Summary Care Record FHIR API (Release Candidate 1.3.2)

Diagnosis Coded Entry

The Diagnosis Coded Entry covers 4 out of the 5 COVID-19 codes

Concept Preferred term SCR Section
1240751000000100 COVID-19 Diagnoses
1300721000000109 COVID-19 confirmed by laboratory test Diagnoses
1300731000000106 COVID-19 confirmed using clinical diagnostic criteria Diagnoses
1240761000000102 Suspected COVID-19 Diagnoses

The Diagnoses HL7v3 CMET will map to a FHIR Condition resource.

Diagnoses (excluding participants)

Diagnosis

Mapping
Item @classCode
HL7v3 UKCT_MT144042UK01.Diagnosis@classCode
FHIR no mapping
Notes HL7v3: Fixed to "OBS"
FHIR: this has no mapping in FHIR
Item @moodCode
HL7v3 UKCT_MT144042UK01.Diagnosis@moodCode
FHIR no mapping
Notes Hl7v3: fixed to "EVN"
FHIR: this has no mapping in FHIR
Item id@root
HL7v3 UKCT_MT144042UK01.Diagnosis.id@root
FHIR Condition\identifier\value@value
Notes a UUID that acts as the identifier for the coded entry
Item code@code
HL7v3 UKCT_MT144042UK01.Diagnosis\code@code
FHIR Condition\code\coding\code@value
Notes This will be one of the 4 COVID-19 diagnoses codes
1240751000000100|COVID-19
1300721000000109|COVID-19 confirmed by laboratory test
1300731000000106|COVID-19 confirmed using clinical diagnostic criteria
1240761000000102|Suspected COVID-19
Item code@codeSystem
HL7v3 UKCT_MT144042UK01.Diagnosis\code@codeSystem
FHIR Condition\code\coding\system@value
Notes HL7v3: fixed to "2.16.840.1.113883.2.1.3.2.4.15"
FHIR: fixed to "http://snomed.info/sct"
Item code@displayName
HL7v3 UKCT_MT144042UK01.Diagnosis\code\displayName
FHIR Condition\code\coding\display@value
Notes The display associated with the selected codes (as above in the Notes fro code@code
Item statusCode.code@value
HL7v3 UKCT_MT144042UK01.Diagnosis\statusCode\code@value
FHIR Condition\verificationStatus\code@value
Condition\clinicalStatus\code@value
Notes FHIR:
normal->clinicalStatus.active
nullified->verificationStatus.entered-in-error
active->clinicalStatus.active
completed->verificationStatus.confirmed
Note: round-tipping from normal & active is not possible. This may be a clinical risk.
Item effectiveTime@value
HL7v3 UKCT_MT144042UK01.Diagnosis\effectiveTime\low@value
UKCT_RM144042UK01.Diagnosis\effectiveTime\high@value
FHIR Condition\onsetDateTime\value@value and Condition\abatementDateTime\value@value
Notes HL7v3: Where known the dates that the diagnosis was affective on the patient should be used i.e when the patient started with asthma and when the asthma was no longer present for the patient.
The date range shall be carried as follows:
If both a start date and an end date are present the Date or Time Interval Complete data type shall be used:
The low attribute shall contain the start date.
The high attribute shall contain the end date.
If only a start date is present the Date or Time Interval After data type shall be used:
The low attribute shall contain the start date.
FHIR: map low to onsetDateTime, map high to abatementDateTime
Item value
HL7v3 UKCT_MT144042UK01.Diagnosis\value
FHIR Observation\value[x]
Notes defined as being "The value of the observation."
FHIR: this should be modelled as a supporting Observation. Link an Observation from Condition\evidence\detail to an Observation resource. The Observation resource has the follwoubg element that are mandated:
Observation\status - fix to either "unknown" if the status is unknown - or an appropriate status
Observation\code - use the same code as used in Condition\code
choose the appropriate value[x] data type to hiold the value of the Observation
Item value
HL7v3 UKCT_MT144042UK01.Diagnosis\value\pertinentInformation\pertinentSupportingInfo\value
FHIR Condition\note
Notes Supporting text for the Diagnosis

