,
alias TEXT[], -- Alternative names
-- Type
type_code TEXT DEFAULT 'prov', -- healthcare provider
type_display TEXT DEFAULT 'Healthcare Provider',
-- Contact
telecom_phone TEXT,
telecom_email TEXT,
telecom_website TEXT,
-- Address
address_line TEXT[],
address_city TEXT,
address_postal_code TEXT,
address_country TEXT DEFAULT 'NL',
-- Active
active BOOLEAN DEFAULT true,
-- Metadata
created_at TIMESTAMPTZ DEFAULT NOW(),
updated_at TIMESTAMPTZ DEFAULT NOW()
);
-- ============================================================================
-- TABLE: patients (FHIR: Patient / ZIB: Patient)
-- Cliënten/patiënten
-- ============================================================================
CREATE TABLE patients (
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
-- FHIR Patient.identifier
identifier_bsn TEXT UNIQUE NOT NULL, -- BSN (verplicht in NL)
identifier_client_number TEXT, -- Interne cliëntnummer
-- FHIR Patient.name (HumanName)
name_family TEXT NOT NULL, -- Achternaam
name_given TEXT[] NOT NULL, -- Voornamen array
name_prefix TEXT, -- Voorvoegsel (van, de, etc)
name_use TEXT DEFAULT 'official', -- official, maiden, nickname
-- FHIR Patient.birthDate
birth_date DATE NOT NULL,
-- FHIR Patient.gender
gender gender_type NOT NULL,
-- FHIR Patient.telecom (ContactPoint)
telecom_phone TEXT,
telecom_email TEXT,
-- FHIR Patient.address (Address)
address_line TEXT[], -- Straat + huisnummer
address_city TEXT,
address_postal_code TEXT,
address_country TEXT DEFAULT 'NL',
-- Insurance (ZIB: Payer)
insurance_company TEXT, -- Zorgverzekeraar
insurance_number TEXT, -- Polisnummer
-- FHIR Patient.contact (naasten)
emergency_contact_name TEXT,
emergency_contact_relationship TEXT,
emergency_contact_phone TEXT,
-- FHIR Patient.active
active BOOLEAN DEFAULT true,
-- FHIR Patient.generalPractitioner (huisarts)
general_practitioner_name TEXT,
general_practitioner_agb TEXT,
-- Metadata
created_at TIMESTAMPTZ DEFAULT NOW(),
updated_at TIMESTAMPTZ DEFAULT NOW()
);
-- ============================================================================
-- TABLE: encounters (FHIR: Encounter / ZIB: Contact)
-- Contactmomenten (intake, behandelsessie, etc)
-- ============================================================================
CREATE TABLE encounters (
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
-- FHIR Encounter.identifier
identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
-- FHIR Encounter.status
status encounter_status NOT NULL DEFAULT 'planned',
-- FHIR Encounter.class
class_code TEXT NOT NULL, -- AMB (ambulatory), IMP (inpatient), EMER (emergency)
class_display TEXT NOT NULL,
-- FHIR Encounter.type
type_code TEXT NOT NULL, -- intake, diagnostiek, behandeling, follow-up
type_display TEXT NOT NULL,
-- FHIR Encounter.priority
priority_code TEXT, -- routine, urgent, emergency
priority_display TEXT,
-- FHIR Encounter.subject (patient)
patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
-- FHIR Encounter.participant (behandelaar)
practitioner_id UUID REFERENCES practitioners(id),
-- FHIR Encounter.serviceProvider (instelling)
organization_id UUID REFERENCES organizations(id),
-- FHIR Encounter.period
period_start TIMESTAMPTZ NOT NULL,
period_end TIMESTAMPTZ,
-- FHIR Encounter.reasonCode
reason_code TEXT[], -- DSM-5 codes, SNOMED codes
reason_display TEXT[], -- Human-readable reason
