SGHI FHIR Profile Implementation Guide
0.1.0 - ci-build
SGHI FHIR Profile Implementation Guide, published by Kathurima Kimathi. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/savannahghi/sil_fhir_profile_ig/ and changes regularly. See the Directory of published versions
| Official URL: https://fhir.slade360.co.ke/fhir/StructureMap/ExtractIcuNeurologicalChart | Version: 0.1.0 | |||
| Active as of 2026-09-14 | Computable Name: ExtractIcuNeurologicalChart | |||
Each round of the ICU neurological chart out as: one Observation for the Glasgow Coma Scale under LOINC 9269-2, carrying the total as its value and the three components under their own LOINC codes, with the total computed by the map when the client submits none; one for limb power; one per eye for pupil size and reaction, because a unilaterally dilating pupil is the finding that matters and it has to be findable per side; and the four vitals each as their own Observation. Every one takes the round's own time, not the form's, because the chart is a time series and a deteriorating conscious level is only visible as one.
/// url = 'https://fhir.slade360.co.ke/fhir/StructureMap/ExtractIcuNeurologicalChart' /// name = 'ExtractIcuNeurologicalChart' /// title = 'ICU Neurological Observation Chart Extraction' /// status = 'active' /// description = 'Each round of the ICU neurological chart out as: one Observation for the Glasgow Coma Scale under LOINC 9269-2, carrying the total as its value and the three components under their own LOINC codes, with the total computed by the map when the client submits none; one for limb power; one per eye for pupil size and reaction, because a unilaterally dilating pupil is the finding that matters and it has to be findable per side; and the four vitals each as their own Observation. Every one takes the round\'s own time, not the form\'s, because the chart is a time series and a deteriorating conscious level is only visible as one.' uses "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse" alias QR as source uses "http://hl7.org/fhir/StructureDefinition/Bundle" alias Bundle as target uses "http://hl7.org/fhir/StructureDefinition/Observation" alias Observation as target group ExtractIcuNeurologicalChart(source qr : QR, target bundle : Bundle) { qr -> bundle.type = 'transaction' "setBundleType"; // Day in unit, as its own Observation. Not a component of anything: it is the // denominator for every length-of-stay question anyone asks of critical care. qr.item as g where (linkId = 'unit') then { g.item as it where ((linkId = 'unit/day-in-unit') and answer.value.exists()) -> bundle.entry as entry, entry.resource = create('Observation') as obs then { qr -> obs, entry then BuildObsBase(qr, obs, entry) "base"; qr -> obs then SetSurveyCategory(qr, obs) "category"; it -> obs.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'https://fhir.slade360.co.ke/fhir/CodeSystem/concept-codesystem' "sys"; it -> cg.code = 'obs-day-in-unit' "cd"; it -> cg.display = 'Day in unit' "dsp"; } "coding"; } "code"; it.answer first as a then { a.value as v -> obs.value = v "set"; }; } "measure_labour_stage_duration"; g.item as it where ((linkId = 'unit/diagnosis') and answer.value.exists()) -> bundle.entry as entry, entry.resource = create('Observation') as obs then { qr -> obs, entry then BuildObsBase(qr, obs, entry) "base"; qr -> obs then SetSurveyCategory(qr, obs) "category"; it -> obs.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '11450-4' "cd"; it -> cg.display = 'Problem list - Reported' "dsp"; } "coding"; it -> cc.text = 'Diagnosis on the ICU neurological chart' "codeText"; } "code"; it.answer first as a then { a.value as txt -> obs.note as n, n.text = txt "text"; }; } "narr_11450_4"; } "unitGroup"; // ── One round at a time ───────────────────────────────────────────────── qr.item as g where (linkId = 'round') then { // ── The Glasgow Coma Scale ──────────────────────────────────────────── // One Observation under LOINC 9269-2, total as the value, the three // components under 9267-6, 9270-0 and 9268-4. The answers are the IG's own // clinical-score codes -- #gcs-eye-1..4 and so on -- reused rather than // minted again, so a GCS charted here and a GCS charted on the pain // templates' Glasgow form are the same coded answers. // The total prefers what the form submitted and otherwise sums the weights // off the tails of the answer codes. Guarded on all