Uzbekistan Digital Health Platform - Integrations
0.10.0 - draft
Uzbekistan Digital Health Platform - Integrations
0.10.0 - draft
This page is part of the Uzbekistan Digital Health Platform - Integrations (v0.10.0: Releases Draft) based on FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version. For a full list of available versions, see the Directory of published versions
This page documents the mapping between cervical and breast cancer screening data and FHIR resources.
Cervical and breast cancer screening captures laboratory results, imaging findings, pathology conclusions, questionnaire answers and clinical observations from the screening programme. The data originates from the Cervical Cancer Screening Quality Assessment and Monitoring and Early Breast Cancer Detection Information System and is added to the DHP as individual, atomic FHIR resources. Resources conform to the screening profiles linked in each section where available, and to UZ Core or standard FHIR profiles otherwise.
Each section gives the value set to use, an example code, the governing profile and a concrete example resource. Height, weight and BMI use the standard FHIR vital signs profiles.
Coded values use SNOMED CT or LOINC wherever an equivalent concept exists. Local codes remain only where no standard concept matches; those are published in the screening-*-cs CodeSystems with Uzbek, Russian and English designations.
Screening program type. A second identifier, system https://dhp.uz/fhir/core/sid/prg/uz/program, naming the SNOMED CT screening program a resource belongs to - for example 171149006 (Cervical screen) or 268547008 (Screening for breast cancer). Written by convention on Observation, DiagnosticReport, ServiceRequest, Condition, Consent, Specimen, Composition, and Questionnaire/QuestionnaireResponse when the whole questionnaire is one program - not on Patient, Practitioner or PractitionerRole, which are shared across programs. The Woman medical exam questionnaire and its response carry both program codes, since the questionnaire spans both programs.
Source system. meta.source identifies which system created a resource: https://dhp.uz/fhir/source/screening (this Cervical Cancer Screening Quality Assessment and Monitoring and Early Breast Cancer Detection Information System) or https://dhp.uz/fhir/source/dmed (DMED). Required and enforced by invariant on ScreeningObservation, ScreeningServiceRequest, ScreeningDiagnosticReport, ScreeningDocumentReference and ScreeningComposition. Do not infer the source system from the presence of an identifier from https://dhp.uz/fhir/core/sid/doc/uz/screening - that identifier system does not indicate which system produced a resource.
Set ServiceRequest.code to the test or procedure being ordered.
Profile: ScreeningServiceRequest
Examples: ServiceRequest-cytology, ServiceRequest-hpv, ServiceRequest-colposcopy, ServiceRequest-mammography
| What is ordered | Value set | Example code |
|---|---|---|
| Cytology smear | ScreeningLaboratoryVS | LOINC#18500-9 |
| HPV test | ScreeningLaboratoryVS | LOINC#82675-0 |
| Colposcopy | ScreeningDiagnosticProcedureVS | SNOMED CT#392003006 |
| Mammography | ScreeningDiagnosticProcedureVS | SNOMED CT#71651007 |
Set DiagnosticReport.code to the procedure (same codes as the referral). A mammography report may also carry an overall conclusion in conclusionCode.
Profile: ScreeningDiagnosticReport
Examples: DiagnosticReport-cytology, DiagnosticReport-colposcopy, DiagnosticReport-mammography
| Information to record | Value set | Example code |
|---|---|---|
| Report type | ScreeningLaboratoryVS / ScreeningDiagnosticProcedureVS | LOINC#18500-9 (cytology)SNOMED CT#392003006 (colposcopy)SNOMED CT#71651007 (mammography) |
| Overall BI-RADS conclusion (mammography) | ScreeningBiradsVS | screening-birads-cs#src-birads-2 (BI-RADS 2) |
Records the grade of a cytological smear.
Profile: ScreeningObservation
Example: cytology-result (AI variant: cytology-ai-analysis, whose output is stored as free text in Observation.value)
| Information to record | Value set | Example code | Stored in |
|---|---|---|---|
| Test code | ScreeningLaboratoryVS | LOINC#18500-9 (cytology smear) |
Observation.code |
| Cytology grade | ScreeningCervicalCytologyVS | screening-cervical-cytology-cs#scr-cyt-3 (LSIL) |
Observation.value |
Records a high-risk HPV DNA result.
