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/ExtractPatientReferral | Version: 0.1.0 | |||
| Active as of 2026-09-14 | Computable Name: ExtractPatientReferral | |||
A referral extracts as a ServiceRequest – the thing the receiving unit has to act on – carrying the destination, the specialty sought, the priority and who is asking. Everything the receiving clinician needs to read lands in Observations alongside it: the history and investigations, the treatment already given, the reason for referral under LOINC 42349-1, and any further comments. The working diagnosis becomes a Condition with clinicalStatus active and verificationStatus provisional, because a referral is precisely the case where the diagnosis is not yet confirmed and saying so is the point.
/// url = 'https://fhir.slade360.co.ke/fhir/StructureMap/ExtractPatientReferral' /// name = 'ExtractPatientReferral' /// title = 'Patient Referral Extraction' /// status = 'active' /// description = 'A referral extracts as a ServiceRequest -- the thing the receiving unit has to act on -- carrying the destination, the specialty sought, the priority and who is asking. Everything the receiving clinician needs to read lands in Observations alongside it: the history and investigations, the treatment already given, the reason for referral under LOINC 42349-1, and any further comments. The working diagnosis becomes a Condition with clinicalStatus active and verificationStatus provisional, because a referral is precisely the case where the diagnosis is not yet confirmed and saying so is the point.' 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/ServiceRequest" alias ServiceRequest as target uses "http://hl7.org/fhir/StructureDefinition/Condition" alias Condition as target group ExtractPatientReferral(source qr : QR, target bundle : Bundle) { qr -> bundle.type = 'transaction' "setBundleType"; qr.item as g where (linkId = 'referral') then { g -> bundle.entry as entry, entry.resource = create('ServiceRequest') as sr then { qr -> sr, entry then BuildServiceRequestBase(qr, sr, entry) "base"; g -> sr.status = 'active' "status"; g -> sr.intent = 'order' "intent"; qr.encounter as e -> sr.encounter = e; qr.authored as t -> sr.authoredOn = t "authoredOn"; g -> sr.code as cr, cr.concept as cc then { g -> cc.coding as cg then { g -> cg.system = 'http://snomed.info/sct' "sys"; g -> cg.code = '3457005' "cd"; g -> cg.display = 'Patient referral' "dsp"; } "coding"; } "code"; // Priority is a code on ServiceRequest, not a Coding: it takes the code // alone and has nowhere to record which system it came from. The form // binds the request-priority value set directly, so the codes line up. g.item as it where ((linkId = 'referral/priority') and answer.value.exists()) then { it.answer first as a then { a.value as cv then { cv.code as c -> sr.priority = c "priorityCode"; } "coding"; }; } "priorityRule"; g.item as it where ((linkId = 'referral/referred-by') and answer.value.exists()) then { it.answer first as a then { a.value as ref -> sr.requester = ref "requester"; }; } "requesterRule"; // Where the patient is going is typed, not picked, so the performer is a // display-only reference. Better than dropping it: the display is what a // human reads off the referral and what an audit of onward referrals // counts. g.item as it where ((linkId = 'referral/referred-to') and answer.value.exists()) then { it.answer first as a then { a.value as txt -> sr.performer = create('Reference') as pref, pref.display = txt "referredTo"; }; } "referredToRule"; g.item as it where ((linkId = 'referral/speciality-sought') and answer.value.exists()) then { it.answer first as a then { a.value as txt -> sr.performerType as pt, pt.text = txt "specialtySought"; }; } "specialtyRule"; g.item as it where ((linkId = 'referral/date') and answer.value.exists()) then { it.answer first as a then { a.value as v -> sr.occurrence = cast(v, 'dateTime') "occurrence"; }; } "dateRule"; // The reason rides as a plain note as well as its own Observation. The // SGHI ServiceRequest profile binds `reason` required to a LOINC value // set and the form takes free text, so a coded reason is not available. qr.item as it where ((linkId = 'reasons-for-referral') and answer.value.exists()) then { it.answer first as a then { a.value as txt -> sr.note as n, n.text = txt "reasonNote"; }; } "reasonNoteRule"; } "referralRequest"; } "referralGroup"; qr.item as it where ((linkId = 'reasons-for-referral') 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 = '42349-1' "cd"; it -> cg.display = 'Reason for referral (narrative)' "dsp"; } "coding"; it -> cc.text = 'Reason the patient is being referred on' "codeText"; } "code"; it.answer first as a then { a.value as txt -> obs.note as n, n.text = txt "text"; }; } "narr_42349_1"; qr.item as it where ((linkId = 'brief-history-and-investigations') 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 = '11329-0' "cd"; it -> cg.display = 'History general Narrative - Reported' "dsp"; } "coding"; it -> cc.text = 'Brief history and investigations on the referral form' "codeText"; } "code"; it.answer first as a then { a.value as txt -> obs.note as n, n.text = txt "text"; }; } "narr_11329_0"; qr.item as it where ((linkId = 'treatment-given') 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 = 'Treatment already given before referral' "codeText"; } "code"; it.answer first as a then { a.value as txt -> obs.note as n, n.text = txt "text"; }; } "narr_18776_5"; qr.item as it where ((linkId = 'other-pertinent-comments') 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 = 'referral-other-pertinent-comments-on-referral' "cd"; it -> cg.display = 'Other pertinent comments on referral' "dsp"; } "coding"; } "code"; it.answer first as a then { a.value as txt -> obs.note as n, n.text = txt "text"; }; } "narr_referral_other_pertinent_comments_on_referral"; // ── The working diagnosis ─────────────────────────────────────────────── // verificationStatus provisional, deliberately. A referral is the case where // the diagnosis is a working one, and a Condition that does not say so reads // as confirmed to everything downstream that looks at it. qr.item as g where (linkId = 'working-diagnosis') then { g.item as it where ((linkId = 'working-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 = 'working-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"; } "workingDiagnosisCondition"; } "workingDiagnosisGroup"; } // ───────────────────────────────────────────────────────────────────────────── // 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 BuildServiceRequestBase(source qr : QR, target r : ServiceRequest, target entry) { qr -> r then SetResponseProvenance(qr, r) "responseProvenance"; qr -> r.id = uuid() then SetServiceRequestFullUrl(r, entry) "idAndFullUrl"; qr -> entry.request as request then { qr -> request.method = 'POST' "requestMethod"; qr -> request.url = 'ServiceRequest' "requestUrl"; } "entryRequest"; qr.subject as s -> r.subject = s; } group SetServiceRequestFullUrl(source r : ServiceRequest, target entry) { r.id as id -> entry.fullUrl = append('https://fhir.slade360.co.ke/fhir/ServiceRequest/', 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 = 'patient-referral' "provenanceCode"; qr -> t.display = 'Patient referral 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"; }