Introduction

Effective infectious disease surveillance is crucial for controlling the spread of disease. It involves a multidisciplinary team of health professionals working in both government and non-government facilities. To ensure data quality and efficient participation, standardized terminology, reporting formats, and methods are essential.

Adapted from Case Definitions For Infectious Disease In Malaysia (3rd Edition January 2017).

Current Limitations:

Malaysia's current surveillance system relies on manual case notification by clinicians, followed by data entry into a standalone platform (CDCIS | e-Notifikasi) for further investigation. This manual process is inefficient and lacks centralization, hindering timely analysis and response.

Proposed Solution:

A centralized Health Information Exchange Platform (HIE) can address these limitations. This platform would offer two intergration point option to improve the notification method:

Source System Integration: Source systems (e.g., hospital information systems) can share/retrieve completed notification record to HIE directly in their application.
SOF Application Integration: Source systems can send raw data to the HIE, to be completed in a standalone Smart on FHIR (SOF) communicable disease notification application.

Objectives

This implementation guide use case outlines the technical specifications for exchanging data between different systems to improve surveillance efficiency.

Source System Integration Specification

Talk about Source System sending bundle with QR and supporting Resource directly to HIE.

Integration Method Considerations

Advantages

1 application entry only, flow easier for user and user prefer like this
Application can be FHIR facade ready (refer FHIR facade documentation)

Disadvantages

Need to do significant changes if application not capture parameter in system
Overlap of function with other existing application thus indirectly
Version changes to notification standard may need significant changes to source system also.

API involved & Business Rules

Business Rule concept

Diagram 1

Need to explain the business rules involved. before can send need to check if similar diagnosis already exist less than 1 week in database.

Questionnaire Format

The Questionnaire is adapted from Borang Notifikasi Penyakit Berjankit (Rev 2010) and CDCIS | e-Notifikasi portal.

Refer Diagram below for the form template details:

Borang Notifikasi Penyakit Berjankit (Rev 2010)

cdn form

Questionnaire Details

The Notification is structured into a FHIR Questionnaire Resource. Below are the details of the Notification Questionnaire.

Defining URL	http://ig.veins.mhnexus.com/Questionnaire/cd-notification
Status	Draft
Version	0.0.1
Title	Communicable Disease Notification Form

The resource cannot be rendered.