three components being // answered: a GCS of 8 over two components is not a lower GCS, it is a // different number, and nothing in the resource would say which. g.item as gcs where ((linkId = 'round/gcs') and (item.answer.value.ofType(Coding).count() = 3)) -> bundle.entry as entry, entry.resource = create('Observation') as obs then { qr -> obs, entry then BuildObsBase(qr, obs, entry) "base"; qr -> obs then SetExamCategory(qr, obs) "category"; gcs -> obs.code as cc then { gcs -> cc.coding as cg then { gcs -> cg.system = 'http://loinc.org' "sys"; gcs -> cg.code = '9269-2' "cd"; gcs -> cg.display = 'Glasgow coma score total' "dsp"; } "coding"; } "code"; gcs -> obs.value = evaluate(gcs, iif(item.where(linkId = 'round/gcs/total').answer.value.exists(), item.where(linkId = 'round/gcs/total').answer.value.truncate(), item.answer.value.ofType(Coding).code.select(iif($this.endsWith('-6'), 6, iif($this.endsWith('-5'), 5, iif($this.endsWith('-4'), 4, iif($this.endsWith('-3'), 3, iif($this.endsWith('-2'), 2, iif($this.endsWith('-1'), 1, 0))))))).aggregate($this + $total, 0))) "totalValue"; // 8 or less is coma. Stated as the interpretation rather than left to a // reader, because that threshold is what triggers intubation. gcs -> obs.interpretation as interp then { gcs -> interp.coding as icg then { gcs -> icg.system = 'http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation' "sys"; gcs -> icg.code = evaluate(gcs, iif(iif(item.where(linkId = 'round/gcs/total').answer.value.exists(), item.where(linkId = 'round/gcs/total').answer.value.truncate(), item.answer.value.ofType(Coding).code.select(iif($this.endsWith('-6'), 6, iif($this.endsWith('-5'), 5, iif($this.endsWith('-4'), 4, iif($this.endsWith('-3'), 3, iif($this.endsWith('-2'), 2, iif($this.endsWith('-1'), 1, 0))))))).aggregate($this + $total, 0)) <= 8, 'LL', iif(iif(item.where(linkId = 'round/gcs/total').answer.value.exists(), item.where(linkId = 'round/gcs/total').answer.value.truncate(), item.answer.value.ofType(Coding).code.select(iif($this.endsWith('-6'), 6, iif($this.endsWith('-5'), 5, iif($this.endsWith('-4'), 4, iif($this.endsWith('-3'), 3, iif($this.endsWith('-2'), 2, iif($this.endsWith('-1'), 1, 0))))))).aggregate($this + $total, 0)) < 15, 'A', 'N'))) "cd"; } "coding"; } "interpretation"; g.item as tm where ((linkId = 'round/time') and answer.value.exists()) then { tm.answer first as a then { a.value as t -> obs.note as n, n.text = 'Round taken at the time recorded on the chart' "timeNote"; }; } "roundTimeRule"; gcs.item as it where ((linkId = 'round/gcs/eyes-open') and answer.value.exists()) -> obs.component as comp then { it -> comp.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '9267-6' "cd"; it -> cg.display = 'Glasgow coma score eye opening' "dsp"; } "coding"; } "code"; it -> comp then SetComponentCodedValue(it, comp) "value"; } "comp_9267_6"; gcs.item as it where ((linkId = 'round/gcs/verbal-response') and answer.value.exists()) -> obs.component as comp then { it -> comp.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '9270-0' "cd"; it -> cg.display = 'Glasgow coma score verbal' "dsp"; } "coding"; } "code"; it -> comp then SetComponentCodedValue(it, comp) "value"; } "comp_9270_0"; gcs.item as it where ((linkId = 'round/gcs/motor-response') and answer.value.exists()) -> obs.component as comp then { it -> comp.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '9268-4' "cd"; it -> cg.display = 'Glasgow coma score motor' "dsp"; } "coding"; } "code"; it -> comp then SetComponentCodedValue(it, comp) "value"; } "comp_9268_4"; } "gcsObservation"; // ── Limb power ──────────────────────────────────────────────────────── // One Observation with arms and legs as components. Together, because the // finding that matters is asymmetry and a reader compares them. g.item as lm where ((linkId = 'round/limb-movement') and item.answer.value.exists()) -> bundle.entry as entry, entry.resource = create('Observation') as obs then { qr -> obs, entry then BuildObsBase(qr, obs, entry) "base"; qr -> obs then SetExamCategory(qr, obs) "category"; lm -> obs.code as cc then { lm -> cc.coding as cg then { lm -> cg.system = 'https://fhir.slade360.co.ke/fhir/CodeSystem/concept-codesystem' "sys"; lm -> cg.code = 'limb-power' "cd"; lm -> cg.display = 'Limb power' "dsp"; } "coding"; } "code"; lm.item as it where ((linkId = 'round/limb-movement/arms') and answer.value.exists()) -> obs.component as comp then { it -> comp.