The aim of PCEtoFHIR is to develop and implement an approach that enables the storage of a SNOMED CT post-coordinated expression (PCE) within FHIR resources by using only pre-coordinated codes. For this alternative representation, the PCE shall be decomposed into pre-coordinated concepts, which can then be stored in suitable elements of matching FHIR resources. An overview of the envisioned approach is shown in Figure 2. A PCE, which is first checked for syntactic and semantic correctness, serves as input. This can be classified within SNOMED CT by using OWL and a reasoner, whereby the direct supertype ancestors can be determined. Of these concepts, the most similar concept to the PCE is determined (superconcept). The delta can then be calculated between the superconcept and the PCE, which includes all the information of the PCE that the superconcept does not represent. In the final step, appropriate elements of matching FHIR resources must be identified to store the information of the superconcept and the delta. In our work, two sets of FHIR profiles were considered as target representations for the mapping:
- profiles of the German National Association of Statutory Health Insurance Physicians (NASHIP, version 1.4.0, based on FHIR R4) [1]
- profiles of the core data set of the German Medical Informatics Initiative (MII, version 1.0, based on FHIR R4) [2].
Therefore, FHIR StructureMaps defining these associations on a general level need to be created beforehand.
The FHIR StructureMaps and the mapping of the individual elements in tabular form are provided in this repository.
Ohlsen T, Drenkhahn C, Ingenerf J. Decomposition of post-coordinated SNOMED CT expressions for storage as HL7 FHIR resources (PCEtoFHIR) (Preprint). JMIR Medical Informatics. Published online February 28, 2024. doi:10.2196/preprints.57853
Value rage: << 609328004 |Allergic disposition (finding)|
| SNOMED CT element |
FHIRPath NASHIP |
FHIRPath MII |
|---|---|---|
| Super concept |
--- | Condition.code |
| Causative agent |
AllergyIntolerance.code | --- |
| Finding site |
Extension von HL7 International: |
Observation.bodySite |
| Condition.bodySite |
||
| Associated morphology |
AllergyIntolerance.reaction.manifestation.coding:snomed |
Observation.code |
| Condition.evidence.code |
||
| Pathological process |
AllergyIntolerance.reaction.manifestation.coding:snomed |
Condition.evidence.code |
| Has realization |
AllergyIntolerance.reaction.manifestation.coding:snomed |
Condition.evidence.code |
| Occurrence |
AllergyIntolerance.onsetAge.extension:lebensphase-von | Condition.onset[x]:onsetPeriod.start.extension:lebensphase-von |
| Clinical course |
--- | Extension von HL7 International: Condition.condition-diseaseCourse |
| Due to |
--- | Extension von HL7 International: Condition.condition-dueTo |
MII:
- Condition.evidence.detail referenced Observation
NASHIP:
- KBV_PR_Base_AllergyIntolerance
MII:
- Profile - Observation - Laboruntersuchung
- Profile - Condition - Diagnose
Value rage: <<781474001 |Allergic disorder (disorder)|
| SNOMED CT element |
FHIRPath NASHIP |
FHIRPath MII |
|---|---|---|
| Super concept |
Condition.code | Condition.code |
| Causative agent |
AllergyIntolerance.code | --- |
| Finding site |
Condition.bodySite |
Observation.bodySite |
| Condition.bodySite |
||
| Associated morphology |
AllergyIntolerance.reaction.manifestation.coding:snomed |
Observation.code |
| Condition.evidence.code | Condition.evidence.code |
|
| Pathological process |
AllergyIntolerance.reaction.manifestation.coding:snomed |
Condition.evidence.code |
| Condition.evidence.code |
||
| Has realization |
AllergyIntolerance.reaction.manifestation.coding:snomed |
Condition.evidence.code |
| Condition.evidence.code |
||
| Occurrence |
Condition.onset[x]:onsetAge.extension:lebensphase-von | Condition.onset[x]:onsetPeriod.start.extension:lebensphase-von |
| AllergyIntolerance.onsetAge.extension:lebensphase-von |
||
| Clinical course |
Extension von HL7 International: Condition.condition-diseaseCourse |
Extension von HL7 International: Condition.condition-diseaseCourse |
| Due to |
Extension von HL7 International: Condition.condition-dueTo |
Extension von HL7 International: Condition.condition-dueTo |
NASHIP:
- Condition.evidence.detail referenced Observation
MII:
- Condition.evidence.detail referenced Observation
