Working drafts of HL7™ FHIR® artefacts authored and maintained by the Informatics Architecture team at the Australian Digital Health Agency that represent atomic Medicare records in the My Health Record system and related applications.
License: Other
The invariants
inv-dh-cons-01: If donation decision is 'permit', there SHALL be a specific organ (except.data.reference).
and
inv-dh-cons-02: If donation decision is 'deny', there SHALL NOT be a specific organ (except.data.reference).
fail for valid examples. In the FHIRPath expressions the antecedents are always true, so e.g. an instance with donation-decision of 'permit' and with a specific organ (except.data.reference) will fail with an error against inv-dh-cons-02.
Correct the FHIRPath expression:
donationDecision.valueCodeableConcept.coding.code='160654005' implies except.exists()
with
extension.where(url='http://ns.electronichealth.net.au/ci/fhir/StructureDefinition/extension-donationdecision').value.coding.where(system='http://snomed.info/sct' and code='160654005').exists()
donationDecision.valueCodeableConcept.coding.code='161034004' implies except.empty()
with
extension.where(url='http://ns.electronichealth.net.au/ci/fhir/StructureDefinition/extension-donationdecision').value.coding.where(system='http://snomed.info/sct' and code='161034004').exists()
Do not validate against the profile.
The package name set in ig.json is in the HL7 AU name space: "npm-name": "hl7.fhir.au.dh.medicare-records".
This is only correct if this is an HL7 AU managed profile, which this is not.
The package name should be in a name space managed by the Agency.
Use a new and appropriate package name
View https://github.com/AuDigitalHealth/ci-medicare-records/blob/master/ig.json
N/A
None
Dependency Checks:
| Dependency Checks | Package | Version | FHIR Release | Canonical | Web Base | Comment |
|---|---|---|---|---|---|---|
| _ | hl7.fhir.au.dh.medicare-records | 2.0.1 | 3.0.2 | http://ns.electronichealth.net.au/ci/fhir | ||
| _ | hl7.fhir.au.base | 0.9.3 | 3.0.1 | http://hl7.org.au/fhir | http://hl7.org.au/fhir/2018Sep |
Medicare profile differential contains two types of undesired element extensions that have been injected by the case tool used to author StructureDefinitions.
Type 1 - binding name extension
extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="BenefitSubCategory"/>
</extension>
Type 2 - explicit type name extension
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
<valueString value="Item"/>
</extension>
As a result of fixing this the differential should only include intended constraints on the base definition.
Do nothing. There is no behaviour change to operations performed with the StructureDefinition.
Make 0..1 Australian Immunisation Register Immunisation - vaccinationProtocol.immunisation-dose-schedule-1
Allows one to supply immunisation information when there is no available dose schedule information
Required for Services Australia to supply vaccination information to My Heath Record.
The content in this space is managed under different conventions. All profiles should be managed the same - only one profile for Flag has a version number in the URL which was introduced in the latest set. This should be reverted so that the content managed under this IG is all managed in the same way.
Originally posted by @dtr-agency in #9 (comment)
Enhanced Use of Immunisation Records (EUIR) Project has provided advice that scope of FHIR payload has changed to remove:
Clarity on actual implementation scope.
Do nothing - no profile enforces the use of these unusued StructureDefinitions.
In 2.0.0 additional constraints on identifier population have been added to the AIR profiles only.
Please provide the evidence that the design approach change to the provision and handling logical identifiers for a patient to the Medicare FHIR payload provided by Services Australia to the MHR system has been understood and agreement by parties.
Out of interest was this a requested by NIO or Services Australia? very handy to know if either of those parties were the originator of this request.
Evidence may be satisfied by attachment of emails, or links to other pages etc.
Please identify in the comment the benefit proposition to enforcing these specific constraints.
Please identify in the comment what the expected impact or action is to the rest of the Medicare data provided by Services Australia - has a migration plan been agreed for the others, is this set of changes only to be limited to the AIR portion? Is this now a commitment by the MHR system when or if they surface this data to provide content in this exact way.... are they actually storing the FHIR and thus able to meet this requirement? I thought they threw it away?
Evidence of design agreement or reversion of introduced change.
