Prepare 0.3.0: ICD-11 MMS integration

2026-03-08 14:40:19 +06:00
parent 4813f63da5
commit 49b3d72cb2
17 changed files with 662 additions and 132 deletions
--- a/input/fsh/BDConditionProfile.fsh
+++ b/input/fsh/BDConditionProfile.fsh
@@ -1,8 +0,0 @@
-Profile: BDConditionProfile
-Parent: Condition
-Id: bd-condition
-Title: "ICD 11"
-Description: "Condition coded with ICD-11"
-
-* code 1..1 MS
-* code from BDConditionICD11VS (preferred)
--- a/input/fsh/extensions/icd11ClusterExpression.fsh
+++ b/input/fsh/extensions/icd11ClusterExpression.fsh
@@ -0,0 +1,68 @@
+// ============================================================
+// icd11ClusterExpression.fsh
+// Extension for ICD-11 postcoordinated cluster expressions
+// Context: Coding (broad — usable across all ICD-11 coded elements)
+// ============================================================
+
+Extension: ICD11ClusterExpression
+Id: icd11-cluster-expression
+Title: "ICD-11 Cluster Expression"
+Description: """
+Carries a postcoordinated ICD-11 cluster expression as a single string
+on a Coding element where the stem code alone is insufficient to fully
+represent the clinical concept.
+
+A cluster expression combines a stem code with one or more satellite
+codes using the & operator (combination) or / operator (specificity).
+Example: NC72.Z&XK8G&XJ7ZH&XJ7YM
+  - NC72.Z  — stem: Fracture of femur, unspecified
+  - XK8G    — satellite: laterality
+  - XJ7ZH   — satellite: fracture subtype
+  - XJ7YM   — satellite: fracture open or closed
+
+Usage rules:
+  - SHALL only be present when the expression contains at least one
+    satellite code joined by & or / operators.
+  - Single stem codes SHALL be represented in Coding.code only and
+    validated via OCL $validate-code. The cluster validator at
+    https://icd11.dghs.gov.bd/cluster/validate explicitly rejects
+    stem-only expressions.
+  - The stem code in Coding.code SHALL match the leading stem code
+    in this expression string.
+  - Satellite codes in the cluster expression are exempt from the
+    Diagnosis/Finding class restriction that applies to stem codes
+    in Condition.code.
+  - Cluster expressions SHALL be validated against the Bangladesh
+    ICD-11 Cluster Validator at https://icd11.dghs.gov.bd/cluster/validate
+    prior to submission to the HIE.
+
+Cluster validator endpoint:
+  POST https://icd11.dghs.gov.bd/cluster/validate
+  Body: { "expression": "NC72.Z&XK8G&XJ7ZH&XJ7YM" }
+
+This extension is not MustSupport and is not mandatory. It is present
+only when postcoordination is clinically required. Cluster expressions
+are typically sourced from the WHO Electronic Coding Tool (ECT) at the
+point of care.
+"""
+
+* ^url = "https://fhir.dghs.gov.bd/core/StructureDefinition/icd11-cluster-expression"
+* ^status = #active
+* ^experimental = false
+* ^publisher = "Directorate General of Health Services (DGHS), MoHFW, Bangladesh"
+* ^contact.name = "DGHS Health Informatics Unit"
+* ^contact.telecom.system = #url
+* ^contact.telecom.value = "https://dghs.gov.bd"
+* ^jurisdiction = urn:iso:std:iso:3166#BD "Bangladesh"
+* ^context[+].type = #element
+* ^context[=].expression = "Coding"
+
+* value[x] only string
+* valueString 1..1
+* valueString ^short = "ICD-11 postcoordinated cluster expression string"
+* valueString ^definition = """
+The full postcoordinated cluster expression, including the stem code and
+all satellite codes joined by & or / operators. Example:
+NC72.Z&XK8G&XJ7ZH&XJ7YM. The stem code in this string SHALL match
+Coding.code on the parent Coding element.
