V.3.0.0 rc1 (#107)

* Updated Observation.coding.system #94 and #85 * Condition-instance with SKS Tillægskode added #100 * fixing DkCoreCondition - handling of unconfirmed conditions #98 * Update DkCoreObservation.fsh #94 * Update StructureDefinition-dk-core-observation-intro.md #95 and #96 are handled * Solved warnings associated with extension, that could be used anywhere * Update sushi-config.yaml * Fixed QA-errors, updated template Invariant on Observation and ^constraint.requirement = "link" * Technical FHIRPath correction value. and Observation. #104 * Updated Observation-instances due to publisher update * Update release-notes.md --------- Co-authored-by: kirstinerosenbeck <[email protected]>
hl7dk · Nov 30, 2023 · 325453f · 325453f
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diff --git a/ig.ini b/ig.ini
@@ -1,4 +1,4 @@
 [IG]
 ig = fsh-generated/resources/ImplementationGuide-hl7.fhir.dk.core.json
-;template = https://github.com/hl7dk/dk-ig-template
-template = fhir.base.template#current 
+template = https://github.com/hl7dk/dk-ig-template
+;template = fhir.base.template#current 
diff --git a/input/fsh/AuthorizationIdentifier.fsh b/input/fsh/AuthorizationIdentifier.fsh
@@ -8,11 +8,8 @@ Description: "Identifier holding the official [authorization identifier](https:/
 * value 1..
   * obeys authorization-id-format
   * ^maxLength = 5
-// WARNING: The constraint index in the following rule (e.g., constraint[0]) may be incorrect.
-// Please compare with the constraint array in the original definition's snapshot and adjust as necessary.
-  * ^constraint.source = "https://stps.dk/da/autorisation/om-autorisationer/autorisations-id/"
-
+
 Invariant: authorization-id-format
-Description: "Authorization ID consists of exactly 5 consonants and Y and or numbers in any order"
+Description: "Authorization ID consists of exactly 5 consonants and Y and or numbers in any order. See https://stps.dk/da/autorisation/om-autorisationer/autorisations-id/"
 Severity: #error
-Expression: "matches('^([b-df-hj-np-tv-zB-DF-HJ-NP-TV-Z0-9]){5}$')"
+Expression: "matches('^([b-df-hj-np-tv-zB-DF-HJ-NP-TV-Z0-9]){5}$')"
diff --git a/input/fsh/CVRIdentifier.fsh b/input/fsh/CVRIdentifier.fsh
@@ -12,9 +12,9 @@ Description: "Identifier holding a danish [CVR](https://datacvr.virk.dk/data/) n
 Invariant: CVR-length
 Description: "CVR must be exactly 8 numeric characters long"
 Severity: #error
-Expression: "value.matches('^[0-9]{8}$')"
+Expression: "matches('^[0-9]{8}$')"
 
 Invariant: CVR-modulus-11
 Description: "CVR must pass the modulus 11 check"
 Severity: #error
-Expression: "((\n    (value.substring(0,1).toInteger()*2)+\n    (value.substring(1,1).toInteger()*7)+\n    (value.substring(2,1).toInteger()*6)+\n    (value.substring(3,1).toInteger()*5)+\n    (value.substring(4,1).toInteger()*4)+\n    (value.substring(5,1).toInteger()*3)+\n    (value.substring(6,1).toInteger()*2)+\n    (value.substring(7,1).toInteger()*1)) mod(11)=0)"
+Expression: "((\n    (substring(0,1).toInteger()*2)+\n    (substring(1,1).toInteger()*7)+\n    (substring(2,1).toInteger()*6)+\n    (substring(3,1).toInteger()*5)+\n    (substring(4,1).toInteger()*4)+\n    (substring(5,1).toInteger()*3)+\n    (substring(6,1).toInteger()*2)+\n    (substring(7,1).toInteger()*1)) mod(11)=0)"
diff --git a/input/fsh/DkCoreCondition.fsh b/input/fsh/DkCoreCondition.fsh
@@ -84,6 +84,22 @@ Usage: #example
 * clinicalStatus = $condition-clinical#active
 * verificationStatus = $condition-ver-status#confirmed
 
