$transform-to-PHMR

https://ehealth.sundhed.dk/fhir/OperationDefinition--s-transform-to-PHMR.html

Bundle of FHIR resources.

The primary source of information is a FHIR Observation.

PHMR v1.3 XML document.

Used in assembly, transformation and upload of FHIR Observation transformed to PHMR to XDS-based document sharing infrastructure as described in Sharing through Registering Documents in National Document Sharing Infrastructure.

$transform-to-QRD

https://ehealth.sundhed.dk/fhir/OperationDefinition--s-transform-to-QRD.html

Bundle of FHIR resources.

The primary source of information is an FHIR QuestionnaireResponse.

QRD v1.3 XML document

Used in assembly, transformation and upload of FHIR QuestionnaireResponse transformed to QRD to XDS-based document sharing infrastructure as described in Sharing through Registering Documents in National Document Sharing Infrastructure.

$transform-to-QFDD

https://ehealth.sundhed.dk/fhir/OperationDefinition--s-transform-to-QFDD.html

Bundle of FHIR resources.

The primary source of information is the FHIR Questionnaire.

QFDD v1.2 XML document

$transform-to-APD

https://ehealth.sundhed.dk/fhir/OperationDefinition--s-transform-to-APD.html

Bundle of FHIR resources.

The primary source of information is a FHIR Appointment.

APD v2.0 XML document

Used in assembly, transformation and upload of FHIR Appointment transformed to APD to XDS-based document sharing infrastructure as described in Sharing through Registering Documents in National Document Sharing Infrastructure.

$transform-from-PHMR

https://ehealth.sundhed.dk/fhir/OperationDefinition--s-transform-from-PHMR.html

PHMR v1.3 XML document.

Bundle of FHIR resources.

The most significant information is within an FHIR Observation.

The resulting Observation(s) is not guaranteed to be a valid FHIR Observation.

$transform-from-QRD

https://ehealth.sundhed.dk/fhir/OperationDefinition--s-transform-from-QRD.html

QRD v1.3 XML document

Bundle of FHIR resources.

The most significant information is within a FHIR QuestionnaireResponse.

The resulting QuestionnaireResponse is not guaranteed to be a valid FHIR QuestionnaireResponse.

$transform-from-QRD-based-on-questionnaire

https://ehealth.sundhed.dk/fhir/OperationDefinition--s-transform-from-QRD-based-on-questionnaire.html

QRD v1.3 XML document

Bundle of FHIR resources

Most significant information is within an FHIR QuestionnaireResponse with a structure matching the Questionnaire given as input. The QuestionnaireResponse will have linkIDs matching the corresponding Questionnaire.

The resulting QuestionnaireResponse is not guaranteed to be a valid FHIR QuestionnaireResponse.

$transform-from-QFDD

https://ehealth.sundhed.dk/fhir/OperationDefinition--s-transform-from-QFDD.html

QFDD v1.2 XML document

The primary resource in the return bundle is the FHIR Questionnaire.

$transform-from-APD

https://ehealth.sundhed.dk/fhir/OperationDefinition--s-transform-from-APD.html

APD v2.0 XML document

Bundle of FHIR resources.

The primary source of information is a FHIR Appointment.

The resulting Appointment is not guaranteed to be a valid FHIR Appointment.

PHMR v1.3

HL7 Implementation Guide for CDA Release 2.0,
Personal Healthcare Monitoring Report (PHMR),
(Danish profile – PHMR DK),

Release 1.3 31. March 2014,
Updated 24. April 2018

http://svn.medcom.dk/svn/releases/Standarder/HL7/PHMR/Dokumentation/PHMR-DK-Profile-v1.3.pdf

(Note: The available v1.3 is now updated as of March 2, 2020)

QRD v1.3

HL7 Implementation Guide for CDA Release 2.0,
Questionnaire Response Document,
(Danish profile – DK QRD),

Release 1.3 February 11th 2022

https://svn.medcom.dk/svn/drafts/Standarder/HL7/PRO/QRD/Dokumentation/DK-QRD-v1.3.pdf

QFDD v.1.2

HL7 Implementation Guide for CDA Release 2.0,
Questionnaire Form Definition Document,
(Danish profile – DK QFDD),

Draft,
Release 1.2 February 11th 2022.

https://svn.medcom.dk/svn/drafts/Standarder/HL7/PRO/QFDD/Dokumentation/DK-QFDD-v1.2.pdf

APD v2.0

HL7 Implementation Guide for CDA Release 2.0,
Appointment Document,
(Danish profile – DK APD),

Draft for Trial Use,
Release 2.0 November 4th 2019

http://svn.medcom.dk/svn/releases/Standarder/HL7/Appointment/Dokumentation/DK-APD-v2.0.pdf

Observation (referenced from ClinicalImpression)

Observation Details

The Observation is the primary driver of the information contained in the generated PHMR document, including observation code, measured value, reference ranges and so on.

DocumentationOf (CDA Header)

Device (referenced from Observation.device)

Medical Equipment Section

Possible details about device(s) used.

Patient (referenced from ClinicalImpression.subject)

Patient Identification

Patient identifier (CPR number), name (given & family), gender, birth date, telecom

EpisodeOfCare (referenced from ClinicalImpression.episodeOfCare)

See Author Organization below

https://ehealth.sundhed.dk/fhir/StructureDefinition-ehealth-clinicalimpression-definitions.html#ClinicalImpression.extension:episodeOfCare

Organization (referenced from EpisodeOfCare.managingOrganization)

Custodian Organization

SOR ID, name, telecom, address

Practitioner (possibly referenced from ClinicalImpression.assessor)

Author, Author Individual

Organization (referenced from ClinicalImpression.assessorOrganization)

Author, Author Organization

Composition (created as part of the assembly)

Document header (CDA Header)

The FHIR Composition resource represents the document and has fixed values as follows:

• Document identifier

  • value = randomUUID

  • system = urn:oid: + OID value from NamingSystem.uniqueId.value (where uniqueId.type is oid) from eHealthIdentifier

  • assigner = the value of NamingSystem.publisher in eHealthIdentifier

• title = “Hjemmemonitorering for “ + <Patient’s CPR identifier value>

• date = ClinicalImpression.effective[x] if present, else now (time of assembly)

Organization possibly referenced from Composition.attester.party

Composition.attester elements:

• party is set to episodeOfCare.CareManagerOrganization

• mode = legal

• time set to now (time of assembly)

Practitioner/Patient/RelatedPerson/Organization referenced from Observation.note.author

Author of observation note

When the Observation.note.author contains a reference, the referenced resource needs to be present in the bundle.

Practitioner/Patient possibly referenced from Observation.performer

Observation performer

If the observation performer is of type Practitioner it must be included in the bundle.

QuestionnaireResponse (referenced from ClinicalImpression)

Question/answer details

The QuestionnaireResponse is the primary driver of the information contained in QRD.

