Hero

Australian CVD Risk Calculator
Iteration3 - ci-build Australia flag

Australian CVD Risk Calculator - Local Development build (vIteration3) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

FHIR Server Requirements

This section outlines the general requirements for implementing a FHIR service that supports the Aus CVD Risk Calculator application, Aus CVD Risk‑i.

For completeness, definitional artefacts have also be included in this guide for the Aus CVD Risk Calculator application. The role that integrators will need to fulfil is that of the Aus CVD Risk Calculator Launch Server.

The AU Core General Requirements section includes useful information on conformance. These conformance patterns and expectations are mirrored here and should be applied to the profiles, capability statements and actor definitions contained within.

Capability Statements

System behaviour, including expectations to support FHIR profiles, RESTful operations and search parameters are defined in the following capability statements:

  • Aus CVD Risk Calculator Application

    This CapabilityStatement describes the capabilities of the Aus CVD Risk-i application. These capabilities include supported FHIR profiles, RESTful operations, and search parameters.

  • Aus CVD Risk Calculator Launch Server

    This CapabilityStatement describes the expected capabilities for systems to launch and exchange data with the Aus CVD Risk Calculator application. It lists the server's conformance expectations for launching the application, supplying information for prepopulation, and recording the results as an output of using the application. These expectations include supported FHIR profiles, RESTful operations, and search parameters.

    • Data Prepopulation

    Data prepopulation requirements are defined in the Aus CVD Risk Calculator Launch Server CapabilityStatement.

    They are also summarised here for further illustration.

    SHALL Requirements

    The minimum expectations to launch Aus CVD Risk‑i and provide enough meaningful information to begin using it includes:

    SHOULD Requirements

    If appropriate for the context of use, support SHOULD also be provided for:

    Support for these additional resources enables prepopulating fields and variables within the calculator. While not mandatory to launch the application, support is highly encouraged to provide a better user experience.

    Pathology Test Name Test Code Unit Code
    coding.system coding.code value.system value.code
    Total cholesterol http://loinc.org 14647-2 http://unitsofmeasure.org mmol/L
    HDL cholesterol http://loinc.org 14646-4 http://unitsofmeasure.org mmol/L
    Ratio of total cholesterol to HDL cholesterol http://loinc.org 32309-7 http://unitsofmeasure.org
    HbA1c http://loinc.org 4548-4 http://unitsofmeasure.org %
    HbA1c (IFCC) http://loinc.org 59261-8 http://unitsofmeasure.org mmol/mol
    eGFR (CKD-EPI) http://loinc.org 62238-1 http://unitsofmeasure.org mL/min/{1.73_m2}
    uACR http://loinc.org 32294-1 http://unitsofmeasure.org mg/mmol
    Prepopulation narrative descriptions

    The following table describes the logic used for prepopulating the CVD risk calculator variables in a human friendly format.

    Variable Prepopulation description
    Clinically determined high risk Moderate-severe chronic kidney disease Prepopulation will not occur. Clinician validated only.
    Familial hypercholesterolaemia Prepopulation will not occur. Clinician validated only.
    Neither present Prepopulation will not occur. Clinician validated only.
    Age Calculated from date of birth.
    Sex at birth Current recorded sex at birth.
    Smoking status Never smoked Latest smoking status indicating patient has never smoked.
    Previously smoked Latest smoking status indicating patient has previously smoked.
    Currently smokes Latest smoking status indicating patient currently smokes or is an occasional smoker.
    Systolic blood pressure The latest systolic blood pressure measurement recorded within the last 2 years and in the sitting position. If a measurement in the sitting position is not available, the latest recorded systolic blood pressure within the last 2 years will be used.
    Cholesterol results Total cholesterol Latest available reported total cholesterol result within the last 5 years.
    HDL cholesterol Latest available reported HDL cholesterol result within the last 5 years.
    Ratio total/HDL Latest available reported total/HDL cholesterol ratio result within the last 5 years.
    Diabetes Patient has an active problem list item of type 2 diabetes mellitus or a more specific condition (SNOMED CT encoded).
    CVD medicines Blood pressure-lowering medicines Patient has had a prescription for a medicine that is an angiotensin converting enzyme inhibitor, betablocker, thiazide, angiotensin II receptor blocker or calcium channel blocker (AMT encoded) within the last 12 months.
    Lipid-modifying medicines Patient has had a prescription for a medicine that contains atorvastatin, fluvastatin, pravastatin, simvastatin, acipimox, bezafibrate, cholestyramine, clofibrate, colestipol, ezetimibe, ezetimibe + simvastatin, gemfibrozil and nicotinic acid (AMT encoded) within the last 12 months.
    Antithrombotic medicines Patient has had a prescription for a medicine that contains aspirin, clopidogrel, dipyridamole, prasugrel, ticagrelor, ticlopidine, warfarin, dabigatran, phenindione, rivaroxaban and apixaban (AMT encoded) within the last 12 months.
    None Prepopulation will not occur. Clinician validated only.
    Postcode Home address postcode.
    History of atrial fibrillation Patient has an active problem list item of atrial fibrillation or a more specific condition (SNOMED CT encoded).
    Diabetes specific variables Time since diagnosis of diabetes Calculated from the clinically determined date when the condition began.
    HbA1c Latest available reported HbA1c result within the last 2 years.
    uACR Latest available reported uACR result within the last 2 years.
    eGFR Latest available reported eGFR result within the last 2 years.
    BMI Calculated from latest available height and weight measurements. Weight measurement must be within the last 12 months.
    Insulin Patient has had a prescription for a medicine that contains insulin (AMT encoded) within the last 12 months.

    Write-back

    Write-back requirements are defined in the Aus CVD Risk Calculator Launch Server CapabilityStatement.

    They are also summarised here for further illustration.

    SHALL Requirements

    To record the CVD risk result in the launching system once a user has completed the necessary process, the following is required:

    Must Support and Obligation

    The meaning of Must Support is specified in terms of Obligation Codes in obligation extensions on an element definition. These Obligation extensions will reference the actor responsible for fulfilling the Must Support requirements.

    Actor Definitions

    The following actor definitions have been defined for this implementation guide.

    • Aus CVD Risk Calculator Launch Server
      • The Aus CVD Risk Calculator Launch Server is responsible for launching the Aus CVD Risk Calculator application according to the SMART App Launch EHR launch flow, supplying information for prepopulation, and recording the results as an output of using the application.
    • Aus CVD Risk Calculator Application
      • The Aus CVD Risk Calculator Application is responsible for launching according to the SMART App Launch EHR launch flow, requesting information for prepopulation, and supplying the results generated as an output of using the application.