FHIR Bundle import for Patient and Condition.

[CzarMich]

1. At the moment FHIR Bundle exports for profile PATIENT is producing a non compliant error, which makes me think this has not yet been implemented, but good to have. I have placed the error reproduced below the sample bundle.
   As for profile CONDITION, the error generated is a validation error, which I have also placed below the sample transaction bundle for condition. I will be glad for any help.

2. Is there anyway for FHIR-BRIDGE to check if a Patient ID exists before creating one. Assuming ehrBASE gets data from 2 sources: A: Parent system that Generates Patient ID hence EHR ID, and one that uses the Patient ID for further processing before being sent to FHIR-Bridge which in the end has to store that data in openEHR/ ehrBase.

### Sample Patient Transaction Bundle FHIR Resource:

{
  "resourceType": "Bundle",
  "type": "transaction",
  "entry": [ {
    "fullUrl": "Patient/Patient-tWn9eF5coYuGC6bz7Ykqko",
    "resource": {
      "resourceType": "Patient",
      "id": "Patient-tWn9eF5coYuGC6bz7Ykqko",
      "meta": {
        "profile": [ "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/Patient" ]
      },
      "extension": [ {
        "url": "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/ethnic-group",
        "valueCoding": {
          "system": "http://snomed.info/sct",
          "code": "261665006"
        }
      }, {
        "url": "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/age",
        "extension": [ {
          "url": "dateTimeOfDocumentation",
          "valueDateTime": "2021-07-01"
        }, {
          "url": "age",
          "valueAge": {
            "value": 56,
            "unit": "years",
            "system": "http://unitsofmeasure.org",
            "code": "a"
          }
        } ]
      } ],
      "active": true,
      "birthDate": "1965-01-01"
    },
    "request": {
      "method": "POST",
      "url": "Patient/Patient-tWn9eF5coYuGC6bz7Ykqko"
    }
  } ]
}

ERROR:

{
    "resourceType": "OperationOutcome",
    "issue": [
        {
            "severity": "error",
            "code": "processing",
            "diagnostics": "Unsupported transaction: provided Bundle should have a resource that uses on of the following profiles: https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/blood-gas-panel, https://www.medizininformatik-initiative.de/fhir/core/modul-labor/StructureDefinition/DiagnosticReportLab"
        }
    ]
}

### Sample Condition Transaction Bundle FHIR resource:

{
  "resourceType": "Bundle",
  "type": "transaction",
  "entry": [ {
    "fullUrl": "Condition/GastrointestinalUlcers-17",
    "resource": {
      "resourceType": "Condition",
      "id": "GastrointestinalUlcers-17",
      "meta": {
        "profile": [ "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/gastrointestinal-ulcers" ]
      },
      "verificationStatus": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "410594000"
        } ]
      },
      "category": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "394584008"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "40845000"
        } ]
      },
      "subject": {
        "reference": "Patient/Patient-tWn9eF5coYuGC6bz7Ykqko"
      },
      "recordedDate": "2021-07-01"
    },
    "request": {
      "method": "PUT",
      "url": "Condition/GastrointestinalUlcers-17"
    }
  } ]
}

ERROR:

{
    "resourceType": "OperationOutcome",
    "issue": [
        {
            "severity": "error",
            "code": "processing",
            "diagnostics": "Condition.verificationStatus.coding:conditionVerificationStatus: minimum required = 1, but only found 0 (from https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/gastrointestinal-ulcers)",
            "location": [
                "Bundle.entry[0].resource.ofType(Condition).verificationStatus",
                "Line 13, Col 20"
            ]
        }
    ]
}

@subigre What do you think of issue (2).

[SevKohler]

Will take a look as soon as i got time.

[subigre]

Regarding the first issue, the current implementation of the FHIR Bridge has a limitation regarding Bundle and it expects and supports only 2 types:

• DiagnosticReportLab
• Blood Gas Panel

I already thought about improving the code to support any bundle that contains resources and profiles supported by the FHIR Bridge. There is not so much to do but I haven't found the time yet.

Regarding the second issue, the FHIR Bridge already searches for an existing patient before creating a new one.
However, this checks is based on the internal database and not using EHRbase.

By the way the second error comes from the missing verificationStatus according to the profile:

The versificationStatus should look like the following:

{
  "verificationStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
        "code": "confirmed",
        "display": "Confirmed"
      },
      {
        "system": "http://snomed.info/sct",
        "code": "410594000"
      }
    ]
  }
}

[CzarMich]

Hi @subigre , yes that is true, but as you can see, the cardinality for display is 0..1, which means it is optional and not mandatory as code or system. So I expected this not to raise and flags.

"verificationStatus": {
       "coding": [ {
         "system": "http://snomed.info/sct",
         "code": "410594000"
       } ]

Yes, for the bundles, it will surely be good to have the main resources& profiles at least being supported as bundles too: Condition, Patient, Procedure and medication/medication statement.

[SevKohler]

You have to turn on either a Terminology server that automatically adds this information (as we programmed) or add the display since openEHR DVCodedText requires it.
You can configure the TermServer in the application.yml

Yes, for the bundles, it will surely be good to have the main resources& profiles at least being supported as bundles too: Condition, Patient, Procedure and medication/medication statement.

I agree anyhow its an opensource project neither I or @subigre are currently working on the bridge, feel free to add it its open, we can surely do the code reviews. We will still try to help you if we can, but features wont be added for now from our side.

[subigre]

Hi @subigre , yes that is true, but as you can see, the cardinality for display is 0..1, which means it is optional and not mandatory as code or system. So I expected this not to raise and flags.

"verificationStatus": {
       "coding": [ {
         "system": "http://snomed.info/sct",
         "code": "410594000"
       } ]

I wanted to say that both mappings are mandatory, SNOMED CT and HL7:

Condition.verificationStatus.coding:conditionVerificationStatus: minimum required = 1, but only found 0 (from https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/gastrointestinal-ulcers)

Regarding display attribute, @SevKohler is right. This optional in FHIR but mandatory in openEHR so either you use a terminology server that allow you to populate the missing display, either you have to set it by hand.