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/ExtractMedicalReport | Version: 0.1.0 | |||
| Active as of 2026-09-14 | Computable Name: ExtractMedicalReport | |||
A medical report is written once, read as a whole, and handed to whoever asked for it – an insurer, a court, another hospital – so it extracts as a Composition under LOINC 34133-9 with one section per printed heading, plus a Condition per diagnosis line so the report does not become the only place the diagnosis is written down. Each section names an Observation carrying its text: Narrative.div is an XhtmlType this engine cannot build from FML, and referencing an Observation is the better shape anyway, because the text becomes something a query can reach rather than a blob inside a document. The stay itself lands in Composition.event.period, which is what makes the report answer 'when was this admission'.
/// url = 'https://fhir.slade360.co.ke/fhir/StructureMap/ExtractMedicalReport' /// name = 'ExtractMedicalReport' /// title = 'Medical Report Extraction' /// status = 'active' /// description = 'A medical report is written once, read as a whole, and handed to whoever asked for it -- an insurer, a court, another hospital -- so it extracts as a Composition under LOINC 34133-9 with one section per printed heading, plus a Condition per diagnosis line so the report does not become the only place the diagnosis is written down. Each section names an Observation carrying its text: Narrative.div is an XhtmlType this engine cannot build from FML, and referencing an Observation is the better shape anyway, because the text becomes something a query can reach rather than a blob inside a document. The stay itself lands in Composition.event.period, which is what makes the report answer \'when was this admission\'.' 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 uses "http://hl7.org/fhir/StructureDefinition/Composition" alias Composition as target uses "http://hl7.org/fhir/StructureDefinition/Condition" alias Condition as target group ExtractMedicalReport(source qr : QR, target bundle : Bundle) { qr -> bundle.type = 'transaction' "setBundleType"; qr -> bundle.entry as entry, entry.resource = create('Composition') as comp then { qr -> comp, entry then BuildCompositionBase(qr, comp, entry) "base"; qr -> comp.status = 'final' "status"; qr -> comp.title = 'Medical report' "title"; qr.authored as t -> comp.date = t "date"; qr.encounter as e -> comp.encounter = e; qr -> comp.type as tp then { qr -> tp.coding as cg then { qr -> cg.system = 'http://loinc.org' "sys"; qr -> cg.code = '34133-9' "cd"; qr -> cg.display = 'Summary of episode note' "dsp"; } "coding"; } "type"; qr -> comp.category as cat then { qr -> cat.coding as cg then { qr -> cg.system = 'https://fhir.slade360.co.ke/fhir/CodeSystem/document-type-codesystem' "sys"; qr -> cg.code = 'medical-report' "cd"; qr -> cg.display = 'Medical report' "dsp"; } "coding"; } "category"; // The doctor who signed it is the author, and the form's own signature // block is what says so -- not qr.source, which is whoever keyed it in. qr.item as g where (linkId = 'sign-off') then { g.item as it where ((linkId = 'sign-off/doctor') and answer.value.exists()) then { it.answer first as a then { a.value as ref -> comp.author = ref "author"; }; } "authorRule"; g.item as it where ((linkId = 'sign-off/purpose') and answer.value.exists()) then { it.answer first as a then { a.value as txt -> comp.note as n, n.text = txt "purposeNote"; }; } "purposeRule"; } "signOffGroup"; // ── The admission the report is about ───────────────────────────────── // Composition.event.period is a Period of dateTimes and the form asks for // dates, hence the casts: a DateType into a dateTime element fails at // transform time rather than at compile