Example of HL7v3 Diagnoses

<UKCT_MT144042UK01.Diagnosis classCode="OBS" moodCode="EVN">
	<id root="0F582D97-8F89-11EA-8B2D-B741F13EFC47"/>
	<code code="1300721000000109" codeSystem="2.16.840.1.113883.2.1.3.2.4.15" displayName="COVID-19 confirmed by laboratory test">
	</code>
	<statusCode code="normal"/>
	<effectiveTime>
		<low value="20200506104819"/>
	</effectiveTime>
      <pertinentInformation typeCode="PERT" contextConductionInd="true">
        <seperatableInd value="false"/>
        <pertinentSupportingInfo classCode="OBS" moodCode="EVN">
            <value>Problem; First, test</value>
            <code code="SupportingText" CodeSystem="2.16.840.1.113883.2.1.3.2.4.17.126" displayName="Supporting Text"/>
        </pertinentSupportingInfo>
    </pertinentInformation>
</UKCT_MT144042UK01.Diagnosis>

Mapping to FHIR

<Condition xmlns="http://hl7.org/fhir">
    <meta>
        <profile value="https://fhir.nhs.uk/StructureDefinition/UKCore-Condition" />
    </meta>
    <identifier>
        <value value="0F582D97-8F89-11EA-8B2D-B741F13EFC47"/>
    </identifier>
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/condition-clinical" />
            <code value="active" />
            <display value="Active" />
        </coding>
    </clinicalStatus>
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="1300721000000109" />
            <display value="COVID-19 confirmed by laboratory test"/>
        </coding>
    </code>
    <onsetDateTime value="2020-05-06T10:48:19+00:00"/>
    <note>
        <text value="Problem; First, test"/>
    </note>
</Condition>

The relevant paticipants for Diagnosis are author and informant. For details on how to populate participants see the Mapping Participants page.

PertinentInformation

Note: This is a link class to supporting information. In terms of FHIR mapping, all the values here are fixed HL7v3 values, except the SupportingInfo.text, which maps to Condition.note

Mapping
Item @typeCode
HL7v3 pertinentInformation@typeCode
FHIR no mapping
Notes HL7v3:fixed to "PERT"
FHIR:no mapping
Item @contextControlCode
HL7v3 pertinentInformation@contextControlCode
FHIR no mapping
Notes HL7v3:fixed to "true"
FHIR:no mapping
Item seperatableInd@value
HL7v3 pertinentInformation.seperatableInd@value
FHIR no mapping
Notes HL7v3:fixed to "false"
FHIR:no mapping

SupportingInformation

Mapping
Item @classCode
HL7v3 SupportingInformation@classCode
FHIR no mapping
Notes HL7v3: fixed to "OBS"
Item @moodCode
HL7v3 SupportingInformation@moodCode
FHIR no mapping
Notes HL7v3: fixed to "EVN"
Item code@code
HL7v3 SupportingInformation.code@code
FHIR no mapping
Notes HL7v3: fixed to "SupportingText"
Item code@codeSystem
HL7v3 SupportingInformation.code@coseSystem
FHIR no mapping
Notes HL7bv3: fixed to "2.16.840.1.113883.2.1.3.2.4.17.126"
Item code@displayName
HL7v3 SupportingInformation.code@displayName
FHIR no mapping
Notes HL7v3: fixed to "Supporting Text"
Item value
HL7v3 SupportingInformation.value
FHIR Condition.note.text
Notes

HL7v3 Diagnoses example with supporting information

<UKCT_MT144042UK01.Diagnosis classCode="OBS" moodCode="EVN">
	<id root="0F582D97-8F89-11EA-8B2D-B741F13EFC47"/>
	<code code="1300721000000109" codeSystem="2.16.840.1.113883.2.1.3.2.4.15" displayName="COVID-19 confirmed by laboratory test">
	</code>
	<statusCode code="normal"/>
	<effectiveTime>
		<low value="20200506104819"/>
	</effectiveTime>
    <pertinentInformation typeCode="PERT" contextConductionInd="true">
	    <seperatableInd value="false"/>
		<pertinentSupportingInfo classCode="OBS" moodCode="EVN">
			<value>Some Supporting Information</value>
			<code code="SupportingText" displayName="Supporting Text" codeSystem="2.16.840.1.113883.2.1.3.2.4.17.126"></code>
		</pertinentSupportingInfo>
	</pertinentInformation>
</UKCT_MT144042UK01.Diagnosis>

