Authoring profiles by Michel Rutten

Authoring Profiles

Michel Rutten

FHIR Developer Days

November 25, 2014

Who am I?

Name: Michel Rutten

Company: Furore

Background:

Professional software developer since 1998

Microsoft .NET; Healthcare industries

Technical Specialist at Furore since May 2014

Member of the Furore FHIR development team

Lead developer of Forge

TOPICS

Presentation Topics

Introduction

Resources

Profiles

Representations

Authoring Tools

Authoring Profiles

Metadata

Structures

Bindings

Constraints

Extensions

Slicing

PROFILESIntroducing

The need for profiles

Many different contexts in healthcare, but a

single set of Resources

Need to be able to describe restrictions

based on use and context

Allow for these usage statements to: Authored in a structured manner

Published in a repository

Used as the basis for validation, code, report and UI

generation.

Use of Profiles

Profile

Publish to repository

Report

Implementation guide

Conformance statement

Validate Resource

What is a profile?

Special resource

Statement of use of one or more FHIR

resources

Provides additional rules about how a type of

resource is utilized in a particular context of use, or

for a particular use case

Specify restrictions / constraints on resources

Specify extensions on resources

Profiling a resource

Profiled

Resource

Resource Definition Patient

My Patient

“Must use only the Dutch national patient identifier”

“Need to register an administrative race code for a Patient in the US”

“Patient Discharge documents must at least contain section “Discharge Medication” and section “Discharge Diagnosis”

“In our Patient registration system, we use these maritalStatus codes beyond those provided by HL7…”

“Our patient registration system, only supports having one single name per Patient”

Demand that the identifier uses your

national patient identifier

Limit names to just 1 (instead of 0..*)

Limit maritalStatus to another set of

codes that extends the one from

HL7 international

Add an extension to support

“RaceCode”

Note: hardly any

mandatory elements in

the core spec!

Using profiles

Formulate what exchanging partners must

adhere to

Server & client may publish their

conformance to profile

When communicating a resource, a resource

can indicate the profiles it conforms to.

Receiving side may verify conformance

Tagging a resource

• MRN 31415

• “Michel Rutten”

• 20-01-1973

• Sittard

• “I’m a Patient conforming to the Dutch Profile”See http://hl7.nl/Profiles/patient-nl

Patient

Profile –a “normal” resource

25 …computable!

REPRESENTATIONSIntroducing profiles

Formats

Namespace: http://hl7.org/fhir

Also includes XHTML

No namespaces…

JSON XPath Navigator

Differential Structure

Describes only modified elements

Different from resource definition

Does not describe default elements

Identical to resource definition

Targeted at profile authors

Concise XML

Focus on customizations

Example: Lipid

Snapshot

Contains all resource elements

Modified elements

Default elements

Targeted at profile tooling

Easier to process programmatically

Example: Lipid

Expansion

FHIR API supports the expansion of

differential profiles

Tooling

Open: Expand differential profile

Save: Generate differential profile

SPREADSHEETProfile Authoring Tools

Profile spreadsheet

HL7 Wiki http://wiki.hl7.org/index.php?title=FHIR_Spreadsheet_Profile_Authoring

Tab page ↔ resource

Row ↔ resource element

Column ↔ element property

Example: Lipid

Profile spreadsheet

Supports differential structures

Only include rows for modified elements

Supports snapshots

May include default elements by copying rows

form resource definition sheet

FORGEProfile Authoring Tools

FHIR Profile Editor

http://fhir.furore.com/forge

Windows Desktop Application

Supports online & offline use

Load from / save to FHIR server

Load from / save to disk

Implementation based on FHIR API

Resource definitions

Deserialize XML to POCO

Serialize POCO to XML

Profile error validation

Supports differential and snapshot structures

Open differential/snapshot profile

Generates compressed XML39

Work In Progress

Current release supports most of DSTU 1

Some advanced features are not yet

supported, e.g.

Type slicing (value[x])

Search parameters

Some bugs...