Profile: ScreeningObservation
Example: hpv-result
| Information to record | Value set | Example code | Stored in |
|---|---|---|---|
| Test code | ScreeningLaboratoryVS | LOINC#82675-0 (HPV test) |
Observation.code |
| HPV result | ScreeningHPVVS | screening-hpv-cs#scr-hpv-3 (Positive) |
Observation.value |
Records the colposcopy impression and the cervical transformation zone.
Profile: ScreeningObservation
Example: colposcopy-result
| Information to record | Value set | Example code | Stored in |
|---|---|---|---|
| Procedure code | ScreeningDiagnosticProcedureVS | SNOMED CT#392003006 (colposcopy) |
Observation.code |
| Colposcopy impression | ScreeningColposcopyVS | screening-colposcopy-cs#scr-colpo-2 (LSIL) |
Observation.value |
| Transformation zone type | ScreeningTransformationZoneVS | screening-transformation-zone-cs#scr-tz-2 (Type 2) |
component (code SNOMED CT#1285652007) |
A structured mammography assessment. The procedure code SNOMED CT#71651007 (Mammography) identifies the observation; each measurement below is recorded as a component.
Profile: ScreeningMammographyObservation
Examples: ScreeningMammographyObservationExample, mammography-summary
| Information to record | Value set | Example code | Stored in (component code) |
|---|---|---|---|
| BI-RADS category | ScreeningBiradsVS | screening-birads-cs#src-birads-2 (BI-RADS 2) |
SNOMED CT#1348266008 |
| Breast density | ScreeningBreastFormVS | screening-breast-form-cs#src-breast-density-4 (Type D) |
SNOMED CT#129793001 |
| Image quality | ScreeningImageQualityVS | screening-image-quality-cs#src-img-quality-3 (moderate) |
SNOMED CT#246646005 |
| Reading number (1-3) | - | 2 |
screening-specialized-observation-parameter-cs#scrn-0073-00026 |
| Selected as consensus result | - | true |
screening-specialized-observation-parameter-cs#scrn-0073-00027 |
| Result of the third arbitration reading | - | true |
screening-specialized-observation-parameter-cs#scrn-0073-00028 |
Double reading is modelled as one Observation per reading, each carrying its own reading number. The reading chosen as final sets the consensus flag; a third, arbitration reading sets the arbitration flag instead.
For each finding seen on mammography, record what it is, which breast and quadrant, and that it is present. The observation's code is SNOMED CT#71651007 (Mammography).
Profile: ScreeningObservation
Examples: mammography-right-breast-finding, mammography-left-breast-finding
| Information to record | Value set | Example code | Stored in |
|---|---|---|---|
The finding (present = true) |
ScreeningBreastFindingVS | SNOMED CT#400096001 (melanocytic naevus)SNOMED CT#17417006 (thickening of skin) |
component.code (value = boolean) |
| Breast | ScreeningBodySiteVS | SNOMED CT#73056007 (Right)SNOMED CT#80248007 (Left) |
Observation.bodySite |
| Quadrant | ScreeningBreastQuadrantVS | screening-breast-quadrant-cs#src-breast-quadrant-2 (UE)screening-breast-quadrant-cs#src-breast-quadrant-1 (UI) |
bodySite quadrant extension |
A structured breast ultrasound examination. Observation.code is SNOMED CT#47079000 (Ultrasonography of breast) and bodySite records the examined side. Whole-breast parameters and the characteristics of a focal lesion are all recorded as components.