The Australian Immunisation Register Immunisation (StructureDefinition-immunization-air) profile has been updated in v2.1.0 of the implementation guide, including removing some of the unused version 1 and adding new functionality; subsequently the profile major version number increased. The profile URL has not changed between the versions.
It is recommended (though not required) to include major version number in the canonical URL for a profile so that it can be referenced by its major version. Managing version dependencies can also be done by other methods (e.g. managing a set of resources with specific versioned references via an Implementation Guide).
How would NIO & Services Australia like to manage breaking changes in the future?
Allow a reference to a particular business version of the structure definition.
N/A
N/A
This implementation guide has different formatting and content presentation and standards to other CI Agency FHIR implementation guides. Apply the latest standards for presentation of the informative content in a Agency CI FHIR implementation guide.
Aligned presentation of the informative content in this and all other Agency CI FHIR implementation guides would improve readability between different implementation guides and decrease potential confusion caused by different presentation and convention.
N/A
N/A
The invariants
inv-dh-eob-01: A PBS or RPBS claim SHALL include a prescription. (: (item.category.coding.code='pbs' or item.category.coding.code='rpbs') implies prescription.exists())
inv-dh-eob-02: A MBS or DVABS claim SHALL NOT include a prescription. (: (item.category.coding.code='mbs' or item.category.coding.code='dva') implies prescription.exists().not())
inv-dh-eob-04: A PBS claim (subType='pbs') SHALL be of type 'Pharmacy' (type='pharmacy'). (: subType.coding.code='pbs' implies type.coding.code='pharmacy')
fail for valid examples. In the FHIRPath expressions the antecedents are always true, so e.g.
Correct the FHIRPath for all invariants.
Do not validate against the profile.
v1.0.0 used the 2018 September of AU Base - it is not normatively equivalent to have all the FHIR profiles enforce the type to v1.1.1 of AU Base. The normative changes are numerous and material.
In this current draft all StructureDefinitions that type a reference to an AU Base profile are NOT backwards compatible.
This is a significant product configuration change. There would need to be agreement to move from the fixed AU Base version to the new one and institute changes across the board has been made and is documented.
Nothing can match the slice category:organDonationConsent, as its use of FixedCodeableConcept does not set discriminator values in a way suitable for slicing.
Define a slice that the validator can match against the discriminator
Do not validate against the profile.
Definition of the profile - title, id, name, url
This is not for the generic concept of a 'declared disclaimer' - it is intended to be constrained for a particular payload of Medicare repository to MHR system. As per the other profiles for this IG the scoping for that particular implementation payload should be reflected in the definition of this profile.
Basic.text
This profile requires text.status=additional. No other value is acceptable given the profile design. This rule should be added to the profile.
Supports targeted and appropriate content, prevents misuse and misleading or poor quality exchange.
If applicable, add screenshots or mockups to help explain the issue / feature.
Helpful
n/A
TBD
Probably caused by tooling limitations at the time, but the extension includes a slice for value[x] that is not required; instead the extension can simply constrain the type.
For example, in an instance of ExtensionDonationDecision:
"id": "Extension.value[x]",
"path": "Extension.value[x]",
"slicing": {
"discriminator": [{
"type": "type",
"path": "$this"
}],
"ordered": false,
"rules": "closed"
},
"short": "Value of extension",
"definition": "Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).",
"min": 1,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [{"code": "dateTime"}],
Suggest removing the slicing and adding a constraint on the value.type instead. This change should not have any normative impacts but it is an improvement in terms of processing requirements and implementing correct profiling practices.
Advice provided from NIO that Service Requestor from Services Australia for MBS has never been received in the past, and is not part of the live feed design.
Impact to design
ADHA Medicare ExplanationOfBenefit ExplanationOfBenefit.referral is not to be supported and the ADHA MBS DVA ReferralRequest profile governing that element is not required.
Actions
StructureDefinition.description should be updated to include the text 'used to represent' instead of 'represents'.
The same fix to be applied to intro.md.
To reduce confusion on publication jurisdiction the title & name should be updated to include ADHA in line with the Agency R4 artefact naming policy.
In Explanation of Benefit Medicare the elements referral and prescription are required to refer to contained resources.
This assertion was made due to a misunderstanding of contained resources and prevents using this resource as intended.
