German Practice Management FHIR Profiles (R4)
0.71.0 - STU1 DE

German Practice Management FHIR Profiles (R4) - Local Development build (v0.71.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Official URL: https://fhir.cognovis.de/praxis/ImplementationGuide/de.cognovis.fhir.praxis Version: 0.71.0
Active as of 2026-05-30 Computable Name: GermanPracticeManagementProfiles
Other Identifiers: OID:2.16.840.1.113883.3.7985

German Practice Management FHIR Profiles

FHIR R4 profiles and extensions for German ambulatory practice management (Vertragsarzt/MVZ). This Implementation Guide defines a comprehensive, PVS-agnostic extension layer for the day-to-day data needs of German medical practices — from billing and budget management to AI provenance tracking under the EU AI Act.

Any German practice management system can map its internal data model to these profiles. The IG deliberately avoids vendor-specific structures and instead models the shared regulatory and clinical domain.

Scope

Domain Description
Billing (EBM/GOÄ/BGT) EBM-Ziffern, GOÄ-Faktoren inkl. Sachkosten/Analogziffern, BGT2001, Scheinarten, Abrechnungsquartal
Selektivverträge (HZV) Generisches Katalogmodell für HZV/Facharztverträge aller KV-Regionen über ChargeItemDefinition
Budget Management (RLV/QZV) Regelleistungsvolumen, qualifikationsgebundene Zusatzvolumina, Entbudgetierung
Remittance (Honorarbescheid) KV-Honorarbescheide, Richtigstellungen, Auszahlungsbeträge
Private Billing Workflow Freigabe-/Review-Status für Privatrechnungen
Queue Management (Warteraum) Ankunftszeiten, Aufrufzeiten, R5-Encounter.subjectStatus-Backport
AI Provenance (EU AI Act) KI-Herkunftskennzeichnung gemäß Art. 50, Modellversion, menschliche Prüfung
Administrative Workflows Aufgaben, Genehmigungen, Überweisungen, Einweisungen, Einwilligungen, AU-Bescheinigungen

HZV/Selektivvertrags-Leistungskontext

HZV-Verträge werden nicht in dieser IG enumeriert — die konkreten Vertragsausprägungen (AOK Bayern, TK, etc.) werden durch den jeweiligen PVS-Adapter als Contract-Ressourcen erzeugt und via Account.coverage -> Coverage(HZV) referenziert (die EXT_HZV.rechnungsschema Extension wurde in Version 0.69.0 retired; der Vertragskontext liegt jetzt auf dem AccountPraxisSchein). Die IG definiert nur die Struktur, nicht den Inhalt der Verträge.

Bei Leistungen im Rahmen eines Hausarztvertrags (73b SGB V) oder Facharztvertrags (73b SGB V) oder Facharztvertrags (

  • ChargeItem.code.coding.system trägt den konkreten Vertragskatalog dieses Vertrags (z.B. https://fhir.cognovis.de/praxis/CodeSystem/hzv-bayern-ek), nicht EBM. EBM bleibt nur korrekt, wenn die Leistung tatsächlich im EBM-Kontext abgerechnet wird.
  • Der Versicherungs-/Vertragskontext wird über Coverage.class (Vertragsreferenz) und Contract (Vertragsdetails mit Contract.identifier / hvg-Extensions) abgebildet.
  • Anti-Pattern: Eine HZV-/Selektivvertragsleistung darf nicht nur deshalb als EBM codiert werden, weil das PVS den Fall als GKV-nahen Schein führt. EBM→HZV ConceptMaps sind nur Übersetzungsvorschläge, keine Pricing-Quelle.
  • Die PVS-spezifische Erkennung des HZV-Kontexts gehört in den jeweiligen Adapter, nicht in dieses IG.

Siehe Beispiel: HZV-Szenario (Coverage mit HZV class, Contract mit hvg-kennung, ChargeItem mit HZV-Katalog-CodeSystem).

Extension Categories

  • Encounter / Warteraum — Queue management with arrival and call timestamps
  • Billing / Abrechnung — EBM and GOÄ billing, charge items, catalog metadata, Scheinpositionen
  • GOÄ Detail / Sachkosten — Ultrasound organs, material costs, analog billing (GOÄ 6/6/
  • EBM auf ChargeItem — Concrete billed EBM values (Kapitel, Punkte, Prüfzeit, RLV-Relevanz)
  • Private Billing Workflow — Review and release status for private invoices
  • HVG / Selektivverträge — Selective contract extensions (73b/73b/
  • BGT2001 / BG-Tarif — Occupational accident tariff details (supplements dguv.basis)
  • Price History — Historical pricing on ChargeItemDefinition catalog entries
  • RLV / Budget — Contract-based physician capitation budget (Regelleistungsvolumen)
  • Honorarbescheid / Remittance — KV payment reconciliation and correction codes
  • AI Provenance — EU AI Act Art. 50 compliance: AI-generated content flagging, human review tracking
  • Genehmigungen / KV Approvals — Leistungsbereichs-Genehmigungen (kopfbezogen/betriebsstättenbezogen)
  • Administrative — Consent management, referrals, hospital admissions, accounts receivable, AU/Arbeitsunfähigkeit

Built On

This IG builds on the German and international FHIR packages declared in sushi-config.yaml, including:

Referenced Standards and Crosswalk Targets

The following standards are used as semantic references or mapping targets, but are not necessarily direct package dependencies:

  • kbv.ita.aws (1.2.0) - AW-SST/PVS archive-change crosswalk target, not a parent package. See AW-SST Crosswalk.
  • KBV formular and key-table artifacts - referenced where local profile bindings or ConceptMaps need KBV terminology.
  • DGUV.Basis - BG/occupational-accident reference semantics where local BG billing context requires it.

