Collective Wisdom Driving Public Health Policies

Del. no. – D3.1 Health Record Structure:

Design and Open Specification v1
Project Deliverable

This project has received funding from the European Union’s Horizon 2020 Programme
(H2020-SC1-2016-CNECT) under Grant Agreement No. 727560
D3.1 Health Record Structure: Design
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D3.1 Health Record Structure: Design and Open Specification v1

Work Package: WP3

Due Date: 31/10/2017
Submission Date: 07/11/2017
Start Date of Project: 01/03/2017
Duration of Project: 36 Months
Partner Responsible of Deliverable: ENG
Version: 1.1
Final Draft Ready for internal Review
Status: Task Leader Accepted WP leader accepted
Project Coordinator accepted
Francesco Torelli, Antonio De Nigro, Domenico Martino (ENG),
Author name(s): Maroje Sorić, Bojan Leskošek (ULJ), Jan Janssen, Serge Autexier
(DFKI), Santiago Aso (ATOS), Thanos Kiourtis (UPRC)
Reviewer(s): Tanja Tomson (KI) Andreas Menychtas (BIO)
Nature: R – Report D – Demonstrator
PU – Public
Dissemination level: CO – Confidential
RE – Restricted

REVISION HISTORY
Version Date Author(s) Changes made
0.1 14/06/2017 Francesco Torelli Draft - Index
(ENG)
0.2 15/09/2017 Antonio De Nigro, Updated index, first draft of HHR model
Domenico Martino, UML diagrams, first draft of HHR to FHIR
Francesco Torelli mapping, first draft of terminology used in
(ENG) HHRs, first draft of FHIR extensions, first
draft of appendix A.5
0.3 06/10/2017 Antonio De Nigro, Edited description of the approach,
Francesco Torelli, requirement coverage, UML conceptual
Domenico Martino model, mapping to FHIR, used terminology,
(ENG) FHIR extensions.
0.4 17/10/2017 F. Torelli, A. De Updated index; edited executive summary,
Nigro, D. Martino introduction, state of the art, UCs dataset
(ENG), M. Sorić schema template; final version of
(ULJ),J. Janssen, conceptual model, HHR to FHIR mapping,
S. Autexier (DFKI), used terminology, FHIR extensions, UCs
S. Aso (ATOS), T. dataset schema mapping to FHIR
Kiourtis (UPRC)

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1.0 31/10/2017 Francesco Torelli, Fixed internal review remarks.

Antonio De Nigro,
Domenico Martino
(ENG), Jan
Janssen (DFKI),
Santiago Aso
(ATOS), Thanos
Kiourtis (UPRC)
1.1 06/11/2017 ATOS Quality Review. Submitted to EC.

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List of acronyms

AMA American Medical Association

ANSI American National Standards Institute
API Application Programming Interface
BMI Body Mass Index
CAS Chemical Abstracts Service
CMD Common Data Model
CPT Current Procedural Terminology
CRC Clinical Research Chart or Data Repository Cell
DOID Human Disease Ontology
EHR Electronic Health Record
ER Entity Relationship
EuroFIR European Food Information Resource
FAO Food and Agriculture Organization of the United Nations
FHIR Fast Healthcare Interoperability Resources
FOKB Food Ontology Knowledge Base
FOOD FOod in Open Data
HHR Holistic Health Records
HL7 Health Level 7
ICD International Classification of Diseases
ICF International Classification of Functioning, Disability and Health
IT Information Technology
JSON JavaScript Object Notation
LOD Linked Open Data
LOINC Logical Observation Identifiers Names and Codes
MeSH Medical Subject Headings
NCIT National Cancer Institute Thesaurus
NHS National Health Service
NLM National Library of Medicine
NoSQL Not Only Structured Query Language
OBO Open Biomedical Ontologies
OMOP Observational Medical Outcomes Partnership
OWL Web Ontology Language
RIM Reference Information Model
SMASH Semantic Mining of Activity, Social, and Health data
SNOMED CT Systematized Nomenclature of Medicine Clinical Terms
SNOMED RT Systematized Nomenclature of Medicine Reference Terminology
SNOP Systematized Nomenclature of Pathology
SPARQL Simple Protocol and RDF (Resource Description Framework) Query Language
SQL Structured Query Language
Turtle Terse RDF (Resource Description Framework) Triple Language
UML Unified Modeling Language
USDA United States Department of Agriculture
WHO World Health Organization
WOF World Obesity Federation
XML eXtensible Markup Language

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Contents

1. Executive Summary ......................................................................................................... 7

2. Introduction ...................................................................................................................... 8
3. State of the Art ................................................................................................................. 9
3.1. Health terminologies ................................................................................................. 9
3.1.1. ICD-9 and ICD-10 Codes – International Classification of Diseases ................... 9
3.1.2. CPT Coding – Current Procedural Terminology ............................................... 10
3.1.3. LOINC – Logical Observation Identifiers Names and Codes ............................ 11
3.1.4. SNOMED CT – Systematized Nomenclature of Medicine ................................ 12
3.2. Health ontologies .................................................................................................... 13
3.2.1. Medical ontologies ........................................................................................... 13
3.2.2. Food Ontologies ............................................................................................... 14
3.2.3. Social and physical activities ............................................................................ 15
3.2.4. Interoperability Problems.................................................................................. 16
3.3. Health data models from international standards..................................................... 17
3.3.1. HL7 FHIR ......................................................................................................... 17
3.3.2. HL7 RIM........................................................................................................... 20
3.3.3. i2b2 CRC ......................................................................................................... 23
3.3.4. OMOP CMD ..................................................................................................... 24
4. Holistic Health Record model ......................................................................................... 26
4.1. Description of the approach .................................................................................... 26
4.1.1. Main principles of the HHR model .................................................................... 26
4.1.2. Level of abstraction and scope of the HHR model ............................................ 27
4.1.3. Mapping of HHR model to FHIR ....................................................................... 29
4.1.4. Steps followed to define the HHR model .......................................................... 29
4.1.5. Usage of the HHR model ................................................................................. 30
4.2. Requirement coverage ............................................................................................ 31
4.3. UML conceptual model............................................................................................ 31
5. Conclusions ................................................................................................................... 48
References ............................................................................................................................ 50

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Table of figures / tables

Figure 1 Classification of some FHIR resources .................................................................... 17

Figure 2 Patient information example in a FHIR resource in XML.......................................... 19

Figure 3 UML diagram of the FHIR resource Patient ............................................................. 20

Figure 4: HL7 Reference Information Model. Core classes.................................................... 21

Figure 5 i2b2 Star Scheme. Main model part......................................................................... 23

Figure 6 Person model .......................................................................................................... 32

Figure 7 School model .......................................................................................................... 33

Figure 8 Identifier model ........................................................................................................ 34

Figure 9 Condition model ...................................................................................................... 35

Figure 10 Activity model (part 1 of 2) ..................................................................................... 36

Figure 11 Activity model (part 2 of 2) ..................................................................................... 37

Figure 12 Measurement model .............................................................................................. 38

Figure 13 Continuous quantity model .................................................................................... 39

Figure 14 Unit of measure model .......................................................................................... 39

Figure 15 Fitness measurements model................................................................................ 41

Figure 16 Heart rate and blood pressure model .................................................................... 42

Figure 17 Laboratory tests (part 1 of 2) ................................................................................. 43

Figure 18 Laboratory tests (part 2 of 2) ................................................................................. 43

Figure 19 Food intake model ................................................................................................. 44

Figure 20 Episode of care (part 1 of 3) .................................................................................. 45

Figure 21 Episode of care (part 2 of 3) .................................................................................. 46

Figure 22 Episode of care (part 3 of 3) .................................................................................. 46

Figure 23 Primitive data types model .................................................................................... 47

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1. Executive Summary
Holistic Health Records (HHRs) are structured health records that may include several types
of information that are relevant to a patient’s health status, such as laboratory medical data;
clinical data; lifestyle data collected by the patient or related people; social care data;
physiological and environment data collected by medical devices and sensors. Currently,
many data models have been specified for representing the aforementioned data (section 3
State of the Art), but there is no single model that covers in an integrated way all the needs of
CrowdHEALTH use cases. This deliverable presents a first version of such an integrated HHR
model.

In order to have a strong foundation, the model is mainly based on the new emerging FHIR
standard. FHIR is considered easier to implement than previous standards, covers very well
the clinical aspects of human health and has a good extension mechanism that allows adding
information models for aspects not yet covered by the model.

The HHR model has been obtained by first producing a separate conceptual data model for
each use case, then clarifying their semantics with a preliminary mapping to the FHIR
standard (annex B1 to B5, which comply to the template reported in annex B) and finally
merging the separate models in a unique HHR conceptual model. A coherent mapping to
FHIR has therefore been defined with respect to the merged conceptual model, in order to
guarantee that different teams adopt the same FHIR representation (as FHIR allows different
representations for the same information). The conceptual HHR model is specified in UML,
with the adoption of specific constraints and stereotypes, while the mapping is expressed
using structured tables and the FHIRPath language (section 4.3 UML conceptual model).

Although based on FHIR, the HHR model is designed at a higher conceptual level, making
explicit several concepts that are implicit in the FHIR standard, other than extending it by
adding missing concepts. By maintaining a double view, the HHR model aims on one hand to
guarantee the interoperability and the possibility to implement it on top of existing FHIR
libraries, and on the other hand it is also intended to be usable independently from FHIR (and
its future evolutions) and applicable also for different purposes than the exchange of health
data. For example, it can be more suitable than FHIR as data schema for Object Oriented
local APIs.

The current HHR model aims to represent the information enabling the execution of the first
cycle of use case demonstrations, expected for the first year of the project. In particular, the
current release of the HHR model fully covers CareAcross and SLOfit datasets and partially
covers HULAFE and BIOASSIST datasets. During the second year, the HHR model will be
extended to satisfy new requirements, to complete the coverage of HULAFE and BIOASSIST
datasets and to include the DFKI and KI datasets.

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2. Introduction
One of the pillars of the CrowdHEALTH project is the development and exploitation of the so
called Holistic Health Records (HHRs). HHRs are intended to provide an integrated view of
the patient including all health determinants. Such data may be produced by different human
actors or systems, in different moments of the patient’s life. They potentially include: social
and lifestyle data collected by either the patient or other individuals (e.g. family members,
friends); social care data collected from social care providers; physiological and environmental
data collected by medical devices and sensors (e.g. home care systems or wearables); clinical
data coming from healthcare information systems and produced by professionals (e.g. primary
care systems and electronic medical records); laboratory medical data.

The goal of this deliverable is to present a first version of the HHR model, and it is organized
in the following way.

Section 3 describes some of the main existing models (terminologies, ontologies, data
models) related to the information produced and consumed by the CrowdHEALTH use cases
and more in general to the concept of HHR. In particular, it introduces the FHIR standard that
has been chosen as starting model for the specification of the HHR model.

Section 4 describes the HHR model. It first describes the goal of this endeavour and the
approach followed to realize it. Then, it presents the requirements considered for the first year
and a high-level specification of the produced model.

Finally, the annexes include additional details on the resulting HHR model and report the
results of analysis of the use case data models performed as first step for the design of the
HHR model. In particular, annex A describes a semi-formal mapping between the HHR model,
related terminologies and all FHIR extensions needed to fully translate HHR instances to FHIR
resources. Annex B includes the template used to gather information about the use case data
models. Annexes B1 to B5 report the analyses of use case data.

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3. State of the Art

3.1. Health terminologies

While terminology can refer to a number of different things, in healthcare it is associated with
the “language” used to code entries in Electronic Health Records (EHRs) including ICD-9 (1),
ICD-10 (2), LOINC (3), CPT (4) and SNOMED CT (5), among others. Most people encounter
medical terminologies at some point in their lives – whether it is as physicians, medical
purchasers, or patients. In the world of EHRs, terminology is one of the keys to true
interoperability between systems and integrating data. For instance, in the case that it is
needed to send data between two systems, for the data to be usable, those systems have to
“talk” in the same language. This means that codes from one system have to be compatible
with codes from the other system. While it can be easy to combine data from multiple systems
in one place, in the case that these codes cannot be mapped to one another, then the data
remain locked. Currently, there exist several standards, and as a result, a lot of research is
performed to map these various vocabularies so that one can move easily from one to the
other as long as one of the key ones listed earlier is used. To this end, there is work that has
been done and is ongoing, such as mappings between ICD-9 and ICD-10 (6), LOINC and
CPT (7), or LOINC and SNOMED CT (8).

3.1.1. ICD-9 and ICD-10 Codes – International Classification of Diseases

The International Classification of Diseases (ICD) is a widely recognized international system
for recording diagnoses. It is developed, monitored, and copyrighted by the World Health
Organization (WHO). Applied to any diagnosis, symptom, or cause of death, ICD consists of
alphanumeric codes that follow an international standard, making sure that the diagnosis will
be interpreted in the same way by every medical professional both in the U.S. and
internationally. Shortly, ICD-9 codes are three-to-five digit numeric and, in certain cases,
alphanumeric codes (9). The first three digits in a code refer to the “category”. The category
describes the general illness, injury, or condition of the patient. In many cases, the category is
not specific enough to describe the full extent of the patient’s condition. In cases where more
specificity is needed, a decimal point is added after the category and one or two more digits
are added. The fourth digit of the ICD-9 code refers to the “subcategory”, and the fifth digit to
the “subclassification.” The subcategory describes the etiology (cause), site, or manifestation
of the disease or condition. The subdivision provides even more information about the site,
cause or manifestation of a disease, and is used only when the subcategory cannot provide
sufficient information.

The current version of ICD used in the U.S. is known as ICD-9, though it is in the process of
being replaced by ICD-10. Rather than simply being an updated version of ICD-9, ICD-10 is a
more comprehensive and complex set of codes designed to address some of the issues of
ICD-9. For example, ICD-10 codes are longer than ICD-9 codes, reducing the risk of running
out of possible available codes in the future. They are also more detailed, registering findings

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such as “laterality”, an option that has been previously absent in ICD-9. Codes in the ICD-10
code set can have three, four, five, six, or seven characters (10). Many three-character codes
are used as headings for categories of codes that can further expand to four, five, or six
characters to add more details regarding the diagnosis. The first three characters of an ICD-10
code designate the category of the diagnosis. A three-character category that has no further
specificity can stand alone as a code. In this case, however, greater specificity is possible, and
can be filled in as many “blanks” as they can. The next three characters (characters three
through six) correspond to the related etiology, anatomic site, severity, or other vital clinical
details. The seventh character represents one of the most significant differences between
ICD-9 and ICD-10, because ICD-9 does not provide a mechanism to capture the details that
the seventh character provides, referring mainly to the information about the phase of
treatment. A seventh character must be assigned to codes in certain ICD-10 categories that
must always be in the seventh position. In the case that a code has fewer than six characters
and requires a seventh character extension, then all of the empty character spaces must be
filled with an “X.”

In 2018, ICD-11 is scheduled to be released by WHO (11). While the idea does not have deep
support among U.S. policymakers, the American Medical Association and other large
organizations have suggested that replacing ICD-9 with ICD-11 and skipping ICD-10.

3.1.2. CPT Coding – Current Procedural Terminology

Current Procedural Terminology (CPT) coding is a U.S. standard for coding medical
procedures, maintained and copyrighted by the American Medical Association (AMA) (12).
Similar to ICD coding, CPT coding is used to standardize medical communication across the
board – but while ICD-9 and ICD-10 focus on the diagnosis, CPT identifies the services
provided, and is used by insurance companies to determine how much physicians will be paid
for their services. As is the case with ICD-9 or ICD-10, the goal of CPT codes is to summarise
as much information as possible into a uniform language. CPT codes are designed to cover all
kinds of procedures and are therefore very specific.

A CPT code looks like a five-digit numeric code with no decimal marks, although some have
four numbers and one letter (13). Some are used frequently like 99213 or 99214 (for general
check-ups). As the practice of health care changes, new codes are developed for new
services, current codes may be revised, and old, unused codes are discarded. Currently, there
exist three different types of CPT Coding, as mentioned below:

CPT Category I Codes: The first category, which is by far the largest of the three, contains
codes for six subtypes of procedures. Much like ICD-9 and ICD-10, these procedural codes
are organized into clusters, which are then subdivided into more specific ranges. Within that
number range, procedures have a designated code, ensuring healthcare payers’ record
exactly which procedure a patient has undergone.

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CPT Category II Codes: The second section of CPT consists of optional supplemental tracking
codes. These codes are formatted with a letter as their fifth character, and are coded after the
initial CPT code. These Category II codes include information on test results, patient status,
and additional medical services performed within the larger Category I procedure. Like
Category I codes, they are divided into clusters. These codes reduce the need for record
abstraction and chart review, and lower the administrative burden on healthcare professionals.
Category II CPT Codes facilitate research and the collection of data related to the quality of
patient care. Some codes also relate to state or federal law, which document the blood alcohol
level of a patient. These codes are a supplement, for the codes in Category I, and must
always be attached to an existing Category I code.

CPT Category III Codes: The third section of the CPT code is devoted to new and emerging
technologies or practices. This code does not indicate that the service performed is ineffectual
or purely experimental. A Category III code simply means the technology or service is new
and data on it is being tracked. Like Category II codes, Category III CPT codes are numeric-
alpha, meaning the last digit is a letter. After a predetermined period of time (typically five
years of data tracking), a procedure or technology described by a Category III code may move
into Category I, unless it is demonstrated that a Category III code is still needed.

3.1.3. LOINC – Logical Observation Identifiers Names and Codes

Logical Observation Identifiers Names and Codes (LOINC) (14) was created in 1994 by the
Regenstrief Institute as a free, universal standard for laboratory and clinical observations, in
order to enable exchange of health information across different systems. Where ICD records
diagnoses and CPT services, LOINC is a code system used to identify test observations.
LOINC codes are often more specific than CPT, and one CPT code can have multiple LOINC
codes associated with it. Currently, more than 54,300 registered users from 170 countries use
LOINC, and it has been recognized as the preferred standard for coding testing and
observations in HL7. The structure of a fully specified LOINC term is determined by six distinct
axes. Each axis must fit into the LOINC structure and contributes to the meaning of the LOINC
term. The axes are separated by a colon. Each axis of the code provides information in an
organized way. By the time that these axes are combined, a complete LOINC concept is
constructed.

A formal, distinct, and unique 6-part name is given to each term for test or observation identity
(15). The LOINC database currently has over 71,000 observation terms that can be accessed
and understood universally. Each database record includes six fields for the unique
specification of each identified single test, observation, or measurement:

 Component: what is measured, evaluated, or observed.

 Kind of property: characteristics of what is measured, such as length, mass, volume,
time stamp and so on.
 Time aspect: interval of time over which the observation or measurement was made.

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 System: context or specimen type within which the observation was made.
 Type of scale: the scale of measure (quantitative, ordinal, nominal or narrative).
 Type of method: procedure used to make the measurement or observation.

A unique code (format: nnnnn-n) is assigned to each entry upon registration. Other database
fields include status and mapping information for database change management, synonyms,
related terms, substance information (e.g. molar mass, CAS registry number), choices of
answers for nominal scales, translations.

3.1.4. SNOMED CT – Systematized Nomenclature of Medicine

SNOMED Clinical Terms (SNOMED CT) is a comprehensive, computerized healthcare
terminology - containing more than 311,000 active concepts – with the purpose of providing a
common language across different providers and sites of care (16). It is the most
comprehensive existing multilingual clinical healthcare terminology. The terminology has roots
with the College of American Pathologists in 1960s with the development of SNOP, or
Systematized Nomenclature of Pathology, which later became SNOMED RT (Reference
Terminology). In 1999, SNOMED RT merged with Clinical Terms Version 3 developed in the
UK by the National Health Service (NHS), becoming SNOMED CT, which is now overseen by
the International Health Terminology Standards Development Organization. It has
subsequently become established as the international medical terminology standard. In
addition to diagnosis, SNOMED CT includes clinical findings, symptoms, procedures, body
structures, and organisms, among other semantic types. As a core EHR terminology,
SNOMED CT is essential for recording clinical data such as patient problem lists and family,
medical and social histories in electronic health records in a consistent, reproducible manner.

SNOMED provides a rich set of inter-relationships between concepts. Hierarchical

relationships define specific concepts as children of more general concepts (17). SNOMED's
design ensures clarity of meaning, consistency in aggregation, and ease of messaging. This
results in a smart and structured search, with specific and relevant return of results. For
diseases/disorders, SNOMED CT uses relationships between concepts to provide logical,
computer readable definitions of medical concepts. There are several types of relationships
described or modelled in SNOMED CT, such as "Is A", "Finding Site", "Causative agent", or
"Associated morphology" relationship.

SNOMED CT content is represented using three types of components supplemented by

Reference Sets, which provide additional flexible features.

Concepts: SNOMED CT concepts represent clinical hypothesises (i.e. thoughts/ logics). Every
concept has a unique numeric concept identifier. Within each hierarchy, concepts are
organized from the general to the more detailed. This allows detailed clinical data to be
recorded and later accessed or aggregated at a more general level.

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Descriptions: SNOMED CT descriptions link appropriate human readable terms to concepts. A

concept can have several associated descriptions, each representing a synonym that
describes the same clinical concept. Each translation of SNOMED CT includes an additional
set of descriptions, which link terms in another language to the same SNOMED CT concepts.

Relationships: SNOMED CT relationships link concepts to other concepts whose meaning is

related in some way. These relationships provide formal definitions and other properties of the
concept.

Reference sets: Reference sets (Refsets) are a flexible standard approach used by SNOMED
CT to support a variety of requirements for customization and enhancement of SNOMED CT.
These include the representation of subsets, language preferences for use of particular terms
and mapping from or to other code systems. Every reference set has a unique numeric
concept identifier.

3.2. Health ontologies

In this section, we give an overview on ontologies and their status related to the information
that will be contained in the holistic health records. This includes, aside from medical
information, also physical and social activities, as well as nutritional information. In addition,
we review ontologies that may be used to provide the information needed for support food
tracking services, such as recipe ontologies and specific recipes. The distinguishing elements
between ontologies and taxonomies are that ontologies allow for classes to be subclasses of
different parent classes, may include relationships between classes of objects and especially
include axiomatic restrictions on classes, relationships and individuals. One standard ontology
language is the OWL 2 Web Ontology Language1, which for a large part has a clean semantic
foundation provided by Description Logics (18).

3.2.1. Medical ontologies

Medical information is typically represented following some standard, as has been presented
in the previous sections. However, the mentioned SNOMED CT terminology actually also is an
ontology which defines (some) concepts, such as, some diseases in terms of their cause, the
part of the body they affect and how they can be diagnosed. It also includes some food
categories, sport categories or activities of daily living.

The Open Biomedical Ontologies (OBO) consortium (19) is an initiative trying to integrate the
many ontologies developed in the biomedical domain, which also includes ontologies
formalizing patient medical care and EHRs. The consortium maintains a repository of 277
active ontologies of which 13 are concerned with diseases. It includes a Human Disease

1
https://www.w3.org/TR/owl2-overview/

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Ontology (DOID) (20), which describes the classification of human diseases organized by
etiology and is referencing SNOMED and other medical terminologies. A similar initiative is
BioPortal2 which contains 654 biomedical ontologies, among which also those from the OBO
consortium.

The International Classification of Functioning, Disability and Health (ICF) 3 is an ontology

classifying health and health-related domains from a body perspective, a personal activities
perspective and a societal perspective. It classifies according to the body structure (eye, ear,
digestive systems, etc.), the body function (mental, voice, etc.), activities and participations
and the environmental context. It thus contains medical categories as well as some social
categories as part of the activities, participations and environmental domains. All concepts
(resp. individuals) are linked to the ICD code in the ICD terminology.

The National Cancer Institute Thesaurus (NCIT) is a reference thesaurus covering biomedical
concepts and inter-concept relationships. As part of that, it also includes medical categories,
categories for physical activities, social activities and behavioural categories. There is also an
experimental version of it in the OBO ontologies that tries to integrate the NCIT reference
terminology with the other OBO ontologies.

The Open mHealth4 is a standardization attempt providing schemas to model mobile health
data in JSON format. It currently provides 91 schemas to model specific health data including
date and time information, data acquisition information and links the health data with the
SNOMED (Section 3.1.4), LOINC (Section 3.1.3) or RxNORM (Section 3.2.4). It is extensible
and provides design rules to develop new schemas for further health information categories.
Note that it also provides a schema to store data about physical activity.

3.2.2. Food Ontologies

Ontologies about food are mainly concerned with standardizing food categories and possibly
providing nutritional information. Rare are ontologies containing actual recipes or linking food
with dietary requirements.

The USDA Food Composition Database5 is the standard reference for nutrients, food and food
products, including classification with respect to manufacturers. It is US related, but the
content is often both in English and Spanish. It provides for each entry (raw or manufactured)
the nutritional information about proximates (energy, lipids, sugar, etc.) minerals and vitamins.
Though this is not an ontology per se, it could in principle be easily turned into an ontology.

2
http://bioportal.bioontology.org
3
http://www.who.int/classifications/icf/en/
4
http://www.openmhealth.org/
5
https://ndb.nal.usda.gov/ndb/

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The Food Ontology Knowledge Base (FOKB)6 is an English and Turkish ontology containing
details of food ingredients such as their codes (e-codex or codex numbers) and also side
effects of them such as allergy.

The FOod in Open Data (FOOD)7 is an ontology about Italian food products, especially of food
quality certification schemes, in accordance with product specifications defined by the Italian
Ministry of Agricultural, Food and Forestry Policies. The dataset is provided under a Creative
Commons license and the developers provide a SPARQL end-point to query the data in the
linked open data (LOD) paradigm.

The FOODON ontology as part of the OBO collection of ontologies is a full food ontology
including 9000 food products. The ontology and data are only in English.

The LIRMM Food Ontology8 is an attempt at defining a food ontology, but very incomplete.
The Food Ontology9 is a more complete ontology about recipes, including the foods they are
made from, the foods they create as well as the diets they are suitable for. It is similar to
Google's rich snippets for recipes, which consist of annotating published recipes using the
standard schema from http://schema.org/Recipe to support better search and retrieval of
recipes. The actual ingredient lists are typically not linked with standards such as the USDA,
LanguaL or AGROVOC (see further below for these). The fact that ingredient lists in recipes
are usually textual descriptions and do not make use of standard food vocabularies or
ontologies seems to be a general problem, at least in open accessible recipes databases.

3.2.3. Social and physical activities

Specifically targeted to support research on sustained weight loss through frequent social
contacts there has been an attempt to develop the SMASH10 ontology (Semantic Mining of
Activity, Social, and Health data). It describes concepts used in describing the semantic
features of healthcare data and social networks and also includes categories for physical and
social activities. However, it is not fully developed and incomplete: For instance, Occupational
Activities consist only of the categories Trimming, Weeding, Masonry and Plumbing.

The already mentioned Open mHealth standard (Section 3.2.1) also contains a schema to
represent health related information about physical activities. However, it does not provide a
taxonomy for the activities but rather how to store information about duration, distance, calorie
consumption and intensity.

6
https://bioportal.bioontology.org/ontologies/FOOD_ONTOLOGY
7
http://etna.istc.cnr.it/food/
8
http://data.lirmm.fr/ontologies/food
9
https://www.bbc.co.uk/ontologies/fo
10
https://bioportal.bioontology.org/ontologies/SMASHPHYSICAL

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The OpenActive Activity List11 is a taxonomy of standard physical activities that can be used to
categorize and describe opportunities for physical activities. The list is intended to be used by
publishers who are sharing open data about events providing opportunities for physical
activities.

3.2.4. Interoperability Problems

A major problem is the success of using ontologies (and taxonomies) in many domains as it
led to the development of many different not necessarily linked ontologies and taxonomies.
This creates in practice the problem of interoperability, both at the taxonomic level as well as
on the semantic level. To try to overcome that problem is a major effort and the reason for
initiatives like OBO and BioPortal. On a general level, it is also the motivation for the
OntoHub12 repository, which behind the scenes attempts to utilize alignment techniques from
formal methods for the ontology domain.

The Medical Subject Headings 13 (MeSH) is a vocabulary maintained by the US National

Library of Medicine (NLM). It is a hierarchically-organized terminology of biomedical
information contained in NLM database, including MEDLINE®/PubMed®. It is often combined
information following the RxNorm 14 (database of pharmaceutical information, used, for
instance, in medication histories), as well as with the LOINC standard (Logical Observation
Identifiers Names and Codes) for medical laboratory observations.

An analogous activity but in the food domain is the LanguaL™ Food Description Thesaurus15.
It aims to provide a standardized language to describe and classify foods and food products.
One problem with food is that food ontologies in different languages are difficult to align,
especially as corresponding terms in different languages do not necessarily mean the same
thing. LanguaL is language-independent by using numeric codes and pointing to the
equivalent terms in different languages (USA and European). More than 27000 foodstuffs in
European food composition databases as well as the entire USDA National Nutrient Database
for Standard Reference are now in LanguaL and can be used to facilitate retrieval of food
information in different food databases.

The FoodEXplorer16 from EuroFIR allows querying food composition databases from different
European Countries, which should be harmonized using LanguaL. However, to date this only
allows for queries in the different databases, while cross-linking between different databases
is not supported.

11
https://www.openactive.io/activity-list/
12
https://ontohub.org/
13
https://www.nlm.nih.gov/mesh/
14
https://www.nlm.nih.gov/research/umls/rxnorm/
15
http://www.langual.org/
16
http://www.eurofir.org/food-information/foodexplorer/

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Finally, AGROVOC is a multilingual vocabulary developed by the Food and Agriculture

Organization of the United Nations (FAO) about food, nutrition, agriculture, fisheries, forestry
and the environment. The vocabulary consists of over 32000 concepts and each concept has
up to 22 labels in different languages, is available under a Creative Commons license and can
be used in order to facilitate the search and retrieval of food information across language
barriers. AGROVOC is published as Linked Open Data (LOD) and links the resources with
many standard web resources, among others EUROVOC, the multilingual thesaurus
maintained by the Publications Office of the European Union, and DBPedia.

3.3. Health data models from international standards

3.3.1. HL7 FHIR

This standard was introduced in the already reported deliverable D2.117, but this section will
explore the possibilities it offers as a clinical data model, despite that it does not include a
typical oriented Entity-Relationship18 data model.

Figure 1 Classification of some FHIR resources

The data model of this standard revolves around a series of interoperability artefacts
composed of a set of modular components called "Resources". These resources are discrete

17
D2.1 State of the Art and Requirements Analysis v1
18
https://en.wikipedia.org/wiki/Entity%E2%80%93relationship_model

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information units with defined behaviour and meaning, and describe what information can be
collected for each type of clinical information.

As can be seen in the Figure 1 or in the complete list19, there are different resources for
structuring information from a patient, an adverse reaction, a procedure and an observation,
among many others. Within FHIR there are 6 major categories in which you can classify the
different types of resources available20:

 Clinical: content of clinical record

 Identification: supporting entities involved in the care process
 Workflow: manage the healthcare process
 Financial: resources that support the billing and payment parts of FHIR
 Conformance: resources use to manage specification, development and testing of
FHIR solutions
 Infrastructure: general functionality and resources for internal FHIR requirements

As discussed at the beginning of this section, this data model is not the traditional model
oriented to ER, but to noSQL21. In this sense, the content of the FHIR resources can now be
represented in different formats such as XML22, JSON23 and Turtle24, although other formats
are also allowed. In this way, it is possible to obtain information structured according to the
FHIR resource data model, and represented in one of these formats, resulting that this
information can be readable by both humans and machines.

19
http://hl7.org/fhir/resourcelist.html
20
https://www.hl7.org/fhir/resourceguide.html
21
https://en.wikipedia.org/wiki/NoSQL
22
https://www.w3.org/XML/
23
http://www.json.org/
24
https://www.w3.org/TeamSubmission/turtle/

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Figure 2 Patient information example in a FHIR resource in XML

As can be seen in the Figure 2, the patient's sample information is available using the FHIR
patient resource structure and in XML format. At the end of the blue part of the example we
can see how the information of this patient is structured in the fields that FHIR has in the
design of this resource for that purpose, such as the name, gender, date of birth and the
patient’s health provider.

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Figure 3 UML diagram of the FHIR resource Patient

Providing a complete view, a UML diagram of the patient FHIR resource is shown in Figure 3,
in order to be able to check the different fields that are available in this structure, following the
example already provided. Apart from the already mentioned fields of name, gender, etc.,
there are others available for use, such as address, data of telematic contact, etc.

Within this standard, 119 other resources (apart from the patient resource) are defined at
different maturity levels. With this, the organization HL7 aims to define and limit the structures
that are used for the exchange of clinical information. Taking into account that, according to
claim,25 they are following Pareto’s principle of being able to cover 80% of the use cases with
20% of effort, meaning that with a constrained and complex definition of resources, for which a
20% of efforts is invested, can cover 80% of the use cases in a consistent manner. Instead of
focusing the solution in a more flexible way to cover 100% of use cases, but losing quality,
consistency and determinism to cover the fundamental use cases, and also requiring a greater
amount of resources.

