Proposal to Include Note in OpenMRS FHIR Condition Resource

Projects FHIR
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Dear OpenMRS Community,

cc: @grace, @ibacher, @dkayiwa, @angshuonline, @raff, @burke, @mohant, @akhilmalhotra

The Bahmni team has been exploring the OpenMRS FHIR Condition resource and observed that the OpenMRS-specific FHIR Condition resource (as outlined in the OpenMRS Core FHIR Implementation Guide v0.1.0) differs in structure from the standard HL7 FHIR R4 Condition resource (FHIR R4 Condition).

Currently, the note added as part of a condition is not included in the OpenMRS FHIR Condition response. To address this, we propose extending the OpenMRS FHIR R4 Condition resource to incorporate the note captured.

In OpenMRS, the note associated with a condition is stored in the additional_detail field.

Screenshot 2025-03-26 at 11.56.21 AM
Screenshot 2025-03-26 at 11.56.21 AM675Ă—617 15.5 KB

To ensure this information is reflected in the FHIR response, we suggest updating the ConditionTranslatorImpl.java file within the openmrs-module-fhir2. This translator is responsible for converting OpenMRS Condition objects into FHIR Condition resources. Specifically, we propose modifying the toFhirResource method to map additional_detail to note, as shown below:

fhirCondition.setNote(condition.getAdditionalDetail());

Since adding a note attribute is likely a minor change within ConditionTranslatorImpl.java, we wanted to understand if there was a specific reason for not including the condition note in the OpenMRS-specific FHIR Condition resource. If the community agrees, we would be happy to raise a PR to the openmrs-module-fhir2 to implement this change.

We appreciate your feedback on this proposal and look forward to your thoughts.

Regards,
Bahmni Team

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A 255 character note field is not terribly useful, but it’s mostly just because we didn’t have a use-case for annotations to most elements.

Feel free to open a ticket in the FHIR2 project on our Jira and create a PR.

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Thanks Ian for clarifying the rationale behind the current implementation. We appreciate your guidance on this.

As we proceed with incorporating notes into the OpenMRS FHIR Condition resource, we would like to request your help in creating a Jira card for this task, as we do not have the necessary privileges to add one ourselves. We have already raised a PR for this change: PR #561. Could you kindly review the PR and let us know if it aligns with OpenMRS standards, or if any modifications are needed?

Below is a draft card description for your reference:

Objective

As a clinician, I want to view the notes captured during consultation as part of a patient’s condition details so that I can access relevant clinical context and make more informed decisions during patient care.

Description

Currently, the OpenMRS FHIR Condition resource does not include consultation notes, which are stored in the additional_detail field of the OpenMRS Condition model. To enhance clinical decision-making and continuity of care, we propose extending the OpenMRS FHIR Condition resource to include the note element, aligning it with HL7 FHIR standards.

Acceptance Criteria

  • The FHIR Condition resource should include a note field that maps to additional_detail in OpenMRS.
  • Clinicians should be able to retrieve consultation notes when accessing a patient’s condition via FHIR.
  • API responses should reflect the updated structure, ensuring compatibility with HL7 FHIR R4 standards.
  • The implementation should be tested and validated to ensure accuracy and completeness.

References

Please let us know your thoughts on this and if any refinements are required. Your support in creating the card and reviewing the PR would be greatly appreciated.

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I have created the jira card at Jira. Feel free to add that to your PR, I have also added a few comments there.

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