+"""
--- a/input/fsh/immunization.json
+++ b/input/fsh/immunization.json
@@ -1,39 +0,0 @@
-{
-  "resourceType": "StructureDefinition",
-<<<<<<< HEAD
-  "id": "bd-Immunization",
-  "url": "http://example.org/StructureDefinition/bd-Immunization",
-  "version": "1.0.0",
-  "name": "BDImmunizationProfile",
-  "title": "Immunization Profile for Bangladesh",
-  "description": "Bangladesh Immunization Profile",
-=======
-  "id": "bd-immunization",
-  "url": "https://fhir.dghs.gov.bd/core/identifier/bd-immunization",
-  "version": "1.0.0",
-  "name": "BDImmunizationProfile",
-  "title": "Patient Immunization Profile for Bangladesh",
-  "description": "Patients Immunization Bangladesh Standard",
->>>>>>> 1c45affa520e64b3b9efc307d9116ff138171fa5
-  "fhirVersion": "4.0.1",
-  "kind": "resource",
-  "abstract": false,
-  "type": "Immunization",
-  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Immunization",
-  "derivation": "constraint",
-  "differential": {
-    "element": [
-      {
-        "id": "Immunization.identifier",
-        "path": "Immunization.identifier",
-<<<<<<< HEAD
-        "short": "Unique identifier",
-=======
-        "short": "Identifier",
->>>>>>> 1c45affa520e64b3b9efc307d9116ff138171fa5
-        "definition": "Unique identifier for the vaccination event",
-        "min": 1
-      }
-    ]
-  }
-}
--- a/input/fsh/namingSystems/ICD11MMSNamingSystem.fsh
+++ b/input/fsh/namingSystems/ICD11MMSNamingSystem.fsh
@@ -0,0 +1,63 @@
+// ============================================================
+// ICD11MMSNamingSystem.fsh
+// NamingSystem for ICD-11 MMS in the Bangladesh national context
+// Canonical authority: WHO
+// National resolver: OCL at https://tr.ocl.dghs.gov.bd
+// ============================================================
+
+Instance: icd11-mms-bd
+InstanceOf: NamingSystem
+Usage: #definition
+Title: "ICD-11 MMS NamingSystem — Bangladesh"
+Description: """
+Declares the ICD-11 Mortality and Morbidity Statistics (MMS) coding system
+as a known and supported terminology within the Bangladesh national health
+information infrastructure.
+
+Canonical system URI: http://id.who.int/icd/release/11/mms
+Canonical authority: World Health Organization (WHO)
+
+Preferred code form: short stem codes (e.g. 1A00, NC72.Z).
+Linearization URIs are not used as code identifiers in this IG.
+
+National terminology resolver (OCL):
+  https://tr.ocl.dghs.gov.bd
+
+Supported OCL operations (use `system=` parameter, not `url=`):
+  - $validate-code: https://tr.ocl.dghs.gov.bd/api/fhir/CodeSystem/$validate-code
+      ?system=http://id.who.int/icd/release/11/mms&code={code}
+  - $lookup: https://tr.ocl.dghs.gov.bd/api/fhir/CodeSystem/$lookup
+      ?system=http://id.who.int/icd/release/11/mms&code={code}
+
+$expand is not supported — known OCL limitation.
+
+Version 2025-01 is active in the national OCL instance with 36,941
+imported concepts. The OCL resolver is an internal national service;
+vendors do not interact with it directly. All vendor submissions are
+validated at the HIE boundary via the Bangladesh ICD-11 Cluster Validator
+at https://icd11.dghs.gov.bd/cluster/validate.
+"""
+
+* name = "ICD11MMSBangladesh"
+* status = #active
+* kind = #codesystem
+* date = "2025-01-01"
+* publisher = "Directorate General of Health Services (DGHS), MoHFW, Bangladesh"
+* contact.name = "DGHS Health Informatics Unit"
+* contact.telecom.system = #url
+* contact.telecom.value = "https://dghs.gov.bd"
+* jurisdiction = urn:iso:std:iso:3166#BD "Bangladesh"
+* responsible = "World Health Organization (WHO)"
+
+// Primary identifier — canonical system URI (WHO authority)
+* uniqueId[+].type = #uri
+* uniqueId[=].value = "http://id.who.int/icd/release/11/mms"
+* uniqueId[=].preferred = true
+* uniqueId[=].comment = "Canonical ICD-11 MMS system URI. Canonical authority is WHO."