3.3.2. HL7 RIM

The HL726 Reference Information Model is part of a release of a standard created by the
organization Health Level Seven. This organization published the new version of their

25
Slide 11 https://www.hl7.org/documentcenter/public_temp_43EF3352-1C23-BA17-
0C875683CE804AD4/calendarofevents/himss/2016/Blazing%20a%20Trail%20Better%20Care,%20Healthier%20P
eople%20and%20Lower%20Costs%20through%20the%20Interoperability%20Roadmap.pdf
26
http://www.hl7.org/

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standard around 2005, HL7 v327, and as part of this release they included a reference data
model, in order to serve as representation to store specific clinical or administrative data.

This model is intended to be used as a reference for the creation of information models aimed
at creating information storage systems of any situation related to the environment of health
services, such as patient diagnoses, sanitary material, costs for treatments and information
concerning the personnel of a health organization. The main classes that compose the model
can be observed in the Figure 4, having the complete model available in the references of this
document28.

Figure 4: HL7 Reference Information Model. Core classes

A more detailed description of these classes is listed below.

 Act: Each instance of act represents an action (clinical or administrative of the sanitary
environment) at any given time. These actions can be found in different states
(planned, pending, completed, etc.), be of different types (procedures, observations,
drug administrations) and involve different entities (patients, health personnel and
material, etc). Therefore, of the different main classes listed, this is the main and most
complex class of this model.

27
https://www.hl7.org/implement/standards/product_brief.cfm?product_id=186
28
http://www.hl7.org/implement/standards/rim.cfm

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 Participation: Each instance represented in this class aims to indicate the type and
degree of participation of different entities with different roles that may be involved in a
clinical action.
 Role: Each instance indicates the functions of an entity that participates in a given
action. It is possible that the same entity participates with various functions in the same
act, as a doctor who performs a clinical test on a patient and at the same time
interprets their results.
 Entity: Each instance represents any being, from a living subject such as a patient or a
sample of a microscopic organism, to chemical substances or physical devices like a
trocar for biopsies.

As can be observed in the same way in Figure 4, and as described in the point describing
class "Act", by the importance of the same it is essential to describe each of these categories
in which the acts are divided. The differences that exist in these subcategories are very
relevant for the consistency of the data, and are very different from each other. Each of these
subclasses has unique attributes, apart from those shared with the main class of act, in order
to satisfy the needs of each of these subclasses.

 Observation: Indicates that the clinical action performed is an act of recognition,

evaluation or indication of certain information about a subject. They can be
measurements, assertive statements, research methods, etc.
 Procedure: Indicates that the action performed on the subject consists of some type of
intervention or manipulation of part or parts of his body.
 Substance Administration: Indicates actions to introduce or apply a particular
substance or compound to a subject. As you can suppose, it is a concrete case of
"Procedure", but to have concrete requirements it is decided to place it in its own
subclass.

This set of subclasses intends to group semantically as similar acts as possible, for which to
design a common set of attributes that serve appropriately to be able to host information
relating to the act. An example of these attributes would be the 'InterpreationCode' attribute
whose purpose is to contain the interplay that is performed from an act of observation, or the
attribute 'DoseQuantity' used to indicate the amount of substance or compound that is
administered to a patient. As subclass 'Substance Administration' is subclass of 'Procedure',
these subclasses may have other types of subclasses like 'DiagnosticImage', which are
intended to subcategorize and group similar types of acts.

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3.3.3. i2b2 CRC

The i2b229 Clinical Research Chart or Data Repository Cell was born from the star model
initially proposed by Ralph Kimball as part of the i2b2 data mart. It is designed to store clinical
trial data, medical records and laboratory tests, as well as many other types of clinical
information. Following an approach similar to that explained with the previous section of HL7
RIM, the acts or facts in this case form the main element of this star model, forming a central
table surrounded by other tables that provide additional dimensions. There are other important
tables 30 , which are outside this main star schema, which for the purpose of providing a
description of the most relevant parts have been kept out.

Figure 5 i2b2 Star Scheme. Main model part

The main table "observation_fact" stores the logical facts of clinical scope. Being the center of
the star schema, it intersects with the rest of the tables and each instance of it describes an
observation made to a patient during a visit.

29
https://www.i2b2.org/index.html
30
https://www.i2b2.org/software/projects/datarepo/CRC_Design_Doc_13.pdf

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The table "patient_dimension" would be in charge of storing all demographic information of the
patient on which the clinical fact is related. This information is such as date of birth, gender,
address, etc.

The "visit_dimension" table represents the session where the observations or clinical facts
were made. Containing information about visits or other encounters, with attributes such as
the date of beginning and end of the visit, location, etc.

The "concept_dimension" table contains any concept (coded clinical ideas) using in the set of
other tables. This table is general enough to store concept information of any medical
terminology. Attributes such as the concept label, its identification, version date, id of the
terminology to which it belongs, etc.

The last table that is included is "provider_dimension", which represents the doctor or provider
of the institution in which the clinical event was performed. Therefore, it contains dedicated
attributes for the identification of the professional, his name, his institutional hierarchy, etc.

3.3.4. OMOP CMD

The Observational Medical Outcomes Partnership31 Common Data Model is oriented to the
analysis of disparate observational databases. Having, as specified in its website 32 , the
objective of transforming data contained between these databases in a common format and
as a common representation (terminologies, code systems, etc.). Once the data is
transformed into a common format, this would allow for systematic analysis using an analytical
standard library created specifically for that common format. For the purpose of this state of
the art, it is of our interest this common format that they propose.

The data model they propose is based on including any clinical observational element
(experiences that the patient receives clinical attention) that is considered relevant. They
propose an ER-type data model, in which they adopt a series of conventions.

These series of conventions that are assumed by this data model vary from general
conventions to specific ones for concrete cases. Within the general conventions we can find
that they pose this model as independent of the platform, that the data types are defined
generically using ANSI SQL (such as VARCHAR, INTEGER, FLOAT, etc.), and do not provide
a format of date or time, and may vary between different configurations.

The different tables that are proposed in this model are the following:

 Person. Demographic information about a person.

31
http://omop.org/
32
https://www.ohdsi.org/data-standardization/the-common-data-model/

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 Drug exposure. Patient exposure to a particular drug.

 Drug era. Length of time that a person is supposed to have been exposed to a drug.
 Condition occurrence. Person's state.
 Condition era. Equivalent to ‘Drug era’ but for the condition.
 Visit occurrence. Person's visits to any health care facility.
 Procedure occurrence. Procedures performed on patients.
 Observation. General observations made to a patient.
 Observation period. Time period in which a person is expected to suffer the effects of
an observation.
 Death. Date and cause of death of a person.
 Drug cost. Cost associated with a Drug Exposure.
 Procedure cost. Cost associated with a procedure.
 Location. Physical location or address.
 Provider. Data of the medical care providers.
 Organization. Data of medical care organizations.
 Care website. Data of the medical attention points, or the particular location within an
organization.
 Payer plan period. Data on the benefits, in terms of medical care, of a person subject
to a policy.
 Cohort. Data that shares a particular characteristic over a period of time, for example,
cohort of patients, providers or visits.

Finally, we add that this model also facilitates a logical data model for vocabularies or
terminologies ("Vocabulary Logical Data Model"), that allows to accommodate concepts of
different ontologies and medical vocabularies.

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4. Holistic Health Record model

4.1. Description of the approach

4.1.1. Main principles of the HHR model

As described in the state of the art section, currently there is not a unique model that covers
all the aforementioned aspects in an integrated way. On the other hand, the goal of
CrowdHEALTH is the development of a set of data analysis tools that can be applied to
different use cases, possibly merging data coming from different contexts. Therefore, there is
the need to define one integrated model for HHRs, in order to guarantee the possibility to
apply these tools to all produced data. More precisely the project pursuits the following
principles.

First, the HHR model has to represent in a consistent way all the data required by the specific
project use cases.

Second, the model is intended to be a seed for future extensions. To this end, it will include
also types of data that are not currently required by any use case, but that the project partners
consider very likely to be used in the near future or that are useful to exemplify how the model
can be extended in the future.

Third, the model is defined using existing models as reference. In particular, on the base of
use case requirements, the project has selected the FHIR standard as the main reference for
the definition of the HHR model. While this standard is still under development and is mainly
capable to represent clinical data, it already includes the possibility to represent data that are
not necessarily clinical, such as information coming from environment sensors or related to
the social aspects. Moreover, thanks to the adoption of the concept of “resource” and the
definition of flexible extension mechanism, the FHIR model is conceived from the fundament
to be applicable in different contexts. Together with the FHIR standard, the CrowdHEALTH
project also takes into account ontologies at the state of the art, useful to qualify entity types
that correspond to specializations or abstractions of entities represented by FHIR elements.

Fourth, the HHR model is designed in UML and in parallel mapped with existing standards.
Several constraints (see next section) are imposed to the designer of the HHR model to
guarantee the feasibility of a direct mapping to FHIR. The reason for not using directly the
selected reference standard is to untie the HHR model from some assumptions adopted by
FHIR (e.g. the distinction between contained and not contained resources) and to make
explicit in the model some aspects that are implicit in FHIR (e.g. the fact that a measurement
is a kind of event), in order to ease the usage of the HHR model independently from FHIR.
Therefore, the HHR model aims on one hand to be easily implementable on top of existing
FHIR implementations, on the other hand it is also intended to be easily implementable using
different technologies.

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4.1.2. Level of abstraction and scope of the HHR model

Similarly, to some of the existing standards, the HHR model is designed using UML. Following
below is a summary of the main characteristics and constraints of the HHR model that make it
strictly related but still distinct from the reference standards.

As a general rule, each class of the HHR model corresponds to a resource type or a data type
of the FHIR model, but the HHR model is designed at an ontological level and (because of a
more specific application context, i.e. the CrowdHEALTH use cases) the HHR model is more
specialized than the FHIR model.

The usage of an ontological approach is in particular evident in two aspects that distinguish
the HHR model from the FHIR model. One aspect is that the multiplicity constraints on the
UML associations and attributes do not represent integrity constraints, as in the case of FHIR,
but represents real world existence constraints; i.e. if an attribute has minimum multiplicity
equal to 1, this does not imply that the value of that attribute must be mandatorily stored or
transmitted when exchanging data, but only that at least one value of that attribute always
exists in the world, also if this information is actually not stored in any IT system or not
transmitted. Another aspect is the usage of abstract classes that have no direct corresponding
type in FHIR, but that correspond to super-types of FHIR resource types. Such classes are
introduced to make explicit some semantic commonalities that are implicit in the FHIR model.

Moreover, in order to represent ontological distinctions that cannot be expressed with

standard UML, some specific stereotype and pattern is adopted. For example, classes of
entities (e.g. Patient) that correspond to roles of instances of other classes (e.g. Person), are
marked with the stereotype <role>. If needed, implementations of the HHR model may exploit
the explicit representation of roles and accept to assign instances of a certain role as value of
attributes which type is not that role but the type of the instances that may play that role (e.g.
accepting a Practitioner as value of an attribute expecting a Person), but not vice versa (i.e. its
forbidden to assign a Person to an attribute expecting a Practitioner).

When a class C has numerous subclasses, but these subclasses add no specific attributes or
constraints, then the subclasses are reified. Each subclass is represented by an item of an
enumeration (stereotype <enum>) and a mandatory attribute of the class C (with name Ctype)
is used to represent the specific subclass of the instance. For instance, the subclasses of the
class Condition correspond to values of the enumeration ConditionType and the specific
subclass of a Condition instance is represented by the value of the attribute named
conditionType.

The fact that the HHR model is more specialized than the FHIR model is also evident in
several aspects. The most important aspect is the absence in the HHR model of classes and
elements that are present in FHIR, because they are not needed by current CrowdHEALTH
use cases, and the presence in the HHR model of additional attributes/associations that
correspond to extensions of the FHIR standard.

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Moreover, an HHR class that corresponds to a certain FHIR resource class may have explicit
subclasses that are not represented as distinct resource classes in FHIR. Differently from the
addition of new attributes, usually the introduction in the HHR model of these explicit
subclasses does not require a corresponding FHIR extension. The instances of all such HHR
subclasses correspond to instances of the same FHIR resource class, and their conceptual
type is distinct by assigning a specific value (chosen from some coding system) to a
“category” or “code” attribute of the resource class. In other terms, the HHR model explicitly
represents concepts that are needed by the CrowdHEALTH use cases and that are implicit in
FHIR or that need a FHIR extension.

As said, a few constraints are imposed to the HHR model to guarantee an easy mapping with
FHIR and with specific coding systems. The main constraint is that any leaf element of the
HHR model (i.e. any class, attribute or association that does not have subclasses or
specializations) must correspond to exactly one (resource or data) type of the FHIR model, i.e.
its possible instances must represent the same entities of some possible instance of one
corresponding FHIR class. Another constraint is that each instance of a HHR class must
correspond to exactly one instance of the FHIR model.

On the other hand, any non-leaf element of the HHR model, is considered ontologically
“abstract”, i.e. all its representable instances or values must be instances or values of some
subclass. This is intended to avoid the usage of instances of non-leaf classes to represent
unintended entities. Implementations may impose the instantiation of only leaf classes. As
HHR classes are conceptual, advanced implementations may also allow to instantiate non-leaf
classes of the HHR model, in order to allow to represent entities which type is not completely
known, possibly allowing to specify a more specific type in a second moment (allowing the
same instance to conceptually move from a superclass to a subclass when more information
is available).

Although the semantics of HHR elements are usually more specific than the ones of the FHIR
model, in order to make the mapping more evident, the name of the most general HHR
element that is mapped to a specific FHIR element usually takes the same name of the
corresponding FHIR element. Anyway, different names are chosen when the semantics of the
HHR element is actually so specific that it would be misleading to adopt the same name than
FHIR.

The higher specialization of the HHR model, with respect to more general purpose standards,
has the advantage to reduce the ambiguity of the model and to simplify its comprehension,
reducing the risk that different standard elements are used to represent the same type of
information (a risk that is higher in standards like FHIR that by design provides alternative
possibilities to represent the same information).

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4.1.3. Mapping of HHR model to FHIR

As said in section 4.1.1 the HHR model is expressed in UML and mapped to the FHIR
standard in order to clarify its semantics and guarantee interoperability.

In order to make the mapping both easily comprehensible by humans and machine
interpretable, it has been decided to represent it at two different levels of formality. On the first
level, the mapping is expressed by means of simple tables that for each class and for each
attribute or association-end of the HHR model specify the corresponding class or attribute of
the FHIR model. As the HHR model is more specific than the FHIR model it can happen that
an attribute of an HHR class is not mapped to an attribute of the corresponding FHIR class,
but is mapped to some attribute of some nested object (i.e. value of an attribute of the class or
of another nested object) of that class. The mapping to nested attributes is specified using the
FHIRPath language. While the FHIRPath language is not specifically designed for mapping
purposes (but is intended to extract information from a FHIR resource), its rich syntax actually
allows to unambiguously refer any attribute nested at any level of any tree-like structure.

The semi-formal mapping expressed using tables and FHIRPath is sufficiently precise to be
quickly expressed and used by humans.

As part of the development phase of the HHR model, the mapping of this model to FHIR will
be also expressed in a machine understandable format, suitable to implement algorithms to
translate HHR instances, represented as objects with a structure strictly conformant to the
HHR model, to objects structured according to the FHIR model. The machine understandable
mapping will be the object of a next software deliverable.

4.1.4. Steps followed to define the HHR model

Following the general incremental development approach of the CrowdHEALTH project, also
the development of the HHR model will be done in different cycles. In this case, a two cycle
process will be followed, producing two different versions of the HHR model aligned with the
first version and the last version of the use case requirements.

In each development cycle, different tasks will be performed. Following is the description of
the tasks followed in the first development cycle.

First, each use case leader has been asked to describe the information that they would like to
store and analyse using the CrowdHEALTH tools, focusing on the data needed for the first
version of their use case implementation. A template was provided to each use case to
perform this description (annex B). In particular, it was asked to create and describe a UML
conceptual diagram representing the type of entities and relationships described by their data
source (abstracting from implementation details of the actual database scheme). It was also
asked to describe, using specific tables, each attribute of each entity and the corresponding
cardinality and value constraints.

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In a second step, different analysts have been assigned to each use case, in order to clarify
ambiguity issues related to their data source and to express a mapping of their dataset
scheme to the FHIR model, in order to disambiguate the semantics of each type, relationship
and attribute. The mapping was expressed using specific tables and the FHIRPath language.
The result of this analysis is reported in annexes B1 to B5.

In a third step, all the conceptual models produced by the use cases have been merged, one
by one, in a unique HHR model. In this phase, different conceptual classes that different use
cases had mapped to the same FHIR classes or to FHIR classes with similar semantics have
been merged in a unique HHR class, or in different subclasses of a same abstract HHR class.
The same analyses have been performed for attributes and associations.

A fourth step has been the formalization of the mapping to FHIR using the same semi-formal
approach used for the mapping of data source conceptual schemes.

Next steps, subject of a next deliverable, will be the coding of the mapping in a human
interpretable format.

Similar steps will be executed in the next development cycle.

4.1.5. Usage of the HHR model

A further mapping step will be performed during the development phase of the use cases. In
this phase, the concrete scheme of each use case will be mapped to the HHR model (instead
of FHIR, as done for the conceptual schemas during the design of the HHR model) in order to
guarantee that all use cases actually use the same representation for the same kind of data.

At runtime, using the machine understandable version of the HHR mapping to FHIR and the
mapping from the concrete scheme to the HHR model, it will be possible to convert all data
provided by the use cases data sources in a high level HHR format or to the equivalent FHIR
format.

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4.2. Requirement coverage

The HHR model reported in this document aims to satisfy the technical requirements reported
in D2.1 impacting on the data modelling and that are scheduled on the first year of the project.
In particular, the following requirements are covered:

Requirement ID Name

TL-FUNC-3211 HHR representation of physical parameters measurements provided

by sensors.

TL-FUNC-3212 Creation of student HHRs.

TL-FUNC-3214 HHR representation of information recorded by patients.

TL-FUNC-3215 Creation of patient-recorded diagnosis information HHRs.

TL-FUNC-3216 Creation of patient-recorded medication HHRs.

TL-FUNC-3218 Creation of professionals-recorded diagnostic information HHRs.

TL-FUNC-3219 Creation of patient recorded medical procedures HHRs.

TL-FUNC-32110 Creation of subject recorded nutritional information HHRs.

TL-FUNC-32111 Creation of subject recorded physical activity information HHRs.

TL-FUNC-32112 Creation of sensor recorded physical activity information HHRs.

TL-DAT-32115 FHIR v.3.0.1 standard compliance.

TL-DAT-32116 FHIR v.3.0.1 extensibility mechanisms employment for additional

data.

4.3. UML conceptual model

The conceptual HHR model is described using UML class diagrams. The overall model is
divided in several fragments to simplify the representation and the description of the reported
information, where each fragment regroups information related to a specific topic, e.g. the
representation of the information characterizing a Person, clinical Conditions of patients or
Measurements performed on Persons. For each fragment, the description of each entity and
its relationships with the other entities in the fragment is reported. The semantic of the entity
attributes is demanded to annex A, which describes the mapping between the conceptual
model and FHIR, whenever the semantic of the HHR entity attribute differs from the semantic
of the corresponding FHIR resource attribute. When the semantic of the HHR attributes or

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enumerations is the same of the corresponding FHIR attribute or enumeration, their

description is demanded to the FHIR documentation.

All attributes of the entities in the HHR model are not mandatory, i.e. their values are not
required to be stored or transmitted for each data transmission occurrence.

The current HHR model aims to represent the information enabling the execution of the first
cycle of UCs demonstrations expected for the first year of the project, and it will be next
extended to satisfy the second year incoming data requirements. In particular, the current
release of the HHR model fully covers CareAcross (annex B.4) and SLOfit (annex B.5)
datasets and partially covers HULAFE (annex B.1) and BIOASSIST (annex B.3) datasets.
During the second year, HHR model will be extended to complete the coverage of HULAFE
and BIOASSIST datasets and to include the DFKI (annex B.2) and KI UCs ones.

Person

The fragment of the conceptual HHR model shown in Figure 6 contains attributes and roles
characterizing a person. The class Person represents demographics and administrative
information about a person that are independent of any specific health context. The gender of
a person is modelled by the Gender enumeration. “Person” inherits the unique identifier from
its superclass Agent (see Identifier” section), by which a specific person may be identified in
the CrowdHEALTH platform.

Figure 6 Person model

A same person can play different individual roles into different contexts. Each individual role of
the same person is represented by a different instance of the class HealthCarePerson. Each
instance describes information of the person that is specific to the corresponding role and is
related, using the “player” association-end, to the person that plays that role. In particular, a
person has the role Patient when he or she is the subject of the health care activities provided
by HealthCare professionals. If the same person has been assisted by two different health

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providers, then it plays two different Patient roles (corresponding to two different instances of
the class Patient). On the other side, the person has the role of Practitioner when he or she is
a qualified medical doctor that works for a specific organization. If the same person works as
practitioner for two different organizations it plays two different practitioner roles,
corresponding to two different instances of the class Practitioner. If a Person’s role is tied to a
specific time frame, then it is an instance of the class PersonInTime. As for the other kind of
roles, a same person may correspond to several instances of PersonInTime. In the next
version of the HHR model the class HealthCarePerson could be considered as a subclass of
EntityInTime. This is still a subject of discussion.

A person is a Student when he or she attends a School. The Grade enumeration (Figure 7)
lists all the possible grade of school handled by the HHR model. Since the school degree of a
student is expected to evolve, the same person may correspond to several instances of
PersonInTime, each one related to a specific school degree.

A school belongs to one and only one Municipality and a municipality belongs to one and only
one Region.

Figure 7 School model

Identifier

All entities of the HHR model inherit from IdentifiedEntity, which represents any entity that can
be identified using a string id that is unique within a given IdentifierSystem. As shown in Figure
8, an IdentifiedEntity has at least one Identifier representing a numeric or alphanumeric string
that is associated with a single entity within a given identifier system, and each identifier is
generated by one system. The acknowledged systems in the HHR model are listed in the
enumeration IdentifierSystem representing a standard to associate a unique id to each entity
belonging to a specific context. Each identified entity may have only one identifier per
IdentifierSystem and it is not possible that two identified entities share the same identifier
belonging to the same IdentifierSystem.

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Figure 8 Identifier model

Condition

A recorded Event (Figure 9) is an automatic or manual activity or observation that is

performed on a person (e.g. the administration of a medication to a patient) or that produces
information about a person (e.g. the calculation of the BMI of a person). It is not required that
the event is directly related to a healthcare service.

The conceptual HHR model introduces several kinds of events.

A Condition is a statement about an objective state of a patient. The statement may be done
by the patient itself (ConditionIdentifiedByPatient) or by a practitioner
(ConditionIdentifiedByPractitioner).

Condition is distinct from a Measure because it refers to a persistent state, while a Measure
refers to a particular instant in time.

A ConditionType represents a specific subtype of condition. A ConditionType may be a

ClinicalFinding or a Diagnosis.

A ClinicalFinding is a statement about a persistent objective status of a patient.

A Diagnosis is a statement that is the result of a cognitive process, i.e. it is the interpretation of
a set of measures and/or clinical findings.

The current status of the clinical condition of the patient is specified by the association
clinicalConditionStatus and may be one of the values in the ClinicalStatus enumeration.

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Figure 9 Condition model

Activity

Planned or performed activities recorded in the HHR model are instances of Event. Each
event has an EventStatus, and each specialization of Event may use a specialized set of
status.

The Activity model shown in Figure 10 describes two specializations of Event, namely
Procedure and MedicationApplication. A Procedure represents any medical action that is
performed on a person. Even if there are many types of medical procedures that could be
performed on a person, the current version of the HHR model includes only two possible
ProcedureTypes, the radiotherapy and the surgery. Moreover, it is possible to associate a
procedure with a ProcedureStatus that characterizes the status of the clinical action. Like
EventStatus, the ProcedureStatus is modelled as an enumeration since that, also in this case,
it can assume a predefined and limited number of different values.

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Figure 10 Activity model (part 1 of 2)

MedicationApplication is an event representing the administration of a medication. Each

MedicationApplication is associated to a Medication entity, which represents a medication
produced by the hospital pharmacy or from external producers. The composition of a
Medication is specified by one or more ingredients and each ingredient is a
MedicationOrSubstance. A Substance is a pure substance (i.e. a form of matter that has

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constant chemical composition and cannot be separated into components by physical

separation methods) or a homogeneous mixture (i.e. a material that has the same proportions
of its components throughout any given sample). A Substance have a definite composition.
The composition of a substance is specified by zero or more ingredients, which are other
substances. The entity MedicationApplication is specialized by MedicationStatement and
MedicationAdministration. MedicationStatement represents an administration of a medication
asserted by an individual that doesn’t belong to the organization that provide it.
MedicationAdministration represents an administration of a medication asserted by an
individual that belongs to the organization that provides it. Respectively,
MedicationStatementStatus and MedicationAdministrationStatus represents the current status
of those entities.

Figure 11 Activity model (part 2 of 2)

Measurement

A Measure is an event consisting in a measurement or an assertion about a patient, made by

the patient itself, by a device or other subject. Measures are associated to an
ObservationStatus representing the status of the measurement observation.

Each measure results in a measured Value. Depending on the type of the value measured,
the measure can be a QuantitativeMeasure, CategoricalMeasure and ComposedMeasure. A
quantitative measure represents the measurement of a Quantity which magnitude is
represented by a number. A categorical measure represents the measurement of value
belonging to a certain Category. A composed measure represents the measurement that is
composed by two or more measures of type CategoricalMeasure or QuantitativeMeasure (e.g.
the measurement of the blood pressure, which is composed by systolic and diastolic
pressure). Quantity values are further specialized in ContinuousQuantity, in which the

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magnitude is represented by a real number and has a specific unit of measure,

DiscreteQuantity in which the magnitude is represented by an integer, and
DimensionlessQuantity, in which the value is a number and doesn’t have a unit of measure.

Figure 12 Measurement model

There exist many specializations of ContinuousQuantity, which are shown in Figure 13. Each
specialization is bound to one unit of measure, which are represented in Figure 14. For
example, a TempoQuantity is a continuous quantity which value is a real number with the
TempoUnit unit of measure, SpeedQuantity is a continuous quantity which value is a real
number with the SpeedUnit unit of measure, etc.

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Figure 13 Continuous quantity model

Figure 14 Unit of measure model

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Quantitative measures

As already mentioned, quantitative measures are measurements of values of type Quantity,

which have a (numerical) magnitude and optionally a unit of measure. Such type of
measurements is specialized by a number of entities, which represents specific types of
measurements.

For simplicity of representation and description, the specialized quantitative measures are
grouped in fitness measures, heart rate and blood pressure measures, and laboratory test
measures.

Fitness measures

Fitness measures are quantitative measures representing the set of parameters measured
during a fitness test, and physical body parameters. Specifically, fitness measures are:

 Waist: the waistline of the person.

 Height: the height of the person.
 Weight: the weight of the person.
 TricepsSF (Triceps skin fold): the width of a fold of skin taken over the triceps muscle.
Triceps skinfold reflects the amount of peripheral sub coutaneous fat. It is a proxy for
body composition.
 Run600m: the time need to run 600 meters.
 Dash60m: the time to run 60 meters.
 StandAndReach (flexibility of lower back and legs): the measure of the distance
fingertips reaches past the toes during a stand-and-reach test.
 BMI: body mass index of the person. It has an interpretation, according to World
Obesity Federation, that is one of the value of the WOF_CODE enumeration.
 PolygonBackwards: the time needed to complete the whole 10m distance during the
polygon backwards fitness test. It is measured during a fitness test designed to
measure coordination. The subject moves backwards on all fours and covers a 10-m
distance. On the course the subject craws over and under the 35 cm high obstacles
that are placed at 3 meters and 6 meters from the starting line, respectively.
 ArmPlateTapping: the number of taps completed in 20 seconds. It is measured during
a reaction test using a tapping action which measures upper body reaction time, hand-
eye quickness and coordination. It is designed to assess the speed and the
coordination of limb movement.
 StandingBroadJump: the distance jumped from a standing position. This test measures
explosive leg power.
 SitUp60s: the number of sit-ups performed in 60 seconds. It is a measure of the
strength of the trunk.
 BentArmHang: the time that a person can hold a flexed arm hang position above a
horizontal bar.

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 HR_FI: the summary measure of health-related fitness. It is calculated as the sum of

individual z-scores from 3 motor tests related to health (tests that assess endurance
and muscular strength and muscular endurance, i.e. 600m run, sit-ups and bent arm
hang).
 PR_FI: the summary measure of performance-related fitness. It is calculated as the
sum of individual z-scores from 4 motor tests related to performance (tests that assess
explosive strength, agility and speed i.e. standing broad jump, 60m run and polygon
backwards and arm-plate tapping).
 Total_FI (total physical fitness index). The sum of the individual z-scores of all 8 motor
tests (i.e. ArmPlateTapping, PolygonBackwards, BentArmHang, SitUp60s,
StandingBroadJump, Dash60m, Run600m and StandAndReach).

Figure 15 Fitness measurements model

Heart rate and blood pressure measures

HeartRateMeasure in Figure 16 is a quantitative measure representing the heart rate of an

individual. The value of the heart rate measure is an HeartRateQuantity, which has the unit of
measure of HeartBeatUnit, and it is a specialization of TempoQuantity. BloodPressure is a
measure composed by SystolicBloodPressure and DiastolicBloodPressure, which are two
quantitative measure inheriting from PressureMeasure.

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Figure 16 Heart rate and blood pressure model

Laboratory test measures

Laboratory test measures are quantitative measures representing the results of observations
generated by laboratories, and are shown in Figure 17 and Figure 18. In particular:

 C_ReactiveProtein: the c-reactive protein measurement.

 GlycosilatedHemoglobin: the glucohemoglobin measurement.
 MicroalbuminCreatinineRatio: the urine microalbumin/creatinine ratio measurement.
 Glucose: the glucose measurement.
 BloodUrea: the blood urea measurement.
 Creatinine: the creatinine measurement.
 TotalCholesterol: the total cholesterol measurement.
 LowDensityCholesterol: the low density lipoprotein cholesterol measurement.
 HighDensityCholesterol: the high density lipoprotein cholesterol measurement.
 GPTTransiminases: the alanine aminotransferase measurement.
 Albumine: the albumin measurement.
 Calcium: the calcium measurement.
 Sodium: the sodium measurement.
 Potasium: the potassium measurement.
 TransferrineSaturationIndex: the transferrin saturation index.
 Ferrinite: the ferritin measurement.
 Transferrine: the transferrin measurement.
 ArterialPh: the hemolglobin free measurement.
 Hematocrite: the platelet hematocrit measurement.
 FreeT4: the T4 free measurement.

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 FreeT3: free tri-iodothyronine measurement used to assess thyroid function (unit of

measure.
 VenousPh: the ph measurement venous.

Figure 17 Laboratory tests (part 1 of 2)

Figure 18 Laboratory tests (part 2 of 2)

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Food intake measures

FoodIntakeFrequency is a categorical measure representing the intake frequency of a specific

food by an individual (Figure 19). The current HHR model limits the types of food intake to the
values listed in the Food enumeration (e.g. “read_meat_intake”, “white_meat_intake” etc.).
The value of the frequency can be a value listed in the FoodIntakeFrequencyCategory, which
tipically represents the number of the portions per week of the specific food.

Figure 19 Food intake model

Episode of care

This section describes the fragment of the HHR model with the information related to an
episode of care. The Encounter is an event representing an interaction between a patient and
healthcare provider(s) with the purpose of providing healthcare service(s) or assessing the
health status of a patient (Figure 20). HospitalizationEncounter, EmergencyEncounter,
HospitalAtHomeEncounter and OutPatientEncounter are specialization of Encounter. In
particular:

HospitalizationEncounter represents an inpatient encounter where a patient is admitted to a

hospital to receive a specific healthcare service.

EmergencyEncounter represents an encounter that takes place at a dedicated healthcare

service delivery location where the patient receives immediate evaluation and treatment,

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provided until he or she is discharged or the responsibility for the patient’s care is transferred
elsewhere.

HospitalAtHomeEncounter represents a healthcare encounter that takes place in the

residence of the patient.

OutPatientEncounter represents all data regarding an outpatient encounter.

An EpisodeOfCare is an association between a patient and an organization/healthcare

provider during which time encounters may occur. In other words, EpisodeOfCare is the
container that can link a series of Encounter(s) together.

The current status of Encounter and EpisodeOfCare is represented by EncounterStatus and

EpisodeOfCareStatus, respectively (Figure 21). Encounter is associated to at least one
diagnosis relevant for the specific encounter. The diagnoses are of type ConditionType (see
Condition section). Each encounter has a Priority that indicates the urgency of the encounter.
DischargeDisposition is the destination of the patient at the end of the encounter (after the
discharge). As shown in Figure 22, discharge dispositions may be one of the destinations
listed in the HospitalizationDischargeDisposition and EmergencyDischargeDisposition
enumerations, which represents, respectively, the possible destinations after the discharge
from hospital and from emergency.

Figure 20 Episode of care (part 1 of 3)

Each Encounter is justified by a reason and possible reasons to be admitted to the encounter
are listed in the EncounterReason enumeration. Specifically, possible reasons to by admitted

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to inpatient encounter are represented by HospitalizationReason and possible reasons to be

admitted to an emergency encounter are represented by EmercencyReason.

