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/ExtractProcedureConsent | Version: 0.1.0 | |||
| Active as of 2026-09-14 | Computable Name: ExtractProcedureConsent | |||
The three consent forms out as one Consent, with a provision per authorisation actually given: the procedure itself, the further-measures clause, the anaesthesia clause, and on an endoscopy form the tissue-disposal clause and each procedure ticked. Each provision is written only when its box was answered yes, so a consent nobody gave never appears as one. An Observation records whether the explanation was given in a language the person consenting understood, because that is what makes the consent informed and what an audit or a complaint turns on.
/// url = 'https://fhir.slade360.co.ke/fhir/StructureMap/ExtractProcedureConsent' /// name = 'ExtractProcedureConsent' /// title = 'Procedure Consent Extraction' /// status = 'active' /// description = 'The three consent forms out as one Consent, with a provision per authorisation actually given: the procedure itself, the further-measures clause, the anaesthesia clause, and on an endoscopy form the tissue-disposal clause and each procedure ticked. Each provision is written only when its box was answered yes, so a consent nobody gave never appears as one. An Observation records whether the explanation was given in a language the person consenting understood, because that is what makes the consent informed and what an audit or a complaint turns on.' 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/Consent" alias Consent as target uses "http://hl7.org/fhir/StructureDefinition/Observation" alias Observation as target group ExtractProcedureConsent(source qr : QR, target bundle : Bundle) { qr -> bundle.type = 'transaction' "setBundleType"; // ── The Consent ───────────────────────────────────────────────────────── // Guarded on the person consenting having actually signed. Everything below // hangs off that signature, and a Consent built from a half-filled form // asserts a permission that was never given. qr where (item.where(linkId = 'signatures').item.where(linkId = 'signatures/consenter-signed').answer.value = true) -> bundle.entry as entry, entry.resource = create('Consent') as consent then { qr -> consent, entry then BuildConsentBase(qr, consent, entry) "base"; qr -> consent.status = 'active' "status"; qr -> consent.decision = 'permit' "decision"; qr -> consent.category as cat then { qr -> cat.coding as cg then { qr -> cg.system = 'http://loinc.org' "sys"; qr -> cg.code = '64293-4' "cd"; qr -> cg.display = 'Procedure consent Document' "dsp"; } "coding"; } "category"; // The signing time, from the form. Not qr.authored: a consent taken the // evening before an operation and transcribed the next morning would // otherwise be dated to the transcription, which is the one date a dispute // about consent turns on. qr.item as sg where (linkId = 'signatures') then { sg.item as it where ((linkId = 'signatures/consenter-signed-at') and answer.value.exists()) then { it.answer first as a then { // The form asks for a date *and time* signed, and Consent.date is a // `date`. The timestamp goes to Consent.period.start, which keeps it: // a consent taken the evening before theatre and one taken in the // anaesthetic room are hours apart and share a date. a.value as t -> consent.period as per, per.start = t "signedPeriodStart"; }; } "signedAtRule"; } "signaturesGroup"; // Who explained it becomes the verifier -- they attested that the // discussion happened -- and who consented becomes the grantor. qr.item as eg where (linkId = 'explained-by') then { eg.item as it where ((linkId = 'explained-by/clinician') and answer.value.exists()) then { it.answer first as a then { a.value as ref -> consent.verification as ver then { ref -> ver.verified = true "verified"; ref -> ver.verifiedBy = ref "verifiedBy"; } "verification"; }; } "clinicianRule"; eg.item as it where ((linkId = 'explained-by/what-was-explained') and answer.value.exists()) then { it.answer first as a then { a.value as txt -> consent.provision as prov, prov.code as pc, pc.text = txt "explanationProvision"; }; } "explanationRule"; } "explainedByGroup"; qr.item as cg2 where (linkId = 'consenter') then { cg2.item as it where ((linkId = 'consenter/name') and answer.value.exists()) then { it.answer first as a then { a.value as txt -> consent.grantor = create('Reference') as ref, ref.display = txt "grantorDisplay"; }; } "consenterNameRule"; cg2.item as it where ((linkId = 'consenter/relationship') and answer.value.exists()) then { it.answer first as a then { a.value as txt -> consent.grantor = create('Reference') as ref, ref.display = txt "relationshipDisplay"; }; } "relationshipRule"; } "consenterGroup"; // ── The provisions ──────────────────────────────────────────────────── // One per authorisation. The procedure itself is always a provision, since // it is what the form exists for; the rest appear only where their own box // was answered yes. qr.item as g where (linkId = 'consent-for') then { g.item as it where ((linkId = 'consent-for/procedure') and answer.value.exists()) -> consent.provision as prov then { it.answer first as a then { a.value as txt -> prov.code as pc, pc.text = txt "procedureText"; }; } "procedureProvision"; g.item as it where ((linkId = 'consent-for/planned-for') and answer.value.exists()) then { it.answer first as a then { a.value as d -> consent.period as