time. qr.item as g where (linkId = 'stay') then { g -> comp.event as ev then { g -> ev.period as per then { g.item as it where ((linkId = 'stay/admitted-on') and answer.value.exists()) then { it.answer first as a then { a.value as v -> per.start = cast(v, 'dateTime') "start"; }; } "admittedRule"; g.item as it where ((linkId = 'stay/discharged-on') and answer.value.exists()) then { it.answer first as a then { a.value as v -> per.end = cast(v, 'dateTime') "end"; }; } "dischargedRule"; } "period"; } "event"; } "stayGroup"; qr.item as it where ((linkId = 'clinical-summary') and answer.value.exists()) -> comp.section as sec then { it -> sec.title = 'Clinical summary' "title"; it -> sec.code as sc then { it -> sc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '11329-0' "cd"; it -> cg.display = 'History general Narrative - Reported' "dsp"; } "coding"; } "code"; it -> bundle.entry as sentry, sentry.resource = create('Observation') as sobs then { qr -> sobs, sentry then BuildObsBase(qr, sobs, sentry) "base"; qr -> sobs then SetSurveyCategory(qr, sobs) "category"; it -> sobs.code as scc then { it -> scc.coding as scg then { it -> scg.system = 'http://loinc.org' "sys"; it -> scg.code = '11329-0' "cd"; it -> scg.display = 'History general Narrative - Reported' "dsp"; } "coding"; it -> scc.text = 'Clinical summary on the Medical report' "codeText"; } "code"; it.answer first as a then { a.value as txt -> sobs.note as n, n.text = txt "text"; }; it -> sec.entry = create('Reference') as sref, sref.reference = reference(sobs) "linkEntry"; } "sectionObservation"; } "section_clinical_summary"; qr.item as it where ((linkId = 'past-medical-surgical-history') and answer.value.exists()) -> comp.section as sec then { it -> sec.title = 'Past medical and surgical history' "title"; it -> sec.code as sc then { it -> sc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '11348-0' "cd"; it -> cg.display = 'History of Past illness note' "dsp"; } "coding"; } "code"; it -> bundle.entry as sentry, sentry.resource = create('Observation') as sobs then { qr -> sobs, sentry then BuildObsBase(qr, sobs, sentry) "base"; qr -> sobs then SetSurveyCategory(qr, sobs) "category"; it -> sobs.code as scc then { it -> scc.coding as scg then { it -> scg.system = 'http://loinc.org' "sys"; it -> scg.code = '11348-0' "cd"; it -> scg.display = 'History of Past illness note' "dsp"; } "coding"; it -> scc.text = 'Past medical and surgical history on the Medical report' "codeText"; } "code"; it.answer first as a then { a.value as txt -> sobs.note as n, n.text = txt "text"; }; it -> sec.entry = create('Reference') as sref, sref.reference = reference(sobs) "linkEntry"; } "sectionObservation"; } "section_past_medical_surgical_history"; qr.item as it where ((linkId = 'investigations') and answer.value.exists()) -> comp.section as sec then { it -> sec.title = 'Investigations' "title"; it -> sec.code as sc then { it -> sc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '30954-2' "cd"; it -> cg.display = 'Relevant diagnostic tests/laboratory data note' "dsp"; } "coding"; } "code"; it -> bundle.entry as sentry, sentry.resource = create('Observation') as sobs then { qr -> sobs, sentry then BuildObsBase(qr, sobs, sentry) "base"; qr -> sobs then SetSurveyCategory(qr, sobs) "category"; it -> sobs.code as scc then { it -> scc.coding as scg then { it -> scg.system = 'http://loinc.org' "sys"; it -> scg.code = '30954-2' "cd"; it -> scg.display = 'Relevant diagnostic tests/laboratory data note' "dsp"; } "coding"; it -> scc.text = 'Investigations on the Medical report' "codeText"; } "code"; it.answer first as a then { a.value as txt -> sobs.note as n, n.text = txt "text"; }; it -> sec.entry = create('Reference') as sref, sref.reference = reference(sobs) "linkEntry"; } "sectionObservation"; } "section_investigations"; qr.item as it where ((linkId = 'interventions') and answer.value.exists()) -> comp.section as sec then { it -> sec.title = 'Interventions' "title"; it -> sec.code as sc then { it -> sc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '62387-6' "cd"; it -> cg.display = 'Interventions Narrative' "dsp"; } "coding"; } "code"; it -> bundle.entry as sentry, sentry.resource = create('Observation') as sobs then { qr -> sobs, sentry then BuildObsBase(qr, sobs, sentry) "base"; qr -> sobs then SetSurveyCategory(qr, sobs) "category"; it -> sobs.code as scc then { it -> scc.coding as scg then { it -> scg.system = 'http://loinc.org' "sys"; it -> scg.code = '62387-6' "cd"; it -> scg.display = 'Interventions Narrative' "dsp"; } "coding"; it -> scc.text = 'Interventions on the Medical report' "codeText"; } "code"; it.answer first as a then { a.value as txt -> sobs.note as n, n.text = txt "text"; }; it -> sec.entry = create('Reference') as sref, sref.reference = reference(sobs) "linkEntry"; } "sectionObservation"; } "section_interventions"; qr.item as it where ((linkId = 'treatment') and answer.value.exists()) -> comp.section as sec then { it -> sec.title = 'Treatment' "title"; it -> sec.code as sc then { it -> sc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '18776-5' "cd"; it -> cg.display = 'Plan of care note' "dsp"; } "coding"; } "code"; it -> bundle.entry as sentry, sentry.resource = create('Observation') as sobs then { qr -> sobs, sentry then BuildObsBase(qr, sobs, sentry) "base"; qr -> sobs then SetSurveyCategory(qr, sobs) "category"; it -> sobs.code as scc then { it -> scc.coding as scg then { it -> scg.system = 'http://loinc.org' "sys"; it -> scg.code = '18776-5' "cd"; it -> scg.display = 'Plan of care note' "dsp"; } "coding"; it -> scc.text = 'Treatment on the Medical report' "codeText"; } "code"; it.answer first as a then { a.value as txt -> sobs.note as n, n.text = txt "text"; }; it -> sec.entry = create('Reference') as sref, sref.reference = reference(sobs) "linkEntry"; } "sectionObservation"; } "section_treatment"; qr.item as it where ((linkId = 'discharge-instructions-and-medications') and answer.value.exists()) -> comp.section as sec then { it -> sec.title = 'Discharge instructions and medications' "title"; it -> sec.code as sc then { it -> sc.coding as cg then { it -> cg.system = 'http://loinc.org' "sys"; it -> cg.code = '8653-8' "cd"; it -> cg.display = 'Hospital Discharge instructions' "dsp"; } "coding"; } "code"; it -> bundle.entry as sentry, sentry.resource = create('Observation') as sobs then { qr -> sobs, sentry then BuildObsBase(qr, sobs, sentry) "base"; qr -> sobs then SetSurveyCategory(qr, sobs) "category"; it -> sobs.code as scc then { it -> scc.coding as scg then { it -> scg.system = 'http://loinc.org' "sys"; it -> scg.code = '8653-8' "cd"; it -> scg.display = 'Hospital Discharge instructions' "dsp"; } "coding"; it -> scc.text = 'Discharge instructions and medications on the Medical report' "codeText"; } "code"; it.answer first as a then { a.value as txt -> sobs.note as n, n.text = txt "text"; }; it -> sec.entry = create('Reference') as sref, sref.reference = reference(sobs) "linkEntry"; } "sectionObservation"; } "section_discharge_instructions_and_medications"; } "medicalReportComposition"; // ── The diagnoses ─────────────────────────────────────────────────────── // One Condition per line. Where the writer picked a Condition the patient // already has, the reference travels as evidence rather than forking the // problem list -- a report written for an insurer should not add a second // copy of a diagnosis that is already on the record. qr.item as g where (linkId = 'diagnosis') then { g.item as d where (linkId = 'diagnosis/entry') then { d.item