FHIR Condition example with supporting information

<Condition xmlns="http://hl7.org/fhir">
    <meta>
        <profile value="https://fhir.nhs.uk/StructureDefinition/UKCore-Condition" />
    </meta>
    <identifier>
        <value value="0F582D97-8F89-11EA-8B2D-B741F13EFC47"/>
    </identifier>
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/condition-clinical" />
            <code value="active" />
            <display value="Active" />
        </coding>
    </clinicalStatus>
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="1300721000000109" />
            <display value="COVID-19 confirmed by laboratory test"/>
        </coding>
    </code>
    <onsetDateTime value="2020-05-06T10:48:19+00:00"/>
    <note> 
        <text value="Some Supporting Information"/>
    </note>
</Condition>

PertinentInformation1

Note: this is a link class to other information that may be referenced in the composition (or bundle).

All of the values here are HL7v3 fixed codes, and have no mapping to FHIR. The only FHIR mapping is from pertinentFinding\id, which maps to Condition\evidence\detail

Mapping
Item @typeCode
HL7v3 @typeCode
FHIR no mapping
Notes HL7v3:fixed to "PERT"
FHIR: no mapping
Item @inversionInd
HL7v3 @inversionInd
FHIR no mapping
Notes HL7v3:fixed to "false"
FHIR: no mapping
Item negationInd
HL7v3 pertinentInformation1@negationInd
FHIR no mapping
Notes HL7v3:fixed to "false"
FHIR: no mapping
Item seperatableInd@value
HL7v3 pertinentInformation1.seperatableInd@value
FHIR no mapping
Notes HL7v3:fixed to "false"
FHIR: no mapping
Item templateId\root@value
HL7v3 pertinentInformation1\root@value
FHIR no mapping
Notes HL7v3:fixed to "2.16.840.1.113883.2.1.3.2.4.18.2"
FHIR: no mapping
Item templateId\extension@value
HL7v3 pertinentInformation1\extension@value
FHIR no mapping
Notes HL7v3:fixed to "CSAB_RM-NPfITUK10.sourceOf1"
FHIR: no mapping

Finding

Mapping
Item @classCode
HL7v3 Finding@classCode
FHIR no mapping
Notes HL7v3: Fixed to "OBS"
FHIR: no mapping
Item @moodCode
HL7v3 Finding@moodCode
FHIR no mapping
Notes Hl7v3: fixed to "EVN"
FHIR: no mapping
Item id@root
HL7v3 Finding@root
FHIR Condition\evidence\detail
Notes FHIR: use the evidence\detail reference to link to any relevant Findings in the bundle

HL7v3 Example of reference to a Finding

<UKCT_MT144042UK01.Diagnosis classCode="OBS" moodCode="EVN">
	<id root="0F582D97-8F89-11EA-8B2D-B741F13EFC47"/>
	<code code="1300721000000109" codeSystem="2.16.840.1.113883.2.1.3.2.4.15" displayName="COVID-19 confirmed by laboratory test">
	</code>
	<statusCode code="normal"/>
	<effectiveTime>
		<low value="20200506104819"/>
	</effectiveTime>
	<pertinentInformation1 typeCode="PERT" inversionInd="false" negationInd="false">
	    <templateId root="2.16.840.1.113883.2.1.3.2.4.18.2" extension="CSAB_RM-NPfITUK10.sourceOf1"/>
		<seperatableInd value="false"/>
		<pertinentFinding classCode="OBS" moodCode="EVN">
			<id root="50E3A850-8F89-11EA-BE46-00155DC3FA77"></id>
		</pertinentFinding>
	</pertinentInformation1>
</UKCT_MT144042UK01.Diagnosis>

FHIR Example of reference to a Finding

<Condition xmlns="http://hl7.org/fhir">
    <meta>
        <profile value="https://fhir.nhs.uk/StructureDefinition/UKCore-Condition" />
    </meta>
    <identifier> 
        <value value="0F582D97-8F89-11EA-8B2D-B741F13EFC47"/>
    </identifier>
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/condition-clinical" />
            <code value="active" />
            <display value="Active" />
        </coding>
    </clinicalStatus>
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="1300721000000109" />
            <display value="COVID-19 confirmed by laboratory test"/>
        </coding>
    </code>
    <onsetDateTime value="2020-05-06T10:48:19+00:00"/>
    <evidence>
        <detail>
		   <reference value="50E3A850-8F89-11EA-BE46-00155DC3FA77"/>
        </detail>
    </evidence>
</Condition>