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

StructureMap: Nursing Care Plan Extraction

Official URL: https://fhir.slade360.co.ke/fhir/StructureMap/ExtractNursingCarePlan Version: 0.1.0
Active as of 2026-09-14 Computable Name: ExtractNursingCarePlan

One CarePlan with an activity per problem, plus a Condition per nursing diagnosis and an Observation carrying the assessment, rationale, implementation and evaluation for that row. Every column is kept, including the scientific rationale – this sheet is the one place the reasoning behind a nursing action is written down, and without it the intervention reads as arbitrary.

/// url = 'https://fhir.slade360.co.ke/fhir/StructureMap/ExtractNursingCarePlan'
/// name = 'ExtractNursingCarePlan'
/// title = 'Nursing Care Plan Extraction'
/// status = 'active'
/// description = 'One CarePlan with an activity per problem, plus a Condition per nursing diagnosis and an Observation carrying the assessment, rationale, implementation and evaluation for that row. Every column is kept, including the scientific rationale -- this sheet is the one place the reasoning behind a nursing action is written down, and without it the intervention reads as arbitrary.'

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/CarePlan" alias CarePlan as target
uses "http://hl7.org/fhir/StructureDefinition/Condition" alias Condition as target

group ExtractNursingCarePlan(source qr : QR, target bundle : Bundle) {
  qr -> bundle.type = 'transaction' "setBundleType";
  qr where (item.where(linkId = 'problem').item.where(linkId = 'problem/nursing-diagnosis').answer.value.exists()) ->  bundle.entry as entry,  entry.resource = create('CarePlan') as plan then {
    qr ->  plan,  entry then BuildCarePlanBase(qr, plan, entry) "base";
    qr -> plan.status = 'active' "status";
    qr -> plan.intent = 'plan' "intent";
    qr -> plan.title = 'Nursing care plan' "title";
    qr.authored as t -> plan.created = t "created";
    qr.encounter as e -> plan.encounter = e;
    qr.source as src -> plan.custodian = src "custodian";
    qr -> plan.category as cat then {
      qr -> cat.coding as cg then {
        qr -> cg.system = 'http://loinc.org' "sys";
        qr -> cg.code = '18776-5' "cd";
        qr -> cg.display = 'Plan of care note' "dsp";
      } "coding";
    } "category";
    // One activity per problem row, displaying the intervention. The expected
    // outcome rides as a note beside it, because a CarePlan activity has
    // nowhere to hold a goal without creating a Goal resource the sheet does
    // not give enough to build honestly -- no target date, no measure.
    qr.item as row where (linkId = 'problem') then {
      row.item as it where ((linkId = 'problem/intervention') and answer.value.exists()) -> plan.activity as act then {
        it.answer first as a then {
          a.value as txt ->  act.plannedActivityReference = create('Reference') as ref,  ref.display = txt "interventionDisplay";
        };
      } "interventionRow";
      row.item as it where ((linkId = 'problem/expected-outcome') and answer.value.exists()) then {
        it.answer first as a then {
          a.value as txt ->  plan.note as n,  n.text = txt "outcomeNote";
        };
      } "outcomeRow";
    } "problemRows";
  } "nursingCarePlan";
  // ── The nursing diagnosis, as a Condition ───────────────────────────────
  // Category 'problem-list-item' and verificationStatus 'unconfirmed': a
  // nursing diagnosis is a real problem statement but it is not a medical
  // diagnosis, and conflating the two would put "risk of falls" alongside
  // "pneumonia" as though a doctor had confirmed it.
  qr.item as row where (linkId = 'problem') then {
    row.item as it where ((linkId = 'problem/nursing-diagnosis') 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.verificationStatus as vs then {
        it -> vs.coding as cg then {
          it -> cg.system = 'http://terminology.hl7.org/CodeSystem/condition-ver-status' "sys";
          it -> cg.code = 'unconfirmed' "cd";
          it -> cg.display = 'Unconfirmed' "dsp";
        } "coding";
      } "verificationStatus";
      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 = 'problem-list-item' "cd";
          it -> cg.display = 'Problem List Item' "dsp";
        } "coding";
        it -> cat.text = 'Nursing diagnosis' "catText";
      } "category";
      it.answer first as a then {
        a.value as txt ->  cond.code as cc,  cc.text = txt "codeText";
      };
      qr.encounter as e -> cond.encounter = e;
      row.item as d where ((linkId = 'problem/date') and answer.value.exists()) then {
        d.answer first as a then {
          a.value as v -> cond.recordedDate = v "recordedDate";
        };
      } "dateRule";
    } "nursingDiagnosis";
    // ── The rest of the nursing process for that row ──────────────────────
    row where (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 SetSurveyCategory(qr, obs) "category";
      row -> obs.code as cc then {
        row -> cc.coding as cg then {
          row -> cg.system = 'https://fhir.slade360.co.ke/fhir/CodeSystem/concept-codesystem' "sys";
          row -> cg.code = 'nursing-process-record' "cd";
          row -> cg.display = 'Nursing process record' "dsp";
        } "coding";
      } "code";
      row.item as it where ((linkId = 'problem/assessment') 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 = 'nursing-process-nursing-assessment' "cd";
            it -> cg.display = 'Nursing assessment' "dsp";
          } "coding";
        } "code";
        it -> comp then SetComponentValue(it, comp) "value";
      } "comp_nursing_process_nursing_assessment";
      row.item as it where ((linkId = 'problem/expected-outcome') 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 = 'nursing-process-expected-outcome-or-goal' "cd";
            it -> cg.display = 'Expected outcome or goal' "dsp";
          } "coding";
        } "code";
        it -> comp then SetComponentValue(it, comp) "value";
      } "comp_nursing_process_expected_outcome_or_goal";
      row.item as it where ((linkId = 'problem/intervention') 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 = 'nursing-process-nursing-intervention' "cd";
            it -> cg.display = 'Nursing intervention' "dsp";
          } "coding";
        } "code";
        it -> comp then SetComponentValue(it, comp) "value";
      } "comp_nursing_process_nursing_intervention";
      row.item as it where ((linkId = 'problem/rationale') 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 = 'nursing-process-scientific-rationale-for-the-intervention' "cd";
            it -> cg.display = 'Scientific rationale for the intervention' "dsp";
          } "coding";
        } "code";
        it -> comp then SetComponentValue(it, comp) "value";
      } "comp_nursing_process_scientific_rationale_for_the_intervention";
      row.item as it where ((linkId = 'problem/implementation') 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 = 'nursing-process-implementation-of-the-nursing-plan' "cd";
            it -> cg.display = 'Implementation of the nursing plan' "dsp";
          } "coding";
        } "code";
        it -> comp then SetComponentValue(it, comp) "value";
      } "comp_nursing_process_implementation_of_the_nursing_plan";
      row.item as it where ((linkId = 'problem/evaluation') 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 = 'nursing-process-evaluation-of-the-nursing-plan' "cd";
            it -> cg.display = 'Evaluation of the nursing plan' "dsp";
          } "coding";
        } "code";
        it -> comp then SetComponentValue(it, comp) "value";
      } "comp_nursing_process_evaluation_of_the_nursing_plan";
      row -> obs then SetNursingRowTime(row, obs) "rowTime";
    } "nursingProcess";
  } "problemRowsAgain";
}