+Instance: JohnFracture
+InstanceOf: DkCoreCondition
+Title: "John fraktur"
+Description: "Johns fraktur-diagnose, udskrivningsdiagnose fra hospitalet med tillægskode"
+Usage: #example
+* code.coding[SKS-D] = urn:oid:1.2.208.176.2.4.12#DS721+TUL1 "Pertrokantær femurfraktur, højresidig"
+* subject.reference = "Patient/john"
+* asserter.reference = "Practitioner/AbrahamLaege"
+* recorder.reference = "Practitioner/AbrahamLaege"
+* category = $condition-category#encounter-diagnosis
+* onsetDateTime = "2022-04-26"
+* recordedDate = "2022-04-27"
+* clinicalStatus = $condition-clinical#active
+* verificationStatus = $condition-ver-status#confirmed
+
+
 Instance: JohnMelanoma
 InstanceOf: DkCoreCondition
 Title: "John mistanke om Modermærkekræft"

diff --git a/input/fsh/DkCoreCprIdentifier.fsh b/input/fsh/DkCoreCprIdentifier.fsh
@@ -9,15 +9,10 @@ Description: "This structure holds the danish [CPR](https://cpr.dk/) identifier"
 * value 1..
   * obeys cpr
   * ^maxLength = 10
-// WARNING: The constraint index in the following rule (e.g., constraint[0]) may be incorrect.
-// Please compare with the constraint array in the original definition's snapshot and adjust as necessary.
-  * ^constraint.source = "https://cpr.dk/cpr-systemet/opbygning-af-cpr-nummeret/#:~:text=5%20%2D%206%20position%20angiver%20personens,i%20personnummeret%20angiver%20personens%20k%C3%B8n."
-// WARNING: The constraint index in the following rule (e.g., constraint[0]) may be incorrect.
-// Please compare with the constraint array in the original definition's snapshot and adjust as necessary.
-  * ^constraint.requirements = "Requirement of danish civil registration numbers"
   * ^mustSupport = false
 
 Invariant: cpr
-Description: "Requirement of danish civil registration numbers"
+Description: "Requirement of danish civil registration numbers. See https://cpr.dk/cpr-systemet/opbygning-af-cpr-nummeret/#:~:text=5%20%2D%206%20position%20angiver%20personens,i%20personnummeret%20angiver%20personens%20k%C3%B8n."
 Severity: #error
-Expression: "value.matches('^((((0[1-9]|1[0-9]|2[0-9]|3[0-1])(01|03|05|07|08|10|12))|((0[1-9]|1[0-9]|2[0-9]|30)(04|06|09|11))|((0[1-9]|1[0-9]|2[0-9])(02)))[0-9]{6})$')"
+Expression: "matches('^((((0[1-9]|1[0-9]|2[0-9]|3[0-1])(01|03|05|07|08|10|12))|((0[1-9]|1[0-9]|2[0-9]|30)(04|06|09|11))|((0[1-9]|1[0-9]|2[0-9])(02)))[0-9]{6})$')"
+* requirements = "Requirement of danish civil registration numbers"
diff --git a/input/fsh/DkCoreObservation.fsh b/input/fsh/DkCoreObservation.fsh
@@ -22,7 +22,7 @@ Description: "HL7 Denmark core profile for observations"
 * code.coding[SNOMEDCT]
   * ^short = "SNOMED CT code for the observation"
   * system 1..
-  * system = "https://www.snomed.org/" (exactly)
+  * system = "http://snomed.info/sct" (exactly)
   * code 1..
 * code.coding[NPU]
   * ^short = "NPU code for the observation. NPU codes are administred by the Danish Health Data Authority." 
@@ -67,7 +67,7 @@ Description: "HL7 Denmark core profile for observations"
 * component.code.coding[SNOMEDCT]
   * ^short = "SNOMED CT code for the observation"
   * system 1..
-  * system = "https://www.snomed.org/" (exactly)
+  * system = "http://snomed.info/sct" (exactly)
   * code 1..
 * component.code.coding[NPU]
   * ^short = "NPU code for the observation. NPU codes are administred by the Danish Health Data Authority." 
@@ -102,7 +102,7 @@ Description: "HL7 Denmark core profile for observations"
 Invariant: dk-core-observation-mandatory-units
 Description: "If value is specified then unit and/or code must be specified"
 Severity: #error
-Expression: "Observation.valueQuantity.value.exists() implies Observation.valueQuantity.unit.exists() or Observation.valueQuantity.code.exists()"
+Expression: "value.ofType(Quantity).value.exists() implies value.ofType(Quantity).unit.exists() or value.ofType(Quantity).code.exists()"
 
 
 