Publisher

cognovis GmbH — cognovis.de

License

This Implementation Guide is published under CC-BY-4.0.

Status

Draft / CI-Build — This IG is under active development. Breaking changes may occur between versions.

International Interoperability

These profiles are designed with international FHIR concepts in mind. Where possible, they use standard R4 resources and documented mappings to international equivalents. See the International Interoperability page for detailed mapping tables.

Dependencies

IGPackageFHIRComment
.. German Practice Management FHIR Profiles (R4)de.cognovis.fhir.praxis#0.71.0R4
... FHIR Extensions Packhl7.fhir.uv.extensions.r4#5.3.0R4Automatically added as a dependency - all IGs depend on the HL7 Extension Pack
.... HL7 Terminology (THO)hl7.terminology.r4#7.1.0R4
..... FHIR Extensions Packhl7.fhir.uv.extensions.r4#5.2.0R4
... de.basisprofil.r4de.basisprofil.r4#1.6.0-ballot2R4
... fhir.dicomfhir.dicom#2022.4.20221006R4
... Interactive Multimedia Report (IMR)ihe.rad.imr#1.1.0R4
.... HL7 Terminology (THO)hl7.terminology.r4#5.5.0R4
.... FHIR Extensions Packhl7.fhir.uv.extensions.r4#5.1.0R4
... dvmd.kdl.r4dvmd.kdl.r4#2025.0.1R4
... International Patient Summary Implementation Guidehl7.fhir.uv.ips#1.1.0R4
.... HL7 Terminology (THO)hl7.terminology.r4#5.0.0R4
... KBV-MIO-Impfpass Vocabulary (cognovis repackage)kbv.mio.impfpass.vocab#1.1.0-cognovis.1R4
... KBV Terminologies (Schluesseltabellen, Basis)de.cognovis.terminology.kbv#1.0.0R4
... kbv.basiskbv.basis#1.8.0R4
.... de.basisprofil.r4de.basisprofil.r4#1.5.4R4
... FHIR Tooling Extensions IGhl7.fhir.uv.tools.r4#1.1.2R4for example references

Package hl7.fhir.uv.extensions.r4#5.2.0

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Mon, Feb 10, 2025 21:45+1100+11:00)

Package hl7.fhir.uv.extensions.r4#5.3.0

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, May 16, 2026 18:32+1000+10:00)

Package de.basisprofil.r4#1.6.0-ballot2

Projekt Basisprofilierung R4 (HL7 Deutschland e.V.)

Package de.cognovis.terminology.imaging#1.0.0

FHIR terminology resources for radiation billing triggers, contrast agents, justifying indications, imaging procedure codes, and radiation protection qualifications. Covers EBM chapter 34, GOÄ 5000-5855, BEMA dental radiology Ä-codes, DICOM CID 12, and ICD-10-GM.

Package hl7.fhir.uv.extensions.r4#5.1.0

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00)

Package ihe.rad.imr#1.1.0

Support encoding and presentation of an interactive multimedia report (built Thu, Jun 20, 2024 08:48-0500-05:00)

Package dvmd.kdl.r4#2025.0.1

Publikation der Terminologie-Ressourcen für die Nutzung der Klinische Dokumentenklassen-Liste (KDL) des DVMD Version 2025

Package hl7.fhir.uv.ips#1.1.0

International Patient Summary (IPS) FHIR Implementation Guide (built Tue, Nov 22, 2022 03:24+0000+00:00)

Package kbv.mio.impfpass.vocab#1.1.0-cognovis.1

KBV-MIO-Impfpass vocabulary (ValueSets/CodeSystems/ConceptMaps) — repackaged subset of kbv.mio.impfpass@1.1.0 with NO de.basisprofil.r4 dependency. Excludes resources that reference fhir.de/CodeSystem/dimdi/* canonicals (renamed to bfarm/* in basisprofil.r4@1.6.0-ballot2). Use as drop-in vocab provider for Immunization extensible bindings without inheriting the legacy 0.9.12 basisprofil structures.

Package de.cognovis.terminology.kbv#1.0.0

KBV Schluesseltabellen and Basis-Terminologie from MII SU-TermServ.

Package de.basisprofil.r4#1.5.4

Projekt Basisprofilierung R4 (HL7 Deutschland e.V.)

Package kbv.basis#1.8.0

KBV-Basis-Profile V 1.8.0

Package hl7.fhir.uv.tools.r4#1.1.2

This IG defines the extensions that the tools use internally. Some of these extensions are content that are being evaluated for elevation into the main spec, and others are tooling concerns (built Tue, Mar 24, 2026 11:13+1100+11:00)

Cross-Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (de.cognovis.fhir.praxis.r4) and R4B (de.cognovis.fhir.praxis.r4b) are available.

Global Profiles

There are no Global profiles defined

IP Statements

This publication includes IP covered under the following statements.