Prepare 0.3.0: ICD-11 MMS integration
This commit is contained in:
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<li>
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<li>
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<a href="spec.html">Detailed Specification</a>
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<a href="spec.html">Detailed Specification</a>
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</li>
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</li>
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<li>
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<a href="icd11.html">ICD-11 Implementation</a>
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</li>
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<li>
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<li>
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<a href="fragments.html">Instance Fragments</a>
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<a href="fragments.html">Instance Fragments</a>
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## ICD-11 Implementation
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### Overview
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The Bangladesh Core FHIR Implementation Guide uses ICD-11 Mortality and
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Morbidity Statistics (MMS) as the mandatory coding system for clinical
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conditions. This page documents the system URI, terminology infrastructure,
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conformance requirements, and postcoordination conventions for implementers.
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---
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### System URI
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All ICD-11 MMS codes SHALL use the WHO canonical system URI:
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```
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http://id.who.int/icd/release/11/mms
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```
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The preferred code form is the short stem code (e.g. `1A00`, `NC72.Z`).
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Linearization URIs are not used as code identifiers in this IG.
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---
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### Terminology Infrastructure
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#### National OCL Terminology Server
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Runtime code validation and lookup are delegated to the national
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OpenConceptLab (OCL) terminology server operated by DGHS/MoHFW:
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**Public FHIR R4 endpoint:** `https://tr.ocl.dghs.gov.bd`
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OCL hosts ICD-11 MMS version 2025-01 with 36,941 concepts across the
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following concept classes: Diagnosis, Finding, Substance, Organism,
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Device, Anatomy, and Misc.
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Vendors do not interact with OCL directly. All vendor submissions are
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validated at the HIE boundary via the Bangladesh ICD-11 Cluster Validator
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(see [Cluster Expressions](#cluster-expressions) below).
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#### Supported OCL Operations
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The following FHIR terminology operations are supported. The `system=`
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parameter must be used — `url=` is not supported by OCL.
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**CodeSystem $validate-code**
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```
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GET https://tr.ocl.dghs.gov.bd/api/fhir/CodeSystem/$validate-code
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?system=http://id.who.int/icd/release/11/mms&code={code}
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```
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**CodeSystem $lookup**
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```
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GET https://tr.ocl.dghs.gov.bd/api/fhir/CodeSystem/$lookup
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?system=http://id.who.int/icd/release/11/mms&code={code}
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```
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**ValueSet $validate-code**
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```
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GET https://tr.ocl.dghs.gov.bd/api/fhir/ValueSet/$validate-code
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?url=https://fhir.dghs.gov.bd/core/ValueSet/bd-condition-icd11-diagnosis-valueset
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&system=http://id.who.int/icd/release/11/mms&code={code}
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```
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#### Unsupported OCL Operations
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`$expand` is not supported — this is a known limitation of the national
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OCL instance. Build-time expansion is suppressed. Implementers SHALL NOT
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depend on `$expand` for ICD-11 ValueSets in this IG.
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#### Local ICD-11 Docker Instance
|
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A local WHO ICD-11 Docker instance is maintained internally by DGHS at
|
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||||||
`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.
|
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---
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### Condition.code Binding and Class Restriction
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`Condition.code` is bound to the
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[Bangladesh ICD-11 MMS Condition ValueSet](ValueSet-bd-condition-icd11-diagnosis-valueset.html)
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at `preferred` strength. This ValueSet includes only Diagnosis (14,071)
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and Finding (5,590) class concepts — 19,661 concepts total as of
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version 2025-01.
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`Condition.code` SHALL contain at least one coding conforming to the
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`coding[stem]` slice with `system = http://id.who.int/icd/release/11/mms`.
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Vendors cannot omit ICD-11 by substituting a local code.
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The following concept classes SHALL NOT appear as standalone stem codes
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in `Condition.code`: Substance, Organism, Device, Anatomy, Misc.