Profile: ScreeningBreastUltrasoundObservation
Example: ScreeningBreastUltrasoundObservationExample
| Information to record | Value set | Stored in (component code) |
|---|---|---|
| Examined side | ScreeningUltrasoundBreastSideVS | Observation.bodySite |
| Breast symmetry | ScreeningUltrasoundBreastSymmetryVS | screening-ultrasound-parameter-cs#scrn-0052-00004 |
| ACR composition | ScreeningUltrasoundAcrCompositionVS | screening-ultrasound-parameter-cs#scrn-0052-00005 |
| Skin and nipple status | ScreeningUltrasoundSkinNippleStatusVS | screening-ultrasound-parameter-cs#scrn-0052-00006 |
| Duct status | ScreeningUltrasoundDuctStatusVS | screening-ultrasound-parameter-cs#scrn-0052-00012 |
| Axillary node status | ScreeningUltrasoundAxillaryNodeStatusVS | screening-ultrasound-parameter-cs#scrn-0052-00017 |
| Focal lesion shape | ScreeningUltrasoundLesionShapeVS | screening-ultrasound-parameter-cs#scrn-0052-00027 |
| Focal lesion orientation | ScreeningUltrasoundLesionOrientationVS | screening-ultrasound-parameter-cs#scrn-0052-00028 |
| Focal lesion contour | ScreeningUltrasoundLesionContourVS | screening-ultrasound-parameter-cs#scrn-0052-00029 |
| Focal lesion echogenicity | ScreeningUltrasoundLesionEchogenicityVS | screening-ultrasound-parameter-cs#scrn-0052-00030 |
| Lesion size, position and distance from nipple | - | scrn-0052-00022 to scrn-0052-00026 |
The full list of parameters is on the profile page; every coded parameter has its own value set under ScreeningUltrasoundParameterVS.
A histology, cytology or immunohistochemistry order. code is fixed to SNOMED CT#714797009 (Histologic test); what was actually sent to the laboratory is carried in orderDetail.parameter.
Profile: ScreeningPathologyServiceRequest
Example: ScreeningPathologyRequestExample
| Parameter | Value set | Parameter code |
|---|---|---|
| Material class | ScreeningBreastMaterialClassVS | screening-histology-order-parameter-cs#scrn-0069-00001 |
| Biopsy subtype | ScreeningBreastBiopsySubtypeVS | screening-histology-order-parameter-cs#scrn-0069-00002 |
| Surgical procedure type | ScreeningBreastSurgicalProcedureTypeVS | screening-histology-order-parameter-cs#scrn-0069-00003 |
| Breast cytology material type | ScreeningBreastCytologyMaterialTypeVS | screening-histology-order-parameter-cs#scrn-0069-00004 |
| Cervical material type | ScreeningCervicalMaterialTypeVS | screening-histology-order-parameter-cs#scrn-0069-00005 |
| Special treatment type (repeatable) | ScreeningSpecialTreatmentTypeVS | screening-histology-order-parameter-cs#scrn-0069-00006 |
| Treatment date or period | Period |
screening-histology-order-parameter-cs#scrn-0069-00007 |
| Other treatment | string |
screening-histology-order-parameter-cs#scrn-0069-00008 |
Five invariants make the second parameter conditional on the material class and require other-treatment text if and only if the special treatment type includes Other. A single treatment date is represented by a Period with equal start and end values; when the treatment date is unknown, the optional parameter is omitted. This historical treatment period is distinct from ServiceRequest.occurrencePeriod, which represents when the requested pathology service should occur.
The material the pathology request refers to.
Profile: ScreeningSpecimen (based on UZCoreSpecimen)
Example: ScreeningSpecimenExample
| Information to record | Value set | Example code | Stored in |
|---|---|---|---|
| Specimen type | ScreeningPathologySpecimenTypeVS | SNOMED CT#258415003 (biopsy specimen) |
Specimen.type |
| Patient | - | - | Specimen.subject |
| How and when it was collected | - | - | Specimen.collection |
The request for a biopsy and the biopsy actually performed both carry the subtype in code.
Profiles: ScreeningBreastBiopsyServiceRequest, ScreeningBreastBiopsyProcedure
Examples: ScreeningBreastBiopsyRequestExample, ScreeningBreastBiopsyProcedureExample
| Information to record | Value set | Example code |
|---|---|---|
| Biopsy subtype | ScreeningBreastBiopsySubtypeVS | SNOMED CT#9911007 (core needle biopsy) |
The breast histology conclusion, including pathological TNM staging. Observation.code is SNOMED CT#394597005 (Histopathology); every finding is a component.