Figure 21 Episode of care (part 2 of 3)

An Appointment represents a booking of a healthcare event among patient, practitioner and

related persons for a specific date/time. The current status of the appointment is represented
by AppointmentStatus.

Figure 22 Episode of care (part 3 of 3)

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Data types

HHR model defines a set of data types that are used for the HHR attributes.

Figure 23 Primitive data types model

The semantic of the HHR data types is the same of the FHIR data types. Refer to the FHIR
specification for their description.

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5. Conclusions
In a context with several sources of data like the one targeted from the CrowdHEALTH
project, the setting of a baseline allowing the aggregation of information avoiding ambiguities
is crucial. Many standards and best practices have been defined over the years with this
purpose (the most relevant of them for the project have been presented in the State of the Art
section). Among them, HL7/FHIR is the specification more tailored to the needs of the project.
It has been selected to found the HHR model, because of its high coverage of clinical data
actually present in the use cases datasets and of its flexible extension mechanism that allows
to model also not yet supported clinical data types.

FHIR covers a big number of requirements for representing and exchanging clinical data,
some of them matching with the CrowdHEALTH requirements, like for example the modelling
of medical observations and clinical conditions. Many other requirements covered by FHIR
are, instead, out of the scope of this project, like the modelling of financial information and
clinical workflows, for which the CrowdHEALTH use cases don’t require any support, at least
for the first year of the project. To this respect, FHIR results in an oversized tool introducing
complexities that are unneeded for the purposes of the project. In some case FHIR allows to
represent the same data using different Resource types and hidden important conceptual
distinction on the choice of the right code values. Therefore, in actual applications the
standard needs to be constrained to simplify the interoperability. On the other hand, FHIR
don’t cover some of the requirements of the project, lacking a specific representation of
information that is present in the analysed use cases dataset. For these reasons, a new
model, the HHR model, has been designed and tailored to the CrowdHEALTH use cases. It
represents information about persons and their individual roles, the organizations to which the
role players belong, diagnosis and clinical findings of the patients, medical procedures,
medication applications and related medication and substances administered to patients,
episodes of care and medical encounters (hospitalization, outpatient, emergency,
hospitalization at home), measurement of vital signs, physiological parameters, physical
activities results and laboratory test results.

The HHR model has been mapped to FHIR, by identifying FHIR resources and their attributes
which correspond to HHR classes and attributes. The extension mechanisms of FHIR has
been used to represent information required by use cases and modelled in the HHR model,
but not yet present in the FHIR resource. The defined extensions aim to add details to health-
related events, like the specification of who assert and/or perform an event during an episode
of care and when it occurs, indicating if the performer is an automatic agent, the age (or range
of age) of the subject at the time the event occurs, the date when a person is registered into
the system.

The mapping to FHIR is expressed in a semi-formal way, documented in an annex to this

deliverable, and in a machine interpretable format that will be documented in a separate
deliverable.

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As FHIR requires also the usage of suitable coding systems, the possibility to use SNOMED
CT for encoding clinical concepts has been investigated. Given the limitations imposed by its
terms of license, such ontology has been discarded and a project specific terminology has
been defined and used. Anyway, acceptable SNOMED terms of license that may apply to the
CrowdHEALTH project are currently under investigation with SNOMED International, and its
usage in next phases of the project will be evaluated.

The next versions of the HHR model will introduce new data entities for representing
nutritional, social and lifestyle information, together with other possible new data requirements
from use cases. The mapping with FHIR will be updated accordingly, and the current
terminology will be possibly extended.

By maintaining a double view, the HHR model aims on one hand to guarantee the
interoperability and the possibility to implement it on top of existing FHIR libraries, and on the
other hand it is also intended to be usable independently from FHIR (and its future evolutions)
and applicable also for different purposes than the exchange of health data. For example, it
can me more suitable than FHIR as data schema for Object Oriented local APIs.

The current HHR model aims to represent the information enabling the execution of the first
cycle of use case demonstrations, expected for the first year of the project. In particular, the
current release of the HHR model fully covers CareAcross and SLOfit datasets and partially
covers HULAFE and BIOASSIST datasets. During the second year, the HHR model will be
extended to satisfy new requirements, to complete the coverage of HULAFE and BIOASSIST
datasets and to include the DFKI and KI datasets.

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http://www.who.int/classifications/icd/revision/en/.

12. H., Pham, and L., Williams. Transfusion Medicine, Apheresis, and Hemostasis: Review
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15. A. Bui, and R. Taira. Medical Imaging Informatics. s.l. : Springer Science & Business
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16. A., Hoerbst et al. Using SNOMED CT Expression Constraints to Bridge the Gap Between
Clinical Decision-Support Systems and Electronic Health Records. s.l. : IOS Press, 2016, pp.
504 – 508.

17. R., Edita. Concept Mapping or Indexing of (Biomedical) Text.

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18. F. Baader, D. Calvanese, D. L. McGuinness, D. Nardi, P. F. Patel-Schneider. The

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Serra, Philippe and Ruttenberg, Alan and Sansone, Susanna-Assunta and
Scheuermann, Richard H and Shah, Nigam and Whetzel, Patricia L and Lewis, Suzanna.
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20. Disease Ontology 2015 update: An expanded and updated database of Human diseases
for linking biomedical knowledge through disease data. Kibbe, Warren A., et al., et al. D1,
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 Collective Wisdom Driving Public Health Policies

Del. no. – D3.1 Annex A: HHR to FHIR

mapping, terminology and FHIR extensions
Project Deliverable

This project has received funding from the European Union’s Horizon 2020 Programme
(H2020-SC1-2016-CNECT) under Grant Agreement No. 727560
D3.1 Annex A: HHR to FHIR mapping,
31/10/2017
terminology and FHIR extensions

1. HHR to FHIR mapping, terminology and FHIR extensions

The mapping between the conceptual model and HL7-FHIR is expressed as a set of
constrains that follows the FHIRPath syntax (documented at: http://hl7.org/fhirpath/) extended
with the notation <expression>.

There is a subsection for each package and a sub-subsection for each conceptual class of that
package. The title of the sub-subsection indicates the name of the mapped conceptual class
and (in brackets) the name of the corresponding FHIR resource. Each section contains at least
a table that defines the constraints of the mapped class. Each row describes the mapping of a
conceptual attribute (or nested attribute). The column “Assumptions” lists the assumptions for
mapping the conceptual attribute.

Assumptions of the form pathExpression=<attribute> or pathExpression.resolve()=<attribute>

(where pathExpression evaluates to a reference in the second case) are equivalent to writing
the pathExpression in the column “FHIRMapping” of the corresponding attribute row.

The value of the construct <expression> is obtained by evaluating the FHIRPath expression
on the mapped object, and returning it, if it is a primitive value, or returning its translation
(using the mapping here defined) in case it is a complex value. Adhoc parameters not
corresponding to any attribute of the mapped object, and esplained in the notes, can be used
in place of expression (e.g. a note could explain that “<category_code> represents a code
corresponding to the value of the attribute category, as defined by table Category_Code”).

Abstract classes are mapped only if the mapping of their attributes is the same for all
subclasses, otherwise the mapping of the attributes is expressed directly in the tables of the
subclasses.

When alternative mappings exist for the same attribute, the table contains multiple rows for
the attribute, one per alternative mapping, and the column “Note” specifies in which condition
each mapping applies.

When alternative mappings exist for the same class, more tables are specified for the same
class. Each table specifies in the first row (in the column assumptions) a set of constraints that
the mapped object (this) has to fulfill to apply the mapping specified by the table.

<enum> classes may be mapped to FHIR value sets or to FHIR resources. In the first case,
for each instance of the enum the tables specify the corresponding value of the value set.

In the case of enumerations (stereotype <<enum>>) additional tables are used to map each
instance of the enumeration to a specific concept/code from the corresponding ValueSet of
FHIR or the corresponding Vocabulary. Such tables have a different colour (orange).

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A description of the HHR entity attributes is provided whenever its semantic differs from the
semantic of the corresponding HL7-FHIR resource attribute, otherwise it is implicitly
understood that the semantic is the same as in FHIR.

1.1. Mapping conceptual model on HL7 FHIR

In this section the mapping of HHR conceptual model on HL7-FHIR is described.

Person model mapped to HL7-FHIR

HHR <role> Patient (Person) mapped to FHIR Patient

Attribute or Type Mandatory FHIR mapping Assumptions Notes

AssociationEnd (YES/NO)
player.identifier Identifier YES Patient.identifier Patient.identifier.value=<Identif
ierEntity.Identifier.value>, Pati
ent.identifier.system=<Identifie
rEntity.Identifier.system>
player.firstName String NO Patient.name.given
player.lastName String NO Patient.name.family
player.email String NO Patient.telecom.value Patient.telecom.system='email'
player.registeredWhen dateTime NO EXTENSION: When the patient
Patient.registeredWhen was registered for
the first time into
the system
player.gender Gender NO Patient.gender
player.birthDate Date NO Patient.birthDate
player.deathDate Date NO Patient.deceased Patient.deceased is dateTime

HHR <role> Practitioner (Person) mapped to FHIR Practitioner

Attribute or Type Mandatory FHIR mapping Assumptions Notes

AssociationEnd (YES/NO)
player.identifier Identifier YES Practitioner.identifier Practitioner.identifier.value=<Id
entifierEntity.Identifier.value>,
Practitioner.identifier.system=<
IdentifierEntity.Identifier.syste
m>
player.firstName String NO Practitioner.practitioner.na
me.given
player.lastName String NO Practitioner.practitioner.na
me.family
player.email String NO Practitioner.practitioner.tel Practitioner.practitioner.teleco
ecom.value m.system='email'
player.registeredWhen dateTime NO EXTENSION: When the
Practitioner.registeredWhe practitioner was
n registered for the
first time into the
system
player.gender Gender NO Practitioner.practitioner.ge
nder
player.birthDate Date NO Practitioner.birthDate
player.deathDate Date NO Practitioner.deceased Practitioner.deceased is

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dateTime

HHR <role> Student (Person) mapped to FHIR Patient

Attribute or Type Mandatory FHIR mapping Assumptions Notes

AssociationEnd (YES/NO)
identifier Identifier YES Patient.identifier Patient.identifier.value=<Identif This is the id of the
ierEntity.Identifier.value>, Pati student
ent.identifier.system=<Identifie
rEntity.Identifier.system>
firstName String NO Patient.name.given
lastName String NO Patient.name.family
dateOfBirth date NO Patient.birthDate
email String NO Patient.telecom.value Patient.telecom.system='email'
registeredWhen dateTime NO EXTENSION:
Patient.registeredWhen
gender Gender NO Patient.gender
birthDate Date NO Patient.birthDate
deathDate Date NO Patient.deceased
attendedSchool School NO Patient.managingOrganizat This is a reference
ion to the FHIR
Organization
resource
representing the
School to which the
student belongs to.
grade Grade Observation.category.coding[0] Observation.subject
.display="social-history" contains the
Observation.category.coding[0] reference to the
. ode=”So ial histo ” FHIR resource
Observation.category.coding[0] representing the
.s ste =”http://hl7.org/fhir/ob student.
servation-category”
O se atio .status=”fi al”,
Observation.code.coding[0].cod
e=”s hool-g ade”
Observation.code.coding[0].dis
play=”S hool g ade”,
Observation.code.coding[0].sys
te =”http://www.crowdhealth
.eu/hhr-t”
Observation.value is
CodeableConcept
Observation.code.coding[0].cod
e=<grade code>
Observation.code.coding[0].dis
play=<grade display>
Observation.code.coding[0].sys
te =”http://www.crowdhealth
.eu/hhr-t/”
Observation.subject.reference.r
esolve() is Patient
Observation.subject=<this>

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Condition model mapped to HL7-FHIR

HHR Condition mapped to FHIR Condition

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
identifier Identifier YES Condition.identifier Condition.identifier.value=<Ide
ntifierEntity.Identifier.value>, C
ondition.identifier.system=<Ide
ntifierEntity.Identifier.system>
isAutomatic Boolean NO isAutomatic USED EXTENSION:
Condition.isAutoma
tic
subject Person YES Condition.subject Condition.subject.reference.res
olve() is Patient
performer HealthCa NO performer USED EXTENSION:
rePerson Condition.performe
r
performedWhen DateTime NO performedWhen USED EXTENSION:
Condition.performe
dWhen
conditionClinicalStatus ClinicalSt YES Condition.clinicalStatus Co ditio . li i alStatus=”a ti e
atus ”
conditionType Diagnosis YES Condition.code.coding[0].code= If conditionType is a
/ClinicalFi <value_code> Diagnosis:
nding Condition.code.coding[0].displa Condition.category.
y=<description> odi g[0]. ode=”di
Condition.code.coding[0].syste ag osis”,
m=<terminology URI> Condition.category.
odi g[0].displa =”
Diag osis”
Condition.category.
coding[0].system=”
http://crowdhealth.e
u/hhr-t”.
If conditionType is
a ClinicalFinding:
Condition.category.
coding[0].code=”cli
nicalFinding”,
Condition.category.
coding[0].display=”
Clinical finding”
Condition.category.
coding[0].system=”
http://crowdhealth.e
u/hhr-t”
asserter HealthCa NO Condition.asseter Condition.asserter.reference.re
rePerson solve() is Patient
Condition.asserter.reference.re
solve() is Practitioner
assertedWhen dateTime NO Condition.asserteredDate
recorder Agent NO <this_provenance>.agent. <this_provenance>.target=<this The parameter
who > <this> refers to the
<this_provenance>.agent.who FHIR resource
is Reference mapped to the
recordedWhen dateTime NO <this_provenance>.recorde translated object.
d <this_provenance>
refers to a FHIR
resource of type
Provenance
specifically created

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to record the
provenance of
<this>.
subjectAge Value NO Condition.onset Condition.onset is Age

Activity model mapped to HL7-FHIR

HHR Radiotherapy mapped to FHIR Procedure

Attribute or Type Mandatory FHIR mapping Assumptions Notes

AssociationEnd (YES/NO)
Procedure..code.coding[0].code
=” adiatio -oncology-and-or-
adiothe ap ”
Procedure.code.coding[0].displ
a =”Radiatio o olog
AND/OR adiothe ap ”
Procedure.code.coding[0].syste
=”http://crowdhealth.eu/hhr-
t”
identifier Identifier YES Procedure.identifier Procedure.identifier.value=<Ide
ntifierEntity.Identifier.value>, C
ondition.identifier.system=<Ide
ntifierEntity.Identifier.system>
isAutomatic boolean NO isAutomatic USED EXTENSION:
Procedure.isAutom
atic
subject HealthCa YES Procedure.subject
rePerson
performer Agent NO Procedure.Performed.actor
performedWhen DateTime NO Procedure.performed Procedure.performed is
dateTime
asserter HealthCa NO asserter USED EXTENSION:
rePerson Procedure.asserter
assertedWhen DateTime NO assertedWhen USED EXTENSION:
Procedure.asserted
When
recorder Agent N0 <this_provenance>.agent. <this_provenance>.target=<this The parameter
who > <this> refers to the
<this_provenance>.agent.who FHIR resource
is Reference mapped to the
recordedWhen DateTime NO <this_provenance>.recorde translated object.
d <this_provenance>
refers to a FHIR
resource of type
Provenance
specifically created
to record the
provenance of
<this>.
status Procedur YES Procedure.status
eStatus

HHR Surgery mapped to FHIR Procedure

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Attribute or Type Mandatory FHIR mapping Assumptions Notes

AssociationEnd (YES/NO)
Procedure..code.coding[0].code
=”su gi al-p o edu e”
Procedure.code.coding[0].displ
a =”Su gi al p o edu e”
Procedure.code.coding[0].syste
=”http://crowdhealth.eu/hhr-
t”
identifier Identifier YES Procedure.identifier Procedure.identifier.value=<Ide
ntifierEntity.Identifier.value>, C
ondition.identifier.system=<Ide
ntifierEntity.Identifier.system>
isAutomatic boolean NO isAutomatic USED EXTENSION:
Procedure.isAutom
atic
subject Patient YES Procedure.subject.reference.re
solve() is Patient
performer Agent NO Procedure.Performed.actor
performedWhen DateTime NO Procedure.performed Procedure.performed is
dateTime
asserter HealthCa NO asserter USED EXTENSION:
rePerson Procedure.asserter
assertedWhen DateTime NO assertedWhen USED EXTENSION:
Procedure.asserted
When
recorder Agent NO <this_provenance>.agent. <this_provenance>.target=<this The parameter
who > <this> refers to the
<this_provenance>.agent.who FHIR resource
is Reference mapped to the
recordedWhen DateTime NO <this_provenance>.recorde translated object.
d <this_provenance>
refers to a FHIR
resource of type
Provenance
specifically created
to record the
provenance of
<this>.
status Procedur YES Procedure.status
eStatus

HHR Medication mapped to FHIR Medication

Attribute or Mandatory
Type FHIR mapping Assumptions Notes
AssociationEnd (YES/NO)
Medicati
ingredient onOrSubs NO Medication.ingredient
tance

HHR MedicationAdministration mapped to MedicationAdministration

Attribute or Type Mandatory FHIR mapping Assumptions Notes

AssociationEnd (YES/NO)
identifier Identifier YES MedicationAdministration.i MedicationAdministration.ident
dentifier ifier.value=<IdentifierEntity.Ide
ntifier.value>, MedicationAdmi
nistration.identifier.system=<Id

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entifierEntity.Identifier.system>
subject Patient YES MedicationAdministration.
subject
performer Agent NO MedicationAdministration.
performer.actor
performedWhen DateTime NO MedicationAdministration. MedicationAdministration.effec
effective tive is dateTime
asserter HealthCa NO asserter USED EXTENSION:
rePerson MedicationAdminis
tration.asserter
assertedWhen DateTime NO assertedWhen USED EXTENSION:
MedicationAdminis
tration.assertedWh
en
recorder Agent NO <this_provenance>.agent. <this_provenance>.target=<this The parameter
who > <this> refers to the
<this_provenance>.agent.who FHIR resource
is Reference mapped to the
recordedWhen DateTime NO <this_provenance>.recorde translated object.
d <this_provenance>
refers to a FHIR
resourse of type
Provenance
specifically created
to record the
provenance of
<this>.
status Medicati YES MedicationAdministration.
onAdmini status
strationSt
atus
medication Medicati YES MedicationAdministration.
onOrSubs medication
tance

HHR MedicationStatement mapped to FHIR MedicationStatement

Attribute or Type Mandatory FHIR mapping Assumptions Notes

AssociationEnd (YES/NO)
identifier Identifier YES MedicationAdministration.i MedicationAdministration.ident
dentifier ifier.value=<IdentifierEntity.Ide
ntifier.value>, MedicationAdmi
nistration.identifier.system=<Id
entifierEntity.Identifier.system>
subject Patient YES MedicationStatement.subj
ect
performer Agent NO performer USED EXTENSION:
MedicationStateme
nt.performer
performedWhen DateTime NO MedicationStatement.effec MedicationAdministration.effec
tive tive is dateTime
asserter HealthCa NO MedicationStatement.infor See also mapping of
rePerson mationSource subclasses of
HealthCarePerson
assertedWhen DateTime NO MedicationStatement.date
Asserted
recorder Agent NO <this_provenance>.agent. <this_provenance>.target=<this The parameter
who > <this> refers to the
<this_provenance>.agent.who FHIR resource

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is Reference mapped to the

recordedWhen DateTime NO <this_provenance>.recorde translated object.
d <this_provenance>
refers to a FHIR
resourse of type
Provenance
specifically created
to record the
provenance of
<this>.
status Medicati YES MedicationStatement.statu
onStatem s
entStatus
medication Medicati YES MedicationStatement.medi
onOrSubs cation
tance

Measurement model mapped to HL7-FHIR

The following table doesn’t represent the mapping of Measure to FHIR Observation resource
because, according to the rule, an abstract class must not be mapped to any FHIR resources.
This mapping avoids, meredy, to report all the attributes that are mapped in the same way to
Observation resource in every subclass of Measure. This choice simplifies the representation
of the mapping to FHIR. specification.

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
identifier Identifier YES Observation.identifier Observation.identifier.value=<I
dentifierEntity.Identifier.value>,
Observation.identifier.system=
<IdentifierEntity.Identifier.syste
m>
perfomerdwhen DateTime YES Observation.effective Observation.effective is
DateTime
note String NO Observation.comment
subject Patient YES Observation.subject.reference.r The subject
esolve() is Patient attribute holds a
Reference to the
Patient
performer HealthCa YES Observation.performer.referen The attribute type
rePerson ce.resolve() is Patient or is must be mapped on
Practitioner one of Patient or
Practitioner
according to the
user who is
performing the
measurement
observationStatus Observati YES Observation.status O se atio .status=”fi al”
onStatus
assertedWhen dateTime NO USED EXTENSION:
Observation.assertedWhen
asserter HealthCa NO USED EXTENSION:
rePerson Observation.asser
recorder Agent NO <this_provenance>.agent. <this_provenance>.target=<this The parameter
who > <this> refers to the
<this_provenance>.agent.who FHIR resource
is Reference mapped to the

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translated object.
recordedWhen dateTime NO <this_provenance>.recorde <this_provenance>
d refers to a FHIR
resource of type
Provenance
specifically created
to record the
provenance of
<this>.

HHR Weight mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0].
display="Vital Signs"
Observation.category.coding[0].
ode=” ital-sig s”
Observation.category.coding[0].
s ste =”http://hl7.org/fhir/obs
ervation-category”
value WeightQ YES Observation.value Observation.value is Quantity The preferred unit
uantity O se atio . alue.u it=”Kg” of measure used for
O se atio . alue.s ste =”htt Body Weight is
p://u itsof easu e.o g” UCUM kilograms
Observation.value.value=<Conti (Kg).
nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].dis
play="Body Weight"
Observation.code.coding[0].cod
e=” od - eigh”
Observation.code.coding[0].sys
te =”http:// o dhealth.eu/h
hr-t”

HHR Height mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value LenghtQu YES Observation.value Observation.value is Quantity The preferred unit
antity O se atio . alue.u it=” ” of measure used for
O se atio . alue.s ste =”htt Body Height is
p://u itsof easu e.o g” UCUM meters (m).
Observation.value.value=<Conti
nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].dis
play="Body height"
Observation.code.coding[0].cod

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e=” od -height”
Observation.code.coding[0].sys
te =”http:// o dhealth.eu/h
hr-t”

HHR Waist mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value LenghtQu YES Observation.value Observation.value is Quantity The preferred unit
antity O se atio . alue.u it=” ” of measure used for
O se atio . alue.s ste =”htt Body Waist is
p://u itsof easu e.o g” UCUM centimeters
Observation.value.value=<Conti (cm).
nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].dis
play="Waist circumference"
Observation.code.coding[0].cod
e=” aist- i u fe e e”
Observation.code.coding[0].sys
te =”http:// o dhealth.eu/h
hr-t”

HHR BMI mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value BMIQuan YES Observation.value Observation.value is Quantity
tity O se atio . alue.u it=”Kg/
”
O se atio . alue.s ste =”htt
p://u itsof easu e.o g”
Observation.value.value=<Conti
nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].dis
pla ="Bod ass i de BMI ”
Observation.code.coding[0].cod
e=” i”
Observation.code.coding[0].sys
te =”http:// o dhealth.eu/h
hr-t”

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interpretation WOF_CODE NO Observation.interpretation Observation.code.coding[0].dis

play=<display value>
Observation.code.coding[0].cod
e=<code value>
Observation.code.coding[0].sys
te =”https://www.worldobesit
y.org/”

HHR Total_FI mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Dimensio YES Observation.value Observation.value is Quantity
nlessQua Observation.value.value=<Conti
ntity nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].cod
e=”Total_FI”
Observation.code.coding[0].dis
pla =”Total ph si al fit ess
i de ”
Observation.code.coding[0].sys
te =”http:// . o dhealth
.eu/hhr-t”

HHR TricepSF mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value LenghtQu YES Observation.value Observation.value is Quantity
antity Observation.value.value=<Conti
nuousQuantity.magnitude>
O se atio . alue.u it=”MilliM
ete ”
O se atio . alue.s ste =”htt
p://u itsof easu e.o g”
Observation.value.code=”mm”
Observation.code Observation.code.coding[0].cod
e=”triceps-skin-fold-thickness”
Observation.code.coding[0].dis
pla =”T i eps ski fold
thi k ess”

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Observation.code.coding[0].sys
te =”http://crowdhealth.eu/h
hr-t”

HHR Run600m mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Duration YES Observation.value Observation.value is Quantity
Observation.value.value=<Conti
nuousQuantity.magnitude>
O se atio . alue.u it=”Se o
d”
O se atio . alue.s ste =”
http://u itsof easu e.o g”
Observation.value.code=”s”
Observation.code Observation.code.coding[0].cod
e=”600 - u ”
Observation.code.coding[0].dis
pla =”600 u ”
Observation.code.coding[0].syst
em=”http://www.crowdhealth.e
u/hhr-t/”

HHR Dash60m mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Duration YES Observation.value Observation.value is Quantity
Observation.value.value=<Conti
nuousQuantity.magnitude>
O se atio . alue.u it=”Se o
d”
O se atio . alue.s ste =”
http://u itsof easu e.o g”
Observation.value.code=”s”
Observation.code Observation.code.coding[0].cod
e=”60 -dash”
Observation.code.coding[0].dis
pla =”60 dash”
Observation.code.coding[0].syst

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em=”http://www.crowdhealth.e
u/hhr-t/”

HHR StandAndReach mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value LenghtQu YES Observation.value Observation.value is Quantity
antity Observation.value.value=<Conti
nuousQuantity.magnitude>
O se atio . alue.u it=”Ce ti
Mete ”
O se atio . alue.s ste =”htt
p://u itsof easu e.o g”
Observation.value.code=”cm”
Observation.code Observation.code.coding[0].cod
e=”sta d-and- ea h”
Observation.code.coding[0].dis
pla =”Sta d a d ea h”
Observation.code.coding[0].sys
te =”http:// . o dhealth
.eu/hhr-t/”

HHR PR_FI mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Dimensio YES Observation.value Observation.value is Quantity
nlessQua Observation.value.value=<Conti
ntity nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].cod
e=”pe fo a e-related-
physical fitness-i de ”
Observation.code.coding[0].dis
pla =”Pe fo a e related
physical fitness i de ”
Observation.code.coding[0].sys
te =”http:// . o dhealth
.eu/hhr-t”

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HHR PolygonBackwards mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Duration YES Observation.value Observation.value is Quantity
Observation.value.value=<Conti
nuousQuantity.magnitude>
O se atio . alue.u it=”Se o
d”
O se atio . alue.s ste =”
http://u itsof easu e.o g”
Observation.value.code=”s”
Observation.code Observation.code.coding[0].cod
e=”pol go - a k a ds”
Observation.code.coding[0].dis
pla =”Pol go a k a ds”
Observation.code.coding[0].syst
em=”http://www.crowdhealth.e
u/hhr-t”

HHR ArmPlateTapping mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Dimensio YES Observation.value Observation.value is Quantity
nlessQua Observation.value.value=<Conti
ntity nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].cod
e=”a -plate-tappi g”
Observation.code.coding[0].dis
pla =”A plate tappi g”
Observation.code.coding[0].sys
te =”http:// . o dhealth
.eu/hhr-t”

HHR StandingBroadJump mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]

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. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value lenghtQu YES Observation.value Observation.value is Quantity
antity Observation.value.value=<Conti
nuousQuantity.magnitude>
O se atio . alue.u it=”
Ce tiMete ”
O se atio . alue.s ste =”
http://u itsof easu e.o g”
Observation.value.code=”cm”
Observation.code Observation.code.coding[0].cod
e=”sta di g-long-ju p”
Observation.code.coding[0].dis
pla =”Sta di g lo g ju p”
Observation.code.coding[0].sys
te =”http:// . o dhealth
.eu”

HHR HR_FI mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Dimensio YES Observation.value Observation.value is Quantity
nlessQua Observation.value.value=<Conti
ntity nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].cod
e=”health-related-physical-
fitness-i de ”
Observation.code.coding[0].dis
pla =”Health-related physical
fit ess i de ”
Observation.code.coding[0].sys
te =”http:// . o dhealth
.eu/hhr-t”

HHR SitUps60s mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Dimensio YES Observation.value Observation.value is Quantity

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nlessQua Observation.value.value=<Conti
ntity nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].cod
e=”sit-ups-60-se o ds”
Observation.code.coding[0].dis
pla =”Sit ups 60 se o ds”
Observation.code.coding[0].sys
te =”http:// . o dhealth
.eu/hhr-t”

HHR BentArmHang mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Dimensio YES Observation.value Observation.value is Quantity
nlessQua Observation.value.value=<Conti
ntity nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].cod
e=” e t-arm-ha g”
Observation.code.coding[0].dis
pla =”Be t a -ha g”
Observation.code.coding[0].sys
te =”http:// . o dhealth
.eu/hhr-t”

Food intake model mapped to HL7-FHIR

HHR FoodIntakeFrequency mapped to FHIR Observation

Attribute or Mandatory
Type FHIR mapping Assumptions Note
AssociationEnd (YES/NO)
Observation.category[0].coding
[0]. ode=”so ial-histo ”,
Observation.category[0].coding
[0].displa =”So ial Histo ”,
value Category YES
Observation.category[0].coding
[0].s ste =”https://www.hl7.o
rg/fhir/valueset-observation-
category.html”
Observation.code.coding[0].cod
e=<value_code>
Observation.code.coding[0].dis
food Food YES Observation.code
play=<description>
Observation.code.coding[0].sys
tem=<terminology URI>
foodIntakeFrequencyCa FoodInta Observation.value Observation.value is Quantity

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tegory keFreque
ncyCateg
ory

Heart rate and blood pressure model

HHR HeartRateMeasure mapped to FHIR Observation

Attribute or Mandatory
Type FHIR mapping Assumptions Note
AssociationEnd (YES/NO)
Observation.category[0].coding
[0].code="vital-signs",
Observation.category[0].coding
[0].display="Vital Signs",
Observation.category[0].coding
[0].system="http://hl7.org/fhir/
observation- atego "”
Observation.code.coding[0].cod
e=”hea t- ate”
Observation.code.coding[0].dis
Observation.code pla =”Hea t ate”
Observation.code.coding[0].syst
e =”http://crowdhealth.eu/hh
HeartRat r-t”
value eQuantit YES Observation.value is Quantity
y Observation.value.value=<value
>,
O se atio . alue.u it=” eats/
Observation.value
i ute”,
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”,
O se atio . alue. ode=”/ i ”

HHR SystolicBloodPressure and HHR DiastolicBloodPreassure mapped to FHIR

Observation

Attribute or Mandatory
Type FHIR mapping Assumptions Note
AssociationEnd (YES/NO)
Observation.category[0].coding
[0].code="vital-signs",
Observation.category[0].coding
[0].display="Vital Signs",
Observation.category[0].coding
[0].system="http://hl7.org/fhir/
observation- atego "”
Observation.code.coding[0].cod
e=” lood-p essu e”
Observation.code.coding[0].dis
Observation.code pla =”Blood p essu e”
Observation.code.coding[0].sys
tem=”http://crowdhealth.eu/h
hr-t”
Observation.component[0].valu
e is Quantity
SystolicBloodPreassure. Pressure
NO Observation.component Observation.component[0].cod
value Quantity
e. odi g[0]. ode=” s stoli -
blood-p essu e”

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Observation.component[0].cod
e. odi g[0].displa =”S stoli
lood p essu e”,
Observation.component[0].cod
e. odi g[0].s ste =”http://cro
wdhealth.eu/hhr-t”

Observation.component[0].valu
e.value=<value>,
Observation.component[0].valu
e.u it=” Hg”,
Observation.component[0].valu
e.s ste =”http://unitsofmeasu
re.org”,
Observation.component[0].valu
e. ode=” [Hg]”
Observation.component[0].valu
e is Quantity

Observation.component[0].cod
e. odi g[0]. ode=” diastoli -
blood-p essu e”
Observation.component[0].cod
e. odi g[0].displa =”Diastoli
lood p essu e”,
Observation.component[0].cod
DiastolicBloodPreassure Pressure e. odi g[0].s ste =”http://cro
NO Observation.component
.value Quantity wdhealth.eu/hhr-t”

Observation.component[0].valu
e.value=<value>,
Observation.component[0].valu
e.u it=” Hg”,
Observation.component[0].valu
e.s ste =”http://unitsofmeasu
re.org”,
Observation.component[0].valu
e. ode=” [Hg]”

HHR CReactiveProtein mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=” illig
a pe lite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”

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O se atio . alue. ode=” g/L”

>
Observation.code Observation.code.coding[0].cod
e=” -reactive-p otei ”
Observation.code.coding[0].dis
pla =”C-reactive protein
easu e e t”
Observation.code.coding[0].sys
te =”http://www.crowdhealth
.eu/hhr-t”