1. Patient Sample 1

2. Patient Sample 2

<Questionnaire xmlns="http://hl7.org/fhir">
    <id value="cd-notification" />
    <meta>
        <versionId value="8" />
        <lastUpdated value="2024-07-12T10:51:04.467+08:00" />
    </meta>
    <url value="http://ig.veins.mhnexus.com/Questionnaire/cd-notification" />
    <title value="Communicable Disease Notification Form" />
    <status value="active" />
    <date value="2024-07-11T08:00:00+08:00" />
    <item>
        <linkId value="patient" />
        <text value="Patient Details" />
        <type value="reference" />
    </item>
    <item>
        <linkId value="address" />
        <text value="Address" />
        <type value="group" />
        <item>
            <linkId value="address-details" />
            <text value="Address Home / Incident Details" />
            <type value="group" />
            <item>
                <linkId value="address-incident" />
                <text value="Address Incident" />
                <type value="string" />
            </item>
            <item>
                <linkId value="postcode" />
                <text value="Postcode" />
                <type value="choice" />
                <answerValueSet value="http://fhir.hie.moh.gov.my/CodeSystem/postcode-my-core" />
            </item>
            <item>
                <linkId value="phone" />
                <text value="Phone Number" />
                <type value="string" />
            </item>
            <item>
                <linkId value="sub-district" />
                <text value="Sub District" />
                <type value="string" />
            </item>
            <item>
                <linkId value="district" />
                <text value="District" />
                <type value="choice" />
                <answerValueSet value="http://fhir.hie.moh.gov.my/CodeSystem/district-my-core" />
            </item>
            <item>
                <linkId value="sector" />
                <text value="Sector" />
                <type value="string" />
            </item>
            <item>
                <linkId value="state" />
                <text value="State" />
                <type value="choice" />
                <answerValueSet value="http://fhir.hie.moh.gov.my/CodeSystem/state-my-core" />
            </item>
            <item>
                <linkId value="locality" />
                <text value="Locality" />
                <type value="string" />
            </item>
            <item>
                <linkId value="latitude" />
                <text value="Latitude" />
                <type value="decimal" />
            </item>
            <item>
                <linkId value="longitude" />
                <text value="Longitude" />
                <type value="decimal" />
            </item>
        </item>
        <item>
            <linkId value="occupation-details" />
            <text value="Occupation Details" />
            <type value="group" />
            <item>
                <linkId value="working-address" />
                <text value="Working Address" />
                <type value="string" />
            </item>
            <item>
                <linkId value="working-phone" />
                <text value="Phone Number" />
                <type value="string" />
            </item>
            <item>
                <linkId value="working-phone-mobile" />
                <text value="Mobile Number" />
                <type value="string" />
            </item>
            <item>
                <linkId value="working-email" />
                <text value="Email" />
                <type value="string" />
            </item>
            <item>
                <linkId value="occupation-category" />
                <text value="Occupation Category" />
                <type value="choice" />
                <answerValueSet value="http://fhir.hie.moh.gov.my/CodeSystem/occupation-sector-my-core" />
            </item>
            <item>
                <linkId value="occupation-name" />
                <text value="Occupation Name" />
                <type value="string" />
            </item>
        </item>
    </item>
    <item>
        <linkId value="dx" />
        <text value="Disease Diagnosis" />
        <type value="group" />
        <item>
            <linkId value="notification-details" />
            <text value="Notification Details" />
            <type value="group" />
            <item>
                <linkId value="notification-identifier" />
                <text value="Notification Identifier" />
                <type value="string" />
            </item>
            <item>
                <linkId value="date-receive-notification" />
                <text value="Received Notification Date" />
                <type value="dateTime" />
            </item>
            <item>
                <linkId value="notification-dae" />
                <text value="Notification Date" />
                <type value="dateTime" />
            </item>
        </item>
        <item>
            <linkId value="encounter-details" />
            <text value="Encounter Details" />
            <type value="group" />
            <item>
                <linkId value="location" />
                <text value="Ward / Clinic Name / No" />
                <type value="string" />
            </item>
            <item>
                <linkId value="mrn" />
                <text value="Encounter Registration Number" />
                <type value="string" />