DocumentationOf (CDA Header)

effectiveTime = QuestionnaireResponse.authored (dateTime)

Patient (referenced from ClinicalImpression.subject)

Patient identification

identifier (CPR number), name (given & family), gender, birth date, telecom

EpisodeOfCare (referenced from ClinicalImpression.episodeOfCare)

See Author Organization below

https://ehealth.sundhed.dk/fhir/StructureDefinition-ehealth-clinicalimpression-definitions.html#ClinicalImpression.extension:episodeOfCare

Organization (referenced from EpisodeOfCare.managingOrganization)

Custodian Organization

SOR ID, name, telecom, address

Practitioner (referenced from ClinicalImpression.assessor)

Author Individual

A consequence is that the Practitioner will appear as working in the context of the Author Organization (which is not necessarily the case).

Organization (referenced from ClinicalImpression.assessorOrganization)

Author organization

The origin of this Organization is dependent on sharingApprovalPolicy in the ServiceRequest

• If sharing approval is manual this is the organization from the approver's context.

• If sharing approval is automatic this is the organization from either CarePlan.author or from EpisodeOfCare.caremanagerOrganization in that order.

If the FHIR Organization has no SOR type identifier, it is checked if it contains a SOR-relation in Organization.ehealth-organization-relatedTo.

Composition (created as part of the assembly)

Document header (CDA Header)

FHIR Resource to represent document fixed values

• Document id

  • value=randomUUID

  • system=” urn:oid: + OID value from NamingSystem.uniqueId.value (where uniqueId.type is oid) from eHealthIdentifier

  • assigner: the value of NamingSystem.publisher in eHealthIdentifier

• title = same as Questionnaire.title

• effectiveTime = now (time of assembly)

Questionnaire (referenced from QuestionnaireResponse.questionnaire)

Used in Document header (CDA Header) above

Questionnaire.identifier must contain the unique QFDD document id:

• Identifier.system set to urn:oid: + <Attribute root in QFDD /ClinicalDocument/id>

• Identifier.value set to <Attribute extension in QFDD /ClinicalDocument/id>

Note on prerequisites for document registering:

• The QFDD must be uploaded to the infrastructure before document registration of QRD.

• The Questionnaire.identifier can contain multiple identifiers but only the identifier for QFDD is allowed to have an Identifier.system starting with the prefix urn:oid:

DocumentReference (soft reference from Questionnaire.identifier )

QFDD

DocumentReference.masterIdentifier shall contain the QFDD document ID (matched in the Questionnaire Questionnaire.identifier).

DocumentReference.status shall be current.

DocumentReference.type must be Coding for QFDD type: system = http://loinc.org and value = 74468-0).

DocumentReference.content.attachment.data shall contain the QFDD XML content.

Random UUID and details from the Infrastructure’s NamingSystem

https://ehealth.sundhed.dk/fhir/NamingSystem-ehealth-identifier.html

Document id

/ClinicalDocument/id

• Document identifier

  • value = randomUUID

  • system =urn:oid: + OID value from NamingSystem.uniqueId.value (where uniqueId.type is oid) from eHealthIdentifier

  • assigner = the value of NamingSystem.publisher in eHealthIdentifier

<specific to document type>

Document title

/ClinicalDocument/title

System time at the time of transformation

Time of document creation

/ClinicalDocument/effectiveTime

<specific to document type>

DocumentationOf (CDA Header)

/ClinicalDocument/documentationOf[0, 1, …]

Code(s) and DateTime

Composition.subject referencing a Patient

Patient identification

/ClinicalDocument/recordTarget/patientRole

CPR-number (identification), name (given & family), gender, birth date, telecom

<specific to document type>

Author, Author Individual

/ClinicalDocument/author/assignedAuthor/assignedPerson

Name (given & family), prefix

Composition.authorOrganization

Author, Author Organization

/ClinicalDocument/author/assignedAuthor/id

/ClinicalDocument/author/assignedAuthor/addr

/ClinicalDocument/author/assignedAuthor/telecom

/ClinicalDocument/author/assignedAuthor/representedOrganization/name

If QuestionnaireResponse.source is a patient, the author is the patient and the ID will be CPR number.

If QuestionnaireResponse.source is a practitioner, the author is a practitioner and it will be a SOR organization.

Composition.custodian

Custodian Organization

/ClinicalDocument/custodian/assignedCustodian/representedCustodianOrganization

<specific to document type>

Legal Authenticator

/ClinicalDocument/legalAuthenticator

(Not generally used but depends on the document type)

n/a

Information Recipient

/ClinicalDocument/informationRecipientOptional

Not used

n/a

Authenticator

/ClinicalDocument/authenticator

Not used

n/a

Optional Participant

/ClinicalDocument/participantOptional

Not used

n/a

Optional In Fulfillment Of

/ClinicalDocument/inFulfillmentOfOptional

Not used

specific to QRD transformation

Data Enterer

/ClinicalDocument/dataEnterer

If QuestionnaireResponse.source is a patient and QuestionnaireResponse.author is a practitioner, then the dataEnterer is filled with QuestionnaireResponse.author info.

If QuestionnaireResponse.source is a practitioner and QuestionnaireResponse.author is a different practitioner, then the dataEnterer is filled with QuestionnaireResponse.author info

Patient.identifier

Document title

/ClinicalDocument/title

“Hjemmemonitorering for “ concatenated with Danish CPR, that is, Patient.identifier.value (where the system is urn:oid:1.2.208.176.1.2)

Observation.effective[x]

DocumentationOf (CDA Header)

/ClinicalDocument/documentationOf[0, 1, …]

One DocumentationOf entry for time:

effectiveTime = (Observation.effective[x] or widest span of multiple Observations Observation.effective[x])

Observation.code

One DocumentationOf for each Observation.code

Observation.component.code

One DocumentationOf for each Observation.component.code

composition.author

Author, Author Individual

/ClinicalDocument/author/assignedAuthor/assignedPerson

Name (given & family), prefix

Composition.attester.party referencing an Organization

Legal Authenticator

/ClinicalDocument/legalAuthenticator

n/a

Observation(s) Section - Results

/ClinicalDocument/component/structuredBody/component[2]/section (title=Results)

Grouping of zero, one or more Observations/Observation components

Observation

Per Observation (or Observation and Observation.component)

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/observation/

Observation.identifier

(if an Observation.identifier has a system resolvable to OID type)

• Measurement id

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/ovservation/id

id@extension is set to Observation.identifier.value.

id@root is set to OID value resolved from Observation.identifier.system.

Resolving as OID type system is either (in order):

• Observation.identifier.system prefixed with urn:oid:

• Observation.identifier.system can be matched to FHIR NamingSystem (in terminology service) which has NamingSystem.uniqueId.value where uniqueId.type is oid

A random UUID

(Observation.identifier has no system resolvable to OID type)

id@extension is set to random UUID

id@root is set to "1.2.208.176.7.200.1" (which is OID type in https://ehealth.sundhed.dk/fhir/NamingSystem-ehealth-identifier.html )

Observation.effective[x]

• Measurement time

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/effectiveTime

Start date of observation.

If Observation.effective is a Period, the Period.start value is used if present, otherwise it is set to the Period.end.

If Observation.effective is a DateTime or InstantType the value is used.

Observation.code

• Measurement type

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/observation/code

SNOMED CT system with value set to nullFlavor.

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/observation/code/translation

Observation.valueQuantity

• Measured value, unit

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/observation/value

Value and unit in percent are converted to unitless decimals (fraction).

Observation.performer

• Measurement Method and Measured By (MethodCode)

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/observation/methodCode

The details for deciding the two method codes can be found in the table below.