HHR GlycosilatedHemoglobin mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Percenta YES Observation.value Observation.value is Quantity
geQuanti Observation.value.value=<Conti
ty nuousQuantity.magnitude>
O se atio . alue.u it=”pe e
t”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=”%”>
Observation.code Observation.code.coding[0].cod
e=”gl osilated-he oglo i ”
Observation.code.coding[0].dis
pla =”Glu ohe oglo i
easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR MicroalbuminCretinineRatio mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Dimensio YES Observation.value Observation.value is Quantity
nlessQua Observation.value.value=<Conti
ntity nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].cod
e=” i oal u i -creatinine-

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atio”
Observation.code.coding[0].dis
pla =”U i e
microalbumin/creatinine ratio
easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR Glucose mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=” illig
a pe de ilite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=” g/d
L”
Observation.code Observation.code.coding[0].cod
e=”glu ose”
Observation.code.coding[0].dis
pla =”Glu ose easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR BloodUrea mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=” illig
a pe de ilite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=” g/d

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L”
Observation.code Observation.code.coding[0].cod
e=” lood-u ea”
Observation.code.coding[0].dis
pla =”Blood u ea
easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR Creatinine mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=” illig
a pe de ilite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=” g/d
L”
Observation.code Observation.code.coding[0].cod
e=” eati i e”
Observation.code.coding[0].dis
pla =”C eati i e
easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR TotalCholesterol mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=” illig
a pe de ilite ”
O se atio . alue.s ste =”htt

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p://unitsofmeasure.org”
O se atio . alue. ode=” g/d
L”
Observation.code Observation.code.coding[0].cod
e=”total- holeste ol”
Observation.code.coding[0].dis
pla =”Total Choleste ol”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR LowDensityCholesterol mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=” illig
a pe de ilite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=” g/d
L”
Observation.code Observation.code.coding[0].cod
e=”lo -density- holeste ol”
Observation.code.coding[0].dis
pla =”Lo de sit lipop otei
holeste ol easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR HighDensityCholesterol mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=” illig
a pe de ilite ”

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O se atio . alue.s ste =”htt

p://unitsofmeasure.org”
O se atio . alue. ode=” g/d
L”
Observation.code Observation.code.coding[0].cod
e=”high-density- holeste ol”
Observation.code.coding[0].dis
pla =”High de sit lipop otei
holeste ol easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR GOTTransaminases mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value EnzymeC YES Observation.value Observation.value is Quantity
oncentrat Observation.value.value=<Conti
ionQuant nuousQuantity.magnitude>
ity O se atio . alue.u it=”e z
e u it pe lite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=”U/L”
Observation.code Observation.code.coding[0].cod
e=”got-t a sa i ases”
Observation.code.coding[0].dis
pla =”Aspa tate
aminotransferase
easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR GPTTransaminases mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value EnzymeC YES Observation.value Observation.value is Quantity
oncentrat Observation.value.value=<Conti
ionQuant nuousQuantity.magnitude>

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ity O se atio . alue.u it=”e z

e u it pe lite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=”U/L”
Observation.code Observation.code.coding[0].cod
e=”gpt-t a sa i ases”
Observation.code.coding[0].dis
pla =”Ala i e a i ot a sfe ase
easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR Albumine mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0].
display="Vital Signs"
Observation.category.coding[0].
ode=” ital-sig s”
Observation.category.coding[0].
s ste =”http://hl7.org/fhir/obs
ervation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=”g a
pe de ilite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=”g/dL”
Observation.code Observation.code.coding[0].cod
e=”al u i e”
Observation.code.coding[0].dis
pla =”Al u i easu e e t”
Observation.code.coding[0].syst
em=”http:// . o dhealth.
eu/hhr-t”

HHR Calcium mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=” illig

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a pe de ilite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=” g/d
L”
Observation.code Observation.code.coding[0].cod
e=” al iu ”
Observation.code.coding[0].dis
pla =”Cal iu easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR Sodium mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value AmountO YES Observation.value Observation.value is Quantity
fSubstanc Observation.value.value=<Conti
eConcent nuousQuantity.magnitude>
rationQu O se atio . alue.u it=” illie
antity ui ale t pe lite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=” e /
L”
Observation.code Observation.code.coding[0].cod
e=”sodiu ”
Observation.code.coding[0].dis
pla =”Sodiu easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR Potasium mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0].
display="Vital Signs"
Observation.category.coding[0].
ode=” ital-sig s”
Observation.category.coding[0].
s ste =”http://hl7.org/fhir/obs
ervation-category”
value AmountO YES Observation.value Observation.value is Quantity
fSubstanc Observation.value.value=<Conti
eConcent nuousQuantity.magnitude>
rationQu O se atio . alue.u it=” illie

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antity ui ale t pe lite ”

O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=” e /
L”
Observation.code Observation.code.coding[0].cod
e=”potasiu ”
Observation.code.coding[0].dis
pla =”Potassiu easu e e t”
Observation.code.coding[0].syst
em=”http:// . o dhealth.
eu/hhr-t”

HHR TransferrineSaturationIndex mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Percenta YES Observation.value Observation.value is Quantity
geQuanti Observation.value.value=<Conti
ty nuousQuantity.magnitude>
O se atio . alue.u it=”pe e
t”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=”%”
Observation.code Observation.code.coding[0].cod
e=”t a sfe i e-saturation-
i de ”
Observation.code.coding[0].dis
pla =”T a sfe i satu atio
i de ”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR Ferritine mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>

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y O se atio . alue.u it=” a og

a pe illliite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=” g/m
L”
Observation.code Observation.code.coding[0].cod
e=”fe iti e”
Observation.code.coding[0].dis
pla =”Fe iti e easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR Transferrine mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=” illig
a pe de ilite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=” g/d
L”
Observation.code Observation.code.coding[0].cod
e=”t a sfe i e ”
Observation.code.coding[0].dis
pla =”T a sfe i e
easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

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HHR ArterialPh mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Dimensio YES Observation.value Observation.value is Quantity
nlessQua Observation.value.value=<Conti
ntity nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].cod
e=”a te ial-ph”
Observation.code.coding[0].dis
pla =”pH easu e e t,
a te ial”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR Hemoglobin mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=”g a
pe de ilite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=”g/dL”
Observation.code Observation.code.coding[0].cod
e=”he oglo i ”
Observation.code.coding[0].dis
pla =”He oglo i , f ee
easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

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HHR Hematocrite mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Percenta YES Observation.value Observation.value is Quantity
geQuanti Observation.value.value=<Conti
ty nuousQuantity.magnitude>
O se atio . alue.u it=”pe e
t”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=”%”
Observation.code.coding[0].cod
e=”he ato ite”
Observation.code.coding[0].dis
pla =”He ato ite”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR FreeT4 mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=” a og
a pe de ilite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=” g/dL
”
Observation.code Observation.code.coding[0].cod
e=”f ee-t ”
Observation.code.coding[0].dis
pla =”T f ee easu e e t”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

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HHR FreeT3 mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value MassCon YES Observation.value Observation.value is Quantity
centratio Observation.value.value=<Conti
nQuantit nuousQuantity.magnitude>
y O se atio . alue.u it=”pi og
a pe de ilite ”
O se atio . alue.s ste =”htt
p://unitsofmeasure.org”
O se atio . alue. ode=”pg/dL
”
Observation.code Observation.code.coding[0].cod
e=”f ee-t ”
Observation.code.coding[0].dis
pla =”F ee T ”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

HHR VenousPh mapped to FHIR Observation

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Observation.category.coding[0]
.display="Vital Signs"
Observation.category.coding[0]
. ode=” ital-sig s”
Observation.category.coding[0]
.s ste =”http://hl7.org/fhir/ob
servation-category”
value Dimensio YES Observation.value Observation.value is Quantity
nlessQua Observation.value.value=<Conti
ntity nuousQuantity.magnitude>
Observation.code Observation.code.coding[0].cod
e=” e ous-ph”
Observation.code.coding[0].dis
pla =”pH easu e e t,
e ous”
Observation.code.coding[0].sys
tem=”http:// . o dhealth
.eu/hhr-t”

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School model mapped to HL7-FHIR

HHR School mapped to FHIR Organization

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Organization.type.code.system
=”http://hl7.org/fhir/organizati
on-type”
Organization.type.code.display
=”Edu atio al I stitute”
O ga izatio .t pe. ode. ode=”
edu”
identifier Identifier YES Organization.identifier Organization.identifier.value=<I
dentifierEntity.Identifier.value>,
Organization.identifier.system
=<IdentifierEntity.Identifier.syst
em>
municipality Municipa YES Organization.partOf This is a reference
lity to the FHIR
Organization
resource
representing the
Municapility to
which the School
belongs to.

HHR Municipality mapped to FHIR Organization

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Organization.type.code.system
=”http://hl7.org/fhir/organizati
on-type”
Organization.type.code.display
=”Go e e t”
O ga izatio .t pe. ode. ode=”
go t”
Organization.name=<name of
the Municipality>
identifier Identifier YES Organization.identifier Organization.identifier.value=<I IdentifierEntity.Iden
dentifierEntity.Identifier.value>, tifier.value is the id
Organization.identifier.system of the Municipality
=<IdentifierEntity.Identifier.syst
em>
region Region YES Organization.partOf This is a reference
to the FHIR
Organization
resource
representing the
Region to which the
Municipality
belongs to.

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HHR Region mapped to FHIR Organization

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
Organization.type.code.system
=”http://hl7.org/fhir/organizati
on-type”
Organization.type.code.display
=”Go e e t”
O ga izatio .t pe. ode. ode=”
go t”
Organization.name=<name of
the Region>
identifier Identifier YES Organization.identifier Organization.identifier.value=<I IdentifierEntity.Iden
dentifierEntity.Identifier.value>, tifier.value is the id
Organization.identifier.system of the Region
=<IdentifierEntity.Identifier.syst
em>

EpisodeOfCare model mapped to HL7-FHIR

HHR Encounter mapped to FHIR Encounter

The following table doesn’t represent the mapping of Encounter to FHIR Encounter resource
because, according to the rule, an abstract class must not be mapped to any FHIR resources.
This mapping avoids, merely, to report all the attributes that are mapped in the same way to
Encounter resource in every subclass of Encounter. This choice simplifies the representation
of the mapping to FHIR specification.

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
identifier Identifier YES Encounter.identifier Encounter.identifier.value=<Ide
ntifierEntity.Identifier.value>, E
ncounter.identifier.system=<Ide
ntifierEntity.Identifier.system>
performedWhen Period NO Encounter.period
class code NO Encounter.class
priority Priority NO Encounter.priority
dischargeDisposition Discharge NO Encounter.hospitalization.d
Dispositio ischargeDisposition
n
reason Reason NO Encounter.reason
diagnosis Condition NO Encounter.diagnosis.conditi
Type on.code
status Encounte YES Encounter.status
rStatus
episodeOfCare EpisodeO NO Encounter.episodeOfCare
fCare
isAutomatic Boolean NO USED Extention: It's true if the
Encounter.isAutomatic performer is an
AutomaticAgent
performer Agent NO Encounter.participant.indiv Encounter.participant.type.con
idual di g.s ste =”http://hl7.org/fhi
r/v3/ParticipationType”
Encounter.participant.type.con

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di g. ode=”PPRF”
Encounter.participant.type.con
di g.displa =”p i a -
pe fo e ”
Encounter.participant.individua
l.resolve() is Practitioner
subject Person NO Encounter.subject
assertedWhen dateTime NO USED Extension:
Encounter.assertedWhen
asserter HealthCa NO USED Extension:
rePerson Encounter.assertedWhen
recorder Agent NO <this_provenance>.agent. The parameter
who <this_provenance>.target=<this <this> refers to the
> FHIR resource
<this_provenance>.agent.who mapped to the
is Reference translated object.
recordedWhen dateTime NO <this_provenance>.recorde <this_provenance>
d refers to a FHIR
resource of type
Provenance
specifically created
to record the
provenance of
<this>.
subjectAge Value NO USED Extension:
Encounter.subjectAge

HHR HospitalizationEncounter mapped to FHIR Encounter

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
E ou te . lass.s ste =”http:/
/hl7.org/fhir/v3/ActCode”
E ou te . lass. ode=”IMP”
E ou te . lass.displa =”i pati
e t e ou te ”
E ou te .status=”u k o ”
lenghtOfStay int NO Encounter.lenghOfStay Quantity of time
the encounter
lasted.
reason Hospitaliz NO Encounter.reason
ationRea
son
dischargeDisposition Hospitaliz NO Encounter.hospitalization.d
ationDisc ischargeDisposition
hargeDis
position

HHR EmergencyEncounter mapped to FHIR Encounter

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
E ou te . lass.s ste =”http:/
/hl7.org/fhir/v3/ActCode”
E ou te . lass. ode=”EMER”
E ou te . lass.displa =”e e g
e ”
E ou te .status=”u k o ”

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reason Emergen NO Encounter.reason

cyReason
dischargeDisposition Emergen NO Encounter.hospitalization.d
cyDischar ischargeDisposition
geDisposi
tion

HHR EmergencyEncounter mapped to FHIR Encounter

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
E ou te . lass.s ste =”http:/
/hl7.org/fhir/v3/ActCode”
E ou te . lass. ode=”AMB”
E ou te . lass.displa =”a ul
ato ”
E ou te .status=”u k o ”
appointment Appointe NO Encounter.appointment The appointment
ment that scheduled the
encounter.

HHR HospitalAtHomeEncounter mapped to FHIR EpisodeOfCare

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
E ou te . lass.s ste =”http:/
/hl7.org/fhir/v3/ActCode”
E ou te . lass. ode=”HH”
E ou te . lass.displa =”ho e
health”
E ou te .status=”u k o ”
lenghtOfStay int NO Encounter.lenghOfStay Quantity of time
the encounter
lasted.

HHR EpisodeOfcare mapped to FHIR EpisodeOfcare

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
identifier Identifier YES EpisodeOfCare.identifier EpisodeOfCare.identifier.value=
<IdentifierEntity.Identifier.value
>, EpisodeOfCare.identifier.syst
em=<IdentifierEntity.Identifier.s
ystem>
status EpisodeO YES EpisodeOfCare.status EpisodeOfCa e.status=”u k o
fCareStat ”
us
subjectAge Value NO USED Extension:
Encounter.subjectAge
isAutomatic Boolean NO USED Extention: It's true if the
Encounter.isAutomatic performer is an
AutomaticAgent
subject Person NO EpisodeOfCare.patient
performer HealthCa NO EpisodeOfCare.team CareTeam.partecipant.role.syst A resource
rePerson e =”http://crowdhealth.eu/hhr- CareTeam is

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t” created containing
CareTeam.partecipant.role.cod the references to
e=”pe fo e -of-event the performers.
CareTeam.partecipant.role.disp EpisodeOfCare.perf
la =”Pe fo e of e e t” ormer contains the
CareTeam.partecipant.member. reference to the
resolve() is Practitioner or created CareTeam
CareTeam.partecipant.member. resource.
resolve() is Patient
performedWhen Period NO EpisodeOfCare.period
assertedWhen dateTime NO USED Extension
EpisodeOfCare.assertedWh
en
asserter HealthCa NO USED Extension
rePerson EpisodeOfCare.asserter
recorder Agent NO <this_provenance>.agent. <this_provenance>.target=<this The parameter
who > <this> refers to the
<this_provenance>.agent.who FHIR resource
is Reference mapped to the
recordedWhen dateTime NO <this_provenance>.recorde translated object.
d <this_provenance>
refers to a FHIR
resource of type
Provenance
specifically created
to record the
provenance of
<this>.

HHR Appointment mapped to FHIR Appointment

Attribute or Type Mandatory FHIR mapping Assumptions Note

AssociationEnd (YES/NO)
identifier Identifier YES Appointment.identifier Appointment.identifier.value=<I
dentifierEntity.Identifier.value>,
Appointment.identifier.system
=<IdentifierEntity.Identifier.syst
em>
status Appoint YES Appointment.status EpisodeOfCa e.status=”u k o
mentStat ”
us
subjectAge Value NO USED Extension:
Appointment.subjectAge
isAutomatic Boolean NO USED Extention: It's true if the
Appointment.isAutomatic performer is an
AutomaticAgent
subject Person NO Appointment.patient
performer Agent NO Appointment.partecipant.a Encounter.participant.type.con
ctor di g.s ste =”http://hl7.org/fhi
r/v3/ParticipationType”
Encounter.participant.type.con
di g. ode=”PPRF”
Encounter.participant.type.con
di g.displa =”p i a -
pe fo e ”
Encounter.participant.type.stat
us=”a epted”
performedWhen Period NO Appointment.start Either start and end
Appointment.end are specified, or
neither

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assertedWhen dateTIme NO USED Extension:

Appointment.assertedWhe
n
asserter HealthCa NO USED Extension
rePerson Appointment.asserter

recorder Agent NO <this_provenance>.agent. <this_provenance>.target=<this The parameter

who > <this> refers to the
<this_provenance>.agent.who FHIR resource
is Reference mapped to the
recordedWhen dateTime NO <this_provenance>.recorde translated object.
d <this_provenance>
refers to a FHIR
resource of type
Provenance
specifically created
to record the
provenance of
<this>.

1.2. Used Terminologies

In this section there is the list of terminologies that are adopted for the FHIR representation of
the HHRs.

Gender enumeration

Code system: http://hl7.org/fhir/administrative-gender

Instance Code Display Definition

MALE male male Male
FEMALE female female Female
OTHER other Other Other

ClinicalStatus enumeration

Code system: http://hl7.org/fhir/condition-clinical

Instance Code Display Definition

ACTIVE active Active The subject is currently experiencing the symptoms of the
condition or there is evidence of the condition.
ACTIVE_RECURRENCE recurrence Recurrence The subject is having a relapse or re-experiencing the
condition after a period of remission or presumed
resolution.
INACTIVE inactive Inactive The subject is no longer experiencing the symptoms of the
condition or there is no longer evidence of the condition.
INACTIVE_REMISSION remission Remission The subject is no longer experiencing the symptoms of the
condition, but there is a risk of the symptoms returning.
INACTIVE_RESOLVED resolved Resolved The subject is no longer experiencing the symptoms of the
condition and there is a negligible perceived risk of the
symptoms returning.

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Diagnosis enumeration

Code system: http://crowdhealth.eu/hhr-t

Instance Code Display

INTRADUCTAL_CARCINOMA intraductal-carcinoma Intraductal carcinoma
ESTROGEN_RECEPTOR_POSITIVE_TUMOR estrogen-receptor-positive-tumor Estrogen receptor positive tumor
ESTROGEN_RECEPTOR_NEGATIVE_NEOPLASM estrogen-receptor-negative-neoplasm Estrogen receptor negative neoplasm
PROGESTERONE_RECEPTOR_POSITIVE_TUMOR progesterone-receptor-positive-tumor Progesterone receptor positive tumor
PROGESTERONE_RECEPTOR_NEGATIVE_NEOPLASM progesterone-receptor-negative- Progesterone receptor negative neoplasm
neoplasm
POSITIVE_CARCINOMA_OF_BREAST her2-positive-carcinoma-of-breast HER2-positive carcinoma of breast
HUMAN_EPIDERMAL_GROWTH_FACTOR_2_NEGATI human-epidermal-growth-factor-2- Human epidermal growth factor 2 negative
VE_CARCINOMA_OF_BREAST negative-carcinoma-of-breast carcinoma of breast
MALIGNANT_TUMOR_OF_BREAST malignant-tumor-of-breast Malignant tumor of breast

SECONDARY_MALIGNANT_NEOPLASM_OF_LIVER secondary-malignant-neoplasm-of-liver Secondary malignant neoplasm of liver

SECONDARY_MALIGNANT_NEOPLASM_OF_LUNG secondary-malignant-neoplasm-of-lung Secondary malignant neoplasm of lung
SECONDARY_MALIGNANT_NEOPLASM_OF_KIDNEY secondary-malignant-neoplasm-of- Secondary malignant neoplasm of kidney
kidney
SECONDARY_MALIGNANT_NEOPLASM_OF_BONE secondary-malignant-neoplasm-of- Secondary malignant neoplasm of bone
bone
SECONDARY_MALIGNANT_NEOPLASM_OF_BRAIN secondary-malignant-neoplasm-of- Secondary malignant neoplasm of brain
brain

ClinicalFinding enumeration

Code system: http://crowdhealth.eu/hhr-t

Instance Code Display

DIABETES_MELLITUS diabetes-mellitus Diabetes mellitus
HYPERCHOLESTEROLEMIA hypercholesterolemia Hypercholesterolemia
CROHN-S_DISEASE crohn-s-disease Crohn's disease
IRRITABLE_BOWEL_SYNDROME irritable-bowel-syndrome Irritable bowel syndrome
STRUCTURAL_DISORDER_OF_HEART structural-disorder-of-heart Structural disorder of heart
HYPERTENSIVE_DISORDER_SYSTEMIC_ARTERIAL hypertensive-disorder-systemic-arterial Hypertensive disorder, systemic arterial
CHRONIC_KIDNEY_DISEASE chronic-kidney-disease Chronic kidney disease
ACID_REFLUX acid-reflux Acid reflux
ANEMIA anemia Anemia
NEOPLASM_OF_LIVER neoplasm-of-liver Neoplasm of liver
NEOPLASM_OF_KIDNEY neoplasm-of-kidney Neoplasm of kidney
NEOPLASM_OF_BONE neoplasm-of-bone Neoplasm of bone
TUMOR_OF_ESOPHAGUS_STOMACH_AND- tumor-of-esophagus-stomach-and-or- Tumor of esophagus, stomach and/or
OR_DUODENUM duodenum duodenum
LOSS_OF_APPETITE loss-of-appetite Loss of appetite
TASTE_SENSE_ALTERED taste-sense-altered Taste sense altered
SWALLOWING_PROBLEM swallowing-problem Swallowing problem
NAUSEA nausea Nausea
VOMITING_SYMPTOM vomiting-symptom Vomiting symptom
ALTERATION_IN_BOWEL_ELIMINATION_CONSTIPA alteration-in-bowel-elimination- Alteration in bowel elimination: constipation
TION constipation

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DIARRHEA diarrhea Diarrhea

SORE_MOUTH sore-mouth Sore mouth
XEROSTOMIA xerostomia Xerostomia
SENSITIVE_TO_SMELLS sensitive-to-smells Sensitive to smells
EARLY_SATIETY early-satiety Early satiety
FATIGUE fatigue Fatigue
STOMACH_ACHE stomach-ache Stomach ache
PERIPHERAL_NERVE_DISEASE peripheral-nerve-disease Peripheral nerve disease
LYMPHEDEMA lymphedema Lymphedema

ProcedureStatus enumeration

Code system: http://hl7.org/fhir/event-status

Instance Code Display Definition

PREPARATION preparation Preparation The core event has not started yet, but some staging
activities have begun (e.g. surgical suite preparation).
Preparation stages may be tracked for billing purposes.
IN_PROGRESS in-progress In progress The event is currently occurring.
SUSPENDED suspended Suspended The event has been temporarily stopped but is expected to
resume in the future.
ABORTED aborted Aborted The event was prior to the full completion of the intended
actions.
COMPLETED completed Completed The event has now concluded.
ENTERED_IN_ERROR entered-in-error Entered in error This electronic record should never have existed, though it
is possible that real-world decisions were based on it. (If
real-world activity has occurred, the status should be
"cancelled" rather than "entered-in-error".)
UNKNOWN unknown Unknown The authoring system does not know which of the status
values currently applies for this request. Note: This concept
is not to be used for "other" - one of the listed statuses is
presumed to apply, it's just not known which one.

MedicationAdministrationStatus enumeration

Code system: http://hl7.org/fhir/medication-admin-status

Instance Code Display Definition

IN_PROGRESS in-progress In progress The administration has started but has not yet
completed.
ON_HOLD on-hold On hold Actions implied by the administration have been
temporarily halted, but are expected to continue later.
May also be called "suspended".
COMPLETED completed Completed All actions that are implied by the administration have
occurred.
ENTERED_IN_ERROR entered-in-error Entered in error The administration was entered in error and therefore
nullified.
STOPPED stopped Stopped Actions implied by the administration have been
permanently halted, before all of them occurred.
UNKNOWN unknown Unknown The authoring system does not know which of the status
values currently applies for this request. Note: This
concept is not to be used for "other" - one of the listed
statuses is presumed to apply, it's just not known which
one.

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MedicationStatementStatus enumeration

Code system: http://hl7.org/fhir/medication-statement-status

Instance Code Display Definition

ACTIVE active Active The medication is still being taken.
COMPLETED completed Completed The medication is no longer being taken.
ENTERED_IN_ERROR entered_in_error Entered in error The statement was recorded incorrectly.
INTENDED intended Intended The medication may be taken at some time in the future.
STOPPED stopped Stopped Actions implied by the statement have been
permanently halted, before all of them occurred.
ON_HOLD on_hold On hold Actions implied by the statement have been temporarily
halted, but are expected to continue later. May also be
called "suspended".

Substance enumeration

This enumeration is mapped on different FHIR type depending on if the ingredients attribute id
empty or not.

HHR Substance encoded with FHIR Substance

Attribute or Type Mandatory FHIR mapping Assumptions Notes

associationEnd (YES/NO)
this.ingredients.empty().not() Mapping to be
used for
Substances with
ingredients.
ingredient Substance NO Substance.ingredient.item=<ingredient>

HHR Substance encoded with FHIR CodeableConcept

Attribute or Type Mandatory FHIR Assumptions Notes

AssociationEnd (YES/NO) mapping
this.ingredients.empty() Mapping to be
used for
Substances
without
ingredients.
CodeableConcept.coding.code[0].code=<Code> The values
CodeableConcept.coding[0].display=<Display > <Code> and
CodeableConcept.coding[0].system=”http://crowdhealth.eu/hhr- <Display>
t” depend from
the specific
translated
instance of the
enumeration.
See next table.

Code system: http://crowdhealth.eu/hhr-t

Instance Value of Attribute: name Values of attribute: Code Display

ingredient

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Anastrozole Anastrozole (Arimidex ®) anastrozole Anastrozole

Bevacizumab Bevacizumab (Avastin ®) bevacizumab Bevacizumab
Cisplatin Cisplatin cisplatin Cisplatin
Cyclophosphamide Cyclophosphamide cyclophosphamide Cyclophosphamide
Docetaxel Docetaxel (Taxotere ®) docetaxel Docetaxel
Doxorubicin Doxorubicin doxorubicin Doxorubicin
Epirubicin Epirubicin (Pharmorubicin ®) epirubicin Epirubicin
Eribulin Eribulin (Halaven ®) eribulin Eribulin

Exemestane Exemestane (Aromasin ®) exemestane Exemestane

FEC FEC: fluorouracil (5FU), Fluorouracil
epirubicin, cyclophosphamide Epirubicin
Cyclophosphamide
FEC-T FEC-T: fluorouracil (5FU), Fluorouracil
epirubicin, cyclophosphamide, Epirubicin
docetaxel (Taxotere ®) Cyclophosphamide
Docetaxel
Fluorouracil Fluorouracil (5FU) fluorouracil Fluorouracil
Fulvestrant Fulvestrant (Faslodex ®) fulvestrant Fulvestrant
Gemcitabine Gemcitabine (Gemzar ®) gemcitabine Gemcitabine
Goserelin Goserelin (Zoladex ®) goserelin Goserelin
Letrozole Letrozole (Femara ®) letrozole Letrozole
Methotrexate Methotrexate methotrexate Methotrexate

Paclitaxel Paclitaxel (Taxol ®) paclitaxel Paclitaxel

Tamoxifen Tamoxifen (Nolvadex ®) tamoxifen Tamoxifen
Toremifene Toremifene (Fareston ®) toremifene Toremifene
Trastuzumab Trastuzumab (Herceptin ®) trastuzumab Trastuzumab
TrastuzumabEmtansine Trastuzumab emtansine trastuzumab- Trastuzumab emtansine
(Kadcyla ®) emtansine
Everolimus Everolimus (Afinitor ®) everolimus Everolimus
Palbociclib Palbociclib (Ibrance ®) palbociclib Palbociclib
Pertuzumab Pertuzumab (Perjeta ®) pertuzumab Pertuzumab
Capecitabine Capecitabine (Xeloda ®) capecitabine Capecitabine
Lapatinib Lapatinib (Tyverb®) lapatinib Lapatinib
AC AC (doxorubicin (Adriamycin Doxorubicin
®), cyclophosphamide) Cyclophosphamide
Capecitabine-Taxotere Capecitabine (Xeloda ®) and Capecitabine
Docetaxel (Taxotere ®) Docetaxel
EC EC (epirubicin, Epirubicin
cyclophosphamide) Cyclophosphamide
ECF ECF (epirubicin Epirubicin
(Pharmorubicin ®), cisplatin, Cisplatin
fluorouracil (5FU)) Fluorouracil
E-CMF E-CMF (epirubicin Epirubicin
(Pharmorubicin ®), Cyclophosphamide
cyclophosphamide, Methotrexate
methotrexate, fluorouracil) Fluorouracil

WOF_CODE enumeration

Code system: https://www.worldobesity.org/

Instance Code Display

UNDERWEIGHT underweight underweight
NORMAL_WEIGHT normal-weight normal weight
OVER_WEIGHT over-weight over weight

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OBESE obese obese

MORBIDLY_OBESE morbidly-obese morbidly obese

Food enumeration

Code system: http://crowdhealth.eu/hhr-t

Instance Code Display

READ_MEAT_INTAKE red-meat-intake Red meat intake
WHITE_MEAT_INTAKE white-meat-intake White meat intake
FISH_INTAKE fish-intake Fish intake
PULSE_VEGETABLE_INTAKE pulse-vegetable-intake Pulse vegetable intake
EGG_INTAKE egg-intake Egg intake
DAIRY_FOOD_INTAKE dairy-food-intake Dairy food intake
NUTS_AND_SEEDS_INTAKE nuts-and-seeds-intake Nuts and seeds intake
FRUIT_INTAKE fruit-intake Fruit intake
VEGETABLE_INTAKE vegetable-intake Vegetable intake
BREAD_INTAKE bread-intake Bread intake
PASTA_INTAKE pasta-intake Pasta intake
POTATO_INTAKE potato-intake Potato intake

FoodIntakeFrequencyCategory enumeration

Attribute or Type Mandatory FHIR mapping Assumptions Notes

association (YES/NO)
Quantity.value=<Value> The values
Qua tit .u it=”po tio s pe eek” <Value>, <URI>
Qua tit .s ste =”http://crowdhealth.eu/hhr- and
t” <Comparator>
Quantity.code=portions-per-week depend from the
Quantity.comparator=<Comparator> specific translated
instance of the
enumeration. See
next table.