-- FHIR Encounter.hospitalization (indien opname)
admission_source TEXT,
discharge_disposition TEXT,
-- Free text notes
notes TEXT,
-- Metadata
created_at TIMESTAMPTZ DEFAULT NOW(),
updated_at TIMESTAMPTZ DEFAULT NOW()
);
-- ============================================================================
-- TABLE: conditions (FHIR: Condition / ZIB: Problem)
-- DSM-5 diagnoses en problemlijst
-- ============================================================================
CREATE TABLE conditions (
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
-- FHIR Condition.identifier
identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
-- FHIR Condition.clinicalStatus
clinical_status condition_clinical_status NOT NULL DEFAULT 'active',
-- FHIR Condition.verificationStatus
verification_status condition_verification_status NOT NULL DEFAULT 'provisional',
-- FHIR Condition.category
category TEXT NOT NULL DEFAULT 'encounter-diagnosis', -- of 'problem-list-item'
-- FHIR Condition.severity
severity_code TEXT, -- mild, moderate, severe
severity_display TEXT,
-- FHIR Condition.code (DSM-5 / ICD-10)
code_system TEXT NOT NULL DEFAULT 'http://hl7.org/fhir/sid/icd-10',
code_code TEXT NOT NULL, -- "F32.2", "F41.1"
code_display TEXT NOT NULL, -- "Depressieve episode, ernstig"
-- FHIR Condition.bodySite (indien relevant)
body_site_code TEXT,
body_site_display TEXT,
-- FHIR Condition.subject (patient)
patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
-- FHIR Condition.encounter (wanneer gesteld)
encounter_id UUID REFERENCES encounters(id),
-- FHIR Condition.onsetDateTime / abatementDateTime
onset_datetime TIMESTAMPTZ,
onset_age INTEGER, -- Leeftijd bij ontstaan (optioneel)
abatement_datetime TIMESTAMPTZ,
abatement_age INTEGER,
-- FHIR Condition.recordedDate
recorded_date TIMESTAMPTZ NOT NULL DEFAULT NOW(),
-- FHIR Condition.recorder (wie legde vast)
recorder_id UUID REFERENCES practitioners(id),
-- FHIR Condition.asserter (wie stelde diagnose)
asserter_id UUID REFERENCES practitioners(id),
-- FHIR Condition.note
note TEXT,
-- Metadata
created_at TIMESTAMPTZ DEFAULT NOW(),
updated_at TIMESTAMPTZ DEFAULT NOW()
);
-- ============================================================================
-- TABLE: observations (FHIR: Observation)
-- ROM-scores, risico's, klachten, metingen
-- ============================================================================
CREATE TABLE observations (
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
-- FHIR Observation.identifier
identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
-- FHIR Observation.status
status observation_status NOT NULL DEFAULT 'final',
-- FHIR Observation.category
category TEXT NOT NULL, -- vital-signs, social-history, exam, survey, therapy
-- FHIR Observation.code (wat werd geobserveerd)
code_system TEXT NOT NULL, -- SNOMED, LOINC, custom
code_code TEXT NOT NULL,
code_display TEXT NOT NULL,
-- FHIR Observation.subject (patient)
patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
-- FHIR Observation.encounter
encounter_id UUID REFERENCES encounters(id),
-- FHIR Observation.effectiveDateTime
effective_datetime TIMESTAMPTZ NOT NULL,
-- FHIR Observation.issued
issued TIMESTAMPTZ DEFAULT NOW(),
-- FHIR Observation.performer (wie deed observatie)
performer_id UUID REFERENCES practitioners(id),
-- FHIR Observation.value[x] (polymorf!)