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'https://fhir.slade360.co.ke/fhir/CodeSystem/concept-codesystem' "sys"; it -> cg.code = 'neuro-arm-power' "cd"; it -> cg.display = 'Arm power' "dsp"; } "coding"; } "code"; it -> comp then SetComponentCodedValue(it, comp) "value"; } "comp_neuro_arm_power"; lm.item as it where ((linkId = 'round/limb-movement/legs') and answer.value.exists()) -> obs.component as comp then { it -> comp.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'https://fhir.slade360.co.ke/fhir/CodeSystem/concept-codesystem' "sys"; it -> cg.code = 'neuro-leg-power' "cd"; it -> cg.display = 'Leg power' "dsp"; } "coding"; } "code"; it -> comp then SetComponentCodedValue(it, comp) "value"; } "comp_neuro_leg_power"; } "limbPowerObservation"; // ── Pupils, one Observation per eye ─────────────────────────────────── // Per eye and not one panel of four. A unilaterally dilating unreactive // pupil is the sign of an expanding mass on that side, and "which side" is // the whole question -- so each eye carries its own bodySite and a query // can ask about the right pupil alone. g.item as pg where ((linkId = 'round/pupils') and item.where(linkId = 'round/pupils/right-reaction').answer.value.exists()) -> bundle.entry as entry, entry.resource = create('Observation') as obs then { qr -> obs, entry then BuildObsBase(qr, obs, entry) "base"; qr -> obs then SetExamCategory(qr, obs) "category"; pg -> obs.code as cc then { pg -> cc.coding as cg then { pg -> cg.system = 'https://fhir.slade360.co.ke/fhir/CodeSystem/concept-codesystem' "sys"; pg -> cg.code = 'pupil-assessment' "cd"; pg -> cg.display = 'Pupil assessment' "dsp"; } "coding"; pg -> cc.text = 'Right pupil' "codeText"; } "code"; pg -> obs.bodySite as bsc then { pg -> bsc.coding as bcg then { pg -> bcg.system = 'http://snomed.info/sct' "sys"; pg -> bcg.code = '18944008' "cd"; pg -> bcg.display = 'Right eye structure' "dsp"; } "coding"; } "bodySite"; pg.item as it where ((linkId = 'round/pupils/right-size') and answer.value.exists()) -> obs.component as comp then { it -> comp.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'https://fhir.slade360.co.ke/fhir/CodeSystem/concept-codesystem' "sys"; it -> cg.code = 'neuro-pupil-size' "cd"; it -> cg.display = 'Pupil size' "dsp"; } "coding"; } "code"; it -> comp then SetComponentValue(it, comp) "value"; } "comp_neuro_pupil_size"; pg.item as it where ((linkId = 'round/pupils/right-reaction') and answer.value.exists()) -> obs.component as comp then { it -> comp.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'https://fhir.slade360.co.ke/fhir/CodeSystem/concept-codesystem' "sys"; it -> cg.code = 'neuro-pupil-reaction' "cd"; it -> cg.display = 'Pupil reaction' "dsp"; } "coding"; } "code"; it -> comp then SetComponentCodedValue(it, comp) "value"; } "comp_neuro_pupil_reaction"; } "pupil_right"; g.item as pg where ((linkId = 'round/pupils') and item.where(linkId = 'round/pupils/left-reaction').answer.value.exists()) -> bundle.entry as entry, entry.resource = create('Observation') as obs then { qr -> obs, entry then BuildObsBase(qr, obs, entry) "base"; qr -> obs then SetExamCategory(qr, obs) "category"; pg -> obs.code as cc then { pg -> cc.coding as cg then { pg -> cg.system = 'https://fhir.slade360.co.ke/fhir/CodeSystem/concept-codesystem' "sys"; pg -> cg.code = 'pupil-assessment' "cd"; pg -> cg.display = 'Pupil assessment' "dsp"; } "coding"; pg -> cc.text = 'Left pupil' "codeText"; } "code"; pg -> obs.bodySite as bsc then { pg -> bsc.coding as bcg then { pg -> bcg.system = 'http://snomed.info/sct' "sys"; pg -> bcg.code = '8966001' "cd"; pg -> bcg.display = 'Left eye structure' "dsp"; } "coding"; } "bodySite"; pg.item as it where ((linkId = 'round/pupils/left-size') and answer.value.exists()) -> obs.component as comp then { it -> comp.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'https://fhir.slade360.co.ke/fhir/CodeSystem/concept-codesystem' "sys"; it -> cg.code = 'neuro-pupil-size' "cd"; it -> cg.display = 'Pupil size' "dsp"; } "coding"; } "code"; it -> comp then SetComponentValue(it, comp) "value"; } "comp_neuro_pupil_size2"; pg.item as it where ((linkId = 'round/pupils/left-reaction') and answer.value.exists()) -> obs.component as comp then { it -> comp.