Profile: ScreeningBreastHistologyObservation
Example: ScreeningBreastHistologyObservationExample
| Information to record | Value set | Stored in (component code) |
|---|---|---|
| Material class (required) | ScreeningBreastMaterialClassVS | SNOMED CT#371439000 |
| Histologic type | ScreeningBreastHistologicTypeVS | screening-specialized-observation-parameter-cs#scrn-0073-00006 |
| Nottingham scores (tubular formation, nuclear pleomorphism, mitotic count) | - | LOINC#85321-8, LOINC#44645-0, LOINC#85300-2 |
| Largest invasive focus (mm) | - | LOINC#44635-1 |
| DCIS grade | ScreeningDCISMalignancyGradeVS | screening-specialized-observation-parameter-cs#scrn-0073-00009 |
| DCIS architectural pattern | ScreeningHistologyDCISArchitecturalPatternVS | LOINC#85302-8 |
| Lymphovascular invasion | ScreeningHistologyLymphovascularInvasionVS | LOINC#59544-7 |
| Stage modifier | ScreeningStageModifierVS | screening-specialized-observation-parameter-cs#scrn-0073-00010 |
| Pathological T / N / M | ScreeningPathologicalTVS, ScreeningPathologicalNVS, ScreeningPathologicalMVS | scrn-0073-00011, scrn-0073-00012, scrn-0073-00013 |
| Resection margin status (invasive, DCIS) | ScreeningResectionMarginStatusVS | scrn-0073-00038, scrn-0073-00039 |
| Residual Cancer Burden class | ScreeningResidualCancerBurdenClassVS | SNOMED CT#444987009 |
| Tumor focality | - | SNOMED CT#396199003 |
The TNM categories use the AJCC pathological staging concepts (for example SNOMED CT#1228957006 pT1, SNOMED CT#1229947003 pN0). AJCC defines no pathological M0, so ScreeningPathologicalMVS uses SNOMED CT#1229901006 (cM0) alongside SNOMED CT#1229916009 (pM1).
The cervical histology conclusion. Observation.code is SNOMED CT#394597005 (Histopathology), bodySite is fixed to SNOMED CT#71252005 (Cervix uteri structure), and the morphological diagnosis goes in Observation.value.
Profile: ScreeningCervicalHistologyObservation
Example: ScreeningCervicalHistologyObservationExample
| Information to record | Value set | Stored in |
|---|---|---|
| Morphological diagnosis | ScreeningCervicalHistologyMorphologyVS | Observation.value |
| Histologic grade | ScreeningCervicalHistologicGradeVS | LOINC#33732-9 |
| Depth of stromal invasion | - | SNOMED CT#396235003 |
| Lymphovascular invasion | ScreeningHistologyLymphovascularInvasionVS | LOINC#59544-7 |
| Resection margin status | ScreeningResectionMarginStatusVS | screening-specialized-observation-parameter-cs#scrn-0073-00019 |
| Other organs involved | ScreeningOtherOrganInvolvementVS | screening-specialized-observation-parameter-cs#scrn-0073-00020 |
| Metastasis type | ScreeningMetastasisTypeVS | screening-specialized-observation-parameter-cs#scrn-0073-00022 |
| Sentinel lymph node examination | ScreeningSentinelLymphNodeExaminationVS | SNOMED CT#396487001 |
| Gross and microscopic description | - | LOINC#22634-0, LOINC#22635-7 |
A breast cytology conclusion graded with the Yokohama system.
Profile: ScreeningBreastCytologyObservation
Example: ScreeningBreastCytologyObservationExample
| Information to record | Value set | Stored in |
|---|---|---|
| Test code | - | Observation.code = screening-specialized-observation-parameter-cs#scrn-0073-00029 |
| Yokohama category | ScreeningYokohamaCategoryVS | Observation.value |
| Material class | ScreeningBreastMaterialClassVS | SNOMED CT#371439000 |
ER, PR, Ki-67, HER2 and p16 results from one immunohistochemistry run. Observation.code is SNOMED CT#117617002 (Immunohistochemistry procedure).
