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: Out-patient Summary Extraction

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

A ClinicalImpression whose summary is the provisional diagnosis and whose supportingInfo names the complaints Observation, plus a Condition with verificationStatus provisional. Provisional is the point: this is written at the end of a single out-patient visit, and a Condition that does not say so reads as settled to everything downstream that looks at it.

/// url = 'https://fhir.slade360.co.ke/fhir/StructureMap/ExtractOutpatientSummary'
/// name = 'ExtractOutpatientSummary'
/// title = 'Out-patient Summary Extraction'
/// status = 'active'
/// description = 'A ClinicalImpression whose summary is the provisional diagnosis and whose supportingInfo names the complaints Observation, plus a Condition with verificationStatus provisional. Provisional is the point: this is written at the end of a single out-patient visit, and a Condition that does not say so reads as settled to everything downstream that looks at it.'

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

group ExtractOutpatientSummary(source qr : QR, target bundle : Bundle) {
  qr -> bundle.type = 'transaction' "setBundleType";
  qr ->  bundle.entry as entry,  entry.resource = create('ClinicalImpression') as ci then {
    qr ->  ci,  entry then BuildClinicalImpressionBase(qr, ci, entry) "base";
    qr -> ci.status = 'completed' "status";
    qr.encounter as e -> ci.encounter = e;
    qr.authored as t -> ci.date = t "date";
    qr -> ci.description = 'Out-patient visit summary' "description";
    qr.item as g where (linkId = 'visit') then {
      g.item as it where ((linkId = 'visit/clinician') and answer.value.exists()) then {
        it.answer first as a then {
          a.value as ref -> ci.performer = ref "performer";
        };
      } "clinicianRule";
      g.item as it where ((linkId = 'visit/date') and answer.value.exists()) then {
        it.answer first as a then {
          a.value as v -> ci.effective = cast(v, 'dateTime') "effective";
        };
      } "dateRule";
    } "visitGroup";
    qr.item as g where (linkId = 'provisional-diagnosis') then {
      g.item as it where ((linkId = 'provisional-diagnosis/text') and answer.value.exists()) then {
        it.answer first as a then {
          a.value as txt -> ci.summary = txt "summary";
        };
      } "summaryRule";
    } "diagnosisGroupForSummary";
    // The complaints, as an Observation the impression names.
    qr.item as it where ((linkId = 'complaints') and answer.value.exists()) ->  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 = '10154-3' "cd";
          it -> scg.display = 'Chief complaint Narrative - Reported' "dsp";
        } "coding";
      } "code";
      it.answer first as a then {
        a.value as txt ->  sobs.note as n,  n.text = txt "text";
      };
      it ->  ci.supportingInfo = create('Reference') as sref,  sref.reference = reference(sobs) "linkSupporting";
    } "complaintsObservation";
  } "outpatientImpression";
  qr.item as it where ((linkId = 'interventions') 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 = '62387-6' "cd";
        it -> cg.display = 'Interventions Narrative' "dsp";
      } "coding";
      it -> cc.text = 'Interventions carried out at the out-patient visit' "codeText";
    } "code";
    it.answer first as a then {
      a.value as txt ->  obs.note as n,  n.text = txt "text";
    };
  } "narr_62387_6";
  qr.item as it where ((linkId = 'plan') 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 = '18776-5' "cd";
        it -> cg.display = 'Plan of care note' "dsp";
      } "coding";
      it -> cc.text = 'Plan and follow-up from the out-patient visit' "codeText";
    } "code";
    it.answer first as a then {
      a.value as txt ->  obs.note as n,  n.text = txt "text";
    };
  } "narr_18776_5";
  // ── The provisional diagnosis ───────────────────────────────────────────
  qr.item as g where (linkId = 'provisional-diagnosis') then {
    g.item as it where ((linkId = 'provisional-diagnosis/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.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 = 'provisional' "cd";
          it -> cg.display = 'Provisional' "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 = '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;
      g.item as ex where ((linkId = 'provisional-diagnosis/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";
    } "provisionalCondition";
  } "diagnosisGroup";
}

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

group SetClinicalImpressionFullUrl(source r : ClinicalImpression, target entry) {
  r.id as id -> entry.fullUrl = append('https://fhir.slade360.co.ke/fhir/ClinicalImpression/', 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 = 'outpatient-summary' "provenanceCode";
      qr -> t.display = 'Out-patient summary form' "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";
}