FHIR Mapping & Profiling
Mapping Process
The process of mapping involves the following steps:
- Identifying Key Data Points: Cataloging the data fields in the clinical registry.
- Selecting Relevant FHIR Resources: Mapping these fields to appropriate FHIR resources (e.g., Patient, Observation, Procedure).
- Defining Terminologies: Aligning data elements with standardized terminologies (e.g., LOINC, SNOMED CT).
FHIR Profiles
Profiling allows you to create custom versions of these resources, adding or removing elements, changing data types, or setting constraints. By creating profiles, you can enforce standardization in how data is represented and exchanged. This ensures that all parties involved in the data exchange understand the exact structure, allowed values, and rules for interpreting the data. For example, you could create a profile for a medication resource that standardizes how medications are coded, what dosage forms are allowed, and the format of the dispensing date.
Clinical registries like the DBIR typically have specific data elements that need to be collected, stored, and exchanged, such as patient demographics, clinical observations, treatment plans, outcomes, and other relevant health data. While FHIR provides standardized resources for many of these data types (e.g., Patient, Observation, Condition), different registries might have different needs. Hence, FHIR profiles allow customization of these base resources to ensure they include the exact elements required for a specific clinical registry. By creating these customized profiles, data can be collected and shared in a consistent format, making it easier for clinical systems to work together.
The FHIR profiles in this implemenatation guide represent guidelines about what data elements are mandatory in the DBIR registry. The profiles created define validation rules to ensure that only valid codes are used, ensuring consistency across different systems.
Variables can be referenced or derived. A derived variable is a data element that is not directly captured but is instead calculated or inferred from existing data. A reference variable is a way for one FHIR resource to point to another FHIR resource. This is essential for linking and maintaining relationships between different types of FHIR Resources.
Patient Journey
A patient journey in FHIR refers to the sequence of healthcare events, interactions, and transitions that a patient goes through within a healthcare system, represented using FHIR resources. For the DBIR clinical registry, we made a patient journey that represents the patients progress through a breast implant surgery. This journey uses all the FHIR Profiles that are listed at Introduction.
The patient journey for the DBIR registry is published to Simplifier.
Mapping Overview
In this mapping, the entities and their relationships are shown. For each FHIR Resource, the following information is provided:
- Which FHIR Resource data element is used for which DICA variable
- Cardinality between FHIR Resources and within each data element
- At which data element two FHIR Resources are related. For example, the relationship from MedicationStatement to Patient is through MedicationStatement.subject
A spider diagram that displays the overall mapping of the DBIR registry is published to Simplifier.
The list below is a comprehensive list of the DICA variables in the DBIR registry. For each variable, the corresponding FHIR Resource and data element within the Resource is listed. Variables that are not in scope are stated as n/a.
| DICA Dataset | DICA Variable | FHIR Profile | Resource Element |
|---|---|---|---|
| patient | id | Patient | managingOrganization |
| patient | upn | Patient | identifier |
| patient | land | Patient | identifier |
| patient | idcode | Patient | identifier |
| patient | tussen | Patient | name |
| patient | naam | Patient | name |
| patient | gebdat | Patient | birthDate |
| patient | geslacht | Patient | gender |
| patient | land-woon | Patient | address |
| patient | pcode | Patient | address |
| surgery | stuurvar-patient-first-augmentic-bilateral | TBD | |
| surgery | stuurvar-side | Breast Implant Surgery | bodySite |
| surgery | surgery-id | (reference variable) Breast Implant Surgery | performer |
| surgery | operdate | Breast Implant Surgery | performed |
| surgery | surgbignumber | (reference variable) Practitioner | identifier |
| surgery | surgbignumberother | Practitioner | identifier |
| surgery | surgery-upn | (reference variable) Breast Implant Surgery | subject |
| surgery | surgasa | Presurgery Observation | code |
| surgery | nicotineabuse | Presurgery Observation | code |
| surgery | ptheight | Presurgery Observation | code |
| surgery | ptweight | Presurgery Observation | code |
| surgery | bmi | n/a (Derived Variable) | n/a |
| sidespecific | surgside | Breast Implant Surgery | bodySite |
| sidespecific | intervention | Breast Implant Surgery | code |
| sidespecific | repautologous | Breast Implant Surgery | code |
| sidespecific | indication | Breast Implant Surgery | reasonCode |