Code system: http://crowdhealth.eu/hhr-t

Instance Value Comparator

O_PORTIONS_PER_WEEK 0 N/A
1_PORTION_PER_WEEK 1 N/A
2_PORTIONS_PER_WEEK 2 N/A
3_PORTIONS_PER_WEEK 3 N/A
4_PORTIONS_PER_WEEK 4 N/A

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5_PORTIONS_PER_WEEK 5 N/A
6_PORTIONS_PER_WEEK 6 N/A
7_PORTIONS_PER_WEEK 7 N/A
8_PORTIONS_PER_WEEK 8 N/A
8_OR_MORE_PORTIONS_PER_WEEK 8 >=
9_PORTIONS_PER_WEEK 9 N/A
10_PORTIONS_PER_WEEK 10 N/A
11_PORTIONS_PER_WEEK 11 N/A
12_PORTIONS_PER_WEEK 12 N/A
13_PORTIONS_PER_WEEK 13 N/A
14_PORTIONS_PER_WEEK 14 N/A
15_PORTIONS_PER_WEEK 15 N/A
16_PORTIONS_PER_WEEK 16 N/A
16_OR_MORE_PORTIONS_PER_WEEK 16 >=
17_PORTIONS_PER_WEEK 17 N/A
18_PORTIONS_PER_WEEK 18 N/A
19_PORTIONS_PER_WEEK 19 N/A
20_PORTIONS_PER_WEEK 20 N/A
21_PORTIONS_PER_WEEK 21 N/A
22_PORTIONS_PER_WEEK 22 N/A
23_OR_MORE_PORTIONS_PER_WEEK 23 >=

Grade enumeration

Code system: http://crowdhealth.eu/hhr-t

Instance Code Display

1ST_GRADE_OF_PRIMARY_SCHOOL 1st-grade-of-primary-school 1st grade of primary school
2ND_GRADE_OF_PRIMARY_SCHOOL 2nd-grade-of-primary-school 2nd grade of primary school
3RD_GRADE_OF_PRIMARY_SCHOOL 3rd-grade-of-primary-school 3rd grade of primary school
4TH_GRADE_OF_PRIMARY_SCHOOL 4th-grade-of-primary-school 4th grade of primary school
5TH_GRADE_OF_PRIMARY_SCHOOL 5th-grade-of-primary-school 5th grade of primary school
1ST_GRADE_OF_LOWER_SECONDARY_SCHOOL 1st-grade-of-lower-secondary- 1st grade of lower secondary school
school
2ND_GRADE_OF_LOWER_SECONDARY_SCHOOL 2nd-grade-of-lower-secondary- 2nd grade of lower secondary school
school
3RD_GRADE_OF_LOWER_SECONDARY_SCHOOL 3rd-grade-of-lower-secondary- 3rd grade of lower secondary school
school
1ST_GRADE_OF_UPPER_SECONDARY_SCHOOL 1st-grade-of-upper-secondary- 1st grade of upper secondary school
school
2ND_GRADE_OF_UPPER_SECONDARY_SCHOOL 2nd-grade-of-upper-secondary- 2nd grade of upper secondary school
school
3RD_GRADE_OF_UPPER_SECONDARY_SCHOOL 3rd-grade-of-upper-secondary- 3rd grade of upper secondary school
school
4TH_GRADE_OF_UPPER_SECONDARY_SCHOO 4th-grade-of-upper-secondary- 4th grade of upper secondary school
school
5TH_GRADE_OF_UPPER_SECONDARY_SCHOOL 5th-grade-of-upper-secondary- 5th grade of upper secondary school
school

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Slovenian Regions enumeration

Code system: http://crowdhealth.eu/hhr-t

Region id Region Name

1 Pomurska
2 Podravska
3 Ko oška
4 Savinjska
5 Zasavska
6 Posavska
7 Jugovzhodna Slovenija
8 Osrednjeslovenska
9 Gorenjska
10 Primorsko-notranjska
11 Go iška
12 Obalno-k aška

Slovenian Municipalities

Code system: http://crowdhealth.eu/hhr-t

Municipalities Name
1 Mu i ipalit of Ajdo šči a
…
212 Municipality of Mirna

HospitalizationDischargeDisposition enumeration

Code system: http://crowdhealth.eu/hhr-t

Instance Code Display

HEALING_OR_IMPROVEMENT hearing-or-improvement Hearing or improvement
VOLUNTARY_DISCHARGE voluntary-discharge Voluntary discharge
TRANSFER transfer Transfer
EXITUS exitus Exitus
OTHER other Other
IN_EXTREMIS in-extremis In extremis

EmergencyDischargeDisposition enumeration

Code system: http://crowdhealth.eu/hhr-t

Instance Code Display

UNKNOWN unknown Unknown
HOME home Home

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VOLUNTARY_DISCHARGE voluntary-discharge Voluntary discharge

TRANSFER_TO_OTHER_HOSPITAL transfer-to-other-hospital Transfer to other hospital
EXITUS exitus Exitus
OUTPATIENT_CONSULTATION outpatient-consultation Outpatient consultation
HOSPITALIZATION hospitalization Hospitalization
GENERAL_PRACTITIONER general-practitioner General practitioner
RUNAWAY runaway Runaway
OTHER other Other
DISCIPLINARY_DISCHARGE disciplinary-discharge Disciplinary discharge
MATERNITY_TRANSFER maternity-transfer Maternity transfer
DAY_HOSPITAL day-hospital Day hospital
HOSPITAL_AT_HOME hospital-at-home Hospital at home
SURGERY_WITHOUT_ADMISSION surgery-without-admission Surgery without admission
PEADITRIC_TRANSFER peaditric-transfer Peaditric transfer
GENERAL_TRANSFER general-transfer General transfer
ACUTE_HOSPITAL acute-hospital Acute hospital
MEDIUM_AND_LONG_STAY_UNIT_TRANSFER medium-and-long-stay-unit-transfe Medium and long stay unit transfer

HospitalizationReason enumeration

Code system: http://crowdhealth.eu/hhr-t

Instance Code Display

UNDETERMINED undetermined Undetermined
MEDICAL_EXAMINATION_STUDY medical-examination -study Medical examination study
COMMON_DISEASE common-disease Common disease
TRAFFIC_ACCIDENT traffic-accident Traffic accident
WORK_ACCIDENT work-accident Work accident
CASUAL_ACCIDENT casual-accident Casual accident
SELF_INJURY self-injury Self injury
AGGRESSION aggression Aggression
CHILDBIRTH_GESTATION childbirth-gestation Childbirth gestation
OTHERS others Others
NEONATE neonate Neonate
URGENT_FROM_CEX urgent-from-cex Urgent from cex
SURGICAL_COMPLICATIONS surgical-complications Surgical complications
DAY_HOSPITAL_COMPLICATIONS day-hospital-complications Day hospital complications
TECHNICAL_COMPLICATIONS technical-complications Technical complications
INFARCTION infarction Infarction
URGENT_TRANSFER urgent-transfer Urgent transfer
PLANNED_TRANSFER planned-transfer planned transfer
INFLUENZA_A_EXAM influenza-a-exam Influenza A exam
PROBABLE_INFLUENZA_A probable-influenza-a Probable influenza A

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CONFIRMED_INFLUENZA_A confirmed-influenza-a Confirmed influenza A

UCSI_COMPLICATIONS ucsi-complications UCSI complications
CATASTROPHE catastrophe Catastrophe

EmergencyReason enumeration

Code system: http://crowdhealth.eu/hhr-t

Instance Code Display

UNDETERMINED undetermined Undetermined
PATIENT_DECISION patient decision Patient decision
MEDICAL_DECISION medical decision Medical decision
FAMILY_DECISION family decision Family decision
GOVERNMENT_DECISION government decision Government decision
JUDGE_DECISION judge decision Judge decision
TRANSFER transfer Transfer
OTHER_MOTIVATION other motivation Other motivation

AppointmentStatus enumeration

Code system: https://www.hl7.org/fhir/appointmentstatus

Instance Code Display Definition

PROPOSED proposed Propose None of the participant(s) have finalized their acceptance
of the appointment request, and the start/end time may
not be set yet.
PENDING pending Pending Some or all of the participant(s) have not finalized their
acceptance of the appointment request.
BOOKED booked Booked All participant(s) have been considered and the
appointment is confirmed to go ahead at the date/times
specified.
ARRIVED arrived Arrived Some of the patients have arrived.
FULFILLED fulfilled Fulfilled This appointment has completed and may have resulted in
an encounter.
CANCELLED cancelled Cancelled The appointment has been cancelled.
NOSHOW noshow No Show Some or all of the participant(s) have not/did not appear
for the appointment (usually the patient).
ENTER-IN-ERROR enter-in-error Enter in error This instance should not have been part of this patient's
medical record.

EncounterStatus enumeration

Code system: https://www.hl7.org/fhir/encounter-status

Instance Code Display Definition

PLANNED planned Planned The Encounter has not yet started.
ARRIVED arrived Arrived The Patient is present for the encounter, however is not
currently meeting with a practitioner.

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TRIAGE triage Triage The patient has been assessed for the priority of their
treatment based on the severity of their condition.
IN-PROGRESS in-progress In Progress The Encounter has begun and the patient is present / the
practitioner and the patient are meeting.
ONLEAVE onleave Onleave The Encounter has begun, but the patient is temporarily on
leave.
FINISHED finished Finished The Encounter has ended..
CANCELLED cancelled Cancelled The Encounter has ended before it has begun.
ENTER-IN-ERROR enter-in-error Enter In Error This instance should not have been part of this patient's
medical record.
UNKNOWN unknown Unknown The encounter status is unknown.

EpisodeOfCareStatus enumeration

Code system: https://www.hl7.org/fhir/episode-of-care-status

Instance Code Display Definition

PLANNED planned Planned This episode of care is planned to start at the date specified
in the period.start. During this status, an organization may
perform assessments to determine if the patient is eligible
to receive services, or be organizing to make resources
available to provide care services.
WAITLIST waitlist Waitlist This episode has been placed on a waitlist, pending the
episode being made active.
ACTIVE active Active This episode of care is current.
ON-HOLD on-hold On Hold This episode of care is on hold, the organization has limited
responsibility for the patient.
FINISHED finished Finished This episode of care is finished and the organization is not
expecting to be providing further care to the patient. Can
also be known as "closed", "completed" or other similar
terms.
CANCELLED cancelled Cancelled The episode of care was cancelled, or withdrawn from
service, often selected during the planned stage as the
patient may have gone elsewhere, or the circumstances
have changed and the organization is unable to provide the
care. It indicates that services terminated outside the
planned/expected workflow.
ENTER-IN-ERROR enter-in-error Enter In Error This instance should not have been part of this patient's
medical record.

1.3. FHIR Extensions

Extensions are a key part of the FHIR specification, providing a standardized way to place
additional data in a resource (or extend the data included in a defined element)1. In the case
some data is not representable with some existing FHIR elements, an extension to the

1
You can find all information about FHIR extensions at this link: https://www.hl7.org/fhir/extensibility.html

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standard is provided. When a new element is defined, to be added to an existing FHIR

resource, the following information are provided:

 ResourceName: name of the resource where the element is added.

 ElementName: the name of the element (sequence of Unicode characters).
 ElementDefinition: short description of the semantics of the new element.
 ElementCardinality: the minimum number of required appearances and the maximum
number. These numbers specify the number of times the element may appear in any
instance of the resource type. The cardinalities allow are: 0..1, 0..*, 1..1, and 1..*.
 ElementType 2 : data type of the element (for example string, date, boolean,
CodeableConcept, Identifier, Coding etc.).
 Comment: any additional information need to explain how to use the element.
 Is-modifier (true/false): an element is labelled “Is-modifier = true” if the value it
contains may change the interpretation of the element that contains it (including if the
element is the resource as a whole).
 Terminology Binding: if the element has a coded value3, in other words if the values
of the element are restricted to a given set of codes or values, the used terminology or
value set is indicated or defined (if not already existing).

Extensions for the resource Patient

ResourceName Patient
ElementName registeredWhen
ElementDefinition When the patient was registered for the first time into the system
ElementCardinality 0..1
ElementType dateTime
Comment
Is-modifier false
Terminology Binding N.A.

Extensions for the resource Practitioner

ResourceName Practitioner
ElementName registeredWhen
ElementDefinition When the practitioner was registered for the first time into the system
ElementCardinality 0..1
ElementType dateTime
Comment
Is-modifier false
Terminology Binding N.A.

2
Fhir contains four categories of data types: Primitive types, Complex types, Complex data for metadata and
special purpose data types.
3
https://www.hl7.org/fhir/terminologies.html

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Extensions for the resource Condition

ResourceName Condition
ElementName isAutomatic
ElementDefinition It's true if the performer is an automatic Agent
ElementCardinality 0..1
ElementType Boolean
Comment
Is-modifier false
Terminology Binding N.A.

ResourceName Condition
ElementName performer
ElementDefinition Who performed the recorded Condition.
ElementCardinality 0..1
ElementType Reference: Patient | Practitioner
Comment
Is-modifier false
Terminology Binding N.A.

ResourceName Condition
ElementName performedWhen
ElementDefinition When the recorded Condition was performed.
ElementCardinality 0..1
ElementType dateTime
Comment
Is-modifier false
Terminology Binding N.A.

Extensions for the resource Procedure

ResourceName Procedure
ElementName isAutomatic
ElementDefinition It's true if the performer is an automatic Agent
ElementCardinality 0..1
ElementType Boolean
Comment
Is-modifier false
Terminology Binding N.A.

ResourceName Procedure
ElementName asserter
ElementDefinition Who asserted that the recorded Procedure happened.
ElementCardinality 0..1
ElementType Reference: Patient | Practitioner
Comment
Is-modifier false
Terminology Binding N.A.

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ResourceName Procedure
ElementName assertedWhen
ElementDefinition When the asserted stated that the recorded Procedure happened.
ElementCardinality 0..1
ElementType dateTime
Comment
Is-modifier false
Terminology Binding N.A.

Extensions for the resource Observation

ResourceName Observation
ElementName asserter
ElementDefinition Who asserted that the recorded Observation happened
ElementCardinality 0..1
ElementType Reference: Patient | Practitioner | RelatedPerson
Comment
Is-modifier false
Terminology Binding N.A.

ResourceName Observation
ElementName assertedWhen
ElementDefinition When the asserted stated that the recorded Observation happened
ElementCardinality 0..1
ElementType dateTime
Comment
Is-modifier false
Terminology Binding N.A.

Extensions for the resource Encounter

ResourceName Encounter
ElementName isAutomatic
ElementDefinition It's true if the performer is an AutomaticAgent
ElementCardinality 0..1
ElementType boolean
Comment
Is-modifier false
Terminology Binding N.A.

ResourceName Encounter
ElementName assertedWhen
ElementDefinition When the asserted stated that the recorded encounter happened.
ElementCardinality 0..1
ElementType dateTime
Comment
Is-modifier false
Terminology Binding N.A.

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ResourceName Encounter
ElementName asserter
ElementDefinition Who asserted that the recorded event (Encounter) happened.
ElementCardinality 0..1
ElementType Reference Patient | Practitioner | Person
Comment
Is-modifier false
Terminology Binding N.A.

ResourceName Encounter
ElementName subjectAge
ElementDefinition Age of the subject at the time of the event.
ElementCardinality 0..1
ElementType Duration | Range
Comment
Is-modifier false
Terminology Binding N.A.

Extensions for the resource EpisodeOfCare

ResourceName EpisodeOfCare
ElementName isAutomatic
ElementDefinition It's true if the performer is an AutomaticAgent.
ElementCardinality 0..1
ElementType boolean
Comment
Is-modifier false
Terminology Binding N.A.

ResourceName EpisodeOfCare
ElementName assertedWhen
ElementDefinition When the asserted stated that the recorded episode of care happened.
ElementCardinality 0..1
ElementType datetime
Comment
Is-modifier false
Terminology Binding N.A.

ResourceName EpisodeOfCare
ElementName asserter
ElementDefinition Who asserted that the recorded event (EpisodeOfCare) happened.
ElementCardinality 0..1
ElementType Reference Patient | Practitioner | Person
Comment
Is-modifier false
Terminology Binding N.A.

ResourceName EpisodeOfCare
ElementName subjectAge
ElementDefinition Age of the subject at the time of event.
ElementCardinality 0..1
ElementType Duration | Range

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Comment
Is-modifier false
Terminology Binding N.A.

Extensions for the resource Appointment

ResourceName Appointment
ElementName isAutomatic
ElementDefinition It's true if the performer is an AutomaticAgent.
ElementCardinality 0..1
ElementType boolean
Comment
Is-modifier false
Terminology Binding N.A.

ResourceName Appointment
ElementName assertedWhen
ElementDefinition Who asserted that the recorded event (Appointment) happened.
ElementCardinality 0..1
ElementType datetime
Comment
Is-modifier false
Terminology Binding N.A.

ResourceName Appointment
ElementName asserter
ElementDefinition When the asserted stated that the recorded event happened.
ElementCardinality 0..1
ElementType Reference Patient | Practitioner | Person
Comment
Is-modifier false
Terminology Binding N.A.

ResourceName Appointment
ElementName subjectAge
ElementDefinition Age of the subject at the time of the appointment.
ElementCardinality 0..1
ElementType Duration | Range
Comment
Is-modifier false
Terminology Binding N.A.

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Del. no. – D3.1 Annex B: Use case dataset

description template
Project Deliverable

This project has received funding from the European Union’s Horizon 2020 Programme
(H2020-SC1-2016-CNECT) under Grant Agreement No. 727560
D3.1 Annex B: Use case dataset
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description template

Appendix A.

<Dataset name>
< Add one section for each dataset you have in your UC. >

Conceptual diagram
< Provide a simple UML class diagram representing the names of entities described in the
dataset, their relationship and cardinality. Just for reference, the following figure provides an
example of class diagram to be replaced with the actual diagram of the dataset. The class
diagram is not required if there is only one entity in the dataset or there are only entities
without relationships. >

List of entities
<List and describe the entities reported in the conceptual diagram of the previous section
using a table as in the following example.>

Entity Name Description

Patient Demographics and other administrative information about an
individual receiving care or other health-related services.
Clinical visit An interaction between a patient and healthcare provider for the
purpose of providing healthcare services or assessing the health
status of a patient.

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D3.1 Annex B: Use case dataset
31/10/2017
description template

Medical Observation Measurements and simple assertions made about a patient.

Patient
< Add a sub-section for each entity reported in the previous section. In each section, list and
describe the attributes or variables belonging to the corresponding entity. Report in the ‘Type’
field the data type of the attribute/variable, and describe the used terms if non-standard data
types are used. Otherwise, specify the standard you are referring to, e.g. SQL data types,
XML scheme data types or others.

If the values of an attribute/variable are restricted to a given set of values or categories or

codes, the ‘Constraint’ field have to be filled and described in the ‘Constraints’ section. >

Attribute Mandatory Type Max num. of Description Constraint

(YES/NO) characters
ID YES Numeric 20 The unique identifier N.A.
of the patient.
birthdate NO Date 10 The date of birth of N.A.
the patient
gender YES String 10 The gender of the GenderCode
patient.
… … … … … …

Clinical visit
Attribute Mandatory Type Max num. of Description Constraint
(YES/NO) characters
ID YES Numeric 20 The unique identifier N.A.
of the visit.
date NO Date 10 The start time of the N.A.
visit.
patient YES Numeric 20 The patient that has N.A.
been visited.
… … … … … …

Medical observation
Attribute Mandatory Type Max num. of Description Constraint
(YES/NO) characters
ID YES Numeric 20 The unique N.A.
identifier of the
medical
observation.
measurement YES String 10 The observed ClinicalMeasurement
feature.
visit YES Numeric 20 The visit during N.A.
which this
observation is
made.
… … … … … …

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D3.1 Annex B: Use case dataset
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description template

Constraints
< Add a sub-section for each constraint reported in the previous section. For each section,
report in ‘Level of measurement’ the nature of information, (e.g.
Nominal/Ordinal/Interval/Ratio) and clarify the used terminology, possibly pointing to existing
documentation/web-pages.

If applicable, report in ‘Coding standard’ the used coding system (e.g. LOINC, SNOMED,
ICD10), and report in ‘Link’ the web-page URL of the used coding system. Report in a table,
like the following example, all the values/codes applicable to the attribute/variable. The table is
not required if all codes of a known coding system are applicable. >

GenderCode
Level of measurement: Nominal
Coding standard: None
Link: None
Value/Code Name Description
male Male Male
female Female Female
other Other The gender of a person that is not uniquely defined as male or
female, such as hermaphrodite.
unknown Unknown The value is non known.

ClinicalMeasurement
Level of measurement: Nominal
Coding standard: LOINC
Link: http://loinc.org
Value/Code Name Description
59574-4 BMI Prctl Body mass index (BMI) [Percentile]
56087-0 Child Waist Circumf Child Waist Circumference Protocol

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 Collective Wisdom Driving Public Health Policies

Del. no. – D3.1 Annex B1: Data scheme

Hospital La Fe mapped to FHIR
Project Deliverable

This project has received funding from the European Union’s Horizon 2020 Programme
(H2020-SC1-2016-CNECT) under Grant Agreement No. 727560
D3.1 Annex B1: Data scheme Hospital
31/10/2017
La Fe mapped to FHIR

Data sources scheme

1. BI_HULAFE
The data that the Health Research Institute can use from the Hospital La Fe are gathered
directly from datamarts where the sources of information are the Information Systems from
Hospital La Fe. Hence, a data scientist is unable to gather data from the original
databases/sources of the Hospital but from datamarts that are almost ready for data analysis
and business intelligence applications.

In this data extraction we did get the data from the following available datamarts:

 Patients1
 Hospitalizations activity
 Emergency room activity
 Hospital at Home activity
 Morbidity information
 Laboratory tests results

Since the Use Case of Hospital La Fe is based on Obesity and Overweight, the data gathering
has been filtered to find out just patients that were identified as being overweight or obese at
any time in their visits to the Hospital. Please, take into account that the datamarts are
continuously being upgraded and some more information may be available during the
development of the project.

The present report tries to give some insight into the data structure that the project
CrowdHEALTH in general and the data architects and data analysts of this project in
particular, will be able to work with.

1
The information about patients is reduced to allow de-identification. In the original databases there is complete
information: complete birthdate, zip codes, address, identity numbers, etc.
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D3.1 Annex B1: Data scheme Hospital
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1.1 Conceptual diagram

See Figure with UML diagram.

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1.2 List of entities

Entity Name Description FHIR mapping (name of Note

the resource)
Patients Description of the patients with overweight or obesity diagnosis Patient
(target patients).
Morbidity All the ICD 9 codes associated to the target patients, with the date Condition,
and origin of the diagnosis. EpisodeOfCare/Encounter
Hospitalization All the data regarding hospitalization episodes of the target Encounter, Procedure, The hospitalization includes
patients, with admission date, discharge date and other Condition, diagnosis (condition) on the
administrative and clinical information Location discharge and if a procedure
took place during the
hospitalization
Emergency All data regarding emergency episodes of the target patients, with Encounter, Observation, The observation related to the
administrative and clinical information Condition, triage. Condition for the
Location diagnoses on the discharge.
This also includes
hospitalization information, so
multiple encounters from this
Outpatient All data regarding secondary outpatient consultations of the target Encounter,
patients, with administrative and clinical information Location,
Appointment
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HaH All the Hospital at Home episodes of the target patients and Encounter,
whether they are included in a Case Management program or not. Location
Administrative and clinical information is included
Lab Tests Specific laboratory tests done and results of the target patients. Observation
The amount of possible tests is quite high. The lab tests have
been reduced to a list of tests that are considered highly relevant
to the Use Case and other co-morbidities: glycosylated
hemoglobin, Microalbumin/creatinine ratio, Glucose, Blood Urea,
Creatinine, Albumine, Calcium, Sodium, Potasium, Transferrine,
Troponin T, arterial CO2, arterial O2, hemoglobin, hematocrite,
venous CO2, venous O2, Pro-BNP, Ferritine, Transferrine
saturation Index, C-Reactive protein, arterial Ph, venous Ph, Total
cholesterol, Low density cholesterol LDL, High density cholesterol,
GOT transaminases, GPT transaminases, TSH thyroid, Free T3,
Total T3, Free T4, Total T4.

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1.2.1 Patients

Max num.
Y1
Mandatory of
Attribute Type Description Constraint FHIR mapping Assumptions Note convera
(YES/NO) character
ge
s

Anonymized
Patient.identifier[0].valu Patient.identifier[0].system=”http:/
PatientID Yes String 36 patient N.A. YES
e /www.hospital-lafe.com/”
identification

1=male
Numer Sex of the GenderCod
Sex No 1 Patient.gender[0].code 2=female, YES
ical patient. e
3=other

Numer Patient.birthDate[0].dat
BirthYear No 4 Year of birth N.A. YES
ical e

Patient.deceased[0].deceasedDat
Year of
eTime.dateTime
ExitusYea Numer death
No 4 NULL=Alive Patient.deceased[0] YES
r ical
Patient.deceased[0].deceasedBo
olean.boolean

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 D3.1 Annex B1: Data scheme Hospital
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1.2.2 Morbidity

Max num. Y1
Mandatory Descriptio
Attribute Type of Constraint FHIR mapping Assumptions Note coverag
(YES/NO) n
characters e

If all the
information is
going to be send
within a bundle, a
temporal id for the
patient resource
must be created,
Anonymize and this temporal
Condition.getSubject().
d patient id of the patient
PatientID Yes String 36 N.A. setReference(PatientIdI YES
identificatio resource must be
nFHIR)
n referenced here. If
patient resource is
not within the
same bundle, the
id of the patient
resource on the
server must be
resolved

Diagnosis Condition.code.coding[
ICD9 Yes String 6 of the ICD9Code 0].code=”code” YES
patient
codified
using ICD- Condition.code.coding[

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 D3.1 Annex B1: Data scheme Hospital
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9-CM 0].display=”Label”
codes
Condition.code.coding[
0].system=”terminology
URI”

Whether
the
diagnosis
is the
primary
diagnosis
of the
If it is a secondary
episode or
diagnostic, such
not. An
relation with the
episode is Encounter/EpisodeOfC
MainDiagn Categ MainDiagnos primary one is
No fulfilled are.diagnosis.reference NO
ostic orical ticCode found through the
with a (to this Condition)
encounter linkage
single
between both
primary
conditions
ICD9 code
and many
secondary
codes
related
with the
first one.

Diagnosis Date when Condition.onset[0].asse

No Date N.A. YES
Date the rtedDate.dateTime
diagnosis

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was
informed to
the system

Condition.onset[0].onse
Age at the tRange.low The ranges of Age
Nume time of GroupAgeCo
GroupAge No 3 seems to be 5 YES
rical diagnosis de
Condition.onset[0].onse years
in groups
tRange.high

Type of
episode Implicit on the
Diagnosis Nume that DiagnosisOri type of
No 1 YES
Origin rical originates ginCode Encounter/Episod
the eOfCare
diagnosis.

Identificatio
n of the
An
Hospital at
EpisodeOfCare
HaHEpiso Nume Home Condition.context.refer
No N.A. could be YES
de rical episode ence()
generated from
taht gave
this
this
diagnosis

Identificatio
Nume Condition.context.refer An
Episode No n of the N.A. YES
rical ence() EpisodeOfCare
Hospitaliza
could be
tion/Emerg
generated from
ency
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 D3.1 Annex B1: Data scheme Hospital
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episode this
taht gave
this
diagnosis

1.2.3 Hospitalization

Max num. Y1
Mandatory Descriptio
Attribute Type of Constraint FHIR mapping Assumptions Note convera
(YES/NO) n
characters ge

Encounter.class=”inpati
ent”

If all the
information is
going to be send
within a bundle, a
Anonymize temporal id for the
Encounter.getSubject().
d patient patient resource
PatientID Yes String 36 N.A. setReference(PatientIdI YES
identificatio must be created,
nFHIR)
n and this temporal
id of the patient
resource must be
referenced here. If
patient resource is
not within the
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same bundle, the

id of the patient
resource on the
server must be
resolved

An
Identifier of EpisodeOfCare
EpisodeC Nume Encounter.episodeOfC
Yes the N.A. could be NO
ode rical are.reference()
episode generated from
this

Age at the Calculated from

time of the BirthDate of
Nume GroupAgeCo
GroupAge No 3 hospitalizat the subject and YES
rical de
ion in the admission
groups date

Encounter.h
Admissio Admission See
Categ ospitalization[0].origin.r
nServiceC No Service additional NO
orical 2 eference(Location of
ode Code Table
the service)

No Code of See Encounter.location.refe NO

RealServi Categ
the health additional rence (location of the

So e ta les are ver large a d the are i luded as a additio al E el ta le i a dire tor alled additionalTables . These are mainly codes that refer to services in
2

this hospital. Each hospital may have a different codification and organization of services. This should be taken into account. The names of the services are not
translated.
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 D3.1 Annex B1: Data scheme Hospital
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ceCode orical service Table service where is

that finally treated)
treated the
patient

Date of the
Admissio admission
No Date N.A. Encounter.period.start YES
nDate to the
hospital

Admissio Reason for Encounter.identifier[0].system=”htt

Categ AdmissionR Encounter.reason.codin
nReasonC No the ps://http://www.hospital-lafe.com/ ValueSet required YES
orical easonCode g[0].code
ode admission AdmissionReasonCode”

Discharge Date of
No Date N.A. Encounter.period.end YES
Date discharge

DischargeRe
Discharge Encounter.hospitalizati
Categ Reason for asonCode
ReasonCo No on.dischargeDispositio ValueSet required YES
orical discharge
de n.coding[0].code

Encounter.h
Discharge Destination
Categ ospitalization[0].destina
Destinatio No after N.A. NO
orical tion.reference(location
nCode discharge
of the service)

Binar If the Explicit on the

Exitus No 1 ExitusCode NO
y patient has discharge reason
passed

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 D3.1 Annex B1: Data scheme Hospital
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away.

LengthOf Nume Length of

No N.A. Encounter.length YES
Stay rical stay

Encounter.priority.coding[0].syste
UrgentAd Binar Urgent Encounter.priority.codin
No AcuityCode m=”https://http://www.hospital- ValueSet required YES
mission y admission g[0].code
lafe.com/AcuityCodes”

If the
patient has
A procedure
Binar received a SurgeryCod Procedure.context.refer
Surgery No resource could be YES
y surgical e ence(to this Encounter)
generated
interventio
n

Date of the
SurgeryDa surgical Procedure.performed.d
No Date N.A. YES
te interventio ateTime
n

Time taken
since the Difference
hospitalizat between the
PreSurger Nume
No ion until N.A. admission date NO
yStay rical
the and the date of
interventio the surgery.
n NULL=0

No String ICD9Code Encounter.diagnosis.ref NO

ICD9Diagn Admission
erence ( ref to a new
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 D3.1 Annex B1: Data scheme Hospital
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ostic ICD9 code Condition generated

with the code used in
this value)

Admission
ICD9Proce Procedure.code[0].cod Procedure.code[0].system=”ICD9
No String procedure ICD9Code NO
dure e URI”
ICD9 code

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 D3.1 Annex B1: Data scheme Hospital
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1.2.4 Emergency

Max num. Y1
Mandatory Descriptio
Attribute Type of Constraint FHIR mapping Assumptions Note convera
(YES/NO) n
characters ge

Encounter.class=”emer
gency”

If all the
information is
going to be send
within a bundle, a
temporal id for the
patient resource
must be created,
Anonymize and this temporal
Encounter.getSubject().
d patient id of the patient
PatientID Yes String 36 N.A. setReference(PatientIdI YES
identificatio resource must be
nFHIR)
n referenced here. If
patient resource is
not within the
same bundle, the
id of the patient
resource on the
server must be
resolved

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 D3.1 Annex B1: Data scheme Hospital
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An
Identifier of EpisodeOfCare
EpisodeC Encounter.episodeOfC
Yes String the N.A. could be YES
ode are.reference()
episode generated from
this

ValueSet creation
Level of for this set of
severity of codes
the present Observation.code
Categ episode. SeverityCod
Severity No NO
orical Not coded e
the same Observation.value.code
in all Result of the
hospitals. Observation of
triage procedure

Episode
shift,
whether
the patient
Admissio has been
Categ
nShiftCod No admitted in ShiftCode NO
orical
e the
morning, in
the
evening or
at night

Discharge Categ Episode

No ShiftCode NO
ShiftCode orical shift,
whether
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 D3.1 Annex B1: Data scheme Hospital
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the patient
has been
discharged
in the
morning, in
the
evening or
at night

Service
code of the Encounter.h
Admissio See
Categ admission ospitalization[0].origin.r
nServiceC No additional NO
orical in the eference(Location of
ode Table
emergency the service)
room

Service Procedure.location.refe
See rence() A new resource of
TriageSer Categ code of the
No additional procedure needs NO
vice orical triage
Table to be created
procedure Procedure.subject…….