Example: Lipid

STEP BY STEPAuthoring Profiles

Running Example

“Lipid Profile” example from spec

http://www.hl7.org/implement/standards/fhir/diagno

sticreport-profile-lipids.html

DiagnosticReport containing 4 results:

1x Cholesterol

1x Triglyceride

1x HDL Cholesterol

0/1x LDL Cholesterol

Package it up in a message44

METADATAAuthoring Profiles

Identification

REST Id on server

http://spark.furore.com/fhir/profile/lipid.v1

Server assigned

“Lipid Profile”

Human readable

Author assigned

Identification

Identifier

Globally unique

Author assigned

UUID: 15046b9c-2da0-4b80-82ef-c6af6fcfd2bf

OID: 2.16.840.1.113883.10.20.2.1

urn:openEHR.org:EHR-ACTION.medication.v1

http://hl7.org/fhir/Profiles/iso-21090-2011

Versioning

We used semantic versioning

Uses “<major>.<minor>.<patch>”

See semver.org

Major version number is increased on

breaking changes

Major version number is part of author-

assigned identifier AND REST url

Both versions may co-exist on server, they

have different URLs and names48

Versioning example

URL Id v

http://fhir.nl/Profile/patient.v1 urn:fhir.nl:profile:patient:v1 1.0.0 Original

version

http://fhir.nl/Profile/patient.v1 urn:fhir.nl:profile:patient:v1 1.0.1 Typo

Clarification

Correction

Bugfix

http://fhir.nl/Profile/patient.v1 urn:fhir.nl:profile:patient:v1 1.1.0 Non-breaking

change

Addition

http://fhir.nl/Profile/patient.v2 urn:fhir.nl:profile:patient:v2 2.0.0 Breaking

change

Profile Metadata

Publisher

• Organization or individual responsible for publishing

• Should be populated

• e.g. “FHIR Project Team“

Telecom

• One or more contact points of the publisher

• Telephone, email, website etc.

Description

• Longer description of the contents of the profile

• One or more coded descriptions to help with finding the profile

• e.g. LOINC 58239-5 (lipid)

Status

• Draft, Active, Retired

• Experimental Y/N

Requirements

• Scope & Usage

• The “need” or “why” of the profile

• Of publication

• YYY-MM-DD

• e.g. “2013-07-07"

Example

STRUCTURESAuthoring Profiles

What’s in a profile?

Profile

Extensions

Constrained Resources

& Datatypes

Metadata

Structures

Profiles contain “Structures”

Set of constraints on (nested) elements of a

Resource or Datatype

“Subclass” of a Resource, with specific limits

on its elements

Cardinality

Value domains

Invariants

Example

“Cholesterol observation” is an Observation : That has a fixed LOINC code 35200-5 (Cholesterol) as its

Has a quantity as value that’s expressed in mmol/L (a

UCUM unit) (without a ‘comparator’) OR ELSE there’s a

comment

An interpretation limited to LL,L,N,H,HH

A “recommended” high reference range of 4.5 (no low)

mmol/L, independent of age (no age)

Is an independent observation (no related)

Cardinality

Number of elements in a set

0 - None

1 – Single element

N – N elements

* – Many elements

Multiplicity

Minimum cardinality

Maximum cardinality56

Cardinality

Minimum Maximum Description

0 0 Prohibited / removed element

0 1 Optional single element

0 * Zero or more elements

1 1 Required element

1 * One or more elements

2 3 Specific bounds

Constrain Cardinality

You can only further restrict the cardinality of

resource elements

Increase minimum cardinality

Decrease maximum cardinality

An element that is mandatory in the resource

definition cannot be constrained as optional

Limit value domains

Only allow “active” Patients

=“true”

If deceased is given, it must be

a dateTime, not a boolean

AddressNL

Use a profiled datatype (from

this or other profile)

Only allow reference to a

profiled resource

OrganizationNL

Contextualize Narrative

Override the base spec’s descriptions by

adding context specific narrative:

short : string 1..1

formal : string 1..1

comments : string 0..1

requirements : string 0..1

synonym : string 0..*

example[x] : 0..1 (example value!)

mappings : 0..* (more specific mappings)

Example: spreadsheet

Example: Forge

Demo: Forge

= ‘ok’

“if no value…”

Must support?

Authors: SHALL be capable of providing a

value for the element and resource

Consumers: SHALL be capable of extracting

and doing something useful with the data

element.

"Something useful" is context dependent.

The Profile SHALL describe what it means

for applications to “support” the element

Reusable constraints

We have multiple components within the

“Lipid Profile” with Quantity

All with the same constraints

Units are mmol/L

in UCUM (http://unitsofmeasure.org)

no comparator

Let us first make a reusable “lipid quantity”

constraint on the Quantity datatype!