@@ -166,13 +166,14 @@ Instance: ObservationRespiratoryVitalSigns
 InstanceOf: DkCoreObservation
 Title: "John's Respiratory rate measurement, Vital Signs"
 Usage: #example
-* category = #vital-signs
+* category = $observation-category#vital-signs
 * status = #final
 * code.coding[LOINC] = $LOINC#9279-1 "Respiratory rate"
 * valueQuantity.value = 50
-* valueQuantity.code = #{Breaths}/min
+* valueQuantity.code = #/min
 * valueQuantity.system = $ucum
 * valueQuantity.unit = "Breaths / minute"
+* effectiveDateTime = 2023-11-01T12:00:00+01:00
 * subject = Reference(john)
 * performer = Reference(AbrahamLaege)
 
@@ -183,22 +184,24 @@ Usage: #inline
 * status = #final
 * code.coding = $NPU#NPU03011 "Iltmætning"
 * valueQuantity.value = 0.97
-* valueQuantity.code = #{1}
+* valueQuantity.code = #1
 * valueQuantity.system = $ucum
+* effectiveDateTime = 2023-11-01T12:00:00+01:00
 * subject = Reference(john)
 * performer = Reference(AbrahamLaege)
 
 Instance: ObservationOxySatVitalSigns
 InstanceOf: DkCoreObservation
 Title: "John's oxygen saturation measurement, Vital Signs"
 Usage: #example
-* category = #vital-signs
+* category = $observation-category#vital-signs
 * status = #final
 * code.coding[LOINC] = $LOINC#2708-6 "Oxygen saturation in Arterial blood"
 * valueQuantity.value = 97.0
 * valueQuantity.code = #%
 * valueQuantity.system = $ucum
 * valueQuantity.unit = "%"
+* effectiveDateTime = 2023-11-01T12:00:00+01:00
 * subject = Reference(john)
 * performer = Reference(AbrahamLaege)
 * contained[0] = ObservationOxySat

diff --git a/input/fsh/DkCorePatient.fsh b/input/fsh/DkCorePatient.fsh
@@ -4,12 +4,6 @@ Id: dk-core-patient
 Title: "Danish Core Patient Profile"
 Description: "HL7 Denmark core profile for a patient"
 * obeys marital-status-unknown-usage
-// WARNING: The constraint index in the following rule (e.g., constraint[0]) may be incorrect.
-// Please compare with the constraint array in the original definition's snapshot and adjust as necessary.
-* . ^constraint.source = "https://cpr.dk/borgere/hvad-staar-der-om-mig-i-cpr-registerindsigt/hvad-og-hvem-er-registreret-i-cpr-og-hvem-opdaterer-oplysninger-om-dig-i-cpr/"
-// WARNING: The constraint index in the following rule (e.g., constraint[0]) may be incorrect.
-// Please compare with the constraint array in the original definition's snapshot and adjust as necessary.
-  * ^constraint.requirements = "Marital status is legally unknown in Denmark"
 * identifier 1..
   * ^slicing.discriminator.type = #value
   * ^slicing.discriminator.path = "system"
@@ -151,6 +145,7 @@ Usage: #example
 * birthDate = "1983-06-07"
 
 Invariant: marital-status-unknown-usage
-Description: "Status in maritalStatus is unknown in a danish context. Consider mapping the value to UNK"
+Description: "Status in maritalStatus is unknown in a danish context. Consider mapping the value to UNK. See https://cpr.dk/borgere/hvad-staar-der-om-mig-i-cpr-registerindsigt/hvad-og-hvem-er-registreret-i-cpr-og-hvem-opdaterer-oplysninger-om-dig-i-cpr/"
 Severity: #warning
-Expression: "maritalStatus.coding.where(code = 'P' and system = 'http://terminology.hl7.org/CodeSystem/v3-MaritalStatus').empty() or maritalStatus.coding.where(code = 'A' and system = 'http://terminology.hl7.org/CodeSystem/v3-MaritalStatus').empty()"
+Expression: "maritalStatus.coding.where(code = 'P' and system = 'http://terminology.hl7.org/CodeSystem/v3-MaritalStatus').empty() or maritalStatus.coding.where(code = 'A' and system = 'http://terminology.hl7.org/CodeSystem/v3-MaritalStatus').empty()"
+* requirements = "Marital status is legally unknown in Denmark"
diff --git a/input/fsh/GLNIdentifier.fsh b/input/fsh/GLNIdentifier.fsh
@@ -12,9 +12,9 @@ Description: "Identifier holding a 13 digit GLN"
 Invariant: gln-length
 Description: "GLN must be exactly 13 characters long"
 Severity: #error
-Expression: "value.matches('^[0-9]{13}$')"
+Expression: "matches('^[0-9]{13}$')"
 