The 16
possible
A different
destination See
Destinatio Categ encounter this
No s that the additional NO
nService orical hospitalization
triage Table
should be created
refers you
to

Discharge No Code of See Encounter.h YES

Categ
ServiceCo the additional ospitalization[0].destina
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 D3.1 Annex B1: Data scheme Hospital
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de orical discharge Table tion.reference(Location

service of the service)

Code
defining
EmergencyC Encounter.hospitalizati
Circumsta Categ the
No ircumstance on.dischargeDispositio YES
ncesCode orical circumstan
sCode n.coding[0].code
ces of
discharge

Reasons EmergencyA Encounter.identifier[0].system=”htt

ReasonsC Categ Encounter.reason.codin
No for dmissionRea ps://http://www.hospital-lafe.com/ ValueSet required YES
ode orical g[0].code
admission. sonCode AdmissionReasonCode”

Date when
the patient
is
Registrati
No Date registered N.A. NO
onDate
in the
emergency
department

Date when
the patient
FirstAttDa
No Date is attented N.A. NO
te
for the first
time

No Date Date when N.A. NO

Admissio
the patient
nObservat
is admitted
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 D3.1 Annex B1: Data scheme Hospital
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ionDate to
observatio
n unit

Discharge Discharge
No Date N.A. NO
Date Date

Date of
hospitalizat
Hospitaliz ion from NULL=Not
No Date NO
ationDate the hospitalized
emergency
room

The patient
was
registered
Registere Binar at the
No emergency 0=No; 1=Yes NO
d y
room

The patient
Binar has been
Classified No 0=No; 1=Yes NO
y in the
triage

AdmittedH Binar The patient

No 0=No; 1=Yes NO
ospital y has been
admitted to
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hospital

The patient
Binar has
Exitus No 0=No; 1=Yes NO
y passed
away

The patient
was
Binar excluded
Excluded No 0=No; 1=Yes NO
y from the
emergency
room

Binar The patient

Runaway No 0=No; 1=Yes NO
y ran away

The patient
Binar
Attended No was 0=No; 1=Yes NO
y
attended

Time that
the patient
WaitingTi
No Time has been N.A. NO
meTriage
waiting for
the triage

WaitingTi Time that

No Time the patient N.A. NO
meAtt
has been
waiting for
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 D3.1 Annex B1: Data scheme Hospital
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attention

Total time
fo the
TotalLeng patient in
No Time N.A. NO
thOfStay the
emergency
room

First
diagnosis
ICD9 No String in ED ICD9Code NO
when is
discharged

1.2.5 Outpatient consultation

Max num. Y1
Mandatory Descriptio
Attribute Type of Constraint FHIR mapping Assumptions Note convera
(YES/NO) n
characters ge

Encounter.class=”ambu
latory”

PatientID Yes String 36 Anonymize N.A. Encounter.getSubject(). If all the YES

d patient setReference(PatientIdI information is

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 D3.1 Annex B1: Data scheme Hospital
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identificatio nFHIR) going to be send

n within a bundle, a
temporal id for the
patient resource
must be created,
and this temporal
id of the patient
resource must be
referenced here. If
patient resource is
not within the
same bundle, the
id of the patient
resource on the
server must be
resolved

Code of
An
the
EpisodeOfCare
EpisodeC episode of Encounter.episodeOfC
Yes String N.A. could be YES
ode the are.reference()
generated from
consultatio
this
n

The
consultatio A location
LocationC Binar LocationCod
No n is in the Encounter.location resource must be NO
ode y e
hospital or created
in a
specialized

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 D3.1 Annex B1: Data scheme Hospital
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clinic

See
ServiceCo Categ Service
No additional Encounter.location NO
de orical code
Table

Date of the An appointment

Consultati
No Date appointme N.A. Encounter.appointment resource must be NO
onDate
nt created

The
Categ consultatio Encounter.appointment
VisitDone No VisitCode YES
orical n has been .status
conducted

BeginTim
No Time Start time N.A. Encounter.period.start YES
e

EndTime No Time End time N.A. Encounter.period.end YES

TypeOfPr Categ Type of ProvisionCo

No NO
ovision orical Provision de

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1.2.6 Hospital at Home

Max num. Y1
Mandatory Descriptio
Attribute Type of Constraint FHIR mapping Assumptions Note coverag
(YES/NO) n
characters e

Encounter.class=”home
health”

If all the
information is
going to be send
within a bundle, a
temporal id for the
patient resource
must be created,
Anonymize and this temporal
Encounter.getSubject().
d patient id of the patient
PatientID Yes String 36 N.A. setReference(PatientIdI YES
identificatio resource must be
nFHIR)
n referenced here. If
patient resource is
not within the
same bundle, the
id of the patient
resource on the
server must be
resolved

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An
Identificatio EpisodeOfCare
EpisodeC Encounter.episodeOfC
Yes String n of the N.A. could be YES
ode are.reference()
episode generated from
this

Start Date
InitDate No Date of the N.A. Encounter.period.start YES
episode

Admissio Date of
No Date N.A. NO
nDate admission

End date
EndDate No Date of the N.A. Encounter.period.end YES
episode

Is it necessary to
store information
Date of the
about the
request to
RequestD request? If so, we
No Date be N.A. NO
ate should model it
admitted to
with the
SP
Encounter.statusH
istory

Date of Is it necessary to
Assessme assessmen store information
No Date N.A. NO
ntDate t of the about the
request to request? If so, we
be should model it
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admitted to with the

SP Encounter.statusH
istory

The patient
has been
Admissio Binar
No "admitted" 0=No;1=Yes NO
n y
(attended)
to HaH

Duration of
LengthOf Nume
No the N.A. Encounter.length YES
Stay rical
episode

SchemaC Categ Type of SchemaCod

No NO
ode orical scheme e

Status on
discharge
Circumsta Categ HaHCircums
No from the NO
nceCode orical tanceCode
episode of
HaH

Type of
HaH
FunctionC Categ FunctionCod
No healthcare NO
ode orical e
attention
(function)

No Type of NO
PatientTy Categ TypePatient
patient
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 D3.1 Annex B1: Data scheme Hospital
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peCode orical when Code

admitted to
SF

Origin/Sour
ce of the
OriginCod Categ
No referral of OriginCode NO
e orical
this
episode

Administrat
StatusCod Categ ive status
No StatusCode NO
e orical of the
referral

Clinical
section
See
SectionCo Categ origin of
No additional NO
de orical the referral
table
of this
episode

Categ Profile of
LineCode No SectionCode NO
orical the patient

Service
origin of See
ServiceOri Categ
No the referral additional NO
ginCode orical
of this Table
episode

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HaHDisch Binar HaH

No 0=No;1=Yes NO
arge y discharge

1.2.7 Laboratory tests

Max num. Y1
Mandatory Descriptio
Attribute Type of Constraint FHIR mapping Assumptions Note coverag
(YES/NO) n
characters e

If all the
information is
going to be send
within a bundle, a
temporal id for the
patient resource
Anonymize must be created,
Observation.getSubject
d patient and this temporal
PatientID Yes String 36 N.A. ().setReference(PatientI YES
identificatio id of the patient
dInFHIR)
n resource must be
referenced here. If
patient resource is
not within the
same bundle, the
id of the patient
resource on the
server must be

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resolved

Date when
the
laboratory
TestRequ test Observation.effective.ef This is not the
No Date N.A. YES
estDate request is fectiveDateTime date
introduced
in the
system

Identifier of
LabTestCod Observation.identifier[0] Encounter.identifier[0].system=”htt
TestId No String the type of YES
e (values) .value ps://http://www.hospital-lafe.com/”
test

Description
of the
magnitude
Observation.code[0].system=”http
TestMagni measured LabTestCod Observation.code[0].co
No String s://http://www.hospital-lafe.com/ ValueSet required YES
tude by the test e (names) de
AdmissionReasonCode”
(related
with
TestId)

Value of
TestResul Nume the result
No N.A. Observation.value YES
t rical of the lab
test

TestUnits No String Description N.A. Observation.value.units YES

of the
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measurem
ent unit
upon which
the lab test
is based

Whether
the test
result
seems
pathologic
or not.
Standard
TestPatho LabPatholog Observation.referenceR
No String measures NO
logy yCode ange
are used.
But not in
all
hospitals
are coded
with this
ranges

The test is
the last
LastPatien Binar
No test carried 0=No;1=Yes YES
tTest y
out to this
patient

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1.3 Constraints

1.3.1 GenderCode
Level of measurement: Nominal

Coding standard: None

Link: None

Mapping to valueSet: http://hl7.org/fhir/valueset-administrative-gender.html

Value/Code Name Description Code identifier Code description Note

1 Male Male male Male

2 Female Female female Female

3 Unspecified The gender of a person that other Other

is not uniquely defined as
male or female, such as

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hermaphrodite.

1.3.2 ICD9Code
Level of measurement: Nominal

Coding standard: ICD-9-CM

Link: http://www.icd9data.com/

1.3.3 MainDiagnosticCode
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description

1 Primary This is the primary diagnostic code of the

episode of the patient (the reason why the

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patient was given health care)

2 Secondary This is a secondary diagnostic code of the

episode of the patient that is usually related
to the primary diagnostic (There can be up to
26 secondary codes)

1.3.4 GroupAgeCode
Level of measurement: Interval

Coding standard: None

Link: None

Value/Code Name Description

0 [0, 5[ Age between 0 and 5 years old

5 [5, 10[ Age between 5 and 10 years old

10 [10, 15[ Age between 10 and 15 years old

15 [15, 20[ Age between 15 and 20 years old

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... … …

1.3.5 DiagnosisOriginCode
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description

1 Emergency The originating episode of this diagnosis

was an emergency visit

2 Hospitalization The originating episode of this diagnosis

was a hospitalization

3 Hospital at Home The originating episode of this diagnosis

was a hospital at home episode

4 Ambulatory surgery The originating episode of this diagnosis

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was an ambulatory surgery episode

5 Outpatient The originating episode of this diagnosis

was an outpatient consultation

1.3.6 AdmissionReasonCode
Level of measurement: Nominal

Coding standard: None

Link: None

Mapping to valueSet: http://crowdhealth.eu/fhir/ValueSet/encounter-reason

Value/Code Name Description Code Description Note

0 Undetermined The reason for admission in No mapping, the

the hospital is undetermined reason code will be

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blank in this case

1 Medical examination- The patient is admitted for general-examination- General examination

Study medical examination inside a of-patient of patient
study

2 Common disease The patient is admitted due disease Disease

to a common disease

3 Traffic accident The patient is admitted with driving-related- Driving-related

injuries due to a traffic medical-examination medical examination
accident

4 Work accident The patient is admitted with examination-for- Examination for work
injuries due to a work work-accident accident
accident

5 Casual accident The patient is admitted with examination-for- Examination for

injuries due to any other type accident accident
of accident

6 Self-injury The patient is admitted with self-inflicted-injury Self inflicted injury

injuries made by
himself/herself

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7 Agression The patient is admitted with victim-of-physical- Victim of physical

injuries due to an agression assault assault

8 Childbirth/Gestation The patient is admitted due patient-currently- Patient currently

to gestation problems or due pregnant pregnant
to an imminent childbirth

9 Others The patient is admitted due

to a reason other than those
described in the other values

10 Neonate The neonate patient is newborn Newborn

admitted due to any
pathology

11 Urgent from CEX The patient is admitted This is specified on

urgently from outpatient the origin of the
consultation admission

12 Surgical complications The patient is admitted due complication-of- Complication of

to complications from a surgical-procedure surgical procedure
previous surgery

13 Day hospital The patient is admitted due complication-of- Complication of Day hospital is
complications to complications from the procedure procedure specified on the
origin of the
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day hospital admission

14 Technical The patient is admitted due complication-of- Complication of

Complications to technical complications procedure procedure
from any other intervention

15 Infarction The patient is admitted due myocardial-infarction Myocardial infarction

to a heart attack

19 Urgent Transfer The patient is urgently This is specified on

admitted as a transfer from the origin of the
other hospital admission

20 Planned Transfer The patient is admitted as a This is specified on

planned transfer from other the origin of the
hospital admission

60 Influenza A exam The patient is admitted for serologic-test-for- Serologic test for
examination of influenza A influenza-virus-A influenza virus A

61 Probable Influenza A The patient is admitted for

probable influenza A

62 Confirmed Influenza A The patient is admitted for influenza-A-virus- Influenza A virus

confirmed influenza A present present

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63 Common disease disease Disease

(deprecated)

90 UCSI Complications The patient is admitted due complication-of- Complication of The origin is
to complications from the surgical-procedure surgical procedure specified on the
Surgery Without Admission origin of the
Unit admission

99 Catastrophe The patient is admitted with victim-of- Victim of

injuries due to a catastrophe environmental-event environmental event

1.3.7 DischargeReasonCode
Level of measurement: Nominal

Coding standard: None

Link: None

Mapping to ValueSet: http://hl7.org/fhir/valueset-encounter-discharge-disposition.html

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Value/Code Name Description Code Description Note

1 Healing or The patient was discharged home Home

improvement due to an improvement in
his/her health

2 Voluntary discharge The patient was voluntarily aadvice Left against advice
discharged

3 Transfer The patient was transferred to Other-hcf Other healthcare

another healthcare facility facility

4 Exitus The patient died during the exp Expired

hospitalization

5 Other Other reasons for discharge oth Other

6 In extremis A patient in an end-of-life hosp Hospice The patient has been

situation is voluntarily discharged into
discharged palliative care.

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1.3.8 ExitusCode
Level of measurement: Ordinal

Coding standard: None

Link: None

Value/Code Name Description

0 No exitus The patient did not die during the

episode

1 Exitus The patient passed away during the

episode

1.3.9 AcuityCode
Level of measurement: Ordinal

Coding standard: None

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Link: None

Value/Code Name Description Code Descriptio Note

0 Not urgent The admission was R Routine

planned

1 Urgent The admission was urgent UR Urgent

and unplanned

1.3.10 SurgeryCode
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description

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0 No No surgical intervention was done to

the patient during the episode

1 Yes A surgical intervention was done to

the patient during the episode

1.3.11 SeverityCode
Level of measurement: Ordinal

Coding standard: Manchester Triage System

Link: http://alsg.org/uk/MTS

Observation.code[0].code = 713011005

Observation.code[0].display = Assessment using Manchester Triage System (procedure)

Observation.code[0].system = http://snomed.info/sct

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Observation.value =

Value/Code Name Description

0 No triage No triage done

1 Immediate Patient in need of immediate treatment

for preservation of life

2 Very urgent Seriously ill or injured patients whose

lives are not in immediate danger

3 Urgent Patients with serious problems, but

apparently stable conditions

4 Not very urgent Standard cases without immediate

danger or distress

5 Not urgent Patients whose conditions are not true

accidents or emergencies

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1.3.12 ShiftCode
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description

1 Morning The event happened from 8:00 to

14:59

2 Afternoon The event happened from 15:00 to

21:59

3 Evening The event happened from 22:00 to

7:59

1.3.13 EmergencyAdmissionReasonCode
Level of measurement: Nominal

Coding standard: None

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Link: None

Value/Code Name Description

0 Undetermined The reason for emergency visit is not

determined

1 Patient decision The reason for emergency visit is

decided by the patient

2 Medical decision The reason for emergency visit is

decided by a physician

3 Family decision The reason for emergency visit is

decided by the family of the patient

4 Government decision The reason for emergency visit is

decided by a governmental authority

5 Judge decision The reason for emergency visit is

decided by a juge

6 Transfer The reason for emergency visit is a

transfer from another healthcare
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facility

7 Undefined Not in use

8 Undefined Not in use

9 Other motivation The reason for emergency visit is

another

1.3.14 EmergencyCircumstancesCode
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description

0 Unkonwn Unkown

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1 Home The patient is discharged

home

2 Voluntary discharge The patient is voluntarily

discharged

3 Tranfer to other The patient is transferred

hospital to another hospital

4 Exitus The patients passed away

5 Outpatient The patient is sent to

consultation outpatient consultation

6 Hospitalization The patient is hospitalized

7 General Practitioner The patient is sent to his

GP for primary care

8 Runaway The patient run away

9 Other Other circumstance

10 Disciplinary discharge The patient is discharge

from the emergency room

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due to his/her behaviour

12 Maternity Transfer
(deprecated)

13 Day hospital The patient is sent to day

hospital

14 Hospital at home The patient is sent to the

Hospital at Home Unit

15 Surgery without The patient is sent to the

admission (UCSI) Surgery without Admission
Unit

16 Peaditric Transfer
(deprecated)

17 General Transfer
(deprecated)

31 Acute Hospital The patient is sent to

Transfer another Acute Hospital

32 Medium and Long The patient is sent to the

Medium and Long Stay
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stay Unit Transfer Unit

99 NULL NULL

1.3.15 LocationCode
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description

0 Hospital The outpatient consultation is

located inside the Hospital facilities

1 Specialized Clinic The outpatient consultation is

located in a community setting

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1.3.16 VisitCode
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description

Urgent Urgent The outpatient consultation was an

urgent consultation

N No The outpatient consultation did not

take place

Y Yes The outpatient consultation was

done

1.3.17 ProvisionCode
Level of measurement: Nominal

Coding standard: None

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Link: None

Value/Code Name Description

PRI First The outpatient consultation is the

first consultation

SUC Succesives The outpatient consultation is a

succesive consultation for follow-up

ENF Nurse The outpatient consultation was

done by nurses

TEC Technical The outpatient consultation was

done by nurses using technological
devices (electrochardiogram, ...)

1.3.18 SchemaCode
Level of measurement: Nominal

Coding standard: None

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Link: None

Value/Code Name Description

TEPIUHDN Common HaH episode The hospital at home episode is a

common admission due to a
decompensation, exacerbation or
follow-up

TEPIUHDSP HaH Scheduled follow-up The patient is admitted to a case

episode management scheduled follow-up
program

1.3.19 HaHCircumstancesCode
Level of measurement: Nominal

Coding standard: None

Link: None

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Value/Code Name Description

DESTD00 Primary Care The patient is discharged/sent to a

Primary Care attention

DESTD01 Hospital admission: medical The patient is admitted to hospital due

reason to a medical reason

DESTD02 Hospital admission: The patient is admitted to hospital for a

diagnostic/treatment diagnosis or treatment

DESTD03 Hospital admission: The patient is admitted to hospital from

emergency out of hospital an emergency department out of the
hospital (community setting or other
hospital)

DESTD04 Hospital admission: The patient is admitted to hospital by

patient/family decision the patient/family decision with the
consent of a physician

DESTD05 Admission UMLE The patient is admitted to the Long- and

Medium- Stay Unit

DESTD06 Transfer other HaH The patient is transferred to another

HaH Unit of other hospital

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DESTD07 Scheduled Follow-up: CM The patient is admitted/sent to the Case

Management Scheduled Follow-u
Program of the HaH Unit

DESTD08 Scheduled Follow-up: The patient is followed-up by the case

Nurse manager nurse

DESTD09 Exitus The patient passed away

DESTD10 Voluntary discharge The patient is discharged voluntarily

DESTD11 Outpatient consultation The patient is sent to outpatient

consultation

DESTD12 Mental Health Unit The patient is sent to the Mental Heath
Unit

1.3.20 FunctionCode
Level of measurement: Nominal

Coding standard: None

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Link: None

Value/Code Name Description

UHD_T1 Assessment/Outpatient Aimed at giving response to specific

consultation clinical attention (often 1 day). For
instance: Is this patient under an
exacerbation of the chronic disease?
Or developing diagnostic test or
treatments that primary care can’t
develop on patients with mobility
problems

UHD_T2 Day hospital Aimed at giving response to specific

clinical attention but usually known
and expected by the team
responsible of the patient (often 2-3
days). For instance: patients treated
with mobility problems require the
first day to make sure about the
clinical needs and the second/third
day to give the treatment

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UHD_T3 Hospitalization at Home Aimed at following clinical situations

at home but with a conventional
hospital intensity, when possible

UHD_T4 Case Management Describes the patients under case

Program management program

UHD_T5 Transition Patients already under case

management who need to be
followed closely after an hospital
discharge by the case manager.
Usually during two weeks after
discharge.

UHD_T6 PEPS When a patient is identified to be

included on case management
intervention. A complete health and
psychosocial assessment,
educational and preventive
interventions related with the chronic
diseases are developed. Usually, the
admission referral is received from
GP-primary health care team
(proactive identification)

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UHD_T7 Transition PEPS When a patient is identified to be

included on case management
intervention. A complete health and
psychosocial assessment,
educational and preventive
interventions related with the chronic
diseases are developed. The
admission referral is received a
hospital ward, (reactive
identification).

1.3.21 TypePatientCode
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description

UHD_TP1 Post-surgical (simple) The patients is a post-surgical

patient with simple condition for
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recovery

UHD_TP2 Post-surgical (complex) The patients is a post-surgical

patient with complex condition for
recovery

UHD_TP3 Post-transplant The patient had a transplant

UHD_TP4 Chronic monoorganic Chronic patient with only one chronic

disease or condition

UHD_TP5 Chronic pluripatholoy Chronic patient with multimorbidity

UHD_TP6 Mental health Mental health patient

UHD_TP7 Oncological Oncological patient

UHD_TP8 Palliative (oncological) Palliative patient with oncological

disease

UHD_TP9 Palliative (non oncological) Palliative patient without any

oncological disease

UHD_TP10 Acute with chronic The patient is an acute patient with a

pathology chronic disease as a base condition

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UHD_TP11 Acute without chronic The patient is an acute patient

pathology

UHD_TP12 Neonate The patient is a newborn child

UHD_TP13 Paediatric The patient is a paediatric patient

1.3.22 OriginCode
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description

UHD_P1 Self-derivation The patient proposed himself/herself

the healthcare attention by the HaH
Unit

UHD_P2 Primary care A GP proposed the healthcare

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attention by the HaH Unit

UHD_P3 Outpatient consultation A physician at outpatient

consultation proposed the healthcare
attention by the HaH Unit

UHD_P4 CMA A physician from the Major

Ambulatory Surgery Unit proposed
the healthcare attention by the HaH
Unit

UHD_P5 HACLE A physician from the Long- and

Medium- stay Unit proposed the
healthcare attention by the HaH Unit

UHD_P6 Day Hospital A physician at day hospital proposed

the healthcare attention by the HaH
Unit

UHD_P7 Other HaH / Hospital A Hospital at Home unit from other

Hospital or other Hospital suggest
the healthcare attention by the HaH
Unit

UHD_P8 Residence A residence proposes the healthcare

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attention by the HaH Unit

UHD_P9 Ward The proposal for the HaH Unit

comes from a ward in the Hospital

UHD_P10 Mental Health Unit The proposal for the HaH Unit
comes from a the Mental Health Unit
in the Hospital

UHD_P11 Emergency Unit The proposal for the HaH Unit

comes from Emergency Room

1.3.23 StatusCode
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description

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EE12 Administrative discharge The patient has been discharge and

the administrative process has bee
completely finished

EE17 Discharge with The patient has been discharge but

Administrative discharge the administrative process is still
pending pending

EIUHD Admitted to HaH The patient has been admitted to the

HaH Unit

EPANUHD Proposal to HaH cancelled The proposal to admit a patient to

the HaH Unit has been cancelled

EPAUHD Proposal to HaH accepted The proposal to admit a patient to

the HaH Unit has been accepted

EPRUHD Proposal to HaH rejected The proposal to admit a patient to

the HaH Unit has been rejected with
justification

EPTUHD Proposal to another HaH The proposal is to admit a patient to

another HaH Unit

EPUHD Proposal to HaH A proposal to admit a patient to the

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admission HaH Unit has been carried out

1.3.24 SectionCode
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description

1 Pediatric The patient is a pediatric one

2 Mental Health The patient is a mental health patient

3 Rehabilitation The patient is in a rehabilitation

stage

4 Adults The patient is an adult one

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1.3.25 LabPathologyCode
Level of measurement: Ordinal

Coding standard: None

Link: None

Value/Code Name Description

0 Normal The result of the laboratory test is

within the normal ranges

1 Validation The result of the laboratory test is

out of the normal ranges, but within
valid ranges. It means that the
patient has possible pathologic
results

2 Outlier The result of the laboratory test is

out of the normal and validation
range. It could be an abnormal result
due to technical reasons or due to
an extreme condition of the patient

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1.3.26 LabTestCode
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description Code Description Y1 coverage

429 C-Reactive protein Laboratory test that c-reactive-protein- C-reactive protein YES
measured... measurement measurement

452 Glycosilated Hemoglobin Laboratory test that glucohemoglobin- Glucohemoglobin YES

measured... measurement measurement

471 Microalbumin/creatinine Laboratory test that urine- Urine YES

ratio measured... microalbumin- microalbumin/creatinine
creatinine-ratio- ratio measurement
measurement

478 Glucose Laboratory test that glucose- Glucose measurement YES

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measured... measurement

490 Blood Urea Laboratory test that blood-urea- Blood urea YES
measured... measurement measurement

491 Creatinine Laboratory test that creatinine- Creatinine YES

measured... measurement measurement

493 Total cholesterol Laboratory test that total-cholesterol- Total cholesterol YES
measured... measurement measurement

494 Low density cholesterol Laboratory test that low-density- Low density lipoprotein YES
LDL measured... lipoprotein- cholesterol
cholesterol- measurement
measurement

495 High density cholesterol Laboratory test that high-density- High density lipoprotein YES
HDL measured... lipoprotein- cholesterol
cholesterol- measurement
measurement

499 GOT transaminases Laboratory test that aspartate- Aspartate YES

measured... aminotransferase- aminotransferase
measurement measurement

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500 GPT transaminases Laboratory test that alanine- Alanine YES

measured... aminotransferase- aminotransferase
measurement measurement

509 Albumine Laboratory test that albumin- Albumin measurement YES

measured... measurement

510 Calcium Laboratory test that calcium- Calcium measurement YES

measured... measurement

514 Sodium Laboratory test that sodium- Sodium measurement YES

measured... measurement

515 Potasium Laboratory test that potassium- Potassium YES

measured... measurement measurement

519 Transferrine saturation Laboratory test that transferrin- Transferrin saturation YES
Index measured... saturation-index index

520 Ferritine Laboratory test that ferritin- Ferritin measurement YES

measured... measurement

521 Transferrine Laboratory test that transferrin- Transferrin YES

measured... measurement measurement

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905 Troponin T Laboratory test that troponin-t- Troponin T NO

measured... measurement measurement

906 PRO-BNP Laboratory test that pro-bnp PRO-BNP NO

measured...

940 Arterial CO2 Laboratory test that measurement-of- Measurement of arterial NO

measured... arterial-partial- partial pressure of
pressure-of- carbon dioxide
carbon-dioxide

941 Arterial O2 Laboratory test that arterial-o2 Arterial O2 YES

measured...

942 Arterial Ph Laboratory test that ph-measurement,- pH measurement, YES

measured... arterial arterial

1099 Hemoglobin Laboratory test that hemoglobin,-free- Hemoglobin, free YES

measured... measurement measurement

1101 Hematocrite Laboratory test that platelet- Platelet hematocrit YES

measured... hematocrit- measurement
measurement

1276 Free T4 Laboratory test that t4-free- T4 free measurement YES

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measured... measurement

1277 Total T4 Laboratory test that serum-total-t4- Serum total T4 NO

measured... measurement measurement

1278 Free T3 Laboratory test that free-t3- Free T3 measurement

measured... measurement

1279 Total T3 Laboratory test that tri-iodothyronine- Tri-iodothyronine NO

measured... measurement,- measurement, total
total

1280 TSH thyroid Laboratory test that thyroid- Thyroid stimulating NO

measured... stimulating- hormone measurement
hormone-
measurement

1601 Venous CO2 Laboratory test that measurement-of- Measurement of NO

measured... venous-partial- venous partial pressure
pressure-of- of carbon dioxide
carbon-dioxide

1602 Venous O2 Laboratory test that venous-oxygen- Venous oxygen NO

measured... concentration- concentration
measurement measurement

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1603 Venous Ph Laboratory test that ph-measurement,- pH measurement, YES

measured... venous venous

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 Collective Wisdom Driving Public Health Policies

Del. no. – D3.1 Annex B2: Data scheme of

DFKI living lab mapped to FHIR
Project Deliverable

This project has received funding from the European Union’s Horizon 2020 Programme
(H2020-SC1-2016-CNECT) under Grant Agreement No. 727560
 D3.1 Annex B2: Data scheme of DFKI
31/10/2017
living lab mapped to FHIR

Data sources scheme

The Use Case is driven by the data entered by participants using our web application to log their
nutritional habits and will be further annotated by manual and automatic activity detection via
fitness tracking hardware.

Figure 1: Patient

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Figure 2: Nutrition

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Figure 3: Activity

Figure 4: BioData

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1. Patient
Attribu Mand Type Ma Description Constraint FHIR mapping Note
te atory x#
(YES/ of
NO) ch
ar

ID YES Nume The unique long Patient.identifier[0].v

ric identifier of the alue
patient.

allergie YES List 0..* List of allergies AllergyIntolerance https://www.hl7.org/fhir/allergyi

s connected to ntolerance.html
patient

diets YES List 0..* List of diets Diet See below

connected to
the patient

Extensions

ResourceName Patient

ElementName postalcode

ElementDefinition the anonymised postal code, referring to a general area

ElementCardinality 0..1

ElementType String

Comment Useful for context based information gathering, like temperatures or

pollination

Is-modifier false

Terminology Binding

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2. Diet

Attribu Mand Type Max # Description Constraint FHIR mapping Note

te atory of
(YES/ char
NO)

ID YES Nume The unique long Identifier

ric identifier of the
diet.

name YES String 100 The name of the

diet

forbidd YES List 0..* List of Ingredients Ingredient See below

en forbidden

prefere YES List 0..* List of Ingredients Ingredient See below

d prefered

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3. Ingredient (Substance)

Attrib Mandat Type Max Description Con FHIR Note

ute ory # of stra mapping
(YES/N cha int
O) r

ID YES Numeri The unique N.A. Identifier

c identifier of
the diet.

name YES String 100 The name of Substance.d

the ingredient escription

relatio YES List 0..* List of Ingredient/ Used to map relations, like <->meat<->red meat<-
ns Ingredients Substance >pork<->porkchop<->bacon
related

type YES Food- 0..* The food type Food-type http://hl7.org/fhir/ValueSet/food-type

type (taxonomy)

nutriti YES Nutritio Nutrition See below

on n

allerg YES List 0..* List of Substance

ens allergens
contained

comp YES Nutritio the NutritionCom

ositio nComp compisition position
n osition

Extensions

ResourceName Substance

ElementName relations

ElementDefinition the relations to other ingredients

ElementCardinality 0..*

ElementType Substance

Comment useful to link ingredients for inheritance and parsing of diets

Is-modifier false

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Terminology Binding

ResourceName Substance

ElementName type

ElementDefinition the food type

ElementCardinality 0..1 (0 for any substance, 1 for any ingredient)

ElementType food-type

Comment http://hl7.org/fhir/ValueSet/food-type

Is-modifier false

Terminology Binding

ResourceName Substance

ElementName nutrition

ElementDefinition the linked nutritions

ElementCardinality 0..1 (0 for any substance, 1 for any ingredient)

ElementType Nutrition

Comment the known nutritions for the ingredient

Is-modifier false

Terminology Binding

ResourceName Substance

ElementName composition

ElementDefinition the nutrional composition

ElementCardinality 0..1 (0 for any substance, 1 for any ingredient)

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ElementType NutritionalComposition

Comment

Is-modifier false

Terminology Binding

ResourceName Substance

ElementName allergens

ElementDefinition the list of contained allergens (substances)

ElementCardinality 0..*

ElementType Substance

Comment

Is-modifier false

Terminology Binding

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4. Nutrition

Attribute Ma Type Max # Description Constrai FHIR Assumption Note

nd of nt mapping s
at char
or
y
(Y
ES
/N
O)

ID YE Num The unique identifier of N.A. Identifier

S eric the Nutrition.

confidenc YE Confi The confidence in the Confidenc see below

e S denc data e
e

reference YE Num byte 1: per

S eric Is the data based on 100g/ml
100g, piece, dish 2: per piece
4: per dish

energy N Float In Joule

O

protein N Float In gram

O

fat N Float In gram

O

carbs N Float In gram

O

sugar N Float In gram

O

fructose N Float In gram

O

sucrose N Float In gram

O

maltose N Float In gram

O

lactose N Float In gram

O

glucose N Float In gram

O

galactose N Float In gram

O

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fiber N Float In gram

O

calcium N Float In gram

O

sodium N Float In gram

O

iron N Float In gram

O

choline N Float In gram

O

niacin N Float In gram

O

riboflavin N Float In gram

O

pantothen N Float In gram

icAcid O

thiamin N Float In gram

O

vitaminA N Float In gram

O

vitaminB1 N Float In gram

2 O

vitaminB6 N Float In gram

O

vitaminC N Float In gram

O

vitaminD N Float In gram

O

vitaminE N Float In gram

O

vitaminK N Float In gram

O

copper N Float In gram

O

magnesiu N Float In gram

m O

manganes N Float In gram

e O

phosphor N Float In gram

us O

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potassium N Float In gram

O

selenium N Float In gram

O

zinc N Float In gram

O

cholestero N Float In gram

l O

alcohol N Float In gram

O

ash N Float In gram

O

caffeine N Float In gram

O

theobromi N Float In gram

ne O

water N Float In gram

O

saturatedf N Float In gram

at O

monounsa N Float In gram

turatedfat O

polyunsat N Float In gram

uratedfat O

transfat N Float In gram

O

Value Set URI: http://crowdhealth.eu/fhir/ValueSet/Confidence

Code Display Definition

0 no confidence no confidence in the data

4 unsure the confidence in the data is not very high

8 moderate the data should be accurate enough

16 confident the information is most likely accurate

32 very confident the information should be very accurate

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64 guaranteed the information is guaranteed to be correct

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5. NutritionalSummary

Attribute Man Type Max # of Description Constrai Note

dato char nt
ry
(YE
S/N
O)

ID YES Numeri the unique identifier unique,

c long

date YES Date the date

patient YES Numeri the ID of the patient long

c

composition YES Numeri the ID of the NutrionalComposition long

c

nutrion YES Numeri the ID of the Nutrition long

c

ingredients YES List 0..* the known NutrionalIngredient used not guaranteed to have all
in this summary ingredients

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6. NutrionalIngredient

Attribute Man Type Max # of Description Constrai Note

dato char nt
ry
(YE
S/N
O)

ID YES Numeri the unique identifier unique,

c long

ingredient YES Numeri the ID of the Ingredient long

c

amount YES Numeri the ID of the patient float

c

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7. NutrionalComposition

Attribute Man Type Max # of Description Constraint Note

dato char
ry
(YE
S/N
O)

ID YES Numeri the unique identifier unique, long

c

grain YES Numeri the amount of grain float in gram

c

fruits YES Numeri the amount of fruits float in gram

c

vegetables YES Numeri the amount of vegetables float in gram

c

dairy YES Numeri the amount of dairy float in gram

c

oils YES Numeri the amount of oil float in ml

c

protein YES Numeri the amount of protein float in gram

c

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8. Activity

Attribute Man Type Max # of Description Constrai Note

dato char nt
ry
(YE
S/N
O)

ID YES Numeri the unique identifier unique,

c long

patient YES Numeri the ID of the patient long

c

date YES date the date

name YES String 100 the name given by the patient or the
system

type YES Numeri the ID of the ActivityType

c

energy YES Numeri the energy burned in kj (above idle in kj

c consumption)

distance YES Numeri the amount of dairy in m

c

duration YES Numeri the amount of oil in s

c

persons YES Numeri how many persons where involved byte

c

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9. ActivityType

Attribute Manda Type Max # of Description Constraint

tory char
(YES/
NO)

ID YES Numeric the unique identifier unique, long

name YES String 100 the name given by the patient or the system

parent NO Numeric the ID of the ActivityType parent

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10. BioData

Attribute Manda Type Amount Description Constraint

tory
(YES/
NO)

ID YES Numeric the unique identifier unique, long

patient YES Numeric the patients ID long

date YES Date the date matching this dataset, only day portion
relevant

sleeps YES List 0..* the IDs of the BioSleeps that day long

snapshots YES List 0..* the IDs of the BioSnapshots that day long

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11. BioSnapshot

Attribute Mandat Type Description Constraint

ory
(YES/N
O)

ID YES Numeric the unique ID long

heartrate YES Numeric the heartrate (average) at that time short

steps YES Numeric the delta of steps between now and the entry before short

time YES Numeric the minutes passed since 00:00 short

confidence YES Numeric the confidence in the data byte

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12. BioSleep

Attribute Mandatory (YES/NO) Type Amount Description Constraint

ID YES Numeric the unique ID long

intervals YES List 1..* the IDs of the SleepIntervals long

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13. BioSleepInterval

Attribute Mandatory Type Description Constraint FHIR mapping

(YES/NO)

ID YES Numeric the unique ID long

start YES Date the begin of this interval

end YES Date the end of this interval

type YES Numeric byte SleepType

SleepType

Value Set URI:http: //crowdhealth.eu/fhir/ValueSet/SleepType

Code Display Definition Note

1 deep deep sleep 30 seconds granularity, better accuracy, normal case

2 light light sleep

4 rem rem phase

8 wake awake

16 asleep asleep 60 seconds granularity, slightly worse, can happen if

data is not synced regularly and has to be compressed
32 restless restless

64 awake awake

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 Collective Wisdom Driving Public Health Policies

Del. no. – D3.1 Annex B3: Data scheme of

BioAssist mapped to FHIR
Project Deliverable

This project has received funding from the European Union’s Horizon 2020 Programme
(H2020-SC1-2016-CNECT) under Grant Agreement No. 727560
D3.1 Annex B3: Data scheme of
31/10/2017
BioAssist mapped to FHIR

Data sources scheme

The Use Case is driven by the data entered or gathered by patients on the BioAssist platform.
More specifically, patients provide information on their vital signs, allergies, and medication. In
addition, data is gathered by the patients’ Personal Health Records (PHRs), while BioAssist
also gathers social data from its platform, referring to the patient’s daily life and behaviour.