per, per.start = cast(d, 'dateTime') "plannedPeriodStart"; }; } "plannedForRule"; } "consentForGroup"; qr.item as g where (linkId = 'additional-authorisations') then { g.item as it where ((linkId = 'additional-authorisations/further-measures') and (answer.value.ofType(Coding).code = 'Y')) -> consent.provision as prov then { it -> prov.code as pc, pc.text = 'Further alternative operative measures or treatment found necessary during the procedure' "furtherMeasuresText"; } "furtherMeasuresProvision"; g.item as it where ((linkId = 'additional-authorisations/anaesthesia') and (answer.value.ofType(Coding).code = 'Y')) -> consent.provision as prov then { it -> prov.code as pc, pc.text = 'Administration of general or other anaesthesia' "anaesthesiaText"; } "anaesthesiaProvision"; g.item as it where ((linkId = 'additional-authorisations/no-named-practitioner') and (answer.value.ofType(Coding).code = 'Y')) then { it -> consent.provision as prov, prov.code as pc, pc.text = 'The person consenting understands no assurance has been given that a particular practitioner will perform the procedure.' "noNamedPractitionerNote"; } "noNamedPractitionerRule"; } "additionalAuthorisationsGroup"; // Endoscopy: one provision per procedure ticked, so a consent for an upper // GI endoscopy alone cannot be read as covering a colonoscopy. qr.item as it where (linkId = 'endoscopy-procedures') then { it.answer as a -> consent.provision as prov then { a.value as cv -> prov.code as pc then { cv -> pc.coding = cv "coding"; cv.display as d -> pc.text = d "text"; } "endoscopyCode"; } "endoscopyProvision"; } "endoscopyProceduresGroup"; qr.item as it where ((linkId = 'endoscopy-tissue-disposal') and (answer.value.ofType(Coding).code = 'Y')) -> consent.provision as prov then { it -> prov.code as pc, pc.text = 'Examination, preservation or disposal of tissues and body fluids removed, and of X-ray or photographic records taken' "tissueDisposalText"; } "tissueDisposalProvision"; // Systemic anti-cancer therapy: the regimen is the provision, and the // purpose and side effects explained are notes on the consent -- they are // what was said, not what was permitted. qr.item as g where (linkId = 'anti-cancer-therapy') then { g.item as it where ((linkId = 'anti-cancer-therapy/regimen') and answer.value.exists()) -> consent.provision as prov then { it.answer first as a then { a.value as txt -> prov.code as pc, pc.text = txt "regimenText"; }; } "regimenProvision"; g.item as it where ((linkId = 'anti-cancer-therapy/intended-purpose') and answer.value.exists()) then { it.answer first as a then { a.value as txt -> consent.provision as prov, prov.code as pc, pc.text = txt "purposeProvision"; }; } "purposeRule"; g.item as it where ((linkId = 'anti-cancer-therapy/side-effects-and-risks') and answer.value.exists()) then { it.answer first as a then { a.value as txt -> consent.provision as prov, prov.code as pc, pc.text = txt "sideEffectsProvision"; }; } "sideEffectsRule"; } "antiCancerGroup"; } "createConsent"; // ── Was it explained in a language they understood? ───────────────────── // Its own Observation. It is not a permission, so it is not a provision; but // it is the fact that makes the consent informed, and a complaint or an // inquest turns on it. An interpreter's name, where one was used, rides // alongside as a note. qr.item as g where (linkId = 'explained-by') then { g.item as it where ((linkId = 'explained-by/language-understood') 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/inpatient-clinical-concept-codesystem' "sys"; it -> cg.code = 'capacity-to-consent' "cd"; it -> cg.display = 'Capacity to consent' "dsp"; } "coding"; it -> cc.text = 'Explained in a language the person consenting fully understands' "codeText"; } "code"; it.answer first as a then { a.value as cv -> obs.value = create('CodeableConcept') as vc then { cv -> vc.coding = cv "valueCoding"; cv.display as d -> vc.text = d "valueText"; } "codedValue"; }; it.answer first as a then { a.value as cv where (code = 'N') -> obs.interpretation as interp then { cv -> interp.coding as icg then { cv -> icg.system = 'http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation' "sys"; cv -> icg.code = 'A' "cd"; cv -> icg.display = 'Abnormal' "dsp"; } "coding"; } "notUnderstoodInterp"; } "languageInterpretation"; g.item as ip where ((linkId = 'explained-by/interpreter-name') and answer.value.exists()) then { ip.answer first as a then { a.value as txt -> obs.note as n, n.text = txt "interpreterNote"; }; } "interpreterRule"; } "languageObservation"; } "languageGroup"; } // ───────────────────────────────────────────────────────────────────────────── // 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 BuildConsentBase(source qr : QR, target r : Consent, target entry) { qr -> r then SetResponseProvenance(qr, r) "responseProvenance"; qr -> r.id = uuid() then SetConsentFullUrl(r, entry) "idAndFullUrl"; qr -> entry.request as request then { qr -> request.method = 'POST' "requestMethod"; qr -> request.url = 'Consent' "requestUrl"; } "entryRequest"; qr.subject as s -> r.subject = s; } group SetConsentFullUrl(source r : Consent, target entry) { r.id as id -> entry.fullUrl = append('https://fhir.slade360.co.ke/fhir/Consent/', 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 = 'procedure-consent' "provenanceCode"; qr -> t.display = 'Consent for a procedure or treatment' "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"; }