EMIS published data transformation and mapping

This article describes the mapping of EMIS published data into the intermediate FHIR store.

Content dependent rules

CareRecord_Observation contains data which is mapped to multiple FHIR resource types. The target resource type is decided by the following rules, using the Read2 code and CodeType from the Coding_ClinicalCode file (looked up using the CodeId from CareRecord_Observation) and the Value field from CareRecord_Observation.

 

Code type Rule	Target profile
If the Value is empty, and the CodeType is one of (Biochemistry, Cyology_Histology,Haematology,Immunology,Microbiology,Radiology, Health_Management)	DiagnosticReport
If the Value is not empty OR the CodeType is one of (Biochemistry,Biological_Values,Cytology_Histology, Haematology, Health_Management, Immunology,Microbiology,Radiology,Symptoms_Findings, Procedure (note, the codes is this category aren't actually "procedures"), Administration_Documents_Attachments, Body_Structure //dental structures,Care_Episode_Outcome, Dental_Finding,Diagnostics, Discharged_From_Service,EMIS_Qualifier,Ethnicity,HMP,Intervention_Category, Intervention_Target, KC60,;Marital_Status, Nationality,Nursing_Problem, Nursing_Problem_Domain, Obsteterics_Birth,Person_Health_Social, Planned_Dental, Problem_Rating_Scale, Reason_For_Care, Referral_Activity, Referral_Rejected, Referral_Withdrawn, Regiment, Religion, Trade_Branch, Unset)	Observation
If the CodeType is Conditions_Operations_Procedures and the Code is in (Preventive procedures, Operations, procedures, sites, Other therapeutic procedures)	Procedure
If the CodeType is Conditions_Operations_Procedures and the Code is in (Infectious and parasitic diseases, Neoplasms,Endocrine, nutritional, metabolic and immunity disorders, Diseases of blood and blood-forming organs, Mental disorders, Nervous system and sense organ diseases, Circulatory system diseases, Respiratory system diseases, Digestive system diseases, Genitourinary system diseases, Skin and subcutaneous tissue diseases, Musculoskeletal and connective tissue diseases)	Condition
Else If the CodeType is Conditions_Operations_Procedures	Observation
If the CodeType is any of (Allergy_Adverse_Drug_Reations, Allergy_Adverse_Reations)	AllergyIntolerance
If the CodeType is any of (Dental_Disorder, Dental_Procedure)	Condition
If the CodeType is (Family_History)	FamilyMemberHistory
f the CodeType is (Immunisations)	Immunization
If code type is (Investigation_Requests)	DiagnosticOrder
If code type is Pathology_Specimen	Specimen
If code type is Referral	Referral request

There is a mismatch between EMIS observations and FHIR resource profiles

Structural Rule	Target profile
IF target profile IS Condition    IF CSV Care Record observation ID is in CSV Care Record Problem ID	Combine problem and Condition into problem onset profile
In addition to the above mappings R1: IF  the target resource select from above is not condition        R2: IF the CSV CareRecord_Observation ID  is in CSV CareRecord_Problem record ID	Combine problem and other into Condition with "problem" profile
R2: ELSE	Observation
R1: Else    : See R3
R3: If the CSV Care Record Observation has PROBLEM ID         R4: IF the CSV care record Observation ID is NOT the PROBLEM ID            R5: IF the CSV care record CODE = the linked problem ID CODE	Condition with episode indicator = review
(R3,R4,R5 : Else	No change

 

Prescribing_DrugRecord End Dates

The Prescribing_DrugRecord file contains both a Boolean active indicator (IsActive) and the medication end date (CancellationDate). Within Emis Web, it’s the IsActive indicator that is used to determine whether medication is active or not, the CancellationDate just providing additional information for ended medication. Analysing the received data has highlighted that there are a number of cases where the CancellationDate doesn’t match what the IsActive flag states:

1. IsActive = true but a CancellationDate is present;
2. IsActive = false but a CancellationDate is absent.

From the dates of affected data, these appear to be related to either a service moving to Emis Web from another GP system, and are an artefact of that transfer.

To ensure consistency in the FHIR MedicationStatements created from this file, the Cancellation date will only be carried over if the DrugRecord is non-active. If no cancellation date is present, it will be derived from the medication start and course length (found from the associated Prescribing_IssueRecord file).