+* uniqueId[=].period.start = "2025-01-01"
+
+// Secondary identifier — national OCL source locator (machine-discoverable, not canonical)
+* uniqueId[+].type = #uri
+* uniqueId[=].value = "https://tr.ocl.dghs.gov.bd/orgs/MoHFW/sources/ICD-11-MMS/"
+* uniqueId[=].preferred = false
+* uniqueId[=].comment = "National terminology resolver — Bangladesh OCL instance. Not the canonical system URI."
--- a/input/fsh/profile/BDConditionProfile.fsh
+++ b/input/fsh/profile/BDConditionProfile.fsh
@@ -0,0 +1,65 @@
+// ============================================================
+// BDConditionProfile.fsh
+// BD-Core Condition profile with mandatory ICD-11 MMS stem slice
+// Binding: Diagnosis and Finding class concepts only
+// Runtime enforcement via OCL ValueSet $validate-code
+// ============================================================
+
+Profile: BDConditionProfile
+Parent: Condition
+Id: bd-condition
+Title: "BD Core Condition Profile (ICD-11)"
+Description: """
+Condition resource coded with ICD-11 MMS, restricted to Diagnosis and
+Finding class concepts. Defined in the Bangladesh Core FHIR Implementation
+Guide (BD-Core-FHIR-IG) published by DGHS/MoHFW.
+"""
+
+* code 1..1 MS
+* code from bd-condition-icd11-diagnosis-valueset (preferred)
+* code ^comment = """
+Condition.code SHALL contain at least one coding conforming to the
+coding[stem] slice with system = http://id.who.int/icd/release/11/mms.
+
+Stem code rules:
+  - The stem code SHALL be a Diagnosis or Finding class ICD-11 MMS concept.
+  - This restriction is enforced at runtime via OCL ValueSet $validate-code
+    against the Bangladesh ICD-11 MMS Condition ValueSet.
+  - Stem-only codes SHALL be validated via OCL $validate-code.
+  - Substance, Organism, Device, Anatomy, and Misc class concepts SHALL NOT
+    appear as standalone stem codes in Condition.code.
+
+Cluster expression rules:
+  - When a concept requires postcoordination, the full cluster expression
+    SHALL be carried in the icd11-cluster-expression extension on coding[stem].
+  - The icd11-cluster-expression extension SHALL only be present when the
+    expression contains at least one satellite code joined by & or / operators.
+  - Satellite codes in the cluster expression are exempt from the
+    Diagnosis/Finding class restriction.
+  - Cluster expressions SHALL be validated against the Bangladesh ICD-11
+    Cluster Validator at https://icd11.dghs.gov.bd/cluster/validate
+    prior to submission to the HIE.
+
+Additional local codings are permitted alongside the mandatory ICD-11 stem
+(slicing is open). Cluster expressions are typically sourced from the WHO
+Electronic Coding Tool (ECT) at the point of care.
+"""
+
+* code.coding ^slicing.discriminator.type = #value
+* code.coding ^slicing.discriminator.path = "system"
+* code.coding ^slicing.rules = #open
+* code.coding ^slicing.description = "Slice requiring exactly one ICD-11 MMS stem code. Additional local codings permitted."
+
+* code.coding contains stem 1..1
+* code.coding[stem] ^short = "Mandatory ICD-11 MMS stem code"
+* code.coding[stem] ^definition = """
+Exactly one ICD-11 MMS stem code is required. The stem code SHALL be a
+Diagnosis or Finding class concept. When the condition requires
+postcoordination, the full cluster expression is carried in the
+icd11-cluster-expression extension on this coding element.
