Nepal HMIS FHIR Implementation Guide – 🚨 DRAFT VERSION
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Value Sets

For the elements whose value is from a set of (coded) options, a FHIR ValueSet should exist. SMART Guidelines can use Common ValueSets or define new ones. ValueSets are used in

  • Logical Models
  • Profiles
  • Questionnaires

  • The L3 should use same codes as defined for LM
ValueSetidentifier 1..*url 1..*status 1..1name 1..1title 1..1experimental 1..1description 1..1Data needsfor value sets(seelegend)

Inputs

  • DAK
  • SMART Common ValueSets
  • Terminology services to lookup and validate the codes

Outputs

  • ValueSets
  • Proposal for any common value sets

Activities

This is the overview of the activities and related artifacts used:

  • For each element in the DAK that has a value set - i.e. the answer depends on the options for the data element - for example sex, etc., the author shall have a value set. this can mean
  • Reusing a value set
  • Creating a new value set
    • only for the purpose of the current SMART Guideline
    • as a candidate for common value set
  • Functionally, the valueset in the L3 level must support the L2 expressed values. However, the actual codes are typically a L3 decision, unless the L2 imposes some codes. The L2 doesn't need to impose a code system, but may do so, for example as a result of an existing SMART Guideline.

The ValueSet should include codes from one of the preferred code systems which are:

  • ICD-11
  • LOINC
  • ICD-(others)
  • Open and globally available code systems without licensing restrictions
  • Jurisdictionally endorsed or required codes

  • Note that FHIR has codes that may be required or extensible - in these cases the FHIR values should be preferred - however, concept maps SHALL be in place between these codes and the codes above.

  • The creation of a value set may require the creation of a new code system

  • The creation of a value set may, in some cases, require changes to the profiles: If a FHIR resource has a binding that is too strict and the L2 model requires a broader value set, normally a new element or extension must be created.
    • For example, adding a gender "changed" to the Administrative Gender Value Set - that is not supported and would require mapping the element and its value set to a new extension in FHIR.
    • Given the impact of this, any such deviations should be identified and discussed with the L2 author who can evaluate consistency, value, and the real need.
  • ValueSet creation:
  • Add "Shareable", “publishable” extensions
  • ValueSet reutilization:
    • ValueSets may be reused if the application needs are consistent.
    • While reusing of ValueSets is recommended, authors should be aware that a reuse also introduces a dependency
  • ValueSet validation: The ValueSet should be valid against the SMARTValueSet profile

CodeSystem creation

When defining a ValueSet, there may be a perceived need to create a CodeSystem:

Review procedure

ValueSets shall be reviewed for criteria

Output Criteria / Definition of Done

  • All the elements in the L3 that have coded values shall have a corresponding valueset
  • All the values in the valueset shall be valid codes:
    • Available in an available code set (for example no SNOMED unless SNOMED is supported)
    • Not deprecated

Terminology Services

  • lookup
  • mapping
  • validate

Terminology Value Sets

The following value sets have been defined for this Implementation Guide:

  • Administrative Gender
  • Age Range
  • Condition/Problem/Diagnosis codes
  • Condition / Diagnosis Severity
  • District
  • Educational Level
  • Employment (रोजगारी स्थिति)
  • Ethnic Code
  • Free Cost
  • Free Service Eligibility
  • LocalBody
  • Marital Status (वैवाहिक स्थिति)
  • Dietary Supplements (SNOMED)
  • Child Nutritional Status (SNOMED CT)
  • Patient Registration Type
  • Province
  • Service Area Address Classification
  • Service Type
  • Vaccines (SNOMED CT)
  • Patient Visit Ordinal
  • Option Set - Yes / No / Yes-only / Don't know / Not applicable
  • For the complete list of terminology value sets, please refer to the Artifacts section.