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1、 http://www.healthintersections.com.au/
:
How to extend severity in AllergyIntolerance resource. Is the following resource where severity is
extended done correctly?
<AllergyIntolerance xmlns="http://hl7.org/fhir">
<id value="uWErIN0G0" />
<recordedDate value="05/10/1980" />
<patient>
<reference value="Patient/DFQA_ghn000003" />
<display value="Newman, Alice Jones" />
</patient>
<substance>
<coding>
<system value="RxNorm" />
<code value="1659592" />
</coding>
<text value="ampicillin-sulbactam" />
</substance>
<status value="confirmed" />
<event>
<manifestation>
<coding />
<text value="urticaria (hives)" />
</manifestation>
<severity>
<extension url="http://phinvads.cdc.gov/vads/ViewValueSet.action?
oid=2.16.840.1.113883.3.88.12.3221.6.8">
<valueCodeableConcept>
<coding>

<system value="" />
<code value="371923003" />
<display value="mild to moderate" />
</coding>
</valueCodeableConcept>
</extension>
</severity>
</event>
</AllergyIntolerance>
Severity is a code, with cardinality 0..1 and a required binding tomild | moderate | severe. You
can replace the code with an extension, as is done here, so that part is valid. But it’s much better to
provide both a code out of the defined choices, so that systems that only know those choices can
process the information correctly, while those that know the refined list can process the refined
list:
Severity 是一个代码,其基数为 0..1,需要绑定到 mild | moderate | severe。 您可以使用
扩展名替换代码,如此处所做,以使该部分有效。 但是,从定义的选择中提供一个代码是
更好的,所以只知道这些选择的系统可以正确处理信息,而那些知道精简列表的系统可以
处理精简列表:
<severity value="mild">
<extension url="http://phinvads.cdc.gov/vads/ViewValueSet.action?
oid=2.16.840.1.113883.3.88.12.3221.6.8">
<valueCodeableConcept>
<coding>
<system value="" />
<code value="371923003" />
<display value="mild to moderate" />
</coding>
</valueCodeableConcept>

</extension>
</severity>
Aside: you could map this code to either mild or moderate, yes. Choosing either is better than
choosing neither.
另外,可以将 code 映射到 mild 或者 moderate。只要选择就比不选择好。
There’s several other issues here, though:
The URL given that identifies the extension actually identifies the value set, not the extension (aka
the data element). The correct thing to do would be to define an extension that use the value set
(see at the bottom of the post)
According to the value set definition, this is a SNOMED CT code, and the system should be filled
out
the recorded date format is not a valid XML date
the system for RxNorm is not correct
manifestation coding can’t be empty
但是,这里还有一些其他的问题:
标识扩展的 URL 实际上标识了值集,而不是扩展名(也称为数据元素)。正确的
做法是定义一个使用值集的扩展名。
根据值集定义,这是一个 SNOMED CT 编码,应该填充 system 值。
记录的日期格式不是有效的 XML 日期
RxNorm 的 system 不是正确的。
表现的 coding 值不能为空
Here it is corrected:
<AllergyIntolerance xmlns="http://hl7.org/fhir">
<id value="uWErIN0G0" />
<recordedDate value="1980-10-05" />
<patient>
<reference value="Patient/DFQA_ghn000003" />
<display value="Newman, Alice Jones" />
</patient>
<substance>
<coding>

<system value="http://www.nlm.nih.gov/research/umls/rxnorm" />
<code value="1659592" />
</coding>
<text value="ampicillin-sulbactam" />
</substance>
<status value="confirmed" />
<event>
<manifestation>
<text value="urticaria (hives)" />
</manifestation>
<severity>
<extension url="http://example.org/fhir/StructureDefinition/my-extension">
<valueCodeableCoding>
<system value="http://snomed.info/sct" />
<code value="371923003" />
<display value="mild to moderate" />
</valueCodeableCoding>
</extension>
</severity>
</event>
</AllergyIntolerance>
With an associated Extension definition:相关的扩展定义
<?xml version="1.0" encoding="utf-8"?>
<StructureDefinition xmlns="http://hl7.org/fhir">
<meta>
<lastUpdated value="2017-07-12T07:05:27.311+10:00" />
</meta>

<url value="http://example.org/fhir/StructureDefinition/my-extension" />
<name value="RefinedSeverity" />
<status value="draft" />
<date value="2017-07-12T07:02:31.9614187+10:00" />
<publisher value="Health Intersections" />
<description value="My definition for FHIR extension" />
<purpose value="an extension" />
<fhirVersion value="3.0.1" />
<kind value="complex-type" />
<abstract value="false" />
<contextType value="resource"/>
<context value="AllergyIntolerance.event.severity"/>
<type value="Extension" />
<baseDefinition value="http://hl7.org/fhir/StructureDefinition/Extension" />
<derivation value="constraint" />
<differential>
<element id="Extension">
<path value="Extension" />
<definition value="This is a description of the level of the severity of the problem." />
</element>
<element id="Extension.url">
<path value="Extension.url" />
<fixedUri value="http://example.org/fhir/StructureDefinition/my-extension" />
</element>
<element id="Extension.value[x]:valueCoding">
<path value="Extension.valueCoding" />
<sliceName value="Severity" />
<type>
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