Observation.quality

Observation.referenceRange

• Reference Range

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/observation/referenceRange

As mentioned above, the PHMR reference ranges are inverted ranges compared to the fhir format, so we need to invert the ranges when transforming to fhir. If a yellow range is present we check if there is also a red range, if so we map the yellow range to an interval between the start of the yellow range and the start of the red range. Otherwise, the ranges are open-ended.

If the reference ranges are exclusive we encode this in fhir by subtracting or adding a small constant. For the same reason, we are not able to handle values with more than 7 decimals. So we check if any referenceRange value has more than 7 decimals and if that is the case we throw an exception and stop the translation.

Observation.note

Observation.note.authorReference (referencing a Practitioner or Organization)

Comment on observation

/ClinicalDocument/component/structuredBody/component/section/entry/organizer/component/observation/entryRelationship/act

An entryRelationship is added to the observation with LOINC code for Annotation comment (code=48767-8, codeSystem=2.16.840.1.113883.6.1).

The author of the note is mapped like Author Organization and/or Author Individual, depending on Observation.note.authorReference.

n/a

Observation(s) Section - Vital Signs

/ClinicalDocument/component/structuredBody/component[x]/section (title=Vital Signs)

Grouping of zero, one or more Observations/Observation components.

Not used. Empty section created as specified in PHMR profile.

n/a

Medical Equipment Section

/ClinicalDocument/component/structuredBody/component[3]/section (title=Medical Equipment)

Grouping of one or more Device details

Device

Per Device in use

/ClinicalDocument/component/structuredBody/component[3]/section/entry/organizer

Device.serialNumber

Device.lotNumber

• Device identifier

/ClinicalDocument/component/structuredBody/component[3]/section/entry/organizer/participant/participantRole/id

If a serial number or lot number is present on the Device, the id is set to the number with assigningAuthority being the number type and the root: “1.2.208.184“

the determined device type code (see below

When no Device.serialNumber or Device.lotNumber is present, the determined device type code is used, with assigningAuthority: "MedCom" and root: "1.2.208.184".

Device.type

Device.manufacturer

Device.deviceName

Device.modelNumber

Device.version.value

• Device type code

/ClinicalDocument/component/structuredBody/component[3]/section/entry/organizer/participant/participantRole/playingDevice/code/translation

If a MedCom Instrument Code matches:
Device.type
Device.manufacturer
Device.deviceName
Device.modelNumber
Device.version.value

can be found, it is used. Otherwise set to the nullflavor NI

Device.manufacturer

Device.deviceName

Device.modelNumber

• Manufacturer and Model Name

/ClinicalDocument/component/structuredBody/component[3]/section/entry/organizer/participant/participantRole/playingDevice/manufacturerModelName

Encoded string comprised of:

• Device manufacturer

• Device model and model number

Device.serialNumber

Device.lotNumber

Device.version

• Software Name

/ClinicalDocument/component/structuredBody/component[3]/section/entry/organizer/participant/participantRole/playingDevice/softwareName

Encoded string, comprised of device.version and device.serialNumber or device.lotNumber depending on which is present.

n/a

External References

Not used

Observation.performer references Patient

Observation.quality contains ehealth-quality with:

• qualityType = UQ (Usage Quality)

• qualityCode = http://ehealth.sundhed.dk/cs/usage-quality | automatically-transferred

POT (performed by citizen)

AUT (electronically)

Observation.performer references Practitioner with at least one Practitioner.qualification which has qualification.identifier.system = https://autregweb.sst.dk .

PNT (performed by a healthcare professional)

AUT (electronically)

Observation.performer references Practitioner with no Practitioner.qualification or (if qualification present) none with qualification.identifier.system = https://autregweb.sst.dk .

PCG (performed by caregiver)

AUT (electronically)

Observation.performer references Patient

Observation.quality contains ehealth-quality with:

• qualityType = UQ (Usage Quality)

• qualityCode = http://ehealth.sundhed.dk/cs/usage-quality | entered-manually

POT (performed by citizen)

TPD (typed in by citizen)

Observation.performer references Practitioner with at least one Practitioner.qualification which has qualification.identifier.system = https://autregweb.sst.dk .

PNT (performed by a healthcare professional)

TPH (typed in by a healthcare professional)

Observation.performer references Practitioner with no Practitioner.qualification or (if qualification present) none with qualification.identifier.system = https://autregweb.sst.dk .

PCG (performed by caregiver)

TPC (typed in by caregiver)

Observation.quality is empty or contains no ehealth-quality with:

• qualityType = UQ (Usage Quality)

• qualityCode = http://ehealth.sundhed.dk/cs/usage-quality | automatically-transferred or http://ehealth.sundhed.dk/cs/usage-quality | entered-manullay

Method codes for performerType and provisionMethod for observation with id {observationId} could not be established

Observation.performer references ehealth-organization or ehealth-relatedperson.

Method codes for performerType and provisionMethod for observation with id {observationId} could not be established

Observation.effective is of type Timing. Valid types are: dateTime, Period and instant.

Invalid Observation.effective, expecting DateTime, Period or Instant

Observation.value is missing or is not of type Quantity.

The Value should be Quantity type and not null

Observation.referenceRange component contains both low and high values.

Observation ranges should not have both High and Low set when transforming to PHRM, but High is: {high}, and Low is: {low}

Observation.referenceRange component value contains more than 7 decimals.

The Value should have no more than 7 decimals but is: {value}

Patient.identifier contains no CPR (Danish citizen identifier).

CPR is mandatory for patients but not present in the fhir bundle

Observation.note.author is not of type Reference(Practitioner | Patient | RelatedPerson | Organization) | string.

Unknown author type: {authorType}

Composition.author is missing or is not of type Patient | Practitioner.

Composition.author should either be a Patient or a Practitioner

Composition.authorOrganization does not contain a SOR identifier.

Composition.authorOrganization must contain SOR identifier

Composition.attester organization does not contain a SOR identifier.

Composition.attester.party must contain SOR identifier

Composition.custodian organization does not contain a SOR identifier.

Custodian organization must contain SOR identifier

Composition.authorOrganization is missing.

Composition.authorOrganization is mandatory for transformation

Composition.custodian is missing.

Custodian is mandatory for transformation

Composition.identifier is missing.

Identifier on composition is mandatory

Composition.confidentiality is missing.

Composition.confidentiality is mandatory

Composition.subject is not of type Patient.

Composition.subject should be a Patient

A Narrative in the Results section and/or Medical Equipment section cannot be generated due to unexpected issues.

Can't generate a narrative for: medical equipment OR

Can't generate a narrative for: results

QuestionnaireResponse.effectivePeriod.start

/ClinicalDocument/documentationOf/serviceEvent/effectiveTime/low

The transformation fails if no effectivePeriod.start has been specified.

QuestionnaireResponse.effectivePeriod.end

/ClinicalDocument/documentationOf/serviceEvent/effectiveTime/high

If effectivePeriod.end is not specified, the transformation results in nullFlavor.

The transformation fails if effectivePeriod.end is specified with the same value as effectivePeriod.start.