Vital Signs

Conceptual diagram

Figure 1 - Vital signs conceptual diagram

List of entities

FHIR mapping
Entity
Description (name of the Note
Name
resource)
patient Demographics and other administrative Patient
information about an individual receiving care or
other health-related services.
observation Signals that belong to a patient that is continually Observation
measured and monitored, using sensors such as
oximeters, glucometers, etc.
performer The one that is responsible for the observation, Performer

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which can be either the practitioner, or the

organization, or the patient, or the related person.
device The device that is used for the specific Device
measurement
identifier A unique identifier assigned to the observation Observation
category A code that classifies the general type of Observation
observation being made
code It describes what was observed Observation

Observation

Ma
Mandator x# Y1
Descriptio Constrai Assumptio
Attribute y Type of FHIR mapping coverag
n nt ns
(YES/NO) cha e
r
The type
resourceType YES String 100 of the N.A. Observation YES
resource
The
unique
identifier
id YES Int 15 N.A. Observation.identifier YES
of the
observatio
n
The status
of the
status YES String 100 ObsStatus Observation.status YES
observatio
n
The date-
effectiveDateTi Date/Tim time of the Observation.effectiveDateTi
YES 24 N.A. YES
me e observatio me
n

Category

Ma
Mandator x# Y1
Attribut Descriptio Constrain
y Type of FHIR mapping Assumptions coverag
e n t
(YES/NO) cha e
r
A code that
classifies
CodeableConcep Observation.categor
category YES - the general N.A. YES
t y
type of
observation
Category is of
type
CodeableConcet
. As a result its
coding YES - - - N.A. structure should YES
contain
([coding[system
, code,
display],text)
Standard
used for
system YES String 100 Coding YES
referring to
the

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category of
the
observation
Unique
Code of the
code YES Int 9 category of Coding YES
the
observation
The way
that the
category of
the
observation
display YES String 100 is displayed N.A. YES
into a non-
standard
format
(e.g. Vital
Signs)
Text
describing
text NO String 100 N.A. YES
the
category

Code

Max
Mandatory Y1
Attribute Type # of Description Constraint FHIR mapping Assumptions
(YES/NO) coverage
char
It describes
code YES CodeableConcept - what was N.A. Observation.code YES
observed
Code is of type
CodeableConcept.
As a result its
structure should
coding YES - - - N.A. YES
contain
([coding[system,
code,
display],text)
Standard
used for
referring to
system YES String 100 the Coding YES
component
of the
category
Unique
Code of the
code YES Int 9 component Coding YES
of the
category
The way
that the
component
of the
category of
display YES String 100 is displayed N.A. YES
into a non-
standard
format (e.g.
Blood
Pressure)
Text
text NO String 100 N.A. NO
describing

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the
component
of the
category

Component

Max
Mandatory Y1
Attribute Type # of Description Constraint FHIR mapping Assumptions
(YES/NO) coverage
char
The
BackBone
component NO - component N.A. Observation.component YES
element
observations

ValueQuantity

Ma
Mandato
x#
ry Typ Descriptio Constrai Assumption Y1
Attribute of FHIR mapping
(YES/NO e n nt s coverage
cha
)
r
An amount
valueQuant Observation.component.valueQuant
YES - - that can be N.A. YES
ity ity
measured
The value
of the
value YES Float 5 N.A. Observation.component.value YES
measurem
ent
The unit of Obsercation.
Strin the Observation.device.reference.resolv device is
unit NO 10 UnitCode YES
g measurem e().unit DeviceMetri
ent c

Identifier

Max
Mandatory Y1
Attribute Type # of Description Constraint FHIR mapping Assumptions
(YES/NO) coverage
char
The unique
identifier NO - - identifier of the N.A. Identifier YES
observation
The namespace for
system YES String 17 N.A. Identifier.system YES
the identifier value
The value that is
unique within the
value YES String 31 N.A. Observation.identifier YES
context of the
system

Patient

Ma
Mandat
x# Y1
Attrib ory Typ Descriptio Constra
of FHIR mapping Assumptions coverag
ute (YES/N e n int
cha e
O)
r
The
patient Observation.s
subject YES - - whose N.A. Observation.subject ubject is YES
characteris Patient
tics are

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described
by the
observatio
n
Unique
identifier
of the
Observation.s
referen patient Observation.subject.reference.resolve().ident
YES Int 4 N.A. ubject is YES
ce whose ifier[0].value
Patient
observatio
n is
measured
Display Observation.s
Stri
display YES 100 name of N.A. Observation.subject.reference.resolve().name ubject is YES
ng
the patient Patient

Performer

Ma
Mandat
x# Y1
Attribu ory Typ Descripti Constra
of FHIR mapping Assumptions covera
te (YES/N e on int
cha ge
O)
r
The
responsib
perfor Observation.su
YES - - le of the N.A. Observation.subject YES
mer bject is Patient
observati
on
Unique
identifier
of the
referen patient Observation.subject.reference.resolve().identi Observation.su
YES Int 4 N.A. YES
ce whose fier[0].value bject is Patient
vital
signs are
measured
Display
Stri name of Observation.su
display YES 100 N.A. Observation.subject.reference.resolve().name YES
ng the bject is Patient
patient

Device

Ma
Mandat
x# Y1
Attrib ory Typ Descripti Constra
of FHIR mapping Assumptions covera
ute (YES/N e on int
cha ge
O)
r
The
device
used for Obsercation.de
device NO - - N.A. Obsercation.device NO
the vice is Device
observatio
n
The Serial
Number
identifi Strin of the Observation.device.reference.resolve().identi Obsercation.de
YES 17 N.A. NO
er g device fier[0].value vice is Device
that takes
the

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measurem
ent
The
identifier
Obsercation.de
type YES Int 10 of the N.A. Observation.device.reference.resolve().type NO
vice is Device
type of
the device
The
Strin Observation.device.reference.resolve().udi.na Obsercation.de
model YES 100 model of N.A. NO
g me vice is Device
the device

Constraints

UnitCode

Description Code - Code - Y1

Value/Code Name Terminology URI
identifier description converage
The units used to YES
millimeters millimeter- Millimeter of http://www.crowdhealth.eu/hhr-
mmHg measure blood
of mercury of-mercury mercury t
pressure
The units used to YES
beats per beats- http://www.crowdhealth.eu/hhr-
bpm measure the resting Beats/minute
minute minute t
heart rate
The units used to YES
http://www.crowdhealth.eu/hhr-
% Per cent measure the oxygen percent Percent
t
saturation
Milligram milligram- http://www.crowdhealth.eu/hhr- YES
mg/dL Milligram/deciliter Milligram/deciliter
per deciliter deciliter t
Liter per http://www.crowdhealth.eu/hhr- NO
L/s Liter/second liter-second Liter/second
second t
http://www.crowdhealth.eu/hhr- NO
L liter liter liter liter
t
Liter per http://www.crowdhealth.eu/hhr- NO
L/m Liter/minute liter-minute Liter/minute
minute t
http://www.crowdhealth.eu/hhr- YES
kg kilogram kilogram kilogram kilogram
t

ObsStatus

Description Code - Code - Y1

Value/Code Name Terminology URI
identifier description converage
The status of http://www.crowdhealth. YES
Final Final end-stage End-stage
the observation eu/hhr-t

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Coding

Description Code - Code - Y1

Value/Code Name Terminology URI
identifier description coverage
The main
category of http://www.crowdhealth.eu/hhr- YES
Vital Signs Vital Signs vital-sign Vital sign
the t
observation
The
component of
the main http://www.crowdhealth.eu/hhr- YES
Blood Pressure Blood Pressure blood-pressure Blood pressure
category of t
the
observation
The
component of
the main http://www.crowdhealth.eu/hhr- YES
Heart Rate Heart Rate heart-rate Heart rate
category of t
the
observation
The specific
Systolic Blood Systolic Blood measurement systolic-blood- Systolic blood http://www.crowdhealth.eu/hhr- YES
Pressure Pressure of the pressure pressure t
component
The specific
Diastolic Blood Diastolic Blood measurement diastolic- Diastolic blood http://www.crowdhealth.eu/hhr- YES
Pressure Pressure of the blood-pressure pressure t
component
The specific
Peripheral Peripheral peripheral- Peripheral NO
measurement http://www.crowdhealth.eu/hhr-
oxygen oxygen oxygen- oxygen
of the t
saturation saturation saturation saturation
component
The specific
Blood glucose Blood glucose measurement blood-glucose- Blood glucose http://www.crowdhealth.eu/hhr- NO
concentration concentration of the concentration concentration t
component
The specific
measurement http://www.crowdhealth.eu/hhr- NO
Emotion Emotion emotion Emotion
of the t
component
forced-
Forced Forced Forced
The specific expiratory-
expiratory flow expiratory flow expiratory flow NO
measurement flow-rate- http://www.crowdhealth.eu/hhr-
rate between rate between rate between
of the between-25- t
25+75% of vital 25+75% of 25+75% of
component 75-percent-of-
capacity vital capacity vital capacity
vital-capacity
The specific forced-
Forced expired Forced expired Forced expired NO
measurement expired- http://www.crowdhealth.eu/hhr-
volume in 1 volume in 1 volume in 1
of the volume-in-1- t
second second second
component second
forced-
Forced Forced Forced
expiratory-
expiratory expiratory The specific expiratory
volume-in- NO
volume in one volume in one measurement volume in one http://www.crowdhealth.eu/hhr-
one-second-
second/Forced second/Forced of the second/Forced t
forced-vital-
vital capacity vital capacity component vital capacity
capacity-
percent percent percent
percent
The specific forced-
Forced expired Forced expired Forced expired NO
measurement expired- http://www.crowdhealth.eu/hhr-
volume in 6 volume in 6 volume in 6
of the volume-in-6- t
seconds seconds seconds
component seconds
The specific
Forced vital Forced vital measurement forced-vital- Forced vital http://www.crowdhealth.eu/hhr- NO
capacity capacity of the capacity capacity t
component

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The specific
peak- NO
Peak expiratory Peak expiratory measurement Peak expiratory http://www.crowdhealth.eu/hhr-
expiratory-
flow rate flow rate of the flow rate t
flow-rate
component
The specific
Perfusion index Perfusion index Perfusion index NO
measurement
Tissue by Pulse Tissue by Pulse 61006-3 Tissue by Pulse https://loinc.org
of the
oximetry oximetry oximetry
component
The specific
pulse- NO
Pulse oximetry Pulse oximetry measurement Pulse oximetry http://www.crowdhealth.eu/hhr-
oximetry-
waveform waveform of the waveform t
waveform
component
The specific
measurement http://www.crowdhealth.eu/hhr- YES
Body weight Body weight body-weight Body weight
of the t
component

Phr_sample

Conceptual diagram

Figure 2 - Phr conceptual diagram

List of entities

FHIR mapping (name

Entity Name Description Note
of the resource)
examination A physical evaluation of a prospective DiagnosticReport
insured, conducted by a doctor acting as
the insured's agent
referenceRange The range of values for a physiologic DiagnosticReport
measurement in healthy persons
resultValues The value of the examination’s results DiagnosticReport

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Phr

M
Mand ax
Y1
atory Ty # Descri Const
Attribute FHIR mapping Assumptions conv
(YES/ pe of ption raint
erage
NO) ch
ar
The
date of
sampling Da
YES 10 the N.A. DiagnosticReport.issued NO
Date te
sampli
ng
The
unique
identifi
er of DiagnosticReport.
examCod
YES Int 4 the N.A. result.reference.resolve().identifier[0].val NO
e
specifi ue
c
examin
ation
DiagnosticReport.result is
Observation
Descri
ption
descriptio Str 10 DiagnosticReport.result.reference.resolve
YES of the N.A. NO
n ing 0 ().context.reference.resolve().type
examin
ation DiagnosticReport.result.refe
rence.resolve().context is
EpisodeOfCare
The
abbrev
Str iation
abbr YES 10 N.A. DiagnosticReport.code NO
ing of the
examin
ation
The
categor
examCate Str y of
YES 10 N.A. DiagnosticReport.category NO
gory ing the
examin
ation
DiagnosticReport.result is
Observation
The
measur
ement DiagnosticReport.
Str Exam
examUnit YES 10 unit of result.reference.resolve().identifier[0].dev NO
ing Un
the ice.reference.resolve().unit
examin
ation DiagnosticReport.
result.reference.resolve().ide
ntifier[0].device is
DeviceMetric
The
unique
identifi
examTyp er of Exam
YES Int 10 DiagnosticReport.identifier NO
e the Type
general
examin
ation
LineCom Str 10 A DiagnosticReport.result.reference.resolve
NO N.A. DiagnosticReport.result is NO
ment ing 0 specifi ().comment

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c Observation
comme
nt
concer
ning a
part of
the
examin
ation
A
general
comme
nt
GeneralC Str 10 concer
NO N.A. DiagnosticReport.conclusion NO
omment ing 0 ning
the
whole
examin
ation
The
expect
ed type
resultTyp Str 10
YES of the N.A. FHIR extension NO
e ing 0
examin
ation
result

Element: resultType - The expected data type of the result

ResourceName DiagnosticReport

ElementName resultType

ElementDefinition The expected data type of the result

ElementCardinality 1..1

ElementType String

Comment Example of resultType: numeric/description

Is-modifier False

Terminology Binding resultType

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Value Set: resultType

Value Set URI: http://crowdhealth.eu/fhir/ValueSet/resultType

Code Display Definition

numeric numeric/description The result data type contains

only numbers

string string/description The result data type contains

strings and/or numbers

other Other Any other data type not listed

in this Value Set

resultValues

Ma
Mandat
x# Y1
ory Ty Descript Constra
Attribute of FHIR mapping Assumptions covera
(YES/N pe ion int
cha ge
O)
r
The
result of DiagnosticReport.
singleResultV Flo DiagnosticReport.result.reference.res
YES 10 the N.A. result is NO
alue at olve().value
examinat Observation
ion

referenceRange

M
Manda ax
Y1
tory Ty # Descript Constr
Attribute FHIR mapping Assumptions covera
(YES/N pe of ion aint
ge
O) ch
ar
The
abbreviat
Same
examComp Stri ion of
YES 10 as the DiagnosticReport.code NO
onent ng the
abbr
examinat
ion
The
It
minimu
depend
m limit DiagnosticReport.
Stri s on the DiagnosticReport.result.reference.resolve(
lower NO 10 of the result is NO
ng measur ).referenceRange.low
examinat Observation
ed
ion
value
result
Stri The It DiagnosticReport.result.reference.resolve( DiagnosticReport.
upper YES 10 NO
ng maximu depend ).referenceRange.high result is

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m limit s on the Observation

of the measur
examinat ed
ion value
result
The
measure
Same
ment DiagnosticReport. DiagnosticReport.
Stri as the
unit YES 10 unit of result.reference.resolve().identifier[0].devi result is NO
ng exam
the ce.reference.resolve().unit Observation
unit
examinat
ion

Constraints

ExamUn

Value/Code Name Description Code - Code - description Terminology URI Y1

identifier converage
mm/h Milimeters The units used to millimeter- Millimeter/hour http://www.crowdhealth.eu/hhr- NO
per hour measure a hour t
medical test
ng/ml Nanogram The units used to nanogram- Nanogram/milliliter http://www.crowdhealth.eu/hhr- YES
per mililiter measure a milliliter t
medical test

ExamType

Terminology Y1
Value/Code Name Description Code - identifier Code - description
URI coverage
NO
1 1 A unique identifier of the examination type
NO
2 2 A unique identifier of the examination type

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Allergies

Conceptual diagram

Figure 3 - Allergies conceptual diagram

List of entities

Entity FHIR mapping (name

Description Note
Name of the resource)
allergies A number of conditions caused by AllergyIntolerance
hypersensitivity of the immune system to
something in the environment that usually causes
little or no problem in most people

Allergies

Max
Mandatory Y1
Attribute Type # of Description Constraint FHIR mapping Assumptions
(YES/NO) coverage
char
The unique
id YES Int 15 identifier of N.A. AllergyIntolerance.identifier NO
the allery
A code that
identifies the
code YES String 100 N.A. AllergyIntolerance.code NO
allergy or
intolerance

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Medication

Conceptual diagram

Figure 4 - Medication conceptual diagram

List of entities

Entity FHIR mapping (name of

Description Note
Name the resource)
medication A drug or other form of medicine that is Medication
used to treat or prevent disease

Medication

Ma
Mandator x# Y1
Attribut Descriptio Constrain Assumption
y Type of FHIR mapping coverag
e n t s
(YES/NO) cha e
r
The unique
Intege identifier
id YES 15 medID Medication.code YES
r of the
medication
The name
name YES String 100 of the N.A. FHIR Extension NO
medication
The form
form YES String 100 N.A. Medication.form NO
of the item
It defined
the
strength YES String 100 strength of N.A. FHIR Extension NO
the
medication
The time
that the
doseTim Intege MedicationStatement.effectiveDateTi
YES 9 medication N.A. YES
e r me
should be
provided

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Element: name - The name of the medication

ResourceName Medication

ElementName name

ElementDefinition The name of the medication

ElementCardinality 1..1

ElementType string

Comment -

Is-modifier false

Terminology Binding -

Element: strength - The strength of the medication

ResourceName Medication

ElementName strength

ElementDefinition The strength of the medication

ElementCardinality 1..1

ElementType string

Comment -

Is-modifier false

Terminology Binding -

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 Collective Wisdom Driving Public Health Policies

Del. no. – D3.1 Annex B4: Data scheme of

CareCross mapped to FHIR
Project Deliverable

This project has received funding from the European Union’s Horizon 2020 Programme
(H2020-SC1-2016-CNECT) under Grant Agreement No. 727560
 D3.1 Annex B4: Data scheme of
31/10/2017
CareCross mapped to FHIR

Data source scheme

The Use Case is driven by the data entered by cancer patients on the secure CareAcross web
platform. More specifically, patients provide information on their diagnosis, treatment, co-
morbidities, health behaviours and side-effects. The platform then provides medical
information based on this input, and attempts to “coach” the patients into behaviour change
based on medical research.

Conceptual diagram

List of entities

FHIR mapping (name of the

Entity Name Description Note
resource)
Patient’s contact info
(email address), used
Patient Patient
only for
communications.
The diagnosis data,
Diagnosis Condition
including metastases.
Procedure or
Treatment Treatment(s) received
MedicationStatement
Comorbidities Other condition(s) Condition
The behaviour as
Behaviour Observation
entered by the patient.
Coaching The coaching provided CarePlan.Activity.Detail.Goal or Each row of the

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due to the behaviour CarePlan.Activity.Detail table Coaching

entered by the patient. related to the same
Patient is mapped
to the same
CarePlan.
The side-effect
Side-effects Condition
reported by the patient

Patient

Mand
Max
Attrib atory Constr
Type # of Description FHIR mapping Assumptions Note
ute (YES/ aint
char
NO)
The unique Patient.identifier[
Numer 0].value Patient.identifier[0].system=
ID YES 10 identifier of the N.A.
ic ”https://www.careacross.com/”
patient.
Patient.telecom[0] Patient.telecom[0].system=”E
Email YES String 100 Patient’s email. N.A.
.value mail”
Resource.meta.las
create Registration tUpdate
YES Date 10 N.A.
d_at date

Diagnosis

Mand
Max
Attrib atory Constr
Type # of Description FHIR mapping Assumptions Note
ute (YES/ aint
char
NO)
This
Condition.category.coding[0].c assumptions
ode=”diagnosis”, must be used if
Condition.category.coding[0].d the
isplay=”Diagnosis” <value_code>
Condition.category.coding[0].s (see row Value)
ystem=” is a subconcept
http://crowdhealth.eu/hhr-t” of “Neoplastic
disease”
This
assumptions
must be used if
the
Condition.category.coding[0].c
<value_code>
ode=” morphologically-
(see row Value)
abnormal-structure”,
is a SNOMED
Condition.category.coding[0].d
concept
isplay=”Morphologically
“Intraductal
abnormal structure”
carcinoma,
Condition.category.coding[0].s
noninfiltrating,
ystem=”
no International
http://crowdhealth.eu/hhr-t”
Classification of
Diseases for
Oncology
subtype”
The unique
Numer
ID YES 20 identifier of the N.A. Not mapped
ic
diagnosis.

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 D3.1 Annex B4: Data scheme of
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This mapping
Condition.subject.
uses the function
Unique reference.resolve(
“resolve()” (see
_Patie ).identifier[0].valu section B.3.3 of
nt_ID: e
Condition.subject.reference.res FHIRPath
Match
User_I Numer The unique ID olve() is Patient specification) to
YES 20 es one
D ic of the patient. Condition.asserter.reference.res return the FHIR
entry
olve() is Patient resource pointed
of Condition.asserter
by a FHIR
Patient .reference.resolve
Reference (that
entity. ().identifier[0].val
in this case is a
ue
Patient).
Each Value
must be
converted in a
corresponding
<value_code>
selected from a
specific
dictionary
identified by a
<terminology_U
RI>. The
<description> of
that
<value_code> as
specified by the
dictionary must
be included.
See codes,
descriptions and
terminology
URIs in the table
DiagnosisValue.

Condition.code.coding[0].code
=<value_code>
Condition.code.coding[0].displ In case of
The diagnosis reverse
Diagno ay=<description>
information translation (from
Value YES String 100 sisVal Condition.code.coding[0].syste
entered by the FHIR to CRA
ue m=<terminology URI>
patient. system) any
Condition.code.text=<Descripti
on of the selected Condition which
DiagnosisValue> code.coding[0].c
ode is
specialization of
the concept
“Neoplastic
disease” or of
the concept
“Intraductal
carcinoma” must
be mapped to a
(CRA)
Diagnosis entity.

To simplify
analytics
processing a
FHIR extension
of the Diagnosis
resource (e.g.
boolean
attribute
isCancerDiagno
sis) could be
defined and put

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 D3.1 Annex B4: Data scheme of
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in a namespace
specific for
CRA use case
(in order to
distinguish it
from general
purpose
extensions).

Treatment

Mand
Max
Attrib atory Constr
Type # of Description FHIR mapping Assumptions Note
ute (YES/ aint
char
NO)
The unique
Numer
ID YES 20 identifier of the N.A. Not Mapped
ic
treatment.
MedicationStatem MedicationStatement.subject.re This mapping
ent.subject.referen ference.resolve() is Patient uses the function
Unique ce.resolve().identi “resolve()” (see
_Patie fier[0].value section B.3.3 of
nt_ID: FHIRPath
User_I Numer The unique ID Match specification) to
YES 20
D ic of the Patient. es one return the FHIR
entry resource pointed
Procedure.subject.
of by a FHIR
reference.resolve( Procedure.subject.reference.res
Patient Reference (that
).identifier[0].valu olve() is Patient
in this case is a
e
Patient).
Here we specify
alternative
MedicationStatem mappings
ent because the
correct “FHIR
The treatment
Treatm mapping”
information depends from
Value YES String 100 entVal
entered by the the content of
ue
patient.
the “Value”
attribute, as
specified in table
TreatmentValue.
Procedure

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Comorbidities

M
Mand ax
Attri atory Typ # Descrip
Constraint FHIR mapping Assumptions Note
bute (YES/ e of tion
NO) ch
ar
Condition.category.coding[
0].code=”clinical-finding”,
Condition.category.coding[
0].display=”Clinical
finding”
Condition.category.coding[
0].system=”
http://crowdhealth.eu/hhr-t”
The
unique
identifi
Num
ID YES 20 er of N.A. Not mapped.
eric
the
comorb
idity.
This
mapping uses
the function
“resolve()”
(see section
Condition.subject.reference.res B.3.3 of
The Unique_Pat
olve().identifier[0].value FHIRPath
unique ient_ID: Condition.subject.reference
specification)
User Num identifi Matches .resolve() is Patient
YES 20 to return the
_ID eric er of one entry Condition.asserter.referenc
FHIR
the of Patient e.resolve() is Patient
Condition.asserter.reference.res resource
patient. entity.
olve().identifier[0].value pointed by a
FHIR
Reference
(that in this
case is a
Patient).
Each Value
must be
converted in
a
correspondin
g
<value_code
> selected
Condition.code.coding[0].c from a
ode=<value_code> specific
Condition.code.coding[0].d dictionary
isplay=<description> identified by
Comorb Condition.code.coding[0].s a
Valu Strin 10 idities Comorbidit ystem=<terminology URI>
YES <terminology
e g 0 for the iesValue. Condition.code.text=<Nam _URI>. The
patient. e of the selected <description
ComorbiditiesValue> > of that
<value_code
> as
specified by
the
dictionary
must be
included.
See codes,
descriptions
and

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terminology
URIs in the
table
Comorbiditie
sValue.

In case of
reverse
translation
(from FHIR
to CRA
system) any
Condition
which
code.coding[
0].code is the
concept
“Acid reflux”
or is a
subconcept
of concept
“Disease”
and is not a
cancer
diagnosis
recorded by
CRA (see
note in
Diagnosis
table) must
be mapped to
a (CRA)
Comorbidity
entity.

To simplify
analytics
processing a
FHIR
extension of
the
Diagnosis
resource (eg.
boolean
attribute
isCancerCo
morbidity)
could be
defined and
put in a
namespace
specific for
CRA use
case (in
order to
distinguish
it from
general
purpose
extensions).

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Behaviour

M
a
Man x
Attr dato # Desc
Ty Constrai
ibut ry of ripti FHIR mapping Assumptions Note
pe nt
e (YES c on
/NO) h
a
r
The value of
<code> and
<display> dep
ends on the
kind of field
“Value” (for
Observation.category[0].coding[0].co
example if
de=<value_code>,
value=”smoki
Observation.category[0].coding[0].di
ng” then
splay=<value_display>,
category.code
Observation.category[0].coding[0].sy
=”social-
stem=”https://www.hl7.org/fhir/value
history).
set-observation-category.html”
“status” is a
Observation.status=”Unknown”
mandatory
element of the
Observation
resource and
must be filled
in.
The
uniqu
e
Nu
2 identi
ID YES mer N.A. Not mapped.
0 fier
ic
of the
beha
viour
Observation.subject.referenc
Unique_ e.resolve().identifier[0].valu
The
Patient_I e
uniqu
Use Nu D:
2 e ID Observation.subject.reference.resolve
r_I YES mer Matches
0 of the () is Patient
D ic one entry
patie
of Patient Observation.performer.refere
nt
entity. nce.resolve().identifier[0].va
lue
Each
VariableValu
e must be
converted in a
corresponding
<value_code>
Observation.code.coding[0].code=<v selected from
The
alue_code> a specific
kind
Observation.code.coding[0].display= dictionary
Var of
Stri 5 Variable <description> identified by a
iabl YES beha
ng 0 Value Observation.code.coding[0].system= <terminology
e viour
<terminology URI> _URI>. The
provi
Condition.code.text=<Description of <description>
ded
the selected ComorbiditiesValue> of that
<value_code>
as specified
by the
dictionary
have to be
included.

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See codes,
descriptions
and
terminology
URIs in the
table
BehaviourVar
iable.
Any
value Observation.value is Quantity
also When the
provi value is equal
ded to “8+” or
(usua Observation.value.value=<value> “15+” or
1
Val Stri lly Observation.value.unit=”portions per “23+” the
YES 0 N.A. Observation.value
ue ng nume week” element
0
rical Observation.value.system=<URI of Observation.v
but the system that provides the coded alue.comparat
not form of the unit> or must be
neces Observation.value.code=”portions/we “>=”
sarily ek”
)

Coaching

Mand
Max
Attrib atory Constr
Type # of Description FHIR mapping Assumptions Note
ute (YES/ aint
char
NO)
CarePlan.intent=”Proposal”.
CarePlan.status=”Unknown”.
CarePlan.author.reference.resol
ve() is Organization
CarePlan.author.name=”CareA
cross”
CarePlan.telecom[0].system=”
URL”
CarePlan.telecom[0].value=”htt
ps://www.careacross.com/”
The unique
Numer
ID YES 20 identifier of the N.A. Not mapped.
ic
coaching.
Unique
_Patie
nt_ID:
CarePlan.subject.r
Match
User_I Numer The unique ID eference.resolve()
YES 20 es one CarePlan.subject is Patient
D ic of the patient. .identifier[0].valu
entry
e
of
Patient
entity.
At this stage
Advic The coaching Advice information
YES String 500
e provided. Value about advices
are not included

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Side-effects

M
Mand ax
Attri atory Typ # Descr Constrain
FHIR mapping Assumptions Note
bute (YES/ e of iption t
NO) ch
ar
Condition.category.coding[0].code
=” clinical-finding”,
Condition.category.coding[0].displ
ay=”Clinical finding”
Condition.category.coding[0].syste
m=”http://crowdhealth.eu/hhr-t”
The
uniqu
e
Nu
identif
ID YES meri 20 N.A. Not mapped
ier of
c
the
side-
effect.
This
mapping
uses the
function
“resolve()”
(see
section
Condition.subject.reference.re
The Unique_P B.3.3 of
solve().identifier[0].value
uniqu atient_ID: Condition.subject.reference.resolve FHIRPath
Nu
User e ID Matches () is Patient specificati
YES meri 20
_ID of the one entry Condition.asserter.reference.resolv on) to
c
patien of Patient e() is Patient return the
Condition.asserter.reference.r
t. entity. FHIR
esolve().identifier[0].value
resource
pointed by
a FHIR
Reference
(that in this
case is a
Patient).
Each
Value
must be
converted
in a
correspond
ing
<value_co
de>
Condition.code.coding[0].code=<v
selected
alue_code>
The from a
Condition.code.coding[0].display=
Side- side- Side- specific
Stri 50 <description>
effec YES effect effectValu dictionary
ng 0 Condition.code.coding[0].system=
ts report e identified
<terminology URI>
ed. by a
Condition.code.text=<Description
<terminolo
of the selected Side-effectValue>
gy_URI>.
The
<descriptio
n> of that
<value_co
de> as
specified
by the
dictionary

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must be
included.
See codes,
description
s and
terminolog
y URIs in
the table
Side-
effectValu
e.

In case of
reverse
translation
(from
FHIR to
CRA
system)
any
Condition
which
code.codin
g[0].code
is
specializati
on of
concept
“Clinical
finding”
and is not a
Diagnosis
or a
Comorbidi
ty (see
note in
correspond
ing tables)
must be
mapped to
a (CRA)
Side-
effects
entity.

To
simplify
analytics
processing
a FHIR
extension
of the
Diagnosis
resource
(e.g.
boolean
attribute
isCancerS
ideEffect)
could be
defined
and put in
a
namespac
e specific
for CRA
use case

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(in order
to
distinguis
h it from
general
purpose
extensions
).