// The row's own timestamp on everything extracted from that row.
group SetNursingRowTime(source row, target obs : Observation) {
  row.item as it where ((linkId = 'problem/date') and answer.value.exists()) then {
    it.answer first as a then {
      a.value as v -> obs.effective = cast(v, 'dateTime') "effective";
    };
  } "rowTimeRule";
  row.item as it where ((linkId = 'problem/nurse') and answer.value.exists()) then {
    it.answer first as a then {
      a.value as ref -> obs.performer = ref "by";
    };
  } "rowByRule";
}

// ─────────────────────────────────────────────────────────────────────────────
// 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 BuildCarePlanBase(source qr : QR, target r : CarePlan, target entry) {
  qr -> r then SetResponseProvenance(qr, r) "responseProvenance";
  qr -> r.id = uuid() then SetCarePlanFullUrl(r, entry) "idAndFullUrl";
  qr -> entry.request as request then {
    qr -> request.method = 'POST' "requestMethod";
    qr -> request.url = 'CarePlan' "requestUrl";
  } "entryRequest";
  qr.subject as s -> r.subject = s;
}

group SetCarePlanFullUrl(source r : CarePlan, target entry) {
  r.id as id -> entry.fullUrl = append('https://fhir.slade360.co.ke/fhir/CarePlan/', 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 = 'nursing-care-plan' "provenanceCode";
      qr -> t.display = 'Nursing care plan' "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";
}