            </item>
            <item>
                <linkId value="encounter-date" />
                <text value="Encounter Date" />
                <type value="dateTime" />
            </item>
        </item>
        <item>
            <linkId value="dx-details" />
            <text value="Notify Details" />
            <type value="group" />
            <item>
                <linkId value="main-dx" />
                <text value="Diagnosis" />
                <type value="reference" />
            </item>
            <item>
                <linkId value="main-dx-onset" />
                <text value="Onset Date" />
                <type value="dateTime" />
            </item>
            <item>
                <linkId value="sub-dx" />
                <text value="Sub Diagnosis" />
                <type value="reference" />
                <repeats value="true" />
            </item>
        </item>
        <item>
            <linkId value="case-detect-method" />
            <text value="Case Detection Method" />
            <type value="group" />
            <item>
                <linkId value="detect-method" />
                <text value="Detection methods" />
                <type value="choice" />
                <answerOption>
                    <valueCoding>
                        <system value="http://snomed.info/sct" />
                        <code value="395098000" />
                        <display value="Active" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://snomed.info/sct" />
                        <code value="428792000" />
                        <display value="Passive" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://snomed.info/sct" />
                        <code value="360156006" />
                        <display value="Screening" />
                    </valueCoding>
                </answerOption>
            </item>
            <item>
                <linkId value="screening-method" />
                <text value="For Screening Method, Please Specify Type:" />
                <type value="choice" />
                <answerOption>
                    <valueCoding>
                        <system value="http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins" />
                        <code value="1" />
                        <display value="FOMEMA" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins" />
                        <code value="2" />
                        <display value="Blood Bank" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins" />
                        <code value="3" />
                        <display value="Antenatal" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins" />
                        <code value="4" />
                        <display value="Prison" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins" />
                        <code value="5" />
                        <display value="Routing Screening" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins" />
                        <code value="6" />
                        <display value="Harm Reduction" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins" />
                        <code value="7" />
                        <display value="Pre-wedding" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins" />
                        <code value="8" />
                        <display value="screening without name" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins" />
                        <code value="99" />
                        <display value="Others" />
                    </valueCoding>
                </answerOption>
            </item>
        </item>
        <item>
            <linkId value="patient-status" />
            <text value="Patient Status" />
            <type value="group" />
            <item>
                <linkId value="deceased-status" />
                <text value="Deceased Status" />
                <type value="boolean" />
            </item>
            <item>
                <linkId value="deceased-date" />
                <text value="Deceased Date" />
                <type value="dateTime" />
            </item>
            <item>
                <linkId value="cod-dx" />
                <text value="Cause Of Death Diagnosis" />
                <type value="reference" />
            </item>
            <item>
                <linkId value="cod-dx-other" />
                <text value="Supporting Death Diagnosis" />
                <type value="reference" />
                <repeats value="true" />
            </item>
        </item>
    </item>
    <item>
        <linkId value="ix" />
        <text value="Laboratory Investigation" />
        <type value="group" />
        <item>
            <linkId value="ix-performed" />
            <text value="Laboratory Investigation Performed?" />
            <type value="boolean" />
        </item>
        <item>
            <linkId value="ix-details" />
            <text value="Investigation Details" />
            <type value="group" />
            <repeats value="true" />
            <item>
                <linkId value="ix-name" />
                <text value="Investigation Name" />
                <type value="string" />
            </item>
            <item>
                <linkId value="ix-note" />
                <text value="Note" />
                <type value="text" />
            </item>
            <item>
                <linkId value="ix-taken-date" />