The most serious problem is that it is impossible to validly include a prescription in Explanation of Benefit Medicare. This is because the element prescription is a contained reference to Medication Request Pharmaceutical Benefits Scheme; it has a required element, medicationReference, which is also a contained reference, and contained resources cannot be nested.
Redesign with business owners a solution with less or no containment.
Relax requirements for containment.
Do not validate against the profile.
Use of AIR acronym is inconsistent - not in the Immunization profile but used in the Flag profile. Current preference is to remove from Flag profile, and various IG pages - but in either case consistency should be improved.
This is trivial and doesn't impede implementation or have normative impact.
Consent Australian Organ Donor Register profile sets the value on Consent.category:organDonationConsent and Consent.except.action using fixedCodeableConcept. Fixing the value in this way prohibits parts of CodeableConcept that are intended to be optional including CodeableConcept.text and CodeableConcept.coding.display.
This is visible in the snapshot display in the IG. The lines in the structure definitions can be found by finding "fixedCodeableConcept"
Probably caused by tooling limitations at the time, but the extension includes a slice for value[x] that is not required; instead the extension can simply constrain the type.
For example, in an instance of ExtensionDonationDecision:
"id": "Extension.value[x]",
"path": "Extension.value[x]",
"slicing": {
"discriminator": [{
"type": "type",
"path": "$this"
}],
"ordered": false,
"rules": "closed"
},
"short": "Value of extension",
"definition": "Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).",
"min": 1,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [{"code": "dateTime"}],
Suggest removing the slicing and adding a constraint on the value.type instead. This change should not have any normative impacts but it is an improvement in terms of processing requirements and implementing correct profiling practices.
Originally raised by @dbojicic-agency https://jira.digitalhealth.gov.au/browse/AN-461
The PBS / RPBS live feed includes medication form and strength by referencing an extension with an Agency canonical URL http://ns.electronichealth.net.au/fhir/StructureDefinition/medication-form-and-strength however this extension does not exist.
A similar Mobile Gateway extension http://ns.electronichealth.net.au/fhir/v1.2.0/StructureDefinition/medication-form-and-strength is published but cannot be used as it is an earlier forwards incompatible version of FHIR.
If the FHIR payload needs to carry this information the Agency should create and publish this extension in the Medicare Records FHIR implementation guide.
Sample snippet below
{
"resourceType": "Medication",
"id": "9b28d0a1-ba17-11ec-833a-b1763b0a7715",
"extension": [
{
"url": "http://ns.electronichealth.net.au/fhir/StructureDefinition/medication-form-and-strength",
"valueString": "BENZYLPENICILLIN 3G INJECTION, 1 VIAL"
}
],
...
Probably caused by tooling limitations at the time, but the extension includes a slice for value[x] that is not required; instead the extension can simply constrain the type.
For example, in an instance of ExtensionDonationDecision:
"id": "Extension.value[x]",
"path": "Extension.value[x]",
"slicing": {
"discriminator": [{
"type": "type",
"path": "$this"
}],
"ordered": false,
"rules": "closed"
},
"short": "Value of extension",
"definition": "Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).",
"min": 1,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [{"code": "dateTime"}],
Suggest removing the slicing and adding a constraint on the value.type instead. This change should not have any normative impacts but it is an improvement in terms of processing requirements and implementing correct profiling practices.
Advice provided from NIO that Date of Initial Registration from Services Australia for AODR is not part of the Live Feed.
Impact to design
ADHA Australian Organ Donor Register Consent Consent.dateInitialRegistration is not to be supported and the Date of Initial Registration extension structure is not required.
Actions
Currently the Must Support information is included in the informative content of a profile.
Update definition of Must Support to be in accordance with FHIR conformance rules on must support and the profiling rules on must support, and to be in line with other CI Agency profiles. This includes moving the definition of must support to StructureDefinition.description.
N/A
N/A
Advice provided from NIO that practitioner-classification extension is part of the live feed from Services Australia for MBS.
Impact to design
The contained Practitioner resource referenced in ExplanationOfBenefit.provider governed by profile ADHA Medicare ExplanationOfBenefit is to support the practitioner-classification extension.
Actions
Examples have not been improved since v1.0.0. Some concepts used are now inactive, some are syntactically correct but not clinically consistent.
Across the board examples should be improved - and aligned to live feed from Services Australia.
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