Assistance with FHIR Bundle Validation Issues (Java 21 & HAPI-FHIR Validator 7.4.0)

[Vinod Aravind]

Hello Team,

We are using Java 21 and HAPI-FHIR validator 7.4.0.

We are validating using packages as described in section 14.2.5 of the HAPI-FHIR documentation (https://hapifhir.io/hapi-fhir/docs/validation/instance_validator.html#packages).

We use FHIR Bundle 4.0.1. When we validate the FHIR Bundle, it throws a few errors related to SNOMED and LOINC.

Here are some errors and the corresponding FHIR input sections that cause the errors:

Error 1:
`
"diagnostics": "None of the codings provided are in the value set 'US Core Condition Codes' (http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code|7.0.0), and a coding from this value set is required) (codes = http://snomed.info/sct#733423003, http://hl7.org/fhir/sid/icd-10-cm#Z59.4)",
                "location": [
                  "Bundle.entry[5].resource/*Condition/ConditionFoodInsecurityExample*/.code",
                  "Line[1] Col[18464]"
                ]
`
FHIR input section:
`
"category" : [{
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/core/CodeSystem/condition-category",
          "code" : "health-concern",
          "display" : "Health Concern"
        }]
      },
      {
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes",
          "code" : "food-insecurity",
          "display" : "Food Insecurity"
        }]
      }],
      "code" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "733423003",
          "display" : "Food insecurity"
        },
        {
          "system" : "http://hl7.org/fhir/sid/icd-10-cm",
          "code" : "Z59.4",
          "display" : "Lack of adequate food"
        }]
      }

`

Error 2:
`
{
            "location": {
              "line": 1,
              "column": 22845,
              "diagnostics": "Bundle.entry[6].resource/*Observation/AssessmentResponseQuestionGrouper1*/.code"
            },
            "message": "None of the codings provided are in the value set 'LOINC Codes' (http://hl7.org/fhir/ValueSet/observation-codes|4.0.1), and a coding from this value set is required) (codes = http://loinc.org#96777-8)",
            "severity": "ERROR"
          }

`
FHIR input section:
`
 "category" : [{
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes",
          "code" : "housing-instability",
          "display" : "Housing Instability"
        },
        {
          "system" : "http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes",
          "code" : "inadequate-housing",
          "display" : "Inadequate Housing"
        },
        {
          "system" : "http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes",
          "code" : "food-insecurity",
          "display" : "Food Insecurity"
        }]
      },
      {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
          "code" : "social-history"
        }]
      },
      {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
          "code" : "survey"
        }]
      }],
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "96777-8",
          "display" : "Accountable health communities (AHC) health-related social needs screening (HRSN) tool"
        }]
      }
   `  
     
We would appreciate any guidance on addressing these validation issues.

Thanks,
Vinod

[James Agnew]

These errors show failures to validate codes from the ICD-10-CM and LOINC codesystems. Do you have these codesystems loaded in your system? They are not included with HAPI FHIR, you need to load them manually (or if you're not using the JPA server, provide an IValidationSupport module in your chain which can handle these systems).

Cheers,

James

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[Vinod Aravind]

Thanks you for the feedback .  I am using plain server. I just tried with the code

supportChain.addValidationSupport(new RemoteTerminologyServiceValidationSupport(fhirContext,"https://tx.fhir.org/r4"));

and now all SNOMED and ICD-10-CM related errors disappeared. but still it shows LOINC  related errors 
Any more options to give in the support chain ?

Thanks,
Vinod A

[James Agnew]

The tx.fhir.org server should be able to handle LOINC validation. FWIW I'd recommend as a next step to put a breakpoint in the RemoteTerminologyServiceValidationSupport and see what response you're getting from the remote server when validating your LOINC code.

Cheers,

James

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[Vinod Aravind]

Okay James, I shall try it.

One more item, it shows error 504 error sometimes.

HAPI-1361: Failed to parse response from server when performing GET to URL https://tx.fhir.org/r4/CodeSystem - org.apache.http.conn.ConnectTimeoutException: Connect to tx.fhir.org:443 [tx.fhir.org/104.196.166.17] failed: Read timed out

Is it better to load the packages for the terminology locally ? 
Thanks,
Vinod 

[James Agnew]

That depends entirely on what you are trying to achieve. Can you elaborate on your use case? (ie. what kind of system are you trying to build, what is your architecture, who would be using it, is it production, etc)

For example, if you're building a production, mission critical system you would never want to rely on a third party API like tx.fhir.org that you have no control over and no agreement with. If this is just for experimentation, it probably doesn't matter.

Cheers,

James

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[Vinod Aravind]

yes, Now it is in experiment mode,  But later it will implement in the original code. Not sure about the use cases that need to use. Given this task as an R&D.
Thanks