value_type TEXT NOT NULL, -- quantity, string, boolean, codeableConcept
value_quantity_value NUMERIC,
value_quantity_unit TEXT,
value_quantity_comparator TEXT, -- <, <=, >=, >
value_string TEXT,
value_boolean BOOLEAN,
value_codeable_concept JSONB, -- {system, code, display}
-- FHIR Observation.interpretation
interpretation_code TEXT, -- H (high), L (low), N (normal)
interpretation_display TEXT,
-- FHIR Observation.note
note TEXT,
-- FHIR Observation.bodySite
body_site TEXT,
-- FHIR Observation.method
method_code TEXT,
method_display TEXT,
-- Reference range (normaalwaarden)
reference_range_low NUMERIC,
reference_range_high NUMERIC,
reference_range_text TEXT,
-- Metadata
created_at TIMESTAMPTZ DEFAULT NOW()
);
-- ============================================================================
-- TABLE: medication_statements (FHIR: MedicationStatement)
-- Huidige medicatie van patiënt
-- ============================================================================
CREATE TABLE medication_statements (
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
-- FHIR MedicationStatement.identifier
identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
-- FHIR MedicationStatement.status
status TEXT NOT NULL DEFAULT 'active', -- active, completed, entered-in-error, stopped
-- FHIR MedicationStatement.medicationCodeableConcept
medication_code TEXT NOT NULL, -- PRK, GPK, HPK code
medication_display TEXT NOT NULL, -- "Sertraline 50mg tablet"
medication_system TEXT DEFAULT 'http://www.whocc.no/atc', -- ATC codes
-- FHIR MedicationStatement.subject
patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
-- FHIR MedicationStatement.context
encounter_id UUID REFERENCES encounters(id),
-- FHIR MedicationStatement.effectiveDateTime / effectivePeriod
effective_datetime TIMESTAMPTZ,
effective_period_start TIMESTAMPTZ,
effective_period_end TIMESTAMPTZ,
-- FHIR MedicationStatement.dateAsserted
date_asserted TIMESTAMPTZ DEFAULT NOW(),
-- FHIR MedicationStatement.informationSource
information_source_id UUID REFERENCES practitioners(id),
-- FHIR MedicationStatement.dosage
dosage_text TEXT, -- "1 tablet 's ochtends"
dosage_route TEXT, -- oraal, intraveneus, etc
dosage_timing TEXT, -- frequency
dosage_dose_quantity NUMERIC,
dosage_dose_unit TEXT,
-- FHIR MedicationStatement.reasonCode
reason_code TEXT[],
reason_display TEXT[],
-- FHIR MedicationStatement.note
note TEXT,
-- Metadata
created_at TIMESTAMPTZ DEFAULT NOW(),
updated_at TIMESTAMPTZ DEFAULT NOW()
);
-- ============================================================================
-- TABLE: care_plans (FHIR: CarePlan)
-- Behandelplannen
-- ============================================================================
CREATE TABLE care_plans (
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
-- FHIR CarePlan.identifier
identifier TEXT UNIQUE DEFAULT gen_random_uuid()::TEXT,
-- FHIR CarePlan.status
status careplan_status NOT NULL DEFAULT 'draft',
-- FHIR CarePlan.intent
intent TEXT NOT NULL DEFAULT 'plan', -- proposal, plan, order, option
-- FHIR CarePlan.category
category_code TEXT DEFAULT 'ggz-behandelplan',
category_display TEXT DEFAULT 'GGZ Behandelplan',
-- FHIR CarePlan.title
title TEXT NOT NULL,
-- FHIR CarePlan.description
description TEXT,
-- FHIR CarePlan.subject (patient)
patient_id UUID REFERENCES patients(id) ON DELETE CASCADE NOT NULL,
-- FHIR CarePlan.encounter (intake waar uit voortkomt)
encounter_id UUID REFERENCES encounters(id),
-- FHIR CarePlan.period
period_start DATE,
period_end DATE,
-- FHIR CarePlan.created
created_date TIMESTAMPTZ DEFAULT NOW(),
-- FHIR CarePlan.author (regiebehandelaar)
author_id UUID REFERENCES practitioners(id),
-- FHIR CarePlan.contributor
contributor_ids UUID[], -- Array van practitioner IDs
-- FHIR CarePlan.careTeam
care_team_ids UUID[], -- Array van practitioner IDs
-- FHIR CarePlan.addresses (welke diagnoses)
addresses_condition_ids UUID[], -- Array van condition IDs
-- FHIR CarePlan.goal (behandeldoelen als array)
goals JSONB, -- [{description: "...", target: {...}}]
-- FHIR CarePlan.note
note TEXT,
-- Metadata
created_at TIMESTAMPTZ DEFAULT NOW(),
updated_at TIMESTAMPTZ DEFAULT NOW()
