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Prepare 0.3.0: ICD-11 MMS integration
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This commit is contained in:
Dr. B. M. Riazul Islam
2026-03-08 14:40:19 +06:00
parent 4813f63da5
commit 49b3d72cb2
17 changed files with 662 additions and 132 deletions
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2
input/bd.fhir.core.xml
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@@ -13,7 +13,7 @@
</extension>--> </extension>-->
<url value="https://fhir.dghs.gov.bd/core/ImplementationGuide/bd.fhir.core"/> <url value="https://fhir.dghs.gov.bd/core/ImplementationGuide/bd.fhir.core"/>
<!-- This version will propagate to all artifacts unless the "propagate-version" extension is overridden --> <!-- This version will propagate to all artifacts unless the "propagate-version" extension is overridden -->
<version value="0.2.5"/> <version value="0.3.0"/>
<name value="BangladeshCoreFHIRIG"/> <name value="BangladeshCoreFHIRIG"/>
<title value="Bangladesh Core FHIR Implementation Guide"/> <title value="Bangladesh Core FHIR Implementation Guide"/>
<status value="active"/> <status value="active"/>

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input/fsh/BDConditionProfile.fsh
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Profile: BDConditionProfile
Parent: Condition
Id: bd-condition
Title: "ICD 11"
Description: "Condition coded with ICD-11"
* code 1..1 MS
* code from BDConditionICD11VS (preferred)

68
input/fsh/extensions/icd11ClusterExpression.fsh Normal file
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// ============================================================
// 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.
"""

39
input/fsh/immunization.json
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@@ -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
}
]
}
}

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input/fsh/namingSystems/ICD11MMSNamingSystem.fsh Normal file
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// ============================================================
// 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."

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input/fsh/profile/BDConditionProfile.fsh Normal file
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// ============================================================
// 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

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input/fsh/valueSets/BDConditionICD11DiagnosisVS.fsh Normal file
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// ============================================================
// 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

6
input/fsh/valueSets/BDConditionICD11VS.fsh
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@@ -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

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input/includes/menu.xml
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@@ -19,6 +19,9 @@
<li> <li>
<a href="spec.html">Detailed Specification</a> <a href="spec.html">Detailed Specification</a>
</li> </li>
<li>
<a href="icd11.html">ICD-11 Implementation</a>
</li>
<li> <li>
<a href="fragments.html">Instance Fragments</a> <a href="fragments.html">Instance Fragments</a>
</li> </li>

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input/package-list.json
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@@ -10,11 +10,19 @@
"path": "https://fhir.dghs.gov.bd/core/", "path": "https://fhir.dghs.gov.bd/core/",
"status": "ci-build", "status": "ci-build",
"current": true "current": true
},
{
"version": "0.2.5",
"date": "2025-10-06",
"desc": "Minor bug fix release",
"path": "https://fhir.dghs.gov.bd/core/0.2.5/",
"status": "trial-use",
"sequence": "STU 1"
}, },
{ {
"version": "0.2.4", "version": "0.2.4",
"date": "2025-10-06", "date": "2025-10-06",
"desc": "Second draft release of the Bangladesh Core FHIR IG", "desc": "Minor visual improvements",
"path": "https://fhir.dghs.gov.bd/core/0.2.4/", "path": "https://fhir.dghs.gov.bd/core/0.2.4/",
"status": "trial-use", "status": "trial-use",
"sequence": "STU 1" "sequence": "STU 1"
@@ -22,7 +30,7 @@
{ {
"version": "0.2.3", "version": "0.2.3",
"date": "2025-10-06", "date": "2025-10-06",
"desc": "Second draft release of the Bangladesh Core FHIR IG", "desc": "Minor documentation updates",
"path": "https://fhir.dghs.gov.bd/core/0.2.3/", "path": "https://fhir.dghs.gov.bd/core/0.2.3/",
"status": "trial-use", "status": "trial-use",
"sequence": "STU 1" "sequence": "STU 1"
@@ -30,7 +38,7 @@
{ {
"version": "0.2.2", "version": "0.2.2",
"date": "2025-10-06", "date": "2025-10-06",
"desc": "Second draft release of the Bangladesh Core FHIR IG", "desc": "Minor bug fix release",
"path": "https://fhir.dghs.gov.bd/core/0.2.2/", "path": "https://fhir.dghs.gov.bd/core/0.2.2/",
"status": "trial-use", "status": "trial-use",
"sequence": "STU 1" "sequence": "STU 1"