 Invariant: gln-modulus-10
 Description: "GLN must pass the modulus 10 check - https://www.gs1.org/services/how-calculate-check-digit-manually"
 Severity: #error
-Expression: "((\n(10-((value.substring(0,1).toInteger()*1)+\n(value.substring(1,1).toInteger()*3)+\n(value.substring(2,1).toInteger()*1)+\n(value.substring(3,1).toInteger()*3)+\n(value.substring(4,1).toInteger()*1)\n+(value.substring(5,1).toInteger()*3)\n+(value.substring(6,1).toInteger()*1)\n+(value.substring(7,1).toInteger()*3)\n+(value.substring(8,1).toInteger()*1)\n+(value.substring(9,1).toInteger()*3)\n+(value.substring(10,1).toInteger()*1)\n+(value.substring(11,1).toInteger()*3))mod(10))mod(10))=value.substring(12,1).toInteger())"
+Expression: "((\n(10-((substring(0,1).toInteger()*1)+\n(substring(1,1).toInteger()*3)+\n(substring(2,1).toInteger()*1)+\n(substring(3,1).toInteger()*3)+\n(substring(4,1).toInteger()*1)\n+(substring(5,1).toInteger()*3)\n+(substring(6,1).toInteger()*1)\n+(substring(7,1).toInteger()*3)\n+(substring(8,1).toInteger()*1)\n+(substring(9,1).toInteger()*3)\n+(substring(10,1).toInteger()*1)\n+(substring(11,1).toInteger()*3))mod(10))mod(10))=substring(12,1).toInteger())"
diff --git a/input/fsh/KombitOrgIdentifier.fsh b/input/fsh/KombitOrgIdentifier.fsh
@@ -12,4 +12,4 @@ Description: "Identifier holding the organization code issued by KOMBIT"
 Invariant: uuid
 Description: "General UUID expression"
 Severity: #error
-Expression: "value.matches('urn:uuid:[0-9a-f]{8}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{12}')"
+Expression: "matches('urn:uuid:[0-9a-f]{8}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{12}')"
diff --git a/input/fsh/Lpr3Identifier.fsh b/input/fsh/Lpr3Identifier.fsh
@@ -1,4 +1,4 @@
-Profile: Lpr3Identifier
+/* Profile: Lpr3Identifier
 Parent: Identifier
 Id: lpr3-Identifier
 Title: "LPR3 Identifier"
@@ -7,14 +7,11 @@ Description: "Identifier holding a LPR3 identifier for an organization"
 * system = "https://www.esundhed.dk/Registre/Landspatientsregisteret" (exactly)
 * value 1..
   * obeys uuidv5
-// WARNING: The constraint index in the following rule (e.g., constraint[0]) may be incorrect.
-// Please compare with the constraint array in the original definition's snapshot and adjust as necessary.
-  * ^constraint.source = "https://scandihealth.github.io/lpr3-docs/"
-// WARNING: The constraint index in the following rule (e.g., constraint[0]) may be incorrect.
-// Please compare with the constraint array in the original definition's snapshot and adjust as necessary.
-  * ^constraint.requirements = "LPR3 episode of care identifiers must conform to a UUIDv5"
 
 Invariant: uuidv5
 Description: "LPR3 episode of care identifiers must conform to a UUIDv5"
 Severity: #error
-Expression: "value.matches('urn:uuid:[a-fA-F0-9]{8}-[a-fA-F0-9]{4}-[5][a-fA-F0-9]{3}-[89aAbB][a-fA-F0-9]{3}-[a-fA-F0-9]{12}')"
+Expression: "matches('urn:uuid:[a-fA-F0-9]{8}-[a-fA-F0-9]{4}-[5][a-fA-F0-9]{3}-[89aAbB][a-fA-F0-9]{3}-[a-fA-F0-9]{12}')"
+* requirements = "LPR3 episode of care identifiers must conform to a UUIDv5"
+* source = "https://scandihealth.github.io/lpr3-docs/"
+ */
diff --git a/input/fsh/SORIdentifier.fsh b/input/fsh/SORIdentifier.fsh
@@ -8,11 +8,9 @@ Description: "Identifier holding the official SOR identifier for a danish health
 * system = "urn:oid:1.2.208.176.1.1" (exactly)
 * value 1..
   * obeys min-digits-sor
-// WARNING: The constraint index in the following rule (e.g., constraint[0]) may be incorrect.
-// Please compare with the constraint array in the original definition's snapshot and adjust as necessary.
-  * ^constraint.requirements = "SOR Identifiers are at minimum 11 digits long"
 