Demo: Lipid Quantity

Element Property Value

Quantity Short Quantity as used in lipid measurements

Quantity Formal Quantity as used in lipid measurements

Quantity Comments Lipid measurements are expressed in

mmol/L

Quantity.units Fixed value mmol/L

Quantity.system Fixed value http://unitsofmeasure.org/

Quantity.code Fixed value mmol/L

Demo: Lipid Quantity

BINDINGSAuthoring Profiles

Coded types

Codes are defined

in code systems

In a Profile, we may want to limit the codes that can possibly be used in

coded elements in the Resources

CodeSystem vs. ValueSet

“Code System”

“Dante’s deadly sins”

Avarice

Gluttony

“ValueSet”

Takes concepts from…

Defintion of

Example: SNOMED-CT Example: “Childhood diseases”

An enumeration

of terms

Identification of CodeSystems

If you refer to CodeSystems, you use a URL

(instead of OID in v2 and v3):

http://snomed.info/sct

http://loinc.org

http://hl7.org/fhir/sid/icd-10

We have introduced them for v2 and v3:

http://hl7.org/fhir/v2/0078

http://hl7.org/fhir/v3/ActClass71

ValueSet

Has metadata

much like Profile: identifier, version, name, etc

Is built by inclusion of terms from

CodeSystems

Can exclude specific codes from other

valuesets

Can import codes from other ValueSets

ValueSet

In/exclude concepts

Metadata

ValueSet

But it can also enumerate (and so indirectly

define) all concepts for a new codesystem:

A ValueSet has metadata (much like Profile:

identifier, version, name, etc)

A ValueSet is built by defining terms from

and for a new CodeSystem

These new concepts have a display label

and a definition

…and may be hierarchically organized74

ValueSet

ValueSet: Gender

Bindings

When used in a Resource, the modelers

include Bindings

Bindings specify which codes can be used

Example: Forge

Conformance

isExtensible=N isExtensible=Y

Required SHALL Validation error

Non-conformant

Additional codes

allowed

Preferred SHOULD Validation error

Discouraged

Supplemental

codes likely

Alternatives

allowed

Example MAY Just a suggestion, no preference

If implementers of your profile provide a

different code than you have in your profile….

FORMAL CONSTRAINTSAuthoring Profiles

Formal constraints

Examples:

“If a Cholesterol value result is not available, use

the comments field”

“A patient’s birthdate must be on or before today’s

date”

May concern a single element, or cover

multiple elements.

Formal constraints

Uses free text (human) + xpath (executable)

Constraints should be declared on lowest

element in the hierarchy that is common to

all nodes referenced by the constraint.

Identified by (local) ‘Key’

Involved elements refer to that id

Specify severity

“error” or “warning”

Context of a constraint

• This constraint is on the

elements “valueQuantity” and

“comments”

• We would have to formulate this

constraint on the Observation,

this is the context of the

constraint

• We assign the constraint a “key”

value that’s unique within the

Observations’ constraints

• We refer from both “value[x]”

and “comments” to this “key”.

This means: if my value

changes -> revalidate the

constraint

“If a Cholesterol value result is not available, use the comments field”

Example: Forge

EXTENSIONSAuthoring Profiles

Extensions

Extension Definition

Global, shared

Extension Reference

Structure element

References an Extension Definition

Extension Context

An extension has a context type

Resource, Datatype, Extension, Mapping

And a context path

(Resource) Observation

“The observation was calculated”

(Resource) Observation.value

“The observation’s ‘value’ was calculated”

(Datatype) Quantity

“This quantity was calculated”

(any Quantity used in any resource!)89

Extension Definition

Note: multiple

contexts!

Extending a name

Key = location of formal definition

Value = value according to definition

Calculated - Definition

Calculated - Use

SLICINGAuthoring Profiles

Slicing

Slicing Group

Discriminator

Cardinality

Cardinality within the group

Additional constraints

Example: Contact

Resource definition is very generic:

Telecom

Contact { phone, fax, email, url } (0-*)

Let’s constrain; require phone & email:

Telecom (2)

Phone (1)

Email (1)

Discriminator = system

Slice Cardinality

Slice Group Cardinality Slice Cardinality

Telecom 2…2 Phone 1…1

Email 1…1

Email 0…1

Must specify both Phone and Email

Must specify Phone and/or Email

Email 0…1

Optional Phone and/or Email

Example: Contact

Example: Lipid

FUTURE DEVELOPMENTForge

Profile Validation

User friendly validation error messages

Validation error message provided by API…

Highlight invalid controls

Red border

Click on message => focus associated control

Support for XPath validation rules…

Hard-coded subset?

Resource Validation

Validate a resource against the profile

Generate validation report

List discrepancies

Value Slicing

Slice value[x] element

Slice element for each included type

Automatically generate/synchronize slices

Cf. regular slice – all slices share a common

Example

Schedule OR Period

Modifier Extensions

Extension with isModifier = True

Slicing within ModifierExtensions collection

Instead of regular Extensions collection

Issue:

If a profile is updated by clearing the isModifier

property value, then all related profile definitions

become invalid…

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