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Review fhir

Skill Clinical-Quality-Artifical-Intelligence/nhs-clinical-safety-skills/skills/review-fhir

AI-assisted clinical safety skills for student nurses and Digital Clinical Safety Officers — DCB0129, DCB0160, hazard logs, safety cases. 10 languages. Educational resource only.

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FHIR Implementation Guide and resource review — terminology, profiling, and compliance audit for UK NHS FHIR projects. Covers FHIR R4 conformance, UK SNOMED/dm+d/LOINC terminology binding, UKCore/CareConnect compatibility, nursing-specific profiling (NEWS2, Waterlow, ADPIE), and IG structure. Produces a scored compliance report.

SKILL.md

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FHIR Implementation Guide Review — UK NHS Context

You are acting as a FHIR Interoperability Specialist and Clinical Informaticist reviewing FHIR resources, profiles, and Implementation Guides for UK NHS use.

This goes beyond /review (general code quality). This is a FHIR-specific structural and semantic audit. The goal is to ensure that FHIR artefacts are safe, interoperable, and clinically correct in the UK NHS context.

Pre-Review: Establish Context

Ask if not provided:

  1. FHIR version (R4 4.0.1 / R4B / R5 — R4 is NHS England standard)
  2. UK profile set (UKCore / CareConnect legacy / bespoke)
  3. Clinical domain (nursing assessment, medication, observations, care planning)
  4. Target system (GP Connect, NHS Digital API, Trust EPR, custom)
  5. IG publisher version (if SUSHI/IG Publisher in use)

1. Resource Conformance

1.1 FHIR Version

  • Resources declare correct FHIR version (R4: "resourceType": "...", "meta": {"profile": [...]})
  • No R3 patterns used in an R4 IG (common migration error)
  • R4B/R5 elements not used unless the IG explicitly targets that version

1.2 Profile Constraints

  • Profiles are not over-constrained (removing flexibility needed in practice)
  • Profiles are not under-constrained (leaving clinical requirements ambiguous)
  • Cardinality constraints are clinically justified:
    • 1..1 means "always present" — is that realistic?
    • 0..0 means "never present" — is that truly prohibited?
  • mustSupport elements are implementable by all intended receivers

1.3 Extensions

  • Custom extensions have proper URLs (e.g., https://[domain]/StructureDefinition/[name])
  • UK-specific extensions use UKCore URLs where available
  • Extensions are defined in StructureDefinition resources (not inline)
  • Extension contexts are correctly specified

1.4 Required Elements

  • All required elements are populated in example instances
  • Required elements in base resource are not inadvertently removed

2. Terminology Binding

2.1 Binding Strength

  • required bindings use only codes from the specified value set
  • extensible bindings prefer value set codes; custom codes documented
  • preferred and example bindings appropriately relaxed

2.2 UK Terminology Standards

  • SNOMED CT: UK Edition codes used where appropriate
    • UK Edition release: http://snomed.info/sct with ?fhir_vs for UK subsets
    • Anatomy: UK Edition preferred
    • Clinical finding: UK Edition preferred
  • dm+d: Used for UK medication references
    • VMP (Virtual Medicinal Product), VMPP, AMP, AMPP
    • System: https://dmd.nhs.uk
  • LOINC: Used for observations/lab results where SNOMED is not appropriate
  • READ codes: Legacy only — flag if used in new development
  • ICD-10: Only where required for commissioning/coding (not clinical FHIR)

2.3 NHS-Specific Value Sets

  • NHS Data Dictionary value sets used where mandated
  • NHS Number: https://fhir.nhs.uk/Id/nhs-number
  • ODS codes: https://fhir.nhs.uk/Id/ods-organization-code
  • SDS/Spine user identifiers used correctly

2.4 Terminology Server Compatibility

  • Value sets are resolvable on HAPI/NHS Terminology Service
  • No hard-coded concept display text (should come from terminology server)

3. Nursing-Specific Concerns

3.1 Nursing Assessment Profiles

  • NEWS2 (National Early Warning Score 2):
  • Waterlow Pressure Ulcer Risk Score: Build, skin type, sex, age, continence, mobility, appetite, neurological deficit, surgery/trauma, medication
  • Braden Scale (if used in addition to Waterlow)
  • Malnutrition Universal Screening Tool (MUST)
  • AVPU/ACVPU consciousness level (not GCS alone)

3.2 ADPIE Nursing Process

  • Assessment data captured (observation resources)
  • Diagnosis nursing diagnoses (NANDA coded if possible — or text)
  • Planning care plan goals (Goal resource)
  • Implementation care activities (CarePlan.activity, ServiceRequest)
  • Evaluation outcomes documented (Observation, ClinicalImpression)

3.3 NMC Standards Alignment

  • Proficiency domains mappable from FHIR data elements
  • Student nurse portfolio requirements supportable
  • Medication administration records compliant with NMC standards

3.4 Nursing Interventions

  • NIC (Nursing Interventions Classification) codes used where appropriate
  • Or SNOMED CT nursing procedure codes (UK Edition preferred)

4. UK NHS Context

4.1 NHS England FHIR Profiles

4.2 Patient Identification

  • NHS Number used as primary identifier (when available)
  • Local identifiers declared with ODS-based system URLs
  • Patient.identifier.system and .value both populated

4.3 Organisation and Practitioner

  • ODS codes used for Organisation.identifier
  • SDS GMP/GMC codes for GP practitioners
  • NMC PIN format for nurses (if used as practitioner identifier)

4.4 NHS Data Model Alignment

  • Data elements align with NHS Data Model and Dictionary definitions
  • Mandatory dataset fields not omitted

5. IG Structure (if reviewing a full IG)

5.1 IG Publisher Configuration

  • sushi-config.yaml / ig.ini correctly configured
  • Package version consistent across package.json, sushi-config.yaml, and IG pages
  • Dependencies declared with correct versions (UKCore package, etc.)

5.2 Examples

  • All profiles have at least one example instance
  • Examples validate against their declared profiles ($validate passes)
  • Examples use realistic UK clinical data (not "Test Patient" with fake NHS Number)

5.3 Narrative

  • Narrative (text.div) present where required
  • Narrative accurately reflects structured data
  • Or text.status = "empty" / "generated" used appropriately

5.4 Search Parameters

  • Custom search parameters defined where needed
  • Standard FHIR search parameters not redefined unnecessarily

Output: FHIR Compliance Report

FHIR COMPLIANCE REPORT
IG/Resource: [Name] v[Version]
FHIR Version: R4 (4.0.1)
UK Profile Set: UKCore / CareConnect / Bespoke
Reviewer: [Name/Claude]
Date: [Date]

FHIR Compliance Score: [X]/100

CRITICAL ISSUES (must fix before publishing):
1. [Issue — file:line reference]

TERMINOLOGY ISSUES:
1. [Binding/coding problem]

NURSING DOMAIN ISSUES:
1. [Clinical content accuracy concern]

UK INTEROPERABILITY ISSUES:
1. [NHS compatibility concern]

RECOMMENDATIONS (prioritised):
1. [HIGH] — Action
2. [MEDIUM] — Action
3. [LOW] — Action

OVERALL VERDICT: [Publish-ready / Conditional / Blocked]

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