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'https://fhir.slade360.co.ke/fhir/CodeSystem/concept-codesystem' "sys"; it -> cg.code = 'neuro-pupil-reaction' "cd"; it -> cg.display = 'Pupil reaction' "dsp"; } "coding"; } "code"; it -> comp then SetComponentCodedValue(it, comp) "value"; } "comp_neuro_pupil_reaction2"; } "pupil_left"; // ── The four vitals the chart graphs ────────────────────────────────── g.item as vg where (linkId = 'round/vitals') then { vg.item as it where ((linkId = 'round/vitals/pulse') and answer.value.exists()) -> bundle.entry as entry, entry.resource = create('Observation') as obs then { qr -> obs, entry then BuildObsBase(qr, obs, entry) "base"; qr -> obs then SetVitalSignsCategory(qr, obs) "category"; it -> obs.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '8867-4' "cd"; it -> cg.display = 'Heart rate' "dsp"; } "coding"; } "code"; it.answer first as a then { a.value as v -> obs.value = v "set"; }; } "vital_8867_4"; vg.item as it where ((linkId = 'round/vitals/respiratory-rate') and answer.value.exists()) -> bundle.entry as entry, entry.resource = create('Observation') as obs then { qr -> obs, entry then BuildObsBase(qr, obs, entry) "base"; qr -> obs then SetVitalSignsCategory(qr, obs) "category"; it -> obs.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '9279-1' "cd"; it -> cg.display = 'Respiratory rate' "dsp"; } "coding"; } "code"; it.answer first as a then { a.value as v -> obs.value = v "set"; }; } "vital_9279_1"; vg.item as it where ((linkId = 'round/vitals/temperature') and answer.value.exists()) -> bundle.entry as entry, entry.resource = create('Observation') as obs then { qr -> obs, entry then BuildObsBase(qr, obs, entry) "base"; qr -> obs then SetVitalSignsCategory(qr, obs) "category"; it -> obs.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '8310-5' "cd"; it -> cg.display = 'Body temperature' "dsp"; } "coding"; } "code"; it.answer first as a then { a.value as v -> obs.value = v "set"; }; } "vital_8310_5"; vg.item as bp where ((linkId = 'round/vitals/blood-pressure') and item.answer.value.exists()) -> bundle.entry as entry, entry.resource = create('Observation') as obs then { qr -> obs, entry then BuildObsBase(qr, obs, entry) "base"; qr -> obs then SetVitalSignsCategory(qr, obs) "category"; bp -> obs.code as cc then { bp -> cc.coding as cg then { bp -> cg.system = 'http://loinc.org' "sys"; bp -> cg.code = '85354-9' "cd"; bp -> cg.display = 'Blood pressure panel with all children optional' "dsp"; } "coding"; } "code"; bp.item as it where ((linkId = 'round/vitals/blood-pressure/systolic') and answer.value.exists()) -> obs.component as comp then { it -> comp.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '8480-6' "cd"; it -> cg.display = 'Systolic blood pressure' "dsp"; } "coding"; } "code"; it -> comp then SetComponentValue(it, comp) "value"; } "comp_8480_6"; bp.item as it where ((linkId = 'round/vitals/blood-pressure/diastolic') and answer.value.exists()) -> obs.component as comp then { it -> comp.code as cc then { it -> cc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '8462-4' "cd"; it -> cg.display = 'Diastolic blood pressure' "dsp"; } "coding"; } "code"; it -> comp then SetComponentValue(it, comp) "value"; } "comp_8462_4"; } "bloodPressureObservation"; } "vitalsGroup"; } "roundGroup"; } // ───────────────────────────────────────────────────────────────────────────── // Shared scaffolding. Repeated in each map rather than imported: the transform // engine resolves `imports` against whatever StructureMaps happen to be on the // server, and a form that stops extracting because a shared map was not // uploaded is a worse failure than a duplicated group. // Two notes on what the publisher's StructureMap validator says about this file. // Source parameters below are left untyped on purpose. Writing `: Element` makes // the validator compare QuestionnaireResponse.item against the literal 'Element' // and report them as incompatible with each other, which is noise, not a finding. // `evaluate(context, expression)` is flagged as "takes 1 parameter but 2 were // found". Leave it. The FML parser in the same jar refuses the one-argument form // outright -- it wants a parameter, a comma, then the FHIRPath -- so the // publisher is objecting to what its own compiler emits. Two arguments is the // only form that compiles, and it is what the R5 transform engine executes. // ───────────────────────────────────────────────────────────────────────────── group BuildObsBase(source qr : QR, target