                <text value="Specimen Taken Date" />
                <type value="dateTime" />
            </item>
            <item>
                <linkId value="ix-receive-date" />
                <text value="specimen Received By Laboratory Date" />
                <type value="dateTime" />
            </item>
            <item>
                <linkId value="ix-result" />
                <text value="Laboratory Investigation Result" />
                <type value="choice" />
                <answerOption>
                    <valueCoding>
                        <system value="http://snomed.info/sct" />
                        <code value="10828004" />
                        <display value="Positive" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://snomed.info/sct" />
                        <code value="260385009" />
                        <display value="Negative" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://snomed.info/sct" />
                        <code value="263921008" />
                        <display value="Pending" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <system value="http://snomed.info/sct" />
                        <code value="42425007" />
                        <display value="Equivocal" />
                    </valueCoding>
                </answerOption>
            </item>
            <item>
                <linkId value="ix-result-date" />
                <text value="laboratory Result Date" />
                <type value="dateTime" />
            </item>
        </item>
        <item>
            <linkId value="case-classifcation" />
            <text value="Case Classification" />
            <type value="group" />
            <item>
                <linkId value="dx-status" />
                <text value="Diagnosis Status" />
                <type value="choice" />
                <answerOption>
                    <valueCoding>
                        <code value="1" />
                        <display value="Clinical" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <code value="2" />
                        <display value="Confirmed By Laboratory Investigation" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <code value="3" />
                        <display value="Probable" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <code value="4" />
                        <display value="Epid link" />
                    </valueCoding>
                </answerOption>
            </item>
            <item>
                <linkId value="classification-date" />
                <text value="slasification Date" />
                <type value="dateTime" />
            </item>
            <item>
                <linkId value="infection-type" />
                <text value="Infection Type" />
                <type value="choice" />
                <answerOption>
                    <valueCoding>
                        <code value="1" />
                        <display value="Local" />
                    </valueCoding>
                </answerOption>
                <answerOption>
                    <valueCoding>
                        <code value="2" />
                        <display value="Import" />
                    </valueCoding>
                </answerOption>
            </item>
        </item>
    </item>
    <item>
        <linkId value="notifier-details" />
        <text value="Notifier details" />
        <type value="group" />
        <item>
            <linkId value="remark" />
            <text value="Remark" />
            <type value="group" />
            <item>
                <linkId value="general-remark" />
                <text value="Remark" />
                <type value="text" />
            </item>
            <item>
                <linkId value="clinical-remark" />
                <text value="Additional Clinical Information" />
                <type value="text" />
            </item>
        </item>
        <item>
            <linkId value="notifier" />
            <text value="Notifier" />
            <type value="group" />
            <item>
                <linkId value="practitioner-name" />
                <text value="Practitoner Name" />
                <type value="reference" />
            </item>
            <item>
                <linkId value="notifier-phone" />
                <text value="Phone Number" />
                <type value="string" />
            </item>
            <item>
                <linkId value="notifier-email" />
                <text value="Email" />
                <type value="string" />
            </item>
            <item>
                <linkId value="notifier-fax" />
                <text value="Fax" />
                <type value="string" />
            </item>
            <item>
                <linkId value="notifier-date" />
                <text value="Date Notification" />
                <type value="dateTime" />
            </item>
        </item>
        <item>
            <linkId value="facility-details" />
            <text value="Facility Details" />
            <type value="group" />
            <item>
                <linkId value="facility" />
                <text value="Healthcare Facility Details" />
                <type value="reference" />
            </item>
            <item>
                <linkId value="department" />
                <text value="Department" />
                <type value="reference" />
            </item>
        </item>
    </item>
</Questionnaire>

