Nepal HMIS FHIR Implementation Guide – 🚨 DRAFT VERSION
0.0.1-ballot - ci-build

Nepal HMIS FHIR Implementation Guide – 🚨 DRAFT VERSION - Local Development build (v0.0.1-ballot) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Governance

L3 authors have the responsibility to ensure that the data models use standard concepts. There are several reference information models and definitions, each with their purpose, their localization possibilities. Picking a standard model is therefore not guarantee of full-proof semantic interoperability.

For an L3 author, the requirement is to ensure that every data element mentioned in the logical model is mapped to a WHO Commons concept in the WHO Common dictionary.

This introduces the WHO SMART Commons dictionary as the pivotal semantic reference. In turn, the WHO SMART Commons dictionary relates to any other semantic reference

- The WHO SMART Commons dictionary is a central, managed repository of concepts, their definitions and mappings.
- Concepts are referenced by their identifier. Concepts can relate to different identifiers
  - For example the concept in Immunization `IMMZ.C#DE2` (Client name) SHALL map to
    - (a concept in the WHO Commons dictionary)
    - `371484003` in SNOMED CT
    - `PatientAttributes.Name`in IPS

Where possible, reference models should be used; different implementations may need to follow different models - this approach supports further semantic interoperability. See section "Semantic Compatibility Assessment" for more details.

### Concepts and dictionary governance

The introduction of concept management (by means of common data dictionaries) enables a more complete approach to semantic interoperability.

Each concept in the Commons dictionary has therefore its definition and mappings:

The mapping is maintained centrally.

- New concepts can be created:
- Authors should consult the core dictionary to see if a concept is defined. If a concept exists and is approved, it can be used in the topic dictionary without further approval.
- Approval is done by a dedicated entity, onboarding concepts into the common dictionary, verifying overlaps, duplicates…
- Concepts can be defined from scratch but normally are onboarded from existing reference dictionaries, e.g. ICD-11 or IPS
  - The onboarding process is the same - at the end, all concepts have one key identifier and are thus part of the common dictionary

### Impact for authors

- To ensure the SMART Guideline is semantically interoperable, it should not be released if its data models use concepts that are not approved - this will be reported as a QA issue.
- It is still possible for authors to proceed with draft concepts, to enable them to continue their work.
- Adaptation requires mappings - See section "Semantic Compatibility Assessment" for more details.

### Impact for implementers

- Using the standard mappings, implementers can define standard mapping / conversion data pipelines