 Invariant: min-digits-sor
 Description: "SOR Identifiers are at minimum 11 digits long. See https://sundhedsdatastyrelsen.dk/-/media/sds/filer/rammer-og-retningslinjer/organisationsregistrering/adgang-til-sor/info-om-opbygningen-af-sor-ider.pdf"
 Severity: #error
-Expression: "matches('^([0-9]){11,}$')"
+Expression: "matches('^([0-9]){11,}$')"
+* requirements = "SOR Identifiers are at minimum 11 digits long"
diff --git a/input/fsh/aliases.fsh b/input/fsh/aliases.fsh
@@ -14,7 +14,7 @@ Alias: $sor-organization-type = http://hl7.dk/fhir/core/ValueSet/sor-organizatio
 Alias: $dk-marital-status_1 = http://hl7.dk/fhir/core/ValueSet/dk-marital-status
 Alias: $ucum = http://unitsofmeasure.org
 Alias: $NPU = urn:oid:1.2.208.176.2.1
-Alias: $Medcom = https://terminology.medcom.dk/fhir/observation-code
+Alias: $Medcom = http://medcomfhir.dk/ig/terminology/CodeSystem/medcom-observation-codes
 Alias: $SKS = urn:oid:1.2.208.176.2.4
 Alias: $LOINC = http://loinc.org
 Alias: $IEEEx73 = urn:iso:std:iso:11073:10101

diff --git a/input/fsh/extensions.fsh b/input/fsh/extensions.fsh
@@ -2,10 +2,11 @@ Extension: ConditionLastAssertedDate
 Id: ConditionLastAssertedDate
 Title: "ConditionLastAssertedDate"
 Description: "Extension for the last date a Condition-instance was confirmed valid in its current state. E.g. with its current clinical- and verification status, stage and severity. Typically the last performed follow-up"
-
 * . ^short = "ConditionLastAssertedDate"
   * ^definition = "Extension for the last date a Condition-instance was confirmed valid in its current state. E.g. with its current clinical- and verification status, stage and severity. Typically the last performed follow-up"
 * value[x] only dateTime
+* ^context.type = http://hl7.org/fhir/extension-context-type#element
+* ^context.expression = "Condition"
 
 Extension: NotFollowedAnymore
 Id: NotFollowedAnymore
@@ -14,6 +15,8 @@ Description: "Extension for the date where a condition lost focus in a specific
 * . ^short = "NotFollowedAnymore"
   * ^definition = "Extension for the date where a condition lost focus in a specific clinical context"
 * value[x] only dateTime
+* ^context.type = http://hl7.org/fhir/extension-context-type#element
+* ^context.expression = "Condition"
 
 Extension: RegionalSubDivisionCodes
 Id: dk-core-RegionalSubDivisionCodes

diff --git a/input/pagecontent/StructureDefinition-dk-core-condition-intro.md b/input/pagecontent/StructureDefinition-dk-core-condition-intro.md
@@ -17,4 +17,8 @@ Given that we have a condition, which is a problem-list-item, ending the conditi
   * The Condition.category looses its "problem-list-item" flag. The idea is to state that from a patient viewpoint the condition has not changed, but in this professional context it is no longer in focus.
   * The Condition.extension.NotFollowedAnymore is populated with the date that it lost focus in a specific professional context.
 
-The Condition profile cover both primary sector, secondary sector (medical specialists ([DA] speciallæger) and hospitals) and municipality cases. As such the profile should be usable in most Danish contexts.
+The status attributes controls the context of a condition. clinicalStatus should be populated with the value “active” if the patient has the condition, and inactive if the patient no longer have the condition. Condition.verificationStatus should be set to “confirmed” if the condition have been established as true by someone with authority (e.g. a diagnosis is confirmed by a doctor). A condition is “unconfirmed”, if the patient is suspected of having a condition, and "refuted" if it has been confirmed that the condition is not present. An example of an unconfirmed condition can be found here [John Melanoma](Condition-JohnMelanoma.html)https://hl7.dk/fhir/core/.
+
+Note that "unconfirmed" is not the same as a risk of developing a condition. The risk of developing a certain condition may be recorded in (at least) two ways in FHIR i.e. as a familyMemberHistory or by populating Condition.code with a code that expresses a risk e.g. the SNOMED CT code ´395112001 At increased risk for cardiovascular event (finding)´. The first would typically be used if recording a family history, the second, if you want to use an increased risk as the reason for starting a prophylactic treatment.
+
+Condition profile cover both primary sector, secondary sector (medical specialists ([DA] speciallæger) and hospitals) and municipality cases. As such the profile should be usable in most Danish contexts.