QuestionnaireResponse.source

Author

/ClinicalDocument/author

QuestionnaireResponse.author

Data Enterer

/ClinicalDocument/dataEnterer/assignedEntity

(telecom, address and assignedPerson)

Transformed only when QuestionnaireResponse.source is not the same as QuestionnaireResponse.author

/ClinicalDocument/id

Document id

Composition.identifier

Composition.identifier is set to a new identifier with
value = @extension
system = “urn:oid:” + @root

/ClinicalDocument/title

Document title

Composition.title

/ClinicalDocument/effectiveTime

Time of document creation

Composition.date

/ClinicalDocument/documentationOf[0, 1, …]

DocumentationOf (CDA Header)

<specific to document type>

Code(s) and datetime

/ClinicalDocument/recordTarget/patientRole

Patient identification

Composition.subject

A new transient Patient resource is created with address, gender, name, birth date, telecom and identifier data mapped from this element and sub-elements.

Composition.subject is set to a reference to this Patient resource.

/ClinicalDocument/author/assignedAuthor/assignedPerson

Author, Author Individual

<specific to document type>

Name (given & family), prefix

/ClinicalDocument/author/assignedAuthor/id

/ClinicalDocument/author/assignedAuthor/addr

/ClinicalDocument/author/assignedAuthor/telecom

/ClinicalDocument/author/assignedAuthor/representedOrganization/name

Author, Author Organization

Composition.authorOrganization

If present the organizationName is taken from assignedAuthor/representedOrganization
Telecom, address and identifier are taken from the assignedAuthor element

The organization source is set to manual and the synchronizationStatus is set to NotSynchronized

/ClinicalDocument/custodian/assignedCustodian/representedCustodianOrganization

Custodian Organization

Composition.custodian

A new transient Organization resource is created with name, identifier and address data set from elements and sub-elements.

The organization source is set to manual and the synchronizationStatus is set to “NotSynchronized”

/ClinicalDocument/legalAuthenticator

Legal Authenticator

<specific to document type>

(Not generally used but depends on the document type)

/ClinicalDocument/informationRecipientOptional

Information Recipient

n/a

Not used

/ClinicalDocument/authenticator

Authenticator

n/a

Not used

/ClinicalDocument/participantOptional

Optional Participant

n/a

Not used

/ClinicalDocument/inFulfillmentOfOptional

Optional In Fulfillment Of

n/a

Not used

/ClinicalDocument/

No assumptions on pedigree

The input PHMR document could be from any source. It is most likely, however, that it was retrieved from the national document-sharing infrastructure.

Assume the PHMR document adheres to the profile

Preserve as much information as possible

The resulting FHIR resources are not guaranteed to be persistable in the eHealth Infrastructure, cf. the note on varying information represented (see above).

The transformation can result in one or more FHIR resources without element values in cases where the presence of the FHIR resource alone represents the information in the PHMR document.

A FHIR MethodOutcome can be part of the FHIR Bundle returned by the transformation operation. The MethodOutcome will reflect possible data loss.

/ClinicalDocument/component/structuredBody/component[2]/section (title=Results)

Observation(s) Section - Results

n/a

Grouping of zero or more measurements each transformed to an observation as described below

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/observation/

Per Observation (or Observation and Observation.component)

Observation

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/ovservation/id

• Measurement id

Observation.identifier

Observation.identifier.value is set to id@extension

Observation.identifier.system is set to “urn:oid:”+id@root

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/effectiveTime

• Measurement time

Observation.effective[x]

Observation.effective

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/observation/code

• Measurement type

Observation.code

if code is present and not “NI” a code is added to Observation.code with code = @code and display = @displayName

If it is possible to match the value of @codeSystem with the oid of the known code system, system is set to the URL of the known codeSystem. If now the value of codeSystem is set to “urn:oid:” +

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/observation/code/translation

if code is present and not “NI” a code is added to Observation.code with code = @code and display = @displayName

If it is possible to match the value of @codeSystem with the oid of the known code system, system is set to the URL of the known codeSystem. If now the value of codeSystem is set to “urn:oid:” +

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/observation/value

• Measured value, unit

Observation.valueQuantity

If the value of @unit is “NA” and the value of @value is a 2 decimal value, the valueQuantity.unit is set to “%” and the value is multiplied by 100 to convert it to a percent. Otherwise the values are used directly.

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/observation/methodCode

• Measurement Method and Measured By (MethodCode)

Observation.performer

If the performer is specified as a citizen the Observation.performer is set to the Patient present in Composition.subject.

If not, it is not possible discern between health-care professionals as performers and care giver as performer in the FHIR model. So Observation.performer is set to a new transient Practitioner ressource and raise an issue noting the original performer.

If a provision method specifies that the observation was entered by a different actor than the performer, there is no way of representing this and an issue is raised.

Observation.quality

If the provision method is listed as automatic, a coding is added to the observation quality specifying this, if not the coding specifies that it is entered manually.

/ClinicalDocument/component/structuredBody/component[2]/section/entry/organizer/component/observation/referenceRange

• Reference Range

Observation.referenceRange

FHIR ranges are inverted to PHMR representation.

Only Observation.referenceRange.type "GAL" and "RAL" are transformed.

Other Observation.referenceRange.type are ignored as these are not supported in PHMR.

/ClinicalDocument/component/structuredBody/component/section/entry/organizer/component/observation/entryRelationship/act

Comment on observation

None

This information is currently ignored.

/ClinicalDocument/component/structuredBody/component[x]/section (title=Vital Signs)

Observation(s) Section - Vital Signs

Grouping of zero or more measurements, handled like the result section as described above

/ClinicalDocument/component/structuredBody/component[3]/section (title=Medical Equipment)

Medical Equipment Section

n/a

Grouping of one or more Device details

/ClinicalDocument/component/structuredBody/component[3]/section/entry/organizer

Per Device in use

Device

/ClinicalDocument/component/structuredBody/component[3]/section/entry/organizer/participant/participantRole/id

• Device identifier

Device.serialNumber

set to @extension

/ClinicalDocument/component/structuredBody/component[3]/section/entry/organizer/participant/participantRole/playingDevice/code/translation

• Device type code

Device.type

A Coding is added to Device.type with

system = "urn:oid:1.2.208.184.100.3"

code = @code

display = @displayName

/ClinicalDocument/component/structuredBody/component[3]/section/entry/organizer/participant/participantRole/playingDevice/manufacturerModelName

• Manufacturer and Model Name

Device.manufacturer

Device.deviceName

Device.modelNumber

If the element value matches the regular expression "Manufacturer: (.*) / Model: (\\S*) (\\S*)"

the string is split in 3 and set to Device.manufacturer, Device.deviceName,and Device.modelNumber, respectively.

Otherwise Device.manufacturer is set to the entire string.

/ClinicalDocument/component/structuredBody/component[3]/section/entry/organizer/participant/participantRole/playingDevice/softwareName

• Software Name

Device.version

External References

n/a

Not used

A measurement with type Observation Media is present

Measurement was of media type. This was not translated to an observation since it is not supported in FHIR

A measurement range with more than 7 decimals is present

Could not transform measurement with reference range Low: %s and High: %s since we cannot correctly translate more than 7 decimals.

A method code denoting the provision method is missing

Measurement provision method code is missing

A method code denoting that the provision method was “typed in by relative”

Provision method of measurement was marked as typed by relative, it is not possible to reflect this in the FHIR model. The usage quality is marked as manually entered.