obs : Observation, target entry) { qr -> obs then SetResponseProvenance(qr, obs) "responseProvenance"; qr -> obs.id = uuid() then SetObservationFullUrl(obs, entry) "idAndFullUrl"; qr -> entry.request as request then { qr -> request.method = 'POST' "requestMethod"; qr -> request.url = 'Observation' "requestUrl"; } "entryRequest"; qr -> obs.status = 'final' "status"; qr.subject as s -> obs.subject = s; qr.encounter as e -> obs.encounter = e; qr.authored as t -> obs.effective = t "effective"; qr.source as src -> obs.performer = src "performerFromSource"; qr where (source.exists().not()) then { qr.author as a -> obs.performer = a "performerFromAuthor"; } "performerFallback"; // A stored response's id already reads "QuestionnaireResponse/<id>", so it is // a relative reference as it stands. The hasValue() guard is what stops an // unsaved response -- one posted straight to $extract rather than saved first // -- from writing "QuestionnaireResponse/null" into the record. qr.id as qid where ($this.hasValue()) -> obs.derivedFrom = create('Reference') as ref, ref.reference = qid "linkQuestionnaireResponse"; } group SetObservationFullUrl(source obs : Observation, target entry) { obs.id as id -> entry.fullUrl = append('https://fhir.slade360.co.ke/fhir/Observation/', id) "assignFullUrl"; } // The two answer shapes a component can carry. Both read the answer through the // untyped `.value` accessor: reading `valueCoding` or `valueQuantity` by its // typed property name fails at transform time on HAPI R5 with "Attempt to read // invalid property ... on QuestionnaireResponse.item.answer". group SetComponentCodedValue(source it, target comp) { it.answer first as a then { a.value as cv -> comp.value = create('CodeableConcept') as cc then { cv -> cc.coding = cv "valueCoding"; cv.display as d -> cc.text = d "valueText"; } "codedValue"; } "componentAnswer"; } group SetComponentValue(source it, target comp) { it.answer first as a then { a.value as v -> comp.value = v "plainValue"; } "componentAnswer"; } group SetSurveyCategory(source qr : QR, target obs : Observation) { qr -> obs.category as cat then { qr -> cat.coding as coding then { qr -> coding.system = 'http://terminology.hl7.org/CodeSystem/observation-category' "categorySystem"; qr -> coding.code = 'survey' "categoryCode"; qr -> coding.display = 'Survey' "categoryDisplay"; } "categoryCoding"; } "category"; } group SetVitalSignsCategory(source qr : QR, target obs : Observation) { qr -> obs.category as cat then { qr -> cat.coding as coding then { qr -> coding.system = 'http://terminology.hl7.org/CodeSystem/observation-category' "categorySystem"; qr -> coding.code = 'vital-signs' "categoryCode"; qr -> coding.display = 'Vital Signs' "categoryDisplay"; } "categoryCoding"; } "category"; } group SetExamCategory(source qr : QR, target obs : Observation) { qr -> obs.category as cat then { qr -> cat.coding as coding then { qr -> coding.system = 'http://terminology.hl7.org/CodeSystem/observation-category' "categorySystem"; qr -> coding.code = 'exam' "categoryCode"; qr -> coding.display = 'Exam' "categoryDisplay"; } "categoryCoding"; } "category"; } // ── Provenance and tenancy ─────────────────────────────────────────────────── // Two tags on everything this map creates. The first says which questionnaire // produced it, so a form that reopens mid-admission recalls its own earlier // entries and not another form's. The second copies the tenant tags off the // response, because nothing else on the path puts them there. // The code is the form's document type, not the questionnaire's id: every // environment mints its own ids, and there is only one set of maps, so an id // here would tie the tag to whichever environment stamped it. // ── Provenance and tenancy ─────────────────────────────────────────────────── group SetResponseProvenance(source qr : QR, target r) { qr -> r.meta as m then { qr -> m.tag as t then { qr -> t.system = 'http://slade360edi.com/questionnaire-provenance' "provenanceSystem"; qr -> t.code = 'icu-neurological-chart' "provenanceCode"; qr -> t.display = 'ICU neurological observation chart' "provenanceDisplay"; } "provenanceTag"; } "provenanceMeta"; // Every tag the response carries, onto the resource. `meta` is 0..1, so this // lands on the same meta the rule above created rather than a second one. qr.meta as qm then { qm.tag as qt -> r.meta as m, m.tag = qt "copyTag"; } "tenantTags"; }