Profile: ScreeningImmunohistochemistryObservation
Example: ScreeningImmunohistochemistryObservationExample
| Information to record | Value set | Stored in (component code) |
|---|---|---|
| Allred score, ER | - | screening-specialized-observation-parameter-cs#scrn-0073-00002 |
| Allred score, PR | - | screening-specialized-observation-parameter-cs#scrn-0073-00003 |
| HER2 IHC score | ScreeningHer2IhcScoreVS | see profile |
| p16 result | ScreeningP16ResultVS | see profile |
Three questionnaires are published. Answers come back as a QuestionnaireResponse whose item hierarchy mirrors the questionnaire, with each linkId matching the published question exactly. Coded answers are bound with answerValueSet.
| Questionnaire | Canonical | Example response |
|---|---|---|
| Breast risk | https://dhp.uz/fhir/integrations/Questionnaire/screening-breast-risk |
ScreeningBreastRiskResponseExample |
| Cervical risk | https://dhp.uz/fhir/integrations/Questionnaire/screening-cervical-risk |
ScreeningCervicalRiskResponseExample |
| Woman medical exam | https://dhp.uz/fhir/integrations/Questionnaire/screening-woman-exam |
ScreeningWomanExamResponse128 |
The screening summary gathers everything recorded for one screening episode into a single downloadable document. It can be produced at any point in the cycle: whatever has not been recorded yet is simply left out, so a summary generated early carries only the questionnaire answers.
Individual steps do not get their own Composition - each result stays an Observation, and this document references them.
Profile: ScreeningComposition
Examples: ScreeningCompositionExample, ScreeningCompositionDocumentExample
| Information to record | Value set | Example code | Stored in |
|---|---|---|---|
| Document type | - | LOINC#34133-9 (Summary of episode note) |
Composition.type |
| Questionnaires | - | LOINC#74465-6 |
section[questionnaire].entry (QuestionnaireResponse) |
| Results of every completed step | - | LOINC#30954-2 |
section[results].entry (Observation) |
| Final ICD-10 diagnosis | - | LOINC#29308-4 |
section[diagnosis].entry (Condition) |
| Author | - | - | Composition.author (PractitionerRole) |
| Responsible organisation | - | - | Composition.custodian |
| Referrals and procedures documented | - | - | Composition.event.detail |
To hand the summary over as an immutable document, put it in a Bundle with type = document, with the Composition as the first entry and every resource it references - Patient, Condition, Observation, QuestionnaireResponse and the rest - in the same Bundle.
Height, weight and BMI are standard FHIR vital signs, each recorded as its own Observation - they are not screening-specific. Use the FHIR profile for each; the code is fixed by the profile.
Profiles: bodyheight, bodyweight, bmi
Examples: body-height, body-weight, body-mass-index
| Measurement | FHIR profile | Code | Example value |
|---|---|---|---|
| Body height | bodyheight |
LOINC#8302-2 |
160 cm |
| Body weight | bodyweight |
LOINC#29463-7 |
52 kg |
| Body mass index | bmi |
LOINC#39156-5 |
20.3 kg/m2 |
These observations carry free text rather than coded values; set Observation.code to the type of note.
Profile: ScreeningObservation
| Observation | Observation.code | What it holds |
|---|---|---|
| gynecological-physical-exam | SNOMED CT#5880005 (Physical examination) |
Obstetric and gynecological history, in note |
| gynecological-complaints | SNOMED CT#1269489004 (Chief complaint) |
Patient-reported complaints, in note |
| oncogynecological-followup | SNOMED CT#281036007 (Follow-up consultation) |
Follow-up findings, in component |
Set PractitionerRole.code from ScreeningRolesVS.
Profile: UZCorePractitionerRole
Examples: practitioner-role-laborant, practitioner-role-gynecologist, practitioner-role-radiologist, practitioner-role-nurse
| Role | Example code |
|---|---|
| Laboratory technician | screening-roles-cs#his_laboratory_laborant |
| Obstetrician-gynecologist | screening-roles-cs#his_centre_obgyn_obstetrician_gynecologist |
| Radiologist | screening-roles-cs#his_ris_ragiologist_head |
| Patronage nurse | screening-roles-cs#his_poliklinika_patronage_nurse |