A method code denoting that the provision method was “typed in by health care professional” and method code denoting that performer was not “health care professional”

Provision method of measurement was marked as typed by healthcare professional, it is not possible to reflect this in the FHIR model. The usage quality is marked as manually entered.

A method code denoting that the provision method was “typed in by care giver” and method code denoting that performer was not “care giver”

Provision method of measurement was marked as typed by caregiver, it is not possible to reflect this in the FHIR model. The usage quality is marked as manually entered.

A method code denoting that the provision method was “typed in by citizen” and method code denoting that performer was not “citizen”

Provision method of measurement was marked as typed by citizen, it is not possible to reflect this in the FHIR model. The usage quality is marked as manually entered.

A method code denoting that the performer is care giver

It is not possible to discern between care giver and health care professional in the FHIR model. The method code indicated the performer was a care giver.

A method code denoting that the performer is health care professional

It is not possible to discern between care giver and health care professional in the FHIR model. The method code indicated the performer was a health care professional.

A method code denoting the performer is missing

Measurement performer code is missing

The confidentiality code is missing

Confidentiality code is missing

The confidentiality code is not “N”

Confidentiality code is not supported

A measurement with a value interval

Measurement contained an interval value. This was not translated to an observation since it is not supported in FHIR

Documentation Time Interval

/ClinicalDocument/documentationOf/serviceEvent/effectiveTime/low

QuestionnaireResponse.effectivePeriod.start

/ClinicalDocument/documentationOf/serviceEvent/effectiveTime/high

QuestionnaireResponse.effectivePeriod.end

Author

/ClinicalDocument/author

QuestionnaireResponse.source

The referenced resource type depends on the following:

• if author/id is a CPR number and the same as in /ClinicalDocument/recordTarget/patientRole (the Patient), then QuestionnaireResponse.source references a Patient;

• otherwise if author/id is a CPR number but different than in /ClinicalDocument/recordTarget/patientRole (the Patient), then QuestionnaireResponse.source references a Person;

• otherwise if author/id is a SOR Id, then QuestionnaireResponse.source references a Practitioner;

Author

/ClinicalDocument/dataEnterer/assignedEntity

QuestionnaireResponse.author

The referenced resource type depends on the following:

• if dataEnterer/assignedEntity/id is a CPR number and same as in /ClinicalDocument/recordTarget/patientRole (the Patient), then QuestionnaireResponse.author references a Patient;

• otherwise if dataEnterer/assignedEntity/id is a CPR number and different than the one in /ClinicalDocument/recordTarget/patientRole, then QuestionnaireResponse.author references a Person;

• otherwise if dataEnterer/assignedEntity/id is a SOR Id, then QuestionnaireResponse.author references a Practitioner;

Information Only Section

/ClinicalDocument/component/structuredBody/component/section

• A root item on Questionnaire.item with Questionnaire.item.type: "group"

  • A child item with type: Questionnaire.item.type: "display"

Title

…/component/section/title

From root item Questionnaire.item.text else QFDD section title (…/component/section/title)

Narrative

…/component/section/text

QFDD text (…/component/section/text)

Language

languageCode

Questionnaire.language

Questionnaire Response Section

/ClinicalDocument/component/structuredBody/component/section

A root item on Questionnaire.item with Questionnaire.item.type: "group"

Title

…/component/section/title

From root item Questionnaire.item.text else QFDD section title (…/component/section/title)

Narrative

…/component/section/text

QFDD text (…/component/section/text)

The narrative (QFDD text) from the QFDD section is updated with answers before being assigned to the QRD section text.

Language

languageCode

Questionnaire.language

Response Organizer

/ClinicalDocument/component/structuredBody/component/section/entry/organizer

An item of type item.type: "group" inside a root item of type Questionnaire.item.type: "group".

Only items of type item.type: "group" are allowed at the level below the root item.

OBS: Items with calculated expression are allowed but is ignored during transformation.

Id

…/section/entry/organizer/id

QFDD id (…/section/entry/organizer/id).

Validating if item(item.extension.externalIdentifier) inside subgroup matches QFDD organizer id.

Code

…/section/entry/organizer/code

Uses code from Questionnaire item item.code

Code: item.code.code

CodeSystem: ifitem.code.system has prefix “urn:oid:” then item.code.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: item.text or else item.code.display

OriginalText: Question text (item.text) or, if not present, (item.code.display)

Numeric Response Pattern Observation

/ClinicalDocument/component/structuredBody/component/section/entry/organizer/component/observation

An item inside a subgroup

• Root item with Questionnaire.item.type: "group" (QRD section)

  • Sub group item with item.type: "group" (QRD organizer)

    • Question item

Numeric Response if

• item.type is either Integer, Decimal or DateTime

• If item.extension does not contain http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl with value ‘slider’

Id

…/observation/id

Uses Id from QFFD question

Validating if Questionnaire item(item.extension.externalIdentifier) matches QFDD question id

Code

…/observation/code

Uses code from Questionnaire item item.code

Code: item.code.code

CodeSystem: ifitem.code.system has prefix “urn:oid:” then item.code.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: item.text or else item.code.display

OriginalText: Question text (item.text) or, if not present, (item.code.display)

Answer

…/observation/value

Value: QuestionnaireResponse.item.answer

For Questionnaire.item.type = integer, the question answer value is from QuestionnaireResponse.item.answer.valueInteger.

For Questionnaire.item.type = decimal, the question answer value is from QuestionnaireResponse.item.answer.valueDecimal.

For Questionnaire.item.type = datetime, the question answer value is from QuestionnaireResponse.item.answer.valueDateTime (formatted as YYYYMMDDHHmmssZ).

QRD Type:

• Questionnaire.item.type equal Integer then 'INT'

• Questionnaire.item.type equal Decimal then ‘REAL’

• Questionnaire.item.type equal DateTime then 'TS'

Help text

Image

…/observation/entryRelationship

Is added if Questionnaire item has one or more extensions:

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-helpText

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-image

External reference

…/observation/reference

The QFDD unique id. From id element and the property 'extension'

Range

…/observation/referenceRange

If Questionnaire.item has the following extension the referenceRange is assigned

• http://hl7.org/fhir/StructureDefinition/minValue

• http://hl7.org/fhir/StructureDefinition/maxValue

Analog Slider Response Pattern Observation

/ClinicalDocument/component/structuredBody/component/section/entry/organizer/component/observation

An item inside a subgroup

• Root item with type: “Group” (QRD section)

  • Sub group item with type: “Group” (QRD organizer)

    • Question item

Analog Slider Response if

• item.type is either Integer or Decimal

• If item.extension contain http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl with value ‘slider’

• if item.extension contains

  • http://hl7.org/fhir/StructureDefinition/minValue

  • http://hl7.org/fhir/StructureDefinition/maxValue

    • an either

      • http://hl7.org/fhir/StructureDefinition/questionnaire-sliderStepValue (integer)

      • http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-sliderStepValueDecimal (Decimal)

Properties: id, code, value, entryRelationship and reference is the same configuration as for numeric Response

Id

…/observation/id

Uses Id from QFFD question

Validating if Questionnaire item(item.extension.externalIdentifier) matches QFDD question id

Code

…/observation/code

Uses code from Questionnaire item item.code

Code: item.code.code

CodeSystem: ifitem.code.system has prefix “urn:oid:” then item.code.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: item.text or else item.code.display

OriginalText: Question text (item.text) or, if not present, (item.code.display)

Answer

…/observation/value

Value: QuestionnaireResponse.item.answer .