Constraints

DiagnosisValue

Value/Code Name Description Code - Code - description Terminology URI

identifier
DCIS DCIS (Ductal Breast Ductal intraductal- Intraductal carcinoma, http://crowdhealth.eu/hhr-t
Carcinoma in Carcinoma in Situ carcinoma, noninfiltrating, no
Situ) International
Classification of
Diseases for Oncology
subtype
ER+ Oestrogen Oestrogen estrogen- Estrogen receptor http://crowdhealth.eu/hhr-t
Receptor (ER) Receptor positive receptor- positive tumor
positive breast cancer positive- tumor
ER- Oestrogen Oestrogen estrogen- Estrogen receptor http://crowdhealth.eu/hhr-t
Receptor (ER) Receptor negative receptor- negative neoplasm
negative breast cancer negative-
neoplasm
PR+ Progesterone Progesterone progesterone- Progesterone receptor http://crowdhealth.eu/hhr-t
Receptor (PR) Receptor positive receptor- positive tumor
positive breast cancer positive-tumor
PR- Progesterone Progesterone progesterone- Progesterone receptor http://crowdhealth.eu/hhr-t
Receptor (PR) Receptor negative receptor- negative neoplasm
negative breast cancer negative-
neoplasm
HER2+ HER2 positive Human Epidermal her2-positive- HER2-positive http://crowdhealth.eu/hhr-t
growth factor carcinoma-of- carcinoma of breast
Receptor 2 breast
positive breast
cancer
HER2- HER2 negative Human Epidermal human- Human epidermal http://crowdhealth.eu/hhr-t
growth factor epidermal- growth factor 2
Receptor 2 growth-factor-2 negative carcinoma of
negative breast breast
cancer
GenericBreastCancer Simply Breast Breast Cancer malignant- Malignant tumor of http://crowdhealth.eu/hhr-t
Cancer (not (generic) tumor-of-breast breast
characterised by
ER, PR, HER2)
Metastasis.Liver Metastasis to Breast cancer with secondary- Secondary malignant http://crowdhealth.eu/hhr-t
liver metastasis to liver malignant- neoplasm of liver
neoplasm-of-
liver
Metastasis.Lung Metastasis to Breast cancer with secondary- Secondary malignant http://crowdhealth.eu/hhr-t
lung metastasis to lung malignant- neoplasm of lung
neoplasm-of-
lung
Metastasis.Kidney Metastasis to Breast cancer with secondary- Secondary malignant http://crowdhealth.eu/hhr-t
kidney metastasis to malignant- neoplasm of kidney
kidney neoplasm-of-

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kidney
Metastasis.Bones Metastasis to Breast cancer with secondary- Secondary malignant http://crowdhealth.eu/hhr-t
bones metastasis to malignant- neoplasm of bone
bones neoplasm-of-
bone
Metastasis.Brain Metastasis to Breast cancer with secondary- Secondary malignant http://crowdhealth.eu/hhr-t
brain metastasis to brain malignant- neoplasm of brain
neoplasm-of-
brain

TreatmentValue

Value/Code Name Code - Code - Terminology URI FHIR mapping Assumption

identifier descriptio
n
NoTreatmen No Not mapped Not mapped
t treatment
Surgery Surgery surgical- Surgical http://crowdhealth. Procedure.code Procedure.status=”Unknown
procedure procedure eu/hhr-t ”
Radiotherap Radiation radiothera Radiation http://crowdhealth. Procedure.code Procedure.status=”Unknown
y therapy py oncology eu/hhr-t ”
AND/OR
radiotherap
y
Anastrozole Anastrozol anastrozol Anastrozol http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
e e e eu/hhr-t cation tion is CodeableConcept
(Arimidex
®) MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Bevacizuma Bevacizum bevacizum Bevacizum http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
b ab (Avastin ab ab eu/hhr-t cation tion is CodeableConcept
®)
MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Docetaxel Docetaxel docetaxel Docetaxel http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
(Taxotere eu/hhr-t cation tion is CodeableConcept
®)
MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Epirubicin Epirubicin epirubicin Epirubicin http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
(Pharmoru eu/hhr-t cation tion is CodeableConcept
bicin ®)
MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Eribulin Eribulin eribulin Eribulin http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
(Halaven eu/hhr-t cation tion is CodeableConcept
®)
MedicationStatement.status=
”Active”

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MedicationStatement.taken=
”Unknown”
Exemestane Exemestan exemestan Exemestan http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
e e e eu/hhr-t cation tion is CodeableConcept
(Aromasin
®) MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
FEC FEC: fluorouraci Fluorouraci http://crowdhealth. MedicationStatement.medi MedicationStament.medicati
fluorouracil l l eu/hhr-t cation.ingredient[0].item on is Medication
(5FU),
epirubicin, MedicationStatement.status=
cyclophosp ”Active”
hamide epirubicin Epirubicin http://crowdhealth. MedicationStatement.medi
eu/hhr-t cation.ingredient[1].item MedicationStatement.taken=
cyclophos Cyclophos http://crowdhealth. MedicationStatement.medi ”Unknown”
phamide phamide eu/hhr-t cation.ingredient[2].item
MedicationStatement.medica
tion.ingredient.item is
CodeableConcept
FEC-T FEC-T: fluorouraci Fluorouraci http://crowdhealth. MedicationStatement.medi MedicationStament.medicati
fluorouracil l l eu/hhr-t cation.ingredient[0].item on is Medication
(5FU), epirubicin Epirubicin http://crowdhealth. MedicationStatement.medi
epirubicin, eu/hhr-t cation.ingredient[1].item MedicationStatement.status=
cyclophosp cyclophos Cyclophos http://crowdhealth. MedicationStatement.medi ”Active”
hamide, phamide phamide eu/hhr-t cation.ingredient[0].item
docetaxel docetaxel Docetaxel http://crowdhealth. MedicationStatement.medi MedicationStatement.taken=
(Taxotere eu/hhr-t cation.ingredient[0].item ”Unknown”
®)
MedicationStatement.medica
tion.ingredient.item is
CodeableConcept
Fluorouracil Fluorouraci fluorouraci Fluorouraci http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
l (5FU) l l eu/hhr-t cation tion is CodeableConcept

MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Fulvestrant Fulvestrant fulvestrant Fulvestrant http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
(Faslodex eu/hhr-t cation tion is CodeableConcept
®)
MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Gemcitabine Gemcitabin gemcitabin Gemcitabin http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
e (Gemzar e e eu/hhr-t cation tion is CodeableConcept
®)
MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Goserelin Goserelin goserelin Goserelin http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
(Zoladex eu/hhr-t cation tion is CodeableConcept
®)
MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”

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D3.1 Annex B4: Data scheme of
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CareCross mapped to FHIR

Letrozole Letrozole letrozole Letrozole http://crowdhealth. MedicationStatement.medi MedicationStatement.medica

(Femara ®) eu/hhr-t cation tion is CodeableConcept

MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Paclitaxel Paclitaxel paclitaxel Paclitaxel http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
(Taxol ®) eu/hhr-t cation tion is CodeableConcept

MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Tamoxifen Tamoxifen tamoxifen Tamoxifen http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
(Nolvadex eu/hhr-t cation tion is CodeableConcept
®)
MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Toremifene Toremifene toremifene Toremifene http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
(Fareston eu/hhr-t cation tion is CodeableConcept
®)
MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Trastuzuma Trastuzuma trastuzuma Trastuzum http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
b b b ab eu/hhr-t cation tion is CodeableConcept
(Herceptin
®) MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Trastuzuma Trastuzuma Trastuzum Trastuzum http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
bEmtansine b ab- ab eu/hhr-t cation tion is CodeableConcept
emtansine emtansine emtansine
(Kadcyla MedicationStatement.status=
®) ”Active”

MedicationStatement.taken=
”Unknown”
Everolimus Everolimus everolimus Everolimus http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
(Afinitor (substance) eu/hhr-t cation tion is CodeableConcept
®)
MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Palbociclib Palbociclib palbociclib Palbociclib http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
(Ibrance ®) eu/hhr-t cation tion is CodeableConcept

MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Pertuzumab Pertuzuma pertuzuma Pertuzuma http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
b (Perjeta b b eu/hhr-t cation tion is CodeableConcept
®)

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MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Capecitabine Capecitabi capecitabi Capecitabi http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
ne (Xeloda ne ne eu/hhr-t cation tion is CodeableConcept
®)
MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
Lapatinib Lapatinib lapatinib Lapatinib http://crowdhealth. MedicationStatement.medi MedicationStatement.medica
(Tyverb®) eu/hhr-t cation tion is CodeableConcept

MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”
AC AC doxorubici Doxorubici http://crowdhealth. MedicationStatement.medi MedicationStament.medicati
(doxorubici n n eu/hhr-t cation.ingredient[0].item on is Medication
n
(Adriamyci cyclophos Cyclophos http://crowdhealth. MedicationStatement.medi MedicationStatement.status=
n ®), phamide phamide eu/hhr-t cation.ingredient[1].item ”Active”
cyclophosp
hamide) MedicationStatement.taken=
”Unknown”

MedicationStatement.medica
tion.ingredient.item is
CodeableConcept
Capecitabine Capecitabi capecitabi Capecitabi http://crowdhealth. MedicationStatement.medi MedicationStament.medicati
+Taxotere ne (Xeloda ne ne eu/hhr-t cation.ingredient[0].item on is Medication
®) and
Docetaxel docetaxel Docetaxel http://crowdhealth. MedicationStatement.medi MedicationStatement.status=
(Taxotere eu/hhr-t cation.ingredient[1].item ”Active”
®)
MedicationStatement.taken=
”Unknown”

MedicationStatement.medica
tion.ingredient.item is
CodeableConcept
EC EC epirubicin Epirubicin http://crowdhealth. MedicationStatement.medi MedicationStament.medicati
(epirubicin, eu/hhr-t cation.ingredient[0].item on is Medication
cyclophosp cyclophos Cyclophos http://crowdhealth. MedicationStatement.medi
hamide) phamide phamide eu/hhr-t cation.ingredient[1].item MedicationStatement.status=
”Active”

MedicationStatement.taken=
”Unknown”

MedicationStatement.medica
tion.ingredient.item is
CodeableConcept
ECF ECF epirubicin Epirubicin http://crowdhealth. MedicationStatement.medi MedicationStament.medicati
(epirubicin eu/hhr-t cation.ingredient[0].item on is Medication
(Pharmoru
bicin ®), cisplatin Cisplatin http://crowdhealth. MedicationStatement.medi MedicationStatement.status=
cisplatin, eu/hhr-t cation.ingredient[1].item ”Active”
fluorouracil fluorouraci Fluorouraci http://crowdhealth. MedicationStatement.medi
(5FU)) l l eu/hhr-t cation.ingredient[2].item MedicationStatement.taken=
”Unknown”

MedicationStatement.medica

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tion.ingredient.item is
CodeableConcept
E-CMF E-CMF epirubicin Epirubicin http://crowdhealth. MedicationStatement.medi MedicationStament.medicati
(epirubicin eu/hhr-t cation.ingredient[0].item on is Medication
(Pharmoru
bicin ®), MedicationStatement.status=
cyclophosp ”Active”
hamide,
methotrexa MedicationStatement.taken=
te, ”Unknown”
fluorouracil
) MedicationStatement.medica
tion.ingredient.item is
CodeableConcept

ComorbiditiesValue

Value/Code Name Code - identifier Code - description Terminology URI

Diabetes Diabetes diabetes-mellitus Diabetes mellitus http://crowdhealth.e
u/hhr-t
Cholesterol Cholesterol hypercholesterolemia Hypercholesterolemia http://crowdhealth.e
u/hhr-t
Chrons Crohn’s disease crohns-disease Crohn's disease http://crowdhealth.e
u/hhr-t
IBS IBS (Irritable Bowel Syndrome) irritable-bowel-syndrome Irritable bowel syndrome http://crowdhealth.e
u/hhr-t
Heart Heart condition (coronary heart structural-disorder-of-heart Structural disorder of heart http://crowdhealth.e
disease, etc) u/hhr-t
Hypertension Hypertension hypertensive-disorder-systemic- Hypertensive disorder, http://crowdhealth.e
arterial systemic arterial u/hhr-t
ChronicKidney Kidney function failure chronic-kidney-disease Chronic kidney disease http://crowdhealth.e
Disease u/hhr-t
AcidReflux Acid Reflux acid-reflux Acid reflux (finding) http://crowdhealth.e
u/hhr-t
Anaemia Anaemia anemia Anemia http://crowdhealth.e
u/hhr-t
Tumour.Liver Other tumours: in the liver neoplasm-of-liver Neoplasm of liver http://crowdhealth.e
u/hhr-t
Tumour.Kidne Other tumours: in the kidney neoplasm-of-kidney Neoplasm of kidney http://crowdhealth.e
y u/hhr-t
Tumour.Bones Other tumours: in the bones neoplasm-of-bone Neoplasm of bone http://crowdhealth.e
u/hhr-t
Tumour.GI Other tumours: oesophageal, tumor-of-esophagus-stomach- Tumor of esophagus, stomach http://crowdhealth.e
stomach, or bowel and-or-duodenum and/or duodenum u/hhr-t

BehaviourVariable

Value/Code Name Description Code - Code - description Terminology URI

identifier
RedMeat[0-8+] RedMeat[0-8+] Number of portions of red-meat-intake Red meat intake http://crowdhealth.eu/hhr-t
RedMeat per week (from 0
to 8+)
Poultry[0-8+] Poultry[0-8+] Number of portions of white-meat- White meat intake http://crowdhealth.eu/hhr-t
Poultry per week (from 0 intake
to 8+)
Fish[0-8+] Fish[0-8+] Number of portions of fish-intake Fish intake http://crowdhealth.eu/hhr-t
Fish per week (from 0 to
8+)

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Legumes[0-8+] Legumes[0-8+] Number of portions of pulse-vegetable- Pulse vegetable intake http://crowdhealth.eu/hhr-t

Legumes per week (from 0 intake
to 8+)
Eggs[0-8+] Eggs[0-8+] Number of portions of egg-intake Egg intake http://crowdhealth.eu/hhr-t
Eggs per week (from 0 to
8+)
Dairy[0-22+] Dairy[0-22+] Number of portions of dairy-food- Dairy food intake http://crowdhealth.eu/hhr-t
Dairy per week (from 0 to intake
22+)
Nuts[0-8+] Nuts[0-8+] Number of portions of nuts-and-seeds- Nuts and seeds intake http://crowdhealth.eu/hhr-t
Nuts per week (from 0 to intake-
8+)
Fruits[0-22+] Fruits[0-22+] Number of portions of fruit-intake Fruit intake http://crowdhealth.eu/hhr-t
Fruits per week (from 0 to
22+)
Vegetables[0- Vegetables[0- Number of portions of vegetable- Vegetable intake http://crowdhealth.eu/hhr-t
22+] 22+] Vegetables per week (from intake-
0 to 22+)
Bread[0-15+] Bread[0-15+] Number of portions of bread-intake Bread intake http://crowdhealth.eu/hhr-t
Bread per week (from 0 to
15+)
Pasta[0-15+] Pasta[0-15+] Number of portions of pasta-intake Pasta intake http://crowdhealth.eu/hhr-t
Pasta per week (from 0 to
15+)
Potatoes[0-15+] Potatoes[0- Number of portions of potato-intake Potato intake http://crowdhealth.eu/hhr-t
15+] Potatoes per week (from 0
to 15+)

Side-effectValue

Value/Code Name Description Code - identifier Code - description Terminology URI

NoAppetite No appetite loss-of-appetite Loss of appetite http://crowdhealth.eu/hhr-t
FoodTaste Food tastes taste-sense- Taste sense altered http://crowdhealth.eu/hhr-t
funny or has altered
no taste
ProblemsSwallo Problems swallowing- Swallowing problem http://crowdhealth.eu/hhr-t
wing swallowing problem
Nausea Nausea nausea Nausea http://crowdhealth.eu/hhr-t
Vomiting Vomiting vomiting- Vomiting symptom http://crowdhealth.eu/hhr-t
symptom
Constipation Constipation alteration in- Alteration in bowel http://crowdhealth.eu/hhr-t
bowel- elimination:
elimination- constipation
constipation
Diarrhoea Diarrhoea diarrhea Diarrhea http://crowdhealth.eu/hhr-t
MouthSores Mouth sores sore-mouth Sore mouth http://crowdhealth.eu/hhr-t
DryMouth Dry mouth xerostomia Xerostomia http://crowdhealth.eu/hhr-t
Smells Smells are sensitive-to- Sensitive to smells http://crowdhealth.eu/hhr-t
bothering me smells
FullQuickly Feeling full early-satiety Early satiety http://crowdhealth.eu/hhr-t
very quickly
Fatigue Fatigue fatigue Fatigue http://crowdhealth.eu/hhr-t
StomachPain Pain in stomach-ache Stomach ache http://crowdhealth.eu/hhr-t
stomach
PeripheralNeur Peripheral peripheral nerve- Peripheral nerve http://crowdhealth.eu/hhr-t
opathy neuropathy disease disease

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Lymphoedema Lymphoedem lymphedema Lymphedema http://crowdhealth.eu/hhr-t

a

19/19
 Collective Wisdom Driving Public Health Policies

Del. no. – D3.1 Annex B5: Data scheme of

Ljubljana mapped to FHIR
Project Deliverable

This project has received funding from the European Union’s Horizon 2020 Programme
(H2020-SC1-2016-CNECT) under Grant Agreement No. 727560
D3.1 Annex B5: Data scheme of
31/10/2017
Ljubljana mapped to FHIR

Data sources scheme

1 Introdution

SLOfit data are stored in relational database (SQL), consisting of around 25 tables, which contain
longitudinal data of (currently around 8.000, in 2018 around 200.000) primary and secondary
school students’ physical fitness. Data are collected by schools’ physical education teachers, then
usually entered into Excel spreadsheet and imported into database. Now, data are accessible to all
students on personal hand-written chart. In April 2018, data will be accessible online
(http://www.slofit.org/) by students, their parents and physical education teachers (currently) over
on-line graphs/tables and PDF reports.

1.1 Conceptual diagram

1.2 List of entities

Entity Name Description FHIR mapping Note

(name of the
resource)

Child Demographics and other Patient, Observation

administrative information
about a child

School Administrative information Organization

about the school

Observation Measurements of fitness Observation

attributes collected yearly

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1.2.1 Child

Max
Mand num
Attrib atory . of Constr
Type Description FHIR mapping Assumptions Note
ute (YES/ char aint
NO) acte
rs

Observation.subject.referenc
e.resolve() is Patient

Observation.status=”final”

Observation.category.coding[
0].code=” social-history”,

Observation.category.coding[
0].display=”Social History”

Observation.category.coding[
0].system=”http://hl7.org/fhir/o
bservation-category”

Observation.code.coding[0].c
ode=” 05421008”

Observation.code.coding[0].di
splay=” Educational
achievement (observable
entity)”

Observation.code.coding[0].s
ystem=”http://snomed.info/”

Observation.value is String

Observation.value=<Grade
Code description>

Observation.effective is
dateTime

Observation.effective=<date
of the last observation made>

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Patient.birthDate This
attribute
contains
the birth
year of the
Child. It is
calculated
as year of
the
observatio
n minus
age of the
Child

CROW YES Nomin 9 Unique N.A. Patient.identifier[ Patient.identifier[0].system=”h

D_ID al anonymized 0].value ttp://www.slofit.org/”
identifier of a
child

Schoo YES Nomin 4 Unique N.A. Patient.manageO Patient.manageOrganization.r

l_ID al identifier of a rganization.refere eference.resolve() is
school nce.resolve().ide Organization
ntifier.value

Sex YES Nomin 1 Sex of child Sex_c Patient.gender

al ode

Age YES Numeri 2 Age at the N.A. Not mapped

cal, moment of the
interval observation

Grade YES Nomin 2 School’s grade Grade Observation Observation.subject.referenc

al at the moment _code e.resolve() is Patient
of the
observation Observation.status=”final”

Observation.category.coding[
0].code=” social-history”,

Observation.category.coding[
0].display=”Social History”

Observation.category.coding[
0].system=”http://hl7.org/fhir/o
bservation-category”

Observation.code.coding[0].c
ode=”14679004”

Observation.code.coding[0].di
splay=” Occupation
(occupation)”

Observation.code.coding[0].s
ystem=”http://snomed.info/”

Observation.value.coding[0].c
ode=”1160498000”

Observation.value.coding[0].d
isplay=” School Child
(occupation)”

Observation.value.coding[0].s

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ystem=”http://snomed.info/”

Observation.effective is
dateTime

Observation.effective=<date
of the last observation made>

1.2.2 School

Max
nu
m.
Attrib Mand Const
Type of Description FHIR mapping Assumptions Note
ute atory raint
cha
ract
ers

Unique
Scho Nomin
YES 4 identifier of N.A. Not Mapped
ol_ID al
the school

Location of
Muni Munici
Nomin the school Organization.ad
cipali YES 3 pality_
al according to dress.city
ty code
municipality

Organization.ad
Location of
Regio dress.district=<
Regio Nomin the school Organization.address.count
YES 2 n_cod Regione Name
n al according to ry=”Slovenia”
e presents in
municipality
Region_Code>

1.2.3 Medical observation

Max
num.
Attrib Mand of Constr FHIR
Type Description Assumptions Note
ute atory char aint mapping
acter
s

Height No Nume 10 Fitness N.A. Observation.v Observation.code.coding[0

rical component alue ].code=”50373000”
(FC)#1: Body
height Observation.code.coding[0
(Longitudinal ].display=”Body height
dimension of measure (observable

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the body) entity)”

Observation.code.coding[0
].system=”http://snomed.in
fo/”

Observation.code.text=”Bo
dy height (Longitudinal
dimension of the body)”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Observation.value.value=<
value>

Observation.value.unit=”
CentiMeter”

Observation.value.system
=”
http://unitsofmeasure.org”

Observation.value.code=”c
m”

Weigh No Nume 10 FC#2: Body N.A. Observation.v Observation.code.coding[0

t rical weight alue ].code=”27113001”
(Voluminous
dimension of Observation.code.coding[0
the body) ].display=”Body weight
(observable entity)”

Observation.code.coding[0
].system=”http://snomed.in
fo/”

Observation.code.text=”Bo
dy weight (Voluminous
dimension of the body)”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Observation.value.value=<
value>

Observation.value.unit=”Ki
loGram”

Observation.value.system
=”
http://unitsofmeasure.org”

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Observation.value.code=”k
g”

Tricep No Nume 10 FC#3: N.A. Observation.v Observation.code.coding[0

s_sf rical Tricpes alue ].code=”301851003”
skinfold
reflects the Observation.code.coding[0
amount of ].display=”Triceps skin fold
peripheral thickness (observable
subcoutaneo entity)”
us fat. It is a
proxy for
body Observation.code.coding[0
composition. ].system=”http://snomed.in
fo/”

Observation.code.text=”Tri
cpes skinfold reflects”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Observation.value.value=<
value>

Observation.value.unit=”Mi
lliMeter”

Observation.value.system
=”
http://unitsofmeasure.org”

Observation.value.code=”
mm”

Arm_ No Nume 10 FC#4: Arm N.A. Observation.v Observation.code.coding[0 The unit of

plate_ rical plate tapping alue ].code=”FC#4” measure is the
tappin represents number of taps
g repetitive Observation.code.coding[0 completed in 20
speed. ].display=”Arm plate seconds.
tapping”

Observation.code.coding[0
].system=”http://www.crow
dhealth.eu/fhir/ValueSet/fit
nessTest”

Observation.code.text=”Ar
m plate tapping represents
repetitive speed”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

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Standi No Nume 10 FC#5: N.A. Observation.v Observation.code.coding[0

ng_br rical Standing alue ].code=”FC#5”
oad_j long jump is
ump a measure of Observation.code.coding[0
explosive ].display=” Standing long
strength. jump”

Observation.code.coding[0
].system=”http://www.crow
dhealth.eu/fhir/ValueSet/fit
nessTest””

Observation.code.text=”St
anding long jump is a
measure of explosive
strength.”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Observation.value.value=<
value>

Observation.value.unit=”
CentiMeter”

Observation.value.system
=”
http://unitsofmeasure.org”

Observation.value.code=”c
m”

Polyg No Nume 10 FC#6: N.A. Observation.v Observation.code.coding[0

on_ba rical Polygon alue ].code=”FC#6”
ckwar backwards
ds represents Observation.code.coding[0
coordination. ].display=”Polygon
backwards”

Observation.code.coding[0
].system=”http://www.crow
dhealth.eu/fhir/ValueSet/fit
nessTest””

Observation.code.text=”Po
lygon backwards
represents coordination”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

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Observation.value.value=<
value>

Observation.value.unit=”S
econd”

Observation.value.system
=”
http://unitsofmeasure.org”

Observation.value.code=”s
”

Sit_up No Nume 10 FC#7: Sit- N.A. Observation.v Observation.code.coding[0 Unit of measure:

s_60s rical ups reflect alue ].code=”FC#7” reps (Repetitive
repetitive strength)
Observation.code.coding[0
strength ].display=”Sit ups 60
which can be seconds”
also called
Observation.code.coding[0
muscle ].system=”http://www.crow
endurance. dhealth.eu/fhir/ValueSet/fit
This is a nessTest””
component of
muscle Observation.code.text=”Sit
fitness -ups reflect repetitive
strength which can be also
called muscle endurance.
This is a component of
muscle fitness”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Stand No Nume 10 FC#8: Stand N.A. Observation.v Observation.code.coding[0

_and_ rical and reach alue ].code=”FC#8”
reach (Flexibility of
lower back Observation.code.coding[0
and legs) ].display=”Stand and
reach”

Observation.code.coding[0
].system=”http://www.crow
dhealth.eu/fhir/ValueSet/fit
nessTest””

Observation.code.text=”St
and and reach (Flexibility
of lower back and legs).”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

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Observation.value.value=<
value>

Observation.value.unit=”
CentiMeter”

Observation.value.system
=”
http://unitsofmeasure.org”

Observation.value.code=”c
m”

Bent_ No Nume 10 FC#9: Bent N.A. Observation.v Observation.code.coding[0

arm_h rical arm-hang alue ].code=”FC#9”
ang measures the
strength of Observation.code.coding[0
arms and ].display=”Bent arm-hang”
shoulder
which can be
also called Observation.code.coding[0
muscle ].system=”
endurance. http://www.crowdhealth.eu
/fhir/ValueSet/fitnessTest””
This is a
component of Observation.code.text=”Be
muscle nt arm-hang measures the
fitness strength of arms and
shoulder which can be
also called muscle
endurance.”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Observation.value.value=<
value>

Observation.value.unit=”S
econd”

Observation.value.system
=”
http://unitsofmeasure.org”

Observation.value.code=”s
”

Dash6 No Nume 10 FC#10: 60m N.A. Observation.v Observation.code.coding[0

0m rical dash (Speed) alue ].code=”FC#10”

Observation.code.coding[0
].display=”60m dash”

Observation.code.coding[0
].system=”http://www.crow
dhealth.eu/fhir/ValueSet/fit
nessTest””

Observation.code.text=”60

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m dash (Speed)”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Observation.value.value=<
value>

Observation.value.unit=”S
econd”

Observation.value.system
=”
http://unitsofmeasure.org”

Observation.value.code=”s
”

Run60 No Nume 10 FC#11: 600m N.A. Observation.v Observation.code.coding[0

0m rical run (Aerobic alue ].code=”FC#11”
capacity)
Observation.code.coding[0
].display=”600m run”

Observation.code.coding[0
].system=”http://www.crow
dhealth.eu/fhir/ValueSet/fit
nessTest””

Observation.code.text=”60
0m run (Aerobic capacity)”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Observation.value.value=<
value>

Observation.value.unit=”S
econd”

Observation.value.system
=”
http://unitsofmeasure.org”

Observation.value.code=”s
”

BMI No Nume 10 Body mass N.A. Observation.v Observation.code.coding[0

rical index alue ].code=”60621009”

Observation.code.coding[0
].display=”Body mass

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index (observable entity)”

Observation.code.coding[0
].system=”http://snomed.in
fo/”

Observation.code.text=”Bo
dy mass index”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Observation.value.value=<
value>

Observation.value.unit=”kg
/m2”

Observation.value.system
=”
http://unitsofmeasure.org”

Observation.value.code=”k
g/m2”

WS_W No Nume 1 Weight status WOF_ Observation.in Observation.interpretation. This attribute can
OF rical according to Code terpretation coding[0].code=<WOF_Co be mapped to
World de value> Observation.value
Obesity
Federation Observation.
cut-off points interpretation.coding[0].dis
play=” WOF_Code name”

Observation.
interpretation.coding[0].sys
tem=”
http://hl7.org/fhir/ValueSet/
observation-interpretation”

Observation.
interpretation.text=<
WOF_Code description>

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Total_ No Nume 10 total physical N.A. Observation.v Observation.code.coding[0

FI rical fitness index, alue ].code=”Total_FI”
aggregated
measure of Observation.code.coding[0
all fitness ].display=”Total physical
tests fitness index”

Observation.code.coding[0

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].system=”http://www.crow
dhealth.eu/fhir/ValueSet/fit
nessTest””

Observation.code.text=”To
tal physical fitness index,
aggregated measure of all
fitness tests”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Observation.value.value=<
value>

HR_FI No Nume 10 health- N.A. Observation.v Observation.code.coding[0

rical related alue ].code=”HR_FI”
physical
fitness index, Observation.code.coding[0
aggregated ].display=”Health-related
measure of 3 physical fitness index”
tests
evaluating
endurance Observation.code.coding[0
and strength ].system=”http://www.crow
dhealth.eu/fhir/ValueSet/fit
nessTest””

Observation.code.text=”pe
rformance-related physical
fitness index, aggregated
measure of 4 tests
evaluating explosive
strength, speed and
coordination”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Observation.value.value=<
value>

PR_FI No Nume 10 performance- N.A. Observation.v Observation.code.coding[0

rical related alue ].code=”PR_FI”
physical
fitness index, Observation.code.coding[0
aggregated ].display=”Performance-
measure of 4 related physical fitness
tests index”
evaluating
explosive
strength, Observation.code.coding[0
speed and ].system=”http://www.crow
coordination dhealth.eu/fhir/ValueSet/fit
nessTest””

Observation.code.text=”
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performance-related
physical fitness index,
aggregated measure of 4
tests evaluating explosive
strength, speed and
coordination”

Observation.status=”final”

Observation.subject.refere
nce.resolve() is Patient

Observation.value is
Quantity

Observation.value.value=<
value>

Year_ Yes Interv 4 year when N.A. Not mapped This value is the
meas al measuremen year of
ured ts were Data_measured
performed

Date_ Yes Date 10 Date of N.A. Observation.ef Observation.effective is

meas fitness fective dateTime
ured assesement

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1.3 Constraints

1.3.1 Sex_Code
Level of measurement: Nominal

Coding standard: None

Link: https://www.hl7.org/fhir/valueset-administrative-gender.html

Value/Code Name Description Code Display Definition

1 Male Male male Male Male

2 Female Female female Female Female

1.3.2 Grade_Code
Level of measurement: Nominal

Coding standard: None

Link: None

Value/Code Name Description

1 1st grade 1st grade of primary school

… … …

14 14th grade 5th grade of secondary school

1.3.3 Municipality_Code
Level of measurement: Nominal

Coding standard: LOINC

Link: None

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Value/Code Name Description Note

1 1 Identifier for a municipality List of Slovenian

Municipalities:
… … … https://en.wikipedia.org/wi
ki/Municipalities_of_Slov
212 212 Identifier for a municipality enia

1.3.4 Region_Code
Level of measurement: Nominal

Coding standard: LOINC

Link: None

Value/Code Name Description Region Name

1 1 Identifier for a region Pomurska

2 2 Identifier for a region Podravska

3 3 Identifier for a region Koroška

4 4 Identifier for a region Savinjska

5 5 Identifier for a region Zasavska

6 6 Identifier for a region Posavska

7 7 Identifier for a region Jugovzhodna Slovenija

8 8 Identifier for a region Osrednjeslovenska

9 9 Identifier for a region Gorenjska

10 10 Identifier for a region Primorsko-notranjska

11 11 Identifier for a region Goriška

12 12 Identifier for a region Obalno-kraška

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1.3.5 WOF_Code
Level of measurement: Nominal

Coding standard: LOINC

Link: None

Value/Code Name Description

-1 Underweight Child has lower than ideal weight according to

World obesity federation standards (a.k.a.
IOTF standards).

0 Normal_weight Child has ideal weight according to World

obesity federation standards(a.k.a. IOTF
standards).

1 Overweight Child has slightly higher than ideal weight

according to World obesity federation
standards(a.k.a. IOTF standards).

2 Obese Child has much higher than ideal weight

according to World obesity federation
standards(a.k.a. IOTF standards).

3 Morbidly obese Child has much higher than ideal weight

according to World obesity federation
standards(a.k.a. IOTF standards). This is the
highest category of weight status

1.4 ValueSet

1.4.1 Fitness Test

Link: http://www.crowdhealth.eu/fhir/ValueSet/fitnessTest

Code Display Description

FC#4 Arm plate tapping Arm plate tapping represents repetitive speed.

FC#5 Standing long jump Standing long jump is a measure of explosive

strength.

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FC#6 Polygon backwards Polygon backwards represents coordination.

FC#7 Sit ups 60 seconds Sit-ups reflect repetitive strength which can be
also called muscle endurance. This is a
component of muscle fitness

FC#8 Stand and reach Stand and reach (Flexibility of lower back and
legs)

FC#9 Bent arm-hang Bent arm-hang measures the strength of arms

and shoulder which can be also called muscle
endurance. This is a component of muscle
fitness

FC#10 60m dash 60m dash (Speed)

FC#11 600m run 600m run (Aerobic capacity)

18/18