Prepare 0.3.0: ICD-11 MMS integration
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### A Heading
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You can also use markdown if that's your thing
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## Bangladesh Core FHIR Implementation Guide — General Specification
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And an icon: 
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### Purpose and Scope
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This Implementation Guide (IG) defines the national FHIR R4 core profiles,
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value sets, code systems, extensions, and implementation rules for digital
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health systems in Bangladesh. It is published by the Directorate General of
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Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW).
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This IG is a foundational component of the **Shareable Health Record (SHR)**
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system — the national Health Information Exchange (HIE) and gateway for
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producing a Personal Health Profile for every citizen of Bangladesh.
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This IG is aligned with and gives technical expression to:
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- **Bangladesh Digital Health Strategy 2023–2027**
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- **Bangladesh Digital Health Architecture Blueprint**
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The Patient profile strictly conforms to the **Citizen Core Data Structure
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(CCDS)** defined by the Cabinet Division of the Government of Bangladesh.
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---
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### Intended Audience
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This IG is addressed to all software systems exchanging health data with
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the national SHR, including but not limited to:
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- Electronic Medical Record (EMR) systems
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- Laboratory Information Systems (LIS)
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- Picture Archiving and Communication Systems (PACS)
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- Hospital Information Systems (HIS)
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This includes systems operated by public sector facilities, private
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hospitals and clinics, autonomous bodies, and non-governmental
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organisations (NGOs) operating within Bangladesh.
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---
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### FHIR Version and Conventions
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This IG is built on **FHIR R4 (4.0.1)**. All profiles, extensions, value
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sets, and code systems defined here conform to the FHIR R4 specification.
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Conformance language in this IG follows **RFC 2119**: SHALL, SHALL NOT,
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SHOULD, SHOULD NOT, and MAY carry their standard normative meanings.
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---
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### Design Principles
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**1. National terminology over international defaults**
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Where international code systems are used (ICD-11, LOINC, SNOMED CT),
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they are bound through national infrastructure. The national OpenConceptLab
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(OCL) terminology server at `https://tr.ocl.dghs.gov.bd` is the single
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public-facing terminology resolution point. Vendors never interact with
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upstream terminology sources directly.
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**2. HIE boundary enforcement**
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All vendor submissions pass through the national SHR HIE boundary. Mandatory
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validation gates — including the Bangladesh ICD-11 Cluster Validator — are
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applied at the HIE layer. Profile conformance is a necessary but not
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sufficient condition for acceptance; HIE boundary rules apply additionally.
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**3. Open slicing for extensibility**
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Where slices are defined on coding elements, slicing is open (`#open`).
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Mandatory slices enforce the presence of nationally required codes;
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additional local or proprietary codings are permitted alongside them.
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This ensures national interoperability without preventing systems from
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carrying additional coded data.
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**4. Citizen-centred identity**
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The Patient profile conforms to the Citizen Core Data Structure (CCDS),
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ensuring that patient identity in the SHR is anchored to the national
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citizen identity infrastructure.
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**5. Must Support obligations**
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Must Support (MS) in this IG means that conformant systems SHALL be capable
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of populating the element if the data is held by the system, and SHALL be
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capable of processing it when received. Specific sender and receiver
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obligations are \[TODO: to be defined in a future revision\].
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---
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### Profiles
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The following national core profiles are defined in this IG:
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| Profile | Base Resource | Purpose |
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|---|---|---|
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| [BD Patient](StructureDefinition-bd-patient.html) | Patient | Citizen identity conforming to CCDS |
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| [BD Condition](StructureDefinition-bd-condition.html) | Condition | Clinical conditions coded with ICD-11 MMS |
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| [BD Observation](StructureDefinition-bd-observation.html) | Observation | Vital signs, laboratory results, clinical findings |
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| [BD Encounter](StructureDefinition-bd-encounter.html) | Encounter | Clinical visits and episodes of care |
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| [BD Medication](StructureDefinition-bd-medication.html) | Medication | Medication definitions |
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| [BD MedicationRequest](StructureDefinition-bd-medicationrequest.html) | MedicationRequest | Prescriptions and medication orders |
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| [BD Immunization](StructureDefinition-bd-immunization.html) | Immunization | Vaccination records |
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| [BD Organization](StructureDefinition-bd-organization.html) | Organization | Health facilities and organisations |
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| [BD Practitioner](StructureDefinition-bd-practitioner.html) | Practitioner | Healthcare providers |
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| [BD Location](StructureDefinition-bd-location.html) | Location | Physical locations and administrative geography |
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---
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### Terminology
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The following external code systems are used in this IG:
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| System | URI | Purpose |
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|---|---|---|
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| ICD-11 MMS | `http://id.who.int/icd/release/11/mms` | Condition coding |
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| LOINC | `http://loinc.org` | Observation coding |
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| UCUM | `http://unitsofmeasure.org` | Observation units |
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| SNOMED CT | `http://snomed.info/sct` | Clinical terminology |
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Runtime terminology resolution is provided by the national OCL terminology
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server. See the [ICD-11 Implementation](icd11.html) page for full details
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of ICD-11 integration, postcoordination conventions, and conformance
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requirements.
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---
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### Known Gaps and Planned Work
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This IG is currently at version 0.2.5 with status `draft`. The following
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are known gaps to be addressed in future revisions:
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- **Must Support semantics** — sender and receiver obligations not yet
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formally defined
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- **Capability Statements** — no CapabilityStatement resources defined yet
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- **Search Parameters** — no defined search parameter requirements yet
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- **Transaction Patterns** — no defined FHIR transaction or message patterns yet
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- **HAPI FHIR deployment** — `RemoteTerminologyServiceValidationSupport`
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configuration for OCL not yet deployed; this is a prerequisite for
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runtime ICD-11 class restriction enforcement before vendor onboarding
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- **Must Support definitions per profile** — individual profile pages do
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not yet carry explicit MS obligation tables
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