For Questionnaire.item.type = integer, the question answer value is from QuestionnaireResponse.item.answer.valueInteger.

For Questionnaire.item.type = decimal, the question answer value is from QuestionnaireResponse.item.answer.valueDecimal.

Type:

• Questionnaire.item.type equal Integer then 'INT'

• Questionnaire.item.type equal Decimal then ‘REAL’

Help text

Image

…/observation/entryRelationship

Is added if Questionnaire item has one or more extensions:

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-helpText

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-image

External reference

…/observation/reference

The QFDD unique id. From id element and the property 'extension'

Range

…/referenceRange/observationRange/

Denominator: item.extension http://hl7.org/fhir/StructureDefinition/maxValue

Head: item.extension http://hl7.org/fhir/StructureDefinition/minValue

Increment: item.extensioneither value from questionnaire-sliderStepValue or ehealth-questionnaire-sliderStepValueDecimal

Text Response Pattern Observation

/ClinicalDocument/component/structuredBody/component/section/entry/organizer/component/observation

An item inside a subgroup

• Root item with type: “Group” (QRD section)

  • Sub group item with type: “Group” (QRD organizer)

    • Question item

Test Response if

• item.type is either text, string or openchoice

Id

…/observation/id

Uses Id from QFFD question

Validating if Questionnaire item(item.extension.externalIdentifier) matches QFDD question id

Code

…/observation/code

Uses code from Questionnaire item item.code

Code: item.code.code

CodeSystem: ifitem.code.system has prefix “urn:oid:” then item.code.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: item.text or else item.code.display

OriginalText: Question text (item.text) or, if not present, (item.code.display)

Answer

…/observation/value

Value: QuestionnaireResponse.item.answer .

For Questionnaire.item.type = text, string or openchoice , the question answer is a text string in QRD. Question answer text is from QuestionnaireResponse.item.answer.valueString.

Type: ST

Help text

Image

…/observation/entryRelationship

Is added if Questionnaire item has one or more extensions:

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-helpText

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-image

External reference

…/observation/reference

Value from QFDD. From id element and the property 'extension'

Multiple Choice Response Pattern Observation

/ClinicalDocument/component/structuredBody/component/section/entry/organizer/component/observation

An item inside a subgroup

• Root item with type: “Group” (QRD section)

  • Sub group item with type: “Group” (QRD organizer)

    • Question item

Multiple Choice Response if

• item.type is choice

• item.extension has no extension containing http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl with value ‘slider’

Id

…/observation/id

Uses Id from QFFD question

Validating if Questionnaire item(item.extension.externalIdentifier) matches QFDD question id

Code

…/observation/code

Uses code from Questionnaire item item.code

Code: item.code.code

CodeSystem: ifitem.code.system has prefix “urn:oid:” then item.code.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: item.text or else item.code.display

OriginalText: Question text (item.text) or, if not present, (item.code.display)

Answer

…/observation/value

Value: from QuestionnaireResponse.item.answer .

For Questionnaire.item.type = choice , the question answer(s) is one or more coded elements in QRD. Question answer code is from QuestionnaireResponse.item.answer.valueCoding.

Code: answer.code

CodeSystem: if answer.system has prefix “urn:oid:” then item.code.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: answer.display

Help text

Image

Associated text question

…/observation/entryRelationship

Is added if Questionnaire item has one or more extensions:

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-helpText

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-image

And if QFDD has associated text question and preconditions are fulfilled.

Structure for associated text question in FHIR Questionnaire:

• Root item with type: “Group” (QRD section)

  • Sub group item with type: “Group” (QRD organizer)

    • Question item with type: “choice“

    • Associated text question item (The item must be right after the question)

      • Question item with either type: “string“ or “text”.

OBS: Supported precondition for Associated text question:

• Only one precondition element

• The precondition is only based on answers from the related multiple choice (no reference to other questions)

• Supported groupers inside the one preconditon element

  • AllTrue

  • AllFalse

  • AtLeastOneTrue

  • AtLeaseOneFalse

  • OnlyOneTrue

  • OnlyOneFalse

External reference

…/observation/reference

The QFDD unique id. From id element and the property 'extension'

Range

…/observation/referenceRange

If Questionnaire.item has the following extension the referenceRange is assigned

• http://hl7.org/fhir/StructureDefinition/minValue

• http://hl7.org/fhir/StructureDefinition/maxValue

Discrete Slider Response Pattern Observation

/ClinicalDocument/component/structuredBody/component/section/entry/organizer/component/observation

An item inside a subgroup

• Root item with type: “Group” (QRD section)

  • Sub group item with type: “Group” (QRD organizer)

    • Question item

Multiple Choice Response if

• item.type is choice

• item.extension has the following extensions:

  • http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl with value: ‘slider’

  • http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs with value: 1

Id

…/observation/id

Uses Id from QFFD question

Validating if Questionnaire item(item.extension.externalIdentifier) matches QFDD question id

Code

…/observation/code

Uses code from Questionnaire item item.code.

Code: item.code.code

CodeSystem: ifitem.code.system has prefix “urn:oid:” then item.code.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: item.text or else item.code.display

OriginalText: Question text (item.text) or, if not present, (item.code.display)

Value

…/observation/value

Value: from QuestionnaireResponse.item.answer .

For Questionnaire.item.type = choice , the question answer is one coded element in QRD. Question answer code is from QuestionnaireResponse.item.answer.valueCoding.

Code: Coding.code

CodeSystem: if Coding.system has prefix “urn:oid:” then Coding.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: Coding.display

Max occurrence

Min occurrence

Help text

Image

…/observation/entryRelationship

Low: http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs

High: http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs always 1 (1 only allowed value for Discrete Slider type)

Is added if Questionnaire item has one or more extensions:

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-helpText

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-image

QFDD reference

…/observation/reference

The QFDD unique id. From id element and the property 'extension'

Copyright Section

/ClinicalDocument/component/structuredBody/component/section

Copyright section is copied directly from the QFDD

text, string

Text Response Pattern Observation

choice

Multiple Choice Response Pattern Observation

Discrete Slider Response Pattern Observation (when Questionnaire.item.extension.itemControl has value 'slider' and Questionnaire.item.maxOccurs = 1)

decimal, integer

Numeric Response Pattern Observation

Analog Slider Response Pattern Observation (when Questionnaire.item.extension.itemControl has value 'slider' )

datetime

Numeric Response Pattern Observation

Information Only Section

A Questionnaire.item at root level with Questionnaire.item.type ="group"

A single child item Questionnaire.item.item with .type = "display"

Question Section (with one or more Question Organizer)

A Questionnaire.item at root level with Questionnaire.item.type ="group"

For each QFDD Question Organizer:

A single child item Questionnaire.item.item with .type = "group"

For each question in the group/QFDD Question Organizer:

A single child item Questionnaire.item.item.item with .type = subtype of "question" eg. ‘decimal’

Not transformed as algorithms and expressions are not supported in QFDD.