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input/pagecontent/icd11.md Normal file
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## ICD-11 Implementation
### Overview
The Bangladesh Core FHIR Implementation Guide uses ICD-11 Mortality and
Morbidity Statistics (MMS) as the mandatory coding system for clinical
conditions. This page documents the system URI, terminology infrastructure,
conformance requirements, and postcoordination conventions for implementers.
---
### System URI
All ICD-11 MMS codes SHALL use the WHO canonical system URI:
```
http://id.who.int/icd/release/11/mms
```
The preferred code form is the short stem code (e.g. `1A00`, `NC72.Z`).
Linearization URIs are not used as code identifiers in this IG.
---
### Terminology Infrastructure
#### National OCL Terminology Server
Runtime code validation and lookup are delegated to the national
OpenConceptLab (OCL) terminology server operated by DGHS/MoHFW:
**Public FHIR R4 endpoint:** `https://tr.ocl.dghs.gov.bd`
OCL hosts ICD-11 MMS version 2025-01 with 36,941 concepts across the
following concept classes: Diagnosis, Finding, Substance, Organism,
Device, Anatomy, and Misc.
Vendors do not interact with OCL directly. All vendor submissions are
validated at the HIE boundary via the Bangladesh ICD-11 Cluster Validator
(see [Cluster Expressions](#cluster-expressions) below).
#### Supported OCL Operations
The following FHIR terminology operations are supported. The `system=`
parameter must be used — `url=` is not supported by OCL.
**CodeSystem $validate-code**
```
GET https://tr.ocl.dghs.gov.bd/api/fhir/CodeSystem/$validate-code
?system=http://id.who.int/icd/release/11/mms&code={code}
```
**CodeSystem $lookup**
```
GET https://tr.ocl.dghs.gov.bd/api/fhir/CodeSystem/$lookup
?system=http://id.who.int/icd/release/11/mms&code={code}
```
**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}
```
#### Unsupported OCL Operations
`$expand` is not supported — this is a known limitation of the national
OCL instance. Build-time expansion is suppressed. Implementers SHALL NOT
depend on `$expand` for ICD-11 ValueSets in this IG.
#### Local ICD-11 Docker Instance
A local WHO ICD-11 Docker instance is maintained internally by DGHS at
`https://icd11.dghs.gov.bd` running release 2025-01. This instance is
internal only and is not exposed to vendors. It serves as the import
source for OCL and as the backend for the cluster validator.
---
### Condition.code Binding and Class Restriction
`Condition.code` is bound to the
[Bangladesh ICD-11 MMS Condition ValueSet](ValueSet-bd-condition-icd11-diagnosis-valueset.html)
at `preferred` strength. This ValueSet includes only Diagnosis (14,071)
and Finding (5,590) class concepts — 19,661 concepts total as of
version 2025-01.
`Condition.code` SHALL contain at least one coding conforming to the
`coding[stem]` slice with `system = http://id.who.int/icd/release/11/mms`.
Vendors cannot omit ICD-11 by substituting a local code.
The following concept classes SHALL NOT appear as standalone stem codes
in `Condition.code`: Substance, Organism, Device, Anatomy, Misc.
This restriction exists because these classes represent entities that
are not themselves diagnoses or clinical findings — they are axes used
in postcoordination (e.g. a causative substance, an affected anatomy
site). Their correct use is as satellite codes within a cluster
expression, not as standalone condition codes.
Class restriction is enforced at runtime via OCL ValueSet `$validate-code`
against the Bangladesh ICD-11 MMS Condition ValueSet. At the HAPI FHIR
layer, enforcement is via `RemoteTerminologyServiceValidationSupport`
configured to call OCL. HAPI FHIR deployment will be completed before
vendor onboarding.
The `coding[stem]` slice is open (`#open`) — additional local codings
are permitted alongside the mandatory ICD-11 stem.
---
### Cluster Expressions
#### Background
ICD-11 supports postcoordination — the combination of a stem code with
one or more satellite codes to precisely represent a clinical concept
that cannot be expressed by a stem code alone. A postcoordinated