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This restriction exists because these classes represent entities that
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are not themselves diagnoses or clinical findings — they are axes used
|
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||||||
in postcoordination (e.g. a causative substance, an affected anatomy
|
|
||||||
site). Their correct use is as satellite codes within a cluster
|
|
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expression, not as standalone condition codes.
|
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||||||
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Class restriction is enforced at runtime via OCL ValueSet `$validate-code`
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against the Bangladesh ICD-11 MMS Condition ValueSet. At the HAPI FHIR
|
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layer, enforcement is via `RemoteTerminologyServiceValidationSupport`
|
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configured to call OCL. HAPI FHIR deployment will be completed before
|
|
||||||
vendor onboarding.
|
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||||||
|
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||||||
The `coding[stem]` slice is open (`#open`) — additional local codings
|
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||||||
are permitted alongside the mandatory ICD-11 stem.
|
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|
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---
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### Cluster Expressions
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#### Background
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ICD-11 supports postcoordination — the combination of a stem code with
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one or more satellite codes to precisely represent a clinical concept
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|
||||||
that cannot be expressed by a stem code alone. A postcoordinated
|
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expression is called a cluster expression.
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||||||
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Cluster expressions are typically sourced from the WHO Electronic Coding
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Tool (ECT) at the point of care.
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#### Syntax
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A cluster expression combines a stem code with satellite codes using
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the `&` operator (combination) or `/` operator (specificity):
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```
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NC72.Z&XK8G&XJ7ZH&XJ7YM
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```
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Where:
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- `NC72.Z` — stem code: Fracture of femur, unspecified
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- `XK8G` — satellite: laterality
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- `XJ7ZH` — satellite: fracture subtype
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- `XJ7YM` — satellite: fracture open or closed
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#### FHIR Representation
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The stem code is carried in `Coding.code`. The full cluster expression
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is carried in the
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[ICD-11 Cluster Expression extension](StructureDefinition-icd11-cluster-expression.html)
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on the same `Coding` element:
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```json
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"code": {
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"coding": [
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{
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"system": "http://id.who.int/icd/release/11/mms",
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"code": "NC72.Z",
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"display": "Fracture of femur, unspecified",
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"extension": [
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{
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"url": "https://fhir.dghs.gov.bd/core/StructureDefinition/icd11-cluster-expression",
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"valueString": "NC72.Z&XK8G&XJ7ZH&XJ7YM"
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}
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]
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}
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],
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"text": "Fracture of femur, unspecified — left, transverse, closed"
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}
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```
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The stem code in `Coding.code` SHALL match the leading stem code in the
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cluster expression string.
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#### Stem-Only vs Cluster
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| Scenario | Representation | Validation |
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|---|---|---|
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| Single stem code | `Coding.code` only | OCL `$validate-code` |
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| Postcoordinated expression | `Coding.code` + cluster extension | Cluster Validator |
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The cluster validator explicitly rejects stem-only expressions. Single
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stem codes SHALL be represented in `Coding.code` only and validated via
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OCL `$validate-code`.
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#### Satellite Code Class Restriction Exemption
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Satellite codes in a cluster expression are exempt from the
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Diagnosis/Finding class restriction that applies to stem codes in
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`Condition.code`. Substance, Anatomy, Organism, and other axis codes
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are valid and expected as satellites.
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|
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||||||
#### Bangladesh ICD-11 Cluster Validator
|
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||||||
|
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||||||
All postcoordinated cluster expressions SHALL be validated against the
|
|
||||||
Bangladesh ICD-11 Cluster Validator prior to submission to the HIE:
|
|
||||||
```
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||||||
POST https://icd11.dghs.gov.bd/cluster/validate
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||||||
Content-Type: application/json
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||||||
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{"expression": "NC72.Z&XK8G&XJ7ZH&XJ7YM"}
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```
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Example response:
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```json
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{
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"valid": true,
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"stem": {
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"code": "NC72.Z",
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"display": "Fracture of femur, unspecified",
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"ocl_validated": true
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},
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"satellites": [
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{"code": "XK8G", "axis": "laterality", "valid": true},
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{"code": "XJ7ZH", "axis": "fractureSubtype", "valid": true},
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{"code": "XJ7YM", "axis": "fractureOpenOrClosed", "valid": true}
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],
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"errors": []
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}
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```
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The cluster validator is a mandatory HIE boundary gate. All vendor
|
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||||||
submissions containing postcoordinated ICD-11 expressions pass through it.
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---
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### Conformance Statements
|
|
||||||
|
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||||||
**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}`
|
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||||||
|
|
||||||
**ICD-11-CONF-02:** The `icd11-cluster-expression` extension SHALL only
|
|
||||||
be present when the expression contains at least one postcoordination
|
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||||||
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.
|
|
||||||
@@ -1,2 +1,244 @@
|
|||||||
### A Heading
|
## ICD-11 Implementation
|
||||||
A child specification page with more detail
|
|
||||||
|
### 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.
|
||||||
Reference in New Issue
Block a user