A Questionnaire.item at any level with .type = "decimal" and .readOnly = "true"

A Calculated expression within the questionnaire, see https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/1716060177/Managing+Questionnaires#Defining-a-Calculation-Expression

Information Only Section

A Questionnaire.item at root level with Questionnaire.item.type ="group"

A single child item Questionnaire.item.item with .type = "display"

Question Section (with one or more Question Organizer)

A Questionnaire.item at root level with Questionnaire.item.type ="group"

Root-level group

For each QFDD Question Organizer:

A single child item Questionnaire.item.item with .type = "group"

Subgroup of root-level group

For each question in the group/QFDD Question Organizer:

A single child item Questionnaire.item.item.item with .type = subtype of "question" for instance "decimal"

Question type item in subgroup of root-level group.

For subtypes of "question" see http://hl7.org/fhir/R4/valueset-item-type.html

Copyright Section

A Questionnaire.item at root level with:

• Questionnaire.item.type ="group"

• Questionnaire.item.isCopyright = true (see isCopyright)

One or more child items Questionnaire.item.item with:

• Questionnaire.item.item.type = "display"

• Questionnaire.item.item.isCopyright = true

Not transformed as algorithms and expressions are not supported in QFDD.

A Questionnaire.item at any level with an .extension http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression and .readOnly = "true"

A Calculated expression within the FHIR Questionnaire, see https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/1716060177/Managing+Questionnaires#Defining-a-Calculation-Expression

Information Only Section

/ClinicalDocument/component/structuredBody/component/section

(with (./templateId root = "2.16.840.1.113883.10.20.32.2.1")

A root-level item with:

• Questionnaire.item.type = "group"

• Title

…/component/section/title

• Questionnaire.item.text containing the group title

• Narrative

…/component/section/text

A child item in the group with:

• Questionnaire.item.item.type = "display"

• Questionnaire.item.item.text.xhtml = formatted text

• (Questionnaire.item.item.text contains the unformatted equivalent)

• Language

/ClinicalDocument/languageCode

Questionnaire.language

Questionnaire Response Section

/ClinicalDocument/component/structuredBody/component/section

A root item on Questionnaire.item with Questionnaire.item.type: "group"

Title

…/component/section/title

From root item Questionnaire.item.text

Narrative

…/component/section/text

The narrative text for the section is created automatically by the transformation . The narrative contains all the questions inside the section.

Additional narrative content:

• Help text

• Images

Language

languageCode

Questionnaire.language

Response Organizer

/ClinicalDocument/component/structuredBody/component/section/entry/organizer

An item of type item.type: "group" inside a root item of type Questionnaire.item.type: "group". (See Questionnaire Form Definition Section)

Only items of type item.type: "group" are allowed at the level below the root item.

OBS: Items with calculated expression are allowed but is ignored during transformation.

Id

…/section/entry/organizer/id

item.item.extension.externalIdentifier

Code

…/section/entry/organizer/code

Uses code from Questionnaire item item.code

Code: item.code.code

CodeSystem: ifitem.code.system has prefix “urn:oid:” then item.code.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: item.text or else item.code.display

OriginalText: Question text (item.text) or, if not present, (item.code.display)

Precondition

…/section/entry/organizer/precondition

See Preconditions

Numeric Response Pattern Observation

/ClinicalDocument/component/structuredBody/component/section/entry/organizer/component/observation

An item inside a subgroup (see Questions Organizer )

• Root item with Questionnaire.item.type: "group" (QFDD section)

  • Sub group item with item.type: "group" (QFDD organizer)

    • Question item

Numeric Response if

• item.type is either Integer, Decimal or DateTime

• If item.extension does not contain http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl with value ‘slider’

  • if 'slider' is present see Analog Slider

Id

…/observation/id

item.extension.externalIdentifier

Code

…/observation/code

Uses code from Questionnaire item item.code

Code: item.code.code

CodeSystem: ifitem.code.system has prefix “urn:oid:” then item.code.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: item.text or else item.code.display

OriginalText: Question text (item.text) or, if not present, (item.code.display)

Help text

Image

…/observation/entryRelationship

Is added if Questionnaire item has one or more extensions:

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-helpText

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-image

Feedback

…/observation/entryRelationship

Not supported

Range

…/observation/referenceRange

If Questionnaire.item has the following extension the referenceRange is assigned

• http://hl7.org/fhir/StructureDefinition/minValue

• http://hl7.org/fhir/StructureDefinition/maxValue

Precondition

See Preconditions

Analog Slider Question Pattern Observation

/ClinicalDocument/component/structuredBody/component/section/entry/organizer/component/observation

An item inside a subgroup

• Root item with type: “Group” (QFDD section)

  • Sub group item with type: “Group” (QFDD organizer)

    • Question item

Analog Slider if

• item.type is either Integer or Decimal

• If item.extension contain http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl with value ‘slider’

• if item.extension contains

  • http://hl7.org/fhir/StructureDefinition/minValue

  • http://hl7.org/fhir/StructureDefinition/maxValue

    • an either

      • http://hl7.org/fhir/StructureDefinition/questionnaire-sliderStepValue (integer)

      • http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-sliderStepValueDecimal (Decimal)

Properties: id, code, help text, image and precondition is the same configuration as for Numeric Question

Feedback

…/observation/entryRelationship

Not supported

Range

…/referenceRange/observationRange/

Denominator: item.extension http://hl7.org/fhir/StructureDefinition/maxValue

Head: item.extension http://hl7.org/fhir/StructureDefinition/minValue

Increment: item.extensioneither value from:

• type: ‘integer’

  • questionnaire-sliderStepValue

• type: 'decimal'

  • ehealth-questionnaire-sliderStepValueDecimal

Text Question Pattern Observation

/ClinicalDocument/component/structuredBody/component/section/entry/organizer/component/observation

An item inside a subgroup

• Root item with type: “Group” (QFDD section)

  • Sub group item with type: “Group” (QFDD organizer)

    • Question item

Test Response if

• item.type is either text, string

Id

…/observation/id

item.extension.externalIdentifier

Code

…/observation/code

Uses code from Questionnaire item item.code

Code: item.code.code

CodeSystem: ifitem.code.system has prefix “urn:oid:” then item.code.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: item.text or else item.code.display

OriginalText: Question text (item.text) or, if not present, (item.code.display)

Help text

Image

…/observation/entryRelationship

Is added if Questionnaire item has one or more extensions:

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-helpText

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-image

Precondition

See Preconditions

Multiple Choice Question Pattern Observation

/ClinicalDocument/component/structuredBody/component/section/entry/organizer/component/observation

An item inside a subgroup

• Root item with type: “Group” (QFDD section)

  • Sub group item with type: “Group” (QFDD organizer)

    • Question item

Multiple Choice if

• item.type is choice

• item.extension has no extension containing http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl with value ‘slider’

  • if 'slider' present see Discrete Slider

Id

…/observation/id

item.extension.externalIdentifier

Code

…/observation/code

Uses code from Questionnaire item item.code

Code: item.code.code

CodeSystem: ifitem.code.system has prefix “urn:oid:” then item.code.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: item.text or else item.code.display

OriginalText: Question text (item.text) or, if not present, (item.code.display)

Options

item.answerOptions

Help text

Image

…/observation/entryRelationship

Is added if Questionnaire item has one or more extensions:

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-helpText

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-image

Associated text question

Not supported

Feedback

Not supported

Range

…/observation/referenceRange

Range is based on item and the fields item.required , item.repeats and the following extensions.