| sidespecific | timingrec | Breast Implant Surgery | extension.SurgeryComponents |
| sidespecific | prevradio | Previous Radiotherapy | code |
| sidespecific | first | Breast Implant Surgery | performed.extension.First |
| sidespecific | incissite | Breast Implant Surgery | extension.SurgeryComponents |
| sidespecific | plane | Breast Implant Surgery | extension.SurgeryComponents |
| sidespecific | capsulectomy | Additional Procedures | code |
| sidespecific | sheet | MeshAdmDevice | type |
| sidespecific | admmanufacturer | MeshAdmDevice | manufacturer |
| sidespecific | admmanother | MeshAdmDevice | manufacturer |
| sidespecific | admserialno | MeshAdmDevice | serialNumber |
| sidespecific | admlotno | MeshAdmDevice | lotNumber |
| sidespecific | admcatalogus | MeshAdmDevice | identifier |
| sidespecific | meshmanufacturer | MeshAdmDevice | manufacturer |
| sidespecific | meshmanother | MeshAdmDevice | manufacturer |
| sidespecific | meshserialno | MeshAdmDevice | serialNumber |
| sidespecific | meshlotno | MeshAdmDevice | lotNumber |
| sidespecific | meshcatalogus | MeshAdmDevice | identifier |
| sidespecific | mastopexy | Additional Procedures | code |
| sidespecific | autologousflapcover | Additional Procedures | code |
| sidespecific | fatgrafting | Additional Procedures | code |
| sidespecific | systantibiot | MedicationStatement | category |
| sidespecific | postopantibiot | MedicationStatement | category |
| sidespecific | antisepticrinse | Antiseptic Precautions | code |
| sidespecific | antisepticrinsetechnique | Antiseptic Precautions | code |
| sidespecific | kellerfunnel | Antiseptic Precautions | code |
| sidespecific | nippleguards | Antiseptic Precautions | code |
| sidespecific | glovchanginsert | Antiseptic Precautions | code |
| sidespecific | drains | Antiseptic Precautions | code |
| sidespecific | te-to-implant | Breast Implant Surgery | extension.SurgeryComponents |
| sidespecific | te-to-autologous | Breast Implant Surgery | extension.SurgeryComponents |
| sidespecific | contralateral | SurgeryRelated Complication | code |
| sidespecific | wound | SurgeryRelated Complication | code |
| sidespecific | skinnecrosis | SurgeryRelated Complication | code |
| sidespecific | seroma19 | SurgeryRelated Complication | code |
| sidespecific | hematoma19 | SurgeryRelated Complication | code |
| sidespecific | flap | SurgeryRelated Complication | code |
| sidespecific | capsular-noyes | Preexisting Condition | n/a |
| sidespecific | capsular | Preexisting Condition | code |
| sidespecific | double-capsule | Preexisting Condition | code |
| sidespecific | breastpain | Preexisting Condition | code |
| sidespecific | dissatisfaction | Preexisting Condition | code |
| sidespecific | asymmetry | Preexisting Condition | code |
| sidespecific | breastcancer | Preexisting Condition | code |
| sidespecific | anaplasticsusp | Preexisting Condition | code |
| sidespecific | anaplasticconf | Preexisting Condition | code |
| sidespecific | pa-nummer | Preexisting Condition | evidence |
| sidespecific | scc | Preexisting Condition | code |
| sidespecific | sccconf | Preexisting Condition | code |
| sidespecific | pa-nummer-scc | Preexisting Condition | evidence |
| sidespecific | asia | Preexisting Condition | code |
| sidespecific | patient-request | Preexisting Condition | code |
| sidespecific | devicedefrupt | Preoperative Findings Device | code |
| sidespecific | silicone-noyes | Preoperative Findings Device | n/a |
| sidespecific | silicone | Preoperative Findings Device | code |
| sidespecific | devmalpos | Preoperative Findings Device | code |
| sidespecific | rippling | Preoperative Findings Device | code |
| sidespecific | recall | Preoperative Findings Device | code |
| sidespecific | other | Breast Implant Surgery | note |
| sidespecific | seroma | Preexisting Condition | code |
| object | action | n/a (Derived Variable) | n/a |
| object | isdeviceregistered | ImplantDevice | owner |
| object | insertiontype | n/a (Derived Variable) | n/a |
| object | implantyear | n/a (Derived Variable) | n/a |
| object | infoexplant | n/a (Derived Variable) | |
| object | infomarkers | n/a (Derived Variable) | |
| object | refno | ImplantDevice | identifier |
| object | manufacturer | ImplantDevice | manufacturer |
| object | manother | ImplantDevice | manufacturer |
| object | implanttype | ImplantDevice | type |
| object | texture | ImplantDevice | extension |
| object | coating | ImplantDevice | extension |
| object | coatingother | ImplantDevice | extension |
| object | fill | ImplantDevice | extension |
| object | fillother | ImplantDevice | extension |
| object | shape | ImplantDevice | extension |
| object | maxweightvol | ImplantDevice | extension |
| object | scan-manual-indicator | ImplantDevice | extension |
| object | gs1-barcode | ImplantDevice | extension |
| object | gs1-ai-processing-status | ImplantDevice | extension |
| object | gs1-gtin | ImplantDevice | extension |
| object | gs1-expiry | ImplantDevice | extension |
| object | gs1-lotno | ImplantDevice | extension |
| object | gs1-serialno | ImplantDevice | extension |