+"""
+* code.coding[stem].system 1..1
+* code.coding[stem].system = "http://id.who.int/icd/release/11/mms" (exactly)
+* code.coding[stem].code 1..1
+* code.coding[stem].extension contains
+    https://fhir.dghs.gov.bd/core/StructureDefinition/icd11-cluster-expression named clusterExpression 0..1
--- a/input/fsh/valueSets/BDConditionICD11DiagnosisVS.fsh
+++ b/input/fsh/valueSets/BDConditionICD11DiagnosisVS.fsh
@@ -0,0 +1,62 @@
+// ============================================================
+// BDConditionICD11DiagnosisVS.fsh
+// ICD-11 MMS ValueSet restricted to Diagnosis and Finding classes
+// Binding target for Condition.code in BDConditionProfile
+// Empty stub — runtime enforcement via OCL $validate-code
+// $expand not available — suppressed in sushi-config.yaml
+// ============================================================
+
+ValueSet: BDConditionICD11DiagnosisVS
+Id: bd-condition-icd11-diagnosis-valueset
+Title: "Bangladesh ICD-11 MMS Condition ValueSet (Diagnosis and Finding)"
+Description: """
+ICD-11 MMS concepts restricted to the Diagnosis (14,071) and Finding (5,590)
+concept classes, totalling 19,661 concepts as of version 2025-01.
+
+This ValueSet is the binding target for Condition.code in the BD-Core
+Condition profile. Substance, Organism, Device, Anatomy, and Misc class
+concepts are excluded and SHALL NOT appear as standalone stem codes in
+Condition.code. This restriction applies to stem codes only — satellite
+codes carried in the icd11-cluster-expression extension are exempt.
+
+This ValueSet is an empty stub. No compose block is declared because
+$expand is not supported by the national OCL terminology server and
+no machine-executable filter for concept_class is available at the
+IG layer. The compose would be nominal only and is omitted to avoid
+misrepresenting machine-executable semantics.
+
+The ValueSet is hosted in OCL as a collection with 19,661 explicit
+concept references (Diagnosis and Finding classes only). Runtime
+enforcement is via OCL ValueSet $validate-code:
+
+  GET https://tr.ocl.dghs.gov.bd/api/fhir/ValueSet/$validate-code
+      ?url=https://fhir.dghs.gov.bd/core/ValueSet/bd-condition-icd11-diagnosis-valueset
+      &system=http://id.who.int/icd/release/11/mms
+      &code={code}
+
+Confirmed behaviour:
+  - Diagnosis class (e.g. 1A00): accepted
+  - Finding class: accepted
+  - Device class (e.g. XD7EB1): rejected
+  - Substance class (e.g. XM6RB2): rejected
+
+At the HAPI FHIR layer, enforcement is via RemoteTerminologyServiceValidationSupport
+configured to call OCL. HAPI FHIR deployment is a known gap to be closed
+before vendor onboarding.
+
+VERSION UPGRADES:
+  Upgrading to a new ICD-11 MMS release requires re-running
+  populate_condition_valueset.py. Automated via version_upgrade.py.
+"""
+
+* ^url = "https://fhir.dghs.gov.bd/core/ValueSet/bd-condition-icd11-diagnosis-valueset"
+* ^status = #active
+* ^experimental = false
+* ^version = "2025-01"
+* ^publisher = "Directorate General of Health Services (DGHS), MoHFW, Bangladesh"
+* ^contact.name = "DGHS Health Informatics Unit"
+* ^contact.telecom.system = #url
+* ^contact.telecom.value = "https://dghs.gov.bd"
+* ^jurisdiction = urn:iso:std:iso:3166#BD "Bangladesh"
+* ^copyright = "ICD-11 is copyright © World Health Organization. Used under licence."
+* ^immutable = false
--- a/input/fsh/valueSets/BDConditionICD11VS.fsh
+++ b/input/fsh/valueSets/BDConditionICD11VS.fsh
@@ -1,6 +0,0 @@
-ValueSet: BDConditionICD11VS
-Id: bd-condition-icd11-valueset
-Title: "Bangladesh ICD-11 MMS ValueSet"
-Description: "ValueSet that includes the ICD-11 MMS CodeSystem for Condition.code"
-* ^url = "https://fhir.dghs.gov.bd/core/ValueSet/bd-condition-icd11-valueset"
-* include codes from system http://id.who.int/icd/release/11/mms