• http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs

• http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs

See more regarding min and max: https://docs.ehealth.sundhed.dk/latest-released/ig/StructureDefinition-ehealth-questionnaire.html#setting-minimal-and-maximal-number-of-permitted-choices

Precondition

See Preconditions

Discrete Slider Question Pattern Observation

/ClinicalDocument/component/structuredBody/component/section/entry/organizer/component/observation

An item inside a subgroup

• Root item with type: “Group” (QFDD section)

  • Sub group item with type: “Group” (QFDD organizer)

    • Question item

Multiple Choice if

• item.type is choice

• item.extension has the following extensions:

  • http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl with value: ‘slider’

  • http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs with value: 1

Properties: id, code, help text, image and precondition is the same configuration as for Multiple Choice

Id

…/observation/id

Uses Id from QFFD question

Validating if Questionnaire item(item.extension.externalIdentifier) matches QFDD question id

Code

…/observation/code

Uses code from Questionnaire item item.code.

Code: item.code.code

CodeSystem: ifitem.code.system has prefix “urn:oid:” then item.code.system without prefix. Else lookup in Questionnaire Terminology.

CodeSystemName: is fetched from CodeSystem in Questionnaire Terminology. Value is taken in the following order: codeSystem.title, codeSystem.name, codeSystem.url or “Unknown“.

Display: item.text or else item.code.display

OriginalText: Question text (item.text) or, if not present, (item.code.display)

Range

…/observation/entryRelationship

Range is based on item and the fields item.required , item.repeats and the following extensions.

Low: http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs

High: http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs always 1 (1 only allowed value for Discrete Slider type)

See more regarding min and max: https://docs.ehealth.sundhed.dk/latest-released/ig/StructureDefinition-ehealth-questionnaire.html#setting-minimal-and-maximal-number-of-permitted-choices

Copyright Section

/ClinicalDocument/component/structuredBody/component/section

Copyright section uses Questionnaire.copyright

Copyright Section

/ClinicalDocument/component/structuredBody/component/section

(with (./templateId root = "2.16.840.1.113883.10.20.32.2.2")

A root-level item with:

• Questionnaire.item.type = "group"

• Questionnaire.item.isCopyright = true

Title

…/component/section/title

• Questionnaire.item.text containing the group title

Narrative

…/component/section/text

The narrative is automatically generated by the transformation and contains the plain text from each copyright text(entry) separated by three <br/>.

Note: When transforming from QFDD to FHIR Questionnaire the narrative is not transformed.

Entry

../entry/observation/value

One or more child items in the group with:

• Questionnaire.item.item.type = "display"

• Questionnaire.item.item.text.xhtml = formatted text

• (Questionnaire.item.item.text contains the unformatted equivalent)

• Questionnaire.item.item.isCopyright = true

Note: When transforming from QFDD the display items will contain the plain text.

• Language

/ClinicalDocument/languageCode

Questionnaire.language

text, string

Text Question Pattern Observation.

choice

Multiple Choice Question Pattern Observation.

Discrete Slider Question Pattern Observation when Questionnaire.item.extension.itemControl has value 'slider'.

decimal, integer

Numeric Question Pattern Observation.

Analog Slider Question Pattern Observation when Questionnaire.item.extension.itemControl has value 'slider'.

datetime

Numeric Question Pattern Observation

Numeric (FHIR type: integer, decimal, timestamp)

If specifying both  ">=" and "<=" to the same question then

• if ">=" value is larger than "<=" value (eg. <=7 or >=10) then

  • Only "any"(AtLeastOneTrue) is allowed

  • Only those two conditions are allowed to the same numeric question.

  • Will be two preconditions in QFDD with min and max as QFDD requires both min and max per precondition. (Precondition Extension Pattern - AtLeastOneTrue)

    • For ">=" a max value will be added

      • For integer: Integer max value.

      • For decimal: Double max value.

      • For timestamp: January 1. 2200.

    • For "<=" a min value

      • For integer: Integer min value.

      • For decimal: Double min value.

      • For timestamp: January 1. 1970.

• if ">=" value is less than "<=" value (absolute range, eg. >=5 <=10) then

  • Only "all" (AND) is allowed.

  • Only those two conditions are allowed to the same question.

  • Will be one preconditions in QFDD with min and max.

If specifying only one operator either ">=" or "<=" to the same numeric question then

• Then "all"(AND) and "any"(OR) is allowed

• Max one condition to the same numeric question allowed.

• As QFDD requires both min and max

  • For ">=" a max value will be added

    • For integer: Integer max value.

    • For decimal: Double max value.

    • For timestamp: January 1. 2200.

  • For "<=" a min value will be added

    • For integer: Integer min value.

    • For decimal: Double min value.

    • For timestamp: January 1. 1970. (epoch time)

if specifying "=" to a numeric question then

• Then "all"(AND) and "any"(OR) is allowed.

• Max one condition to the same numeric question allowed.

• As QFDD requires both min and max.

  • min and max will be assigned the same value.

Choice (FHIR type: choice)

When specifying "=" to a choice question then

• If only conditions to choice questions then both AllTrue(all) and AtLeastOneTrue(any) is allowed.

• If the conditions are combined with conditions to numeric questions then the numeric rules determines if both AllTrue(all) and AtLeastOneTrue(any) is allowed.

text, string

Precondition to text or string questions are not supported.

exists

Not supported

=

Supported.

If numeric:

• min/max same value in QFDD

If multiple choice

• The option

!=

Not supported

>

Not supported

<

Not supported

>=

if numeric:

• Supported

  • Used a minimum value in QFDD

If multiple choice

• Not supported

<=

if numeric:

• Supported

  • Used as maximum value in QFDD

If multiple choice

• Not supported

Information Only Section

A Questionnaire.item at root level with Questionnaire.item.type ="group"

A single child item Questionnaire.item.item with .type = "display"

Question Section (with one or more Question Organizer)

A Questionnaire.item at root level with Questionnaire.item.type ="group"

For each QFDD Question Organizer:

A single child item Questionnaire.item.item with .type = "group"

For each question in the group/QFDD Question Organizer:

A single child item Questionnaire.item.item.item with .type = subtype of "question" eg. ‘decimal’

Copyright Section

A Questionnaire.item at root level with:

• Questionnaire.item.type ="group"

• Questionnaire.item.isCopyright = true (See isCopyright)

One or more child items Questionnaire.item.item with:

• Questionnaire.item.item.type = "display"

• Questionnaire.item.item.isCopyright = true

Not transformed as algorithms and expressions are not supported in QFDD.

A Questionnaire.item at any level with an .extension http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression and .readOnly = "true"

A Calculated expression within the questionnaire, see https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/1716060177/Managing+Questionnaires#Defining-a-Calculation-Expression

footnote

p, with a data attribute: data-cda-tag = "footnote"

footnoteRef

a, with a data attribute data-cda-tag="footnoteRef"

renderMultiMedia

Limitation: The base64 image to be inside @referencedObject attribute, and not a reference to an existing image from other section from QFDD document. We don't search the image.