NASHIP:
- KBV_PR_Base_AllergyIntolerance
- KBV_PR_Base_Condition_Diagnosis
MII:
- Profile - Observation - Laboruntersuchung
- Profile - Condition - Diagnose
Value rage: <<419076005 |Allergic reaction (disorder)|
| SNOMED CT element |
FHIRPath NASHIP |
FHIRPath MII |
|---|---|---|
| Super concept |
Condition.code | Condition.code |
| Causative agent |
AllergyIntolerance.code | --- |
| Finding site |
Condition.bodySite |
Observation.bodySite |
| Condition.bodySite |
||
| Associated morphology |
AllergyIntolerance.reaction.manifestation.coding:snomed |
Observation.code |
| Condition.evidence.code | Condition.evidence.code |
|
| Pathological process |
AllergyIntolerance.reaction.manifestation.coding:snomed |
Condition.evidence.code |
| Condition.evidence.code |
||
| Has realization |
AllergyIntolerance.reaction.manifestation.coding:snomed |
Condition.evidence.code |
| Condition.evidence.code |
||
| Occurrence |
Condition.onset[x]:onsetAge.extension:lebensphase-von | Condition.onset[x]:onsetPeriod.start.extension:lebensphase-von |
| AllergyIntolerance.onsetAge.extension:lebensphase-von |
||
| Clinical course |
Extension von HL7 International: Condition.condition-diseaseCourse |
Extension von HL7 International: Condition.condition-diseaseCourse |
| Due to |
Extension von HL7 International: Condition.condition-dueTo |
Extension von HL7 International: Condition.condition-dueTo |
NASHIP:
- Condition.evidence.detail referenced Observation
MII:
- Condition.evidence.detail referenced Observation
NASHIP:
- KBV_PR_Base_AllergyIntolerance
- KBV_PR_Base_Condition_Diagnosis
MII:
- Profile - Observation - Laboruntersuchung
- Profile - Condition - Diagnose
Value range: <<404684003 | Clinical finding (finding)| MINUS (<<781474001 |Allergic disorder (disorder)| OR << 609328004 |Allergic disposition (finding)| OR <<419076005 |Allergic reaction (disorder)| )
| SNOMED CT element |
FHIRPath NASHIP |
FHIRPath MII |
|---|---|---|
| Super concept |
Condition.code | Condition.code |
| Finding site |
Condition.bodySite |
Observation.bodySite |
| Condition.bodySite |
||
| Associated morphology |
Condition.evidence.code |
Condition.evidence.code |
| Pathological process |
Condition.evidence.code |
Condition.evidence.code |
| Clinical course |
Extension von HL7 International: Condition.condition-diseaseCourse |
Extension von HL7 International: Condition.condition-diseaseCourse |
| Due to |
Extension von HL7 International: Condition.condition-dueTo |
Extension von HL7 International: Condition.condition-dueTo |
NASHIP:
- Condition.evidence.detail referenced Observation
MII:
- Condition.evidence.detail referenced Observation
NASHIP:
- KBV_PR_Base_Condition_Diagnosis
MII:
- Profile - Observation - Laboruntersuchung
- Profile - Condtion - Diagnosis
Value range: <<71388002 |Procedure (procedure)|
| SNOMED CT element |
FHIRPath NASHIP |
FHIRPath MII |
|---|---|---|
| Super concept |
Procedure.code | Procedure.code |
| Method |
Extension von HL7 International: Procedure.procedure-method |
Extension von HL7 International: Procedure.procedure-method |
| Procedure site - Direct |
Procedure.bodySite | Procedure.bodySite |
| Procedure site - Indirect |
Procedure.bodySite | Procedure.bodySite |
| Dirct substance |
Procedure.usedCode | Procedure.usedCode |
| Dirct morphology |
Procedure.bodySite | Procedure.bodySite |
| Using substance |
Procedure.usedCode | Procedure.usedCode |
| Using device |
Procedure.usedCode | Procedure.usedCode |
| Using access device |
Procedure.usedCode | Procedure.usedCode |
| Has intent |
Procedure.category | Procedure.category |
| Access |
Procedure.usedCode | Procedure.usedCode |
| Surgical approach |
Procedure.usedCode | Procedure.usedCode |
| Has Focus |
Procedure.reasonCode | Procedure.reasonCode |
NASHIP:
- Procedure.partOf referenced Pocedure (if more than one RoleGroup is used)
MII:
- Procedure.partOf referenced Pocedure (if more than one RoleGroup is used)
NASHIP:
- KBV_PR_Base_Procedure
MII:
- SD MII Prozedur Procedure
[1] Kassenärztliche Bundesvereinigung. KBV-Basis-Profile. Accessed November 29, 2023. https://simplifier.net/organization/kassenrztlichebundesvereinigungkbv
[2] Medizininformatik Initiative. Der Kerndatensatz der Medizininformatik-Initiative. Accessed November 29, 2023. https://www.medizininformatik-initiative.de/de/der-kerndatensatz-der-medizininformatik-initiative