{
    "resourceType": "Questionnaire",
    "id": "cd-notification",
    "meta": {
        "versionId": "8",
        "lastUpdated": "07/12/2024 02:51:04"
    },
    "url": "http://ig.veins.mhnexus.com/Questionnaire/cd-notification",
    "title": "Communicable Disease Notification Form",
    "status": "active",
    "date": "07/11/2024 00:00:00",
    "item":  [
        {
            "linkId": "patient",
            "text": "Patient Details",
            "type": "reference"
        },
        {
            "linkId": "address",
            "text": "Address",
            "type": "group",
            "item":  [
                {
                    "linkId": "address-details",
                    "text": "Address Home / Incident Details",
                    "type": "group",
                    "item":  [
                        {
                            "linkId": "address-incident",
                            "text": "Address Incident",
                            "type": "string"
                        },
                        {
                            "linkId": "postcode",
                            "text": "Postcode",
                            "type": "choice",
                            "answerValueSet": "http://fhir.hie.moh.gov.my/CodeSystem/postcode-my-core"
                        },
                        {
                            "linkId": "phone",
                            "text": "Phone Number",
                            "type": "string"
                        },
                        {
                            "linkId": "sub-district",
                            "text": "Sub District",
                            "type": "string"
                        },
                        {
                            "linkId": "district",
                            "text": "District",
                            "type": "choice",
                            "answerValueSet": "http://fhir.hie.moh.gov.my/CodeSystem/district-my-core"
                        },
                        {
                            "linkId": "sector",
                            "text": "Sector",
                            "type": "string"
                        },
                        {
                            "linkId": "state",
                            "text": "State",
                            "type": "choice",
                            "answerValueSet": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core"
                        },
                        {
                            "linkId": "locality",
                            "text": "Locality",
                            "type": "string"
                        },
                        {
                            "linkId": "latitude",
                            "text": "Latitude",
                            "type": "decimal"
                        },
                        {
                            "linkId": "longitude",
                            "text": "Longitude",
                            "type": "decimal"
                        }
                    ]
                },
                {
                    "linkId": "occupation-details",
                    "text": "Occupation Details",
                    "type": "group",
                    "item":  [
                        {
                            "linkId": "working-address",
                            "text": "Working Address",
                            "type": "string"
                        },
                        {
                            "linkId": "working-phone",
                            "text": "Phone Number",
                            "type": "string"
                        },
                        {
                            "linkId": "working-phone-mobile",
                            "text": "Mobile Number",
                            "type": "string"
                        },
                        {
                            "linkId": "working-email",
                            "text": "Email",
                            "type": "string"
                        },
                        {
                            "linkId": "occupation-category",
                            "text": "Occupation Category",
                            "type": "choice",
                            "answerValueSet": "http://fhir.hie.moh.gov.my/CodeSystem/occupation-sector-my-core"
                        },
                        {
                            "linkId": "occupation-name",
                            "text": "Occupation Name",
                            "type": "string"
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "dx",
            "text": "Disease Diagnosis",
            "type": "group",
            "item":  [
                {
                    "linkId": "notification-details",
                    "text": "Notification Details",
                    "type": "group",
                    "item":  [
                        {
                            "linkId": "notification-identifier",
                            "text": "Notification Identifier",
                            "type": "string"
                        },
                        {
                            "linkId": "date-receive-notification",
                            "text": "Received Notification Date",
                            "type": "dateTime"
                        },
                        {
                            "linkId": "notification-dae",
                            "text": "Notification Date",
                            "type": "dateTime"
                        }
                    ]
                },
                {
                    "linkId": "encounter-details",
                    "text": "Encounter Details",
                    "type": "group",
                    "item":  [
                        {
                            "linkId": "location",
                            "text": "Ward / Clinic Name / No",
                            "type": "string"
                        },
                        {
                            "linkId": "mrn",
                            "text": "Encounter Registration Number",
                            "type": "string"
                        },
                        {
                            "linkId": "encounter-date",
                            "text": "Encounter Date",
                            "type": "dateTime"
                        }
                    ]
                },
                {
                    "linkId": "dx-details",
                    "text": "Notify Details",
                    "type": "group",
                    "item":  [
                        {
                            "linkId": "main-dx",
                            "text": "Diagnosis",
                            "type": "reference"
                        },
                        {
                            "linkId": "main-dx-onset",
                            "text": "Onset Date",
                            "type": "dateTime"
                        },
                        {
                            "linkId": "sub-dx",
                            "text": "Sub Diagnosis",
                            "type": "reference",
                            "repeats": true
                        }
                    ]
                },
                {
                    "linkId": "case-detect-method",
                    "text": "Case Detection Method",
                    "type": "group",
                    "item":  [
                        {
                            "linkId": "detect-method",
                            "text": "Detection methods",
                            "type": "choice",
                            "answerOption":  [
                                {
                                    "valueCoding": {
                                        "system": "http://snomed.info/sct",
                                        "code": "395098000",
                                        "display": "Active"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://snomed.info/sct",
                                        "code": "428792000",
                                        "display": "Passive"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://snomed.info/sct",
                                        "code": "360156006",
                                        "display": "Screening"
                                    }
                                }
                            ]
                        },
                        {
                            "linkId": "screening-method",
                            "text": "For Screening Method, Please Specify Type:",
                            "type": "choice",
                            "answerOption":  [
                                {
                                    "valueCoding": {
                                        "system": "http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins",
                                        "code": "1",
                                        "display": "FOMEMA"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins",
                                        "code": "2",
                                        "display": "Blood Bank"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins",
                                        "code": "3",
                                        "display": "Antenatal"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins",
                                        "code": "4",
                                        "display": "Prison"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins",
                                        "code": "5",