);
-- ============================================================================
-- TABLE: care_plan_activities (FHIR: CarePlan.activity)
-- Behandelactiviteiten binnen een behandelplan
-- ============================================================================
CREATE TABLE care_plan_activities (
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
-- Reference to parent CarePlan
care_plan_id UUID REFERENCES care_plans(id) ON DELETE CASCADE NOT NULL,
-- FHIR CarePlan.activity.outcomeCodeableConcept
outcome_code TEXT,
outcome_display TEXT,
-- FHIR CarePlan.activity.outcomeReference
outcome_observation_ids UUID[], -- References to observations
-- FHIR CarePlan.activity.progress
progress TEXT[], -- Array van voortgangsnotities
-- FHIR CarePlan.activity.reference (ServiceRequest, Task, etc)
reference_type TEXT, -- ServiceRequest, Appointment, Task
reference_id UUID,
-- FHIR CarePlan.activity.detail
detail_kind TEXT, -- ServiceRequest, Appointment, etc
detail_code_code TEXT,
detail_code_display TEXT NOT NULL, -- "Individuele CGT", "ROM-meting"
detail_status activity_status NOT NULL DEFAULT 'not-started',
detail_status_reason TEXT,
detail_do_not_perform BOOLEAN DEFAULT false,
-- Scheduling
detail_scheduled_timing TEXT, -- "1x per week", "daily"
detail_scheduled_period_start DATE,
detail_scheduled_period_end DATE,
-- Location
detail_location TEXT, -- "Polikliniek", "Online"
-- Performer (wie voert uit)
detail_performer_id UUID REFERENCES practitioners(id),
-- Description
detail_description TEXT,
-- Metadata
created_at TIMESTAMPTZ DEFAULT NOW(),
updated_at TIMESTAMPTZ DEFAULT NOW()
);
-- ============================================================================
-- TABLE: goals (FHIR: Goal / ZIB: TreatmentObjective)
-- Behandeldoelen
-- ============================================================================
CREATE TABLE goals (
id UUID PRIMARY KEY DEFAULT gen_random_uuid(),
-- 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();
CREATE TRIGGER set_updated_at BEFORE UPDATE ON goals
FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
CREATE TRIGGER set_updated_at BEFORE UPDATE ON consents
FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
CREATE TRIGGER set_updated_at BEFORE UPDATE ON flags
FOR EACH ROW EXECUTE FUNCTION update_updated_at_column();
-- ============================================================================
-- COMMENTS (documentatie in database)
-- ============================================================================
COMMENT ON TABLE practitioners IS 'FHIR: Practitioner - Behandelaren en zorgprofessionals';
COMMENT ON TABLE organizations IS 'FHIR: Organization - GGZ-instellingen';
COMMENT ON TABLE patients IS 'FHIR: Patient / ZIB: Patient - Cliënten/patiënten';
COMMENT ON TABLE encounters IS 'FHIR: Encounter / ZIB: Contact - Contactmomenten (intake, behandeling, etc)';
COMMENT ON TABLE conditions IS 'FHIR: Condition / ZIB: Problem - DSM-5 diagnoses en problemlijst';
COMMENT ON TABLE observations IS 'FHIR: Observation - ROM-scores, risico-inschattingen, metingen';
COMMENT ON TABLE medication_statements IS 'FHIR: MedicationStatement - Huidige medicatie van patiënt';
COMMENT ON TABLE care_plans IS 'FHIR: CarePlan - Behandelplannen';
COMMENT ON TABLE care_plan_activities IS 'FHIR: CarePlan.activity - Behandelactiviteiten';
COMMENT ON TABLE document_references IS 'FHIR: DocumentReference - Intakeverslagen, brieven, etc';
COMMENT ON TABLE goals IS 'FHIR: Goal / ZIB: TreatmentObjective - Behandeldoelen';
COMMENT ON TABLE consents IS 'FHIR: Consent / ZIB: AdvanceDirective - Toestemmingen en wilsverklaringen';
COMMENT ON TABLE flags IS 'FHIR: Flag / ZIB: Alert - Waarschuwingen en alerts in dossier';
-- ============================================================================
-- SAMPLE DATA (optioneel - voor development/demo)
-- ============================================================================
-- Uncomment onderstaande voor demo data:
-- INSERT INTO organizations (name, identifier_agb) VALUES
-- ('Demo GGZ Instelling', 'AGB12345678');
-- Voltooid! Schema is FHIR-compliant en klaar voor MedMIJ/Koppeltaal integratie.