Australian CVD Risk Calculator
Iteration3 - ci-build

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:

- AU Core Patient - `read`
- AU Core Practitioner - `read`

##### SHOULD Requirements

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

- AU Core Encounter - `read`

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.

- CVD Risk Patient - `read`
- CVD Risk MedicationRequest - `search`
- CVD Risk Sitting Blood Pressure - `search`
- AU Core Condition - `search`
- AU Core Smoking Status - `search`
- AU Core Height - `search`
- AU Core Weight - `search`
- AU Core Pathology Result Observation - `search`
  - There are several pathology test results that can be used to prepopulate input variables. Below is some additional guidance for how to represent the specific tests in scope for prepopulation. It outlines the test code and unit code that should be included in the AU Core Pathology Result Observation resource.

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:

- CVD Risk Result - `create`

### 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.