                                        "display": "Routing Screening"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins",
                                        "code": "6",
                                        "display": "Harm Reduction"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins",
                                        "code": "7",
                                        "display": "Pre-wedding"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins",
                                        "code": "8",
                                        "display": "screening without name"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://ig.veins.mhnexus.com/CodeSystem/screening-method-veins",
                                        "code": "99",
                                        "display": "Others"
                                    }
                                }
                            ]
                        }
                    ]
                },
                {
                    "linkId": "patient-status",
                    "text": "Patient Status",
                    "type": "group",
                    "item":  [
                        {
                            "linkId": "deceased-status",
                            "text": "Deceased Status",
                            "type": "boolean"
                        },
                        {
                            "linkId": "deceased-date",
                            "text": "Deceased Date",
                            "type": "dateTime"
                        },
                        {
                            "linkId": "cod-dx",
                            "text": "Cause Of Death Diagnosis",
                            "type": "reference"
                        },
                        {
                            "linkId": "cod-dx-other",
                            "text": "Supporting Death Diagnosis",
                            "type": "reference",
                            "repeats": true
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "ix",
            "text": "Laboratory Investigation",
            "type": "group",
            "item":  [
                {
                    "linkId": "ix-performed",
                    "text": "Laboratory Investigation Performed?",
                    "type": "boolean"
                },
                {
                    "linkId": "ix-details",
                    "text": "Investigation Details",
                    "type": "group",
                    "repeats": true,
                    "item":  [
                        {
                            "linkId": "ix-name",
                            "text": "Investigation Name",
                            "type": "string"
                        },
                        {
                            "linkId": "ix-note",
                            "text": "Note",
                            "type": "text"
                        },
                        {
                            "linkId": "ix-taken-date",
                            "text": "Specimen Taken Date",
                            "type": "dateTime"
                        },
                        {
                            "linkId": "ix-receive-date",
                            "text": "specimen Received By Laboratory Date",
                            "type": "dateTime"
                        },
                        {
                            "linkId": "ix-result",
                            "text": " Laboratory Investigation Result",
                            "type": "choice",
                            "answerOption":  [
                                {
                                    "valueCoding": {
                                        "system": "http://snomed.info/sct",
                                        "code": "10828004",
                                        "display": "Positive"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://snomed.info/sct",
                                        "code": "260385009",
                                        "display": "Negative"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://snomed.info/sct",
                                        "code": "263921008",
                                        "display": "Pending"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "system": "http://snomed.info/sct",
                                        "code": "42425007",
                                        "display": "Equivocal"
                                    }
                                }
                            ]
                        },
                        {
                            "linkId": "ix-result-date",
                            "text": "laboratory Result Date",
                            "type": "dateTime"
                        }
                    ]
                },
                {
                    "linkId": "case-classifcation",
                    "text": "Case Classification",
                    "type": "group",
                    "item":  [
                        {
                            "linkId": "dx-status",
                            "text": "Diagnosis Status",
                            "type": "choice",
                            "answerOption":  [
                                {
                                    "valueCoding": {
                                        "code": "1",
                                        "display": "Clinical"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "code": "2",
                                        "display": "Confirmed By Laboratory Investigation"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "code": "3",
                                        "display": "Probable"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "code": "4",
                                        "display": "Epid link"
                                    }
                                }
                            ]
                        },
                        {
                            "linkId": "classification-date",
                            "text": "slasification Date",
                            "type": "dateTime"
                        },
                        {
                            "linkId": "infection-type",
                            "text": "Infection Type",
                            "type": "choice",
                            "answerOption":  [
                                {
                                    "valueCoding": {
                                        "code": "1",
                                        "display": "Local"
                                    }
                                },
                                {
                                    "valueCoding": {
                                        "code": "2",
                                        "display": "Import"
                                    }
                                }
                            ]
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "notifier-details",
            "text": "Notifier details",
            "type": "group",
            "item":  [
                {
                    "linkId": "remark",
                    "text": "Remark",
                    "type": "group",
                    "item":  [
                        {
                            "linkId": "general-remark",
                            "text": "Remark",
                            "type": "text"
                        },
                        {
                            "linkId": "clinical-remark",
                            "text": "Additional Clinical Information",
                            "type": "text"
                        }
                    ]
                },
                {
                    "linkId": "notifier",
                    "text": "Notifier",
                    "type": "group",
                    "item":  [
                        {
                            "linkId": "practitioner-name",
                            "text": "Practitoner Name",
                            "type": "reference"
                        },
                        {
                            "linkId": "notifier-phone",
                            "text": "Phone Number",
                            "type": "string"
                        },
                        {
                            "linkId": "notifier-email",
                            "text": "Email",
                            "type": "string"
                        },
                        {
                            "linkId": "notifier-fax",
                            "text": "Fax",
                            "type": "string"
                        },
                        {
                            "linkId": "notifier-date",
                            "text": "Date Notification",
                            "type": "dateTime"
                        }
                    ]
                },
                {
                    "linkId": "facility-details",
                    "text": "Facility Details",
                    "type": "group",
                    "item":  [
                        {
                            "linkId": "facility",
                            "text": "Healthcare Facility Details",
                            "type": "reference"
                        },
                        {
                            "linkId": "department",
                            "text": "Department",
                            "type": "reference"
                        }
                    ]
                }
            ]
        }
    ]
}