expression is called a cluster expression.
Cluster expressions are typically sourced from the WHO Electronic Coding
Tool (ECT) at the point of care.
#### Syntax
A cluster expression combines a stem code with satellite codes using
the `&` operator (combination) or `/` operator (specificity):
```
NC72.Z&XK8G&XJ7ZH&XJ7YM
```
Where:
- `NC72.Z` — stem code: Fracture of femur, unspecified
- `XK8G` — satellite: laterality
- `XJ7ZH` — satellite: fracture subtype
- `XJ7YM` — satellite: fracture open or closed
#### FHIR Representation
The stem code is carried in `Coding.code`. The full cluster expression
is carried in the
[ICD-11 Cluster Expression extension](StructureDefinition-icd11-cluster-expression.html)
on the same `Coding` element:
```json
"code": {
"coding": [
{
"system": "http://id.who.int/icd/release/11/mms",
"code": "NC72.Z",
"display": "Fracture of femur, unspecified",
"extension": [
{
"url": "https://fhir.dghs.gov.bd/core/StructureDefinition/icd11-cluster-expression",
"valueString": "NC72.Z&XK8G&XJ7ZH&XJ7YM"
}
]
}
],
"text": "Fracture of femur, unspecified — left, transverse, closed"
}
```
The stem code in `Coding.code` SHALL match the leading stem code in the
cluster expression string.
#### Stem-Only vs Cluster
| Scenario | Representation | Validation |
|---|---|---|
| Single stem code | `Coding.code` only | OCL `$validate-code` |
| Postcoordinated expression | `Coding.code` + cluster extension | Cluster Validator |
The cluster validator explicitly rejects stem-only expressions. Single
stem codes SHALL be represented in `Coding.code` only and validated via
OCL `$validate-code`.
#### Satellite Code Class Restriction Exemption
Satellite codes in a cluster expression are exempt from the
Diagnosis/Finding class restriction that applies to stem codes in
`Condition.code`. Substance, Anatomy, Organism, and other axis codes
are valid and expected as satellites.
#### Bangladesh ICD-11 Cluster Validator
All postcoordinated cluster expressions SHALL be validated against the
Bangladesh ICD-11 Cluster Validator prior to submission to the HIE:
```
POST https://icd11.dghs.gov.bd/cluster/validate
Content-Type: application/json
{"expression": "NC72.Z&XK8G&XJ7ZH&XJ7YM"}
```
Example response:
```json
{
"valid": true,
"stem": {
"code": "NC72.Z",
"display": "Fracture of femur, unspecified",
"ocl_validated": true
},
"satellites": [
{"code": "XK8G", "axis": "laterality", "valid": true},
{"code": "XJ7ZH", "axis": "fractureSubtype", "valid": true},
{"code": "XJ7YM", "axis": "fractureOpenOrClosed", "valid": true}
],
"errors": []
}
```
The cluster validator is a mandatory HIE boundary gate. All vendor
submissions containing postcoordinated ICD-11 expressions pass through it.
---
### Conformance Statements
**ICD-11-CONF-01:** ICD-11 MMS codes SHALL use system URI
`http://id.who.int/icd/release/11/mms`. Stem code validation is available
via OCL at:
`https://tr.ocl.dghs.gov.bd/api/fhir/CodeSystem/$validate-code?system=http://id.who.int/icd/release/11/mms&code={code}`
**ICD-11-CONF-02:** The `icd11-cluster-expression` extension SHALL only
be present when the expression contains at least one postcoordination
satellite code using `&` or `/` operators. Single stem codes SHALL be
represented in `Coding.code` only and validated via OCL `$validate-code`.
**ICD-11-CONF-03:** Postcoordinated cluster expressions SHALL be validated
against the Bangladesh ICD-11 Cluster Validator at
`https://icd11.dghs.gov.bd/cluster/validate` prior to submission to the HIE.
**ICD-11-CONF-04:** `Condition.code` SHALL contain at least one coding
conforming to the `coding[stem]` slice with
`system = http://id.who.int/icd/release/11/mms`. The stem code SHALL be
a member of the Bangladesh ICD-11 MMS Condition ValueSet, which includes
only Diagnosis and Finding class concepts. This restriction is enforced
at runtime via OCL ValueSet `$validate-code`.
**ICD-11-CONF-05:** Substance, Organism, Device, Anatomy, and Misc class
ICD-11 concepts SHALL NOT appear as standalone stem codes in
`Condition.code`. This restriction does not apply to satellite codes