as it where ((linkId = 'diagnosis/entry/text') and answer.value.exists()) -> bundle.entry as entry, entry.resource = create('Condition') as cond then { qr -> cond, entry then BuildConditionBase(qr, cond, entry) "base"; it -> cond.clinicalStatus as cs then { it -> cs.coding as cg then { it -> cg.system = 'http://terminology.hl7.org/CodeSystem/condition-clinical' "sys"; it -> cg.code = 'active' "cd"; it -> cg.display = 'Active' "dsp"; } "coding"; } "clinicalStatus"; it -> cond.category as cat then { it -> cat.coding as cg then { it -> cg.system = 'http://terminology.hl7.org/CodeSystem/condition-category' "sys"; it -> cg.code = 'encounter-diagnosis' "cd"; it -> cg.display = 'Encounter Diagnosis' "dsp"; } "coding"; } "category"; it.answer first as a then { a.value as txt -> cond.code as cc, cc.text = txt "codeText"; }; qr.authored as t -> cond.recordedDate = t "recordedDate"; qr.encounter as e -> cond.encounter = e; d.item as ex where ((linkId = 'diagnosis/entry/condition') and answer.value.exists()) then { ex.answer first as ea then { ea.value as existing -> cond.evidence as ev, ev.reference = existing "evidenceReference"; }; } "existingRule"; } "diagnosisCondition"; } "diagnosisRows"; } "diagnosisGroup"; // ── The wards ─────────────────────────────────────────────────────────── // Observations rather than anything on the Composition. Which ward a patient // was admitted to and which one they left from is a fact about the stay that // gets asked in aggregate, and there is nowhere on a Composition to put it // where a query would find it. qr.item as g where (linkId = 'stay') then { g.item as it where ((linkId = 'stay/ward-of-admission') 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 = 'discharge-ward-of-admission' "cd"; it -> cg.display = 'Ward of admission' "dsp"; } "coding"; } "code"; it.answer first as a then { a.value as txt -> obs.note as n, n.text = txt "text"; }; } "narr_discharge_ward_of_admission"; g.item as it where ((linkId = 'stay/ward-of-discharge') 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 = 'discharge-ward-of-discharge' "cd"; it -> cg.display = 'Ward of discharge' "dsp"; } "coding"; } "code"; it.answer first as a then { a.value as txt -> obs.note as n, n.text = txt "text"; }; } "narr_discharge_ward_of_discharge"; } "wardGroup"; } // ───────────────────────────────────────────────────────────────────────────── // 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 BuildCompositionBase(source qr : QR, target r : Composition, target entry) { qr -> r then SetResponseProvenance(qr, r) "responseProvenance"; qr -> r.id = uuid() then SetCompositionFullUrl(r, entry) "idAndFullUrl"; qr -> entry.request as request then { qr -> request.method = 'POST' "requestMethod"; qr -> request.url = 'Composition' "requestUrl"; } "entryRequest"; qr.subject as s -> r.subject = s; } group SetCompositionFullUrl(source r : Composition, target entry) { r.id as id -> entry.fullUrl = append('https://fhir.slade360.co.ke/fhir/Composition/', id) "assignFullUrl"; } group BuildConditionBase(source qr : QR, target r : Condition, target entry) { qr -> r then SetResponseProvenance(qr, r) "responseProvenance"; qr -> r.id = uuid() then SetConditionFullUrl(r, entry) "idAndFullUrl"; qr -> entry.request as request then { qr -> request.method = 'POST' "requestMethod"; qr -> request.url = 'Condition' "requestUrl"; } "entryRequest"; qr.subject as s -> r.subject = s; } group SetConditionFullUrl(source r : Condition, target entry) { r.id as id -> entry.fullUrl = append('https://fhir.slade360.co.ke/fhir/Condition/', id) "assignFullUrl"; } // ── 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 = 'medical-report' "provenanceCode"; qr -> t.display = 'Medical report' "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"; }