QuestionnaireResponse Sample Data

The QR

a sample data of QR only
a sample data complete in a bundle

API involved:

Source System must comply to the API defined below to consider the integration point a success

Step	Description	Method	API
1	Check ptient in database	`GET`	`[base]/Patient?identifier=@patientIdentifier`
2	Retrive all existing notification of patient	`GET`	`[base]/QuestionnaireResponse?questionnaire=&subject.identifier=@patientIdentifier`
3	Create Notification (Bundle)	`POST`	`[base]`
4	Update Notification	`PUT`	`[base]QuestionnaireResponse/@questionnaireResponseId`

For creating the notification Bundle. Source system must provide the conditional create parameter to prevent duplication of record created

Resource	Conditional Create Parameter
Condition	`?subject=@patientIdentifier&code=@diagnosisCode&authoredDate=ge@currentDateTime-1week&authoredDate=le@currentDateTime`

Below is an example of a notification bundle example

Communicable Disease Bundle

Smart On FHIR (SOF) Integration Specification

Talk about

Diagram (Diagram 1) below is an overview of the CDN application in relation to Integration with Source System and FHIR server access via SOF launcher

Diagram 1

Step 1: Send Record Captured from Source System to FHIR server

Talk about the FHIR Resource required and the API concept.

Below are the related FHIR Resources required to be sent from Source System

No	FHIR Resource	Cardinality	Description	Conditional Create Parameter	Sample Data
1	Patient	Mandatory	Demographic details of patient	- source - identifier (MRN number)	Patient Conditional Create
2	Encounter	Mandatory	Encounter details of patient	- source - identifier (RN number)	Patient Conditional Create
3	Condition	Mandatory	Main diagnosis being the reason notification registered	- source - code (Diagnosis Code)	Patient Conditional Create
4	Practitioner	Mandatory	Details of the notifier or the clinician in charge	- source - code (Diagnosis Code)	Patient Conditional Create

These resource must be compiled as a Bundle transaction with conditional create parameter mentioned. below is an example of Complete Bundle with its conditional create defined.

Communicable Disease Bundle

The bundle will then be sent to the FHIR server based on the API below:

No	API Function	Method	API
1	Send Resource Bundle	POST	`[base]`

Step 2: Source System launch CDN application via SOF launcher

Refer to SOF launcher guide.

Step 3, 4 & 5: CDN application handling notification process

These steps will be handled by the CDN application.

Placeholder Questionnaire

Link ID

Question

Answer Options

How old are you?

Code	Display	Score
0	Younger than 40 years	0
1	40-49 years	1
2	50-59 years	2
3	60 years or older	3

Are you a man or a women?

Code	Display	Score
male	Male	1
female	Female	0

If you are a woman, have you ever been diagnosed with gestational diabetes?

Code	Display	Score
373066001	Yes	1
373067005	No	0

Do you have a mother, father, sister, or brother with diabetes?

Code	Display	Score
373066001	Yes	1
373067005	No	0

Have you ever been diagnosed with high blood pressure?

Code	Display	Score
373066001	Yes	1
373067005	No	0

Are you physically active?