carried in the `icd11-cluster-expression` extension.

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

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package-feed.xml
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<?xml version="1.0" encoding="UTF-8"?>
<feed xmlns="http://www.w3.org/2005/Atom">
<id>https://fhir.dghs.gov.bd/core/package-feed.xml</id>
<title>Bangladesh Core FHIR IG Package Feed</title>
<subtitle>FHIR Package Feed for bd.fhir.core</subtitle>
<link rel="self" href="https://fhir.dghs.gov.bd/core/package-feed.xml"/>
<link rel="alternate" href="https://fhir.dghs.gov.bd/core/"/>
<updated>2025-10-02T00:00:00Z</updated>
<author>
<name>MIS, Directorate General of Health Services (DGHS), Bangladesh</name>
<uri>https://dghs.gov.bd</uri>
</author>
<!-- Entries will be automatically added by the CI/CD pipeline -->
<!-- Example entry structure (will be generated): -->
<!--
<entry>
<title>bd.fhir.core version 0.2.0</title>
<link rel="alternate" href="https://fhir.dghs.gov.bd/core/0.2.0/"/>
<id>https://fhir.dghs.gov.bd/core/0.2.0/</id>
<updated>2025-10-02T00:00:00Z</updated>
<summary>Release 0.2.0 of Bangladesh Core FHIR Implementation Guide</summary>
</entry>
-->
<entry>
<title>bd.fhir.core version 0.2.0</title>
<link rel="alternate" href="https://fhir.dghs.gov.bd/core/0.2.0/"/>
<id>https://fhir.dghs.gov.bd/core/0.2.0/</id>
<updated>2025-10-02T00:00:00Z</updated>
<summary>First draft release of Bangladesh Core FHIR Implementation Guide</summary>
</entry>
</feed>

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package-list.backup
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{
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"title": "Bangladesh Core FHIR Implementation Guide",
"canonical": "https://fhir.dghs.gov.bd",
"introduction": "The Bangladesh Core FHIR IG defines national base profiles, value sets, and extensions for health data interoperability.",
"list": [
{
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},
{
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"desc": "First draft release of the Bangladesh Core FHIR IG.",
"path": "https://fhir.dghs.gov.bd/v0.2.0",
"status": "trial-use",
"sequence": "STU 1"
}
]
}

14
package-list.json
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@@ -10,11 +10,19 @@
"path": "https://fhir.dghs.gov.bd/core/", "path": "https://fhir.dghs.gov.bd/core/",
"status": "ci-build", "status": "ci-build",
"current": true "current": true
},
{
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{ {
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"status": "trial-use", "status": "trial-use",
"sequence": "STU 1" "sequence": "STU 1"
@@ -22,7 +30,7 @@
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"status": "trial-use", "status": "trial-use",
"sequence": "STU 1" "sequence": "STU 1"
@@ -30,7 +38,7 @@
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"date": "2025-10-06", "date": "2025-10-06",
"desc": "Second draft release of the Bangladesh Core FHIR IG", "desc": "Minor bug fix release",
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"status": "trial-use", "status": "trial-use",
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12
publication-request.backup
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@@ -1,12 +0,0 @@
{
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"title": "Bangladesh Core FHIR Implementation Guide",
"canonical": "https://fhir.dghs.gov.bd",
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2
sushi-config.yaml
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@@ -6,7 +6,7 @@ description: >
This Implementation Guide defines the Bangladesh Core FHIR profiles, This Implementation Guide defines the Bangladesh Core FHIR profiles,
value sets, code systems, and implementation rules for national digital health systems. value sets, code systems, and implementation rules for national digital health systems.
status: draft status: draft
version: 0.2.5 version: 0.3.0
fhirVersion: 4.0.1 fhirVersion: 4.0.1
copyrightYear: 2025+ copyrightYear: 2025+
releaseLabel: CI Build releaseLabel: CI Build