Code	Display	Score
373066001	Yes	0
373067005	No	1

What is your weight category?

Code	Display	Score
310252000	Normal (18.5-24.9kg/m2)	1
162863004	Overweight (25-29.9kg/m2)	2
162864005	Obese (30kg/m2 or greater)	3

Final Score

Sum of all answer score

Questionnaire Communicable Disease Notification Form

Link ID

Question

Question Type

Patient Details

patient

Patient Details

reference

Address

Link ID

Question

Question Type

address

Address

group

address-details

Address Home / Incident Details

group

Link ID	Question	Question Type	Answer Options
address-incident	Address Incident	string
postcode	Postcode	choice	ValueSetPostcode (MY Core)
phone	Phone Number	string
sub-district	Sub District	string
district	District	choice	ValueSetDistrict (MY Core)
sector	Sector	string
state	State	choice	ValueSetState (MY Core)
locality	Locality	string
latitude	Latitude	decimal
longitude	Longitude	decimal

occupation-details

Occupation Details

group

Link ID	Question	Question Type	Answer Options
working-address	Working Address	string
working-phone	Phone Number	string
working-phone-mobile	Mobile Number	string
working-email	Email	string
occupation-category	Occupation Category	choice	ValueSetOccupationSector (MY Core)
occupation-name	Occupation Name	string

Disease Diagnosis

Link ID

Question

Question Type

Disease Diagnosis

group

notification-details

Notification Details

group

Link ID	Question	Type
notification-identifier	Notification Identifier	string
date-receive-notification	Received Notification Date	dateTime
notification-dae	Notification Date	dateTime

encounter-details

Encounter Details

group

Link ID	Question	Question Type
location	Ward / Clinic Name / No	string
mrn	Encounter Registration Number	string
encounter-date	Encounter Date	dateTime

dx-details

Notify Details

group

Link ID	Question	Question Type
main-dx	Diagnosis	reference
main-dx-onset	Onset Date	dateTime
sub-dx	Sub Diagnosis	reference

case-detect-method

Case Detection Method

group

Link ID	Question	Question Type	Answer Options
detect-method	Detection methods	choice	Active Passive Screening
screening-method	For Screening Method, Please Specify Type:	choice	FOMEMA Blood Bank Antenatal Prison Routine Screening Harm Reduction Pre-wedding Screening without name Others

patient-status

Patient Status

group

Link ID	Question	Question Type
deceased-status	Deceased Status	boolean
deceased-date	Deceased Date	dateTime
cod-dx	Cause Of Death Diagnosis	reference
cod-dx-other	Supporting Death Diagnosis	reference

Laboratory Investigation

Link ID

Question

Question Type

Laboratory Investigation

group

ix-performed

Laboratory Investigation Performed?

boolean

ix-details

Investigation Details

group

Link ID	Question	Question Type	Answer Option
ix-name	Investigation Name	string
ix-note	Note	text
ix-taken-date	Specimen Taken Date	dateTime
ix-receive-date	specimen Received By Laboratory Date	dateTime
ix-result	Laboratory Investigation Result	choice	Positive Negative Pending Equivocal
ix-result-date	laboratory Result Date	dateTime

case-classifcation

Case Classification

group

Link ID	Question	Question Type	Answer Options
dx-status	Diagnosis Status	choice	Clinical Confirmed By Laboratory Investigation Probable Epid link
classification-date	Classification Date	dateTime
infection-type	Infection Type	choice	Local Import

Notifier Details

Link ID

Question

Question Type

notifier-details

Notifier details

group

remark

Remark

group

Link ID	Question	Question Type
general-remark	Remark	Text
clinical-remark	Additional Clinical Information	Text

notifier

Notifier

group

Link ID	Question	Question Type
practitioner-name	Practitoner Name	reference
notifier-phone	Phone Number	string
notifier-email	Email	string
notifier-fax	Fax	string
notifier-date	Date Notification	dateTime

facility-details

Facility Details

group

Link ID	Question	Question Type
facility	Healthcare Facility Details	reference
department	Department	reference