Building reports using SQL on FHIR

This article provides a step-by-step guide to building a report using Aidbox Forms and SQL on FHIR.

Overview

The SQL on FHIR specification allows users to create flat views of their resources in a simple, straightforward way and use it for performing analysis or building reports.

In our case, we will focus on the QuestionnaireResponse that references the Vitals Signs Record Form to show how it works.

Example of the Vitals Signs Record Form (Questionnaire):

// {
  "title": "Vitals Sign Test Form",
  "id": "ed0ac227-19d1-41f7-960c-bab88f9a84da",
  "status": "draft",
  "url": "http://forms.aidbox.io/questionnaire/vitals-sign-test-form",
  "meta": {
    "lastUpdated": "2024-08-07T14:09:56.567202Z",
    "versionId": "310",
    "extension": [
      {
        "url": "https://fhir.aidbox.app/fhir/StructureDefinition/created-at",
        "valueInstant": "2024-08-07T13:53:26.150467Z"
      }
    ]
  },
  "resourceType": "Questionnaire",
  "item": [
    {
      "linkId": "group_1",
      "item": [
        {
          "text": "Visit Date",
          "type": "date",
          "linkId": "vd"
        },
        {
          "text": "Blood Pressure",
          "type": "string",
          "linkId": "blood_pr"
        },
        {
          "text": "Temperature ",
          "type": "quantity",
          "linkId": "tempr",
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unitOption",
              "valueCoding": {
                "display": "C"
              }
            }
          ]
        }
      ],
      "repeats": true,
      "extension": [
        {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [
              {
                "code": "gtable"
              }
            ]
          }
        }
      ],
      "type": "group"
    }
  ]
} 

Example of the completed Vitals Signs Record Form (QuestionnaireResponse):

// {
 "item": [
  {
   "item": [
    {
     "text": "Visit Date",
     "answer": [
      {
       "valueDate": "2024-08-05"
      }
     ],
     "linkId": "vd"
    },
    {
     "text": "Blood Pressure",
     "answer": [
      {
       "valueString": "120/80"
      }
     ],
     "linkId": "blood_pr"
    },
    {
     "text": "Temperature ",
     "answer": [
      {
       "valueQuantity": {
        "unit": "C",
        "value": 37
       }
      }
     ],
     "linkId": "tempr"
    }
   ],
   "linkId": "group_1"
  },
  {
   "item": [
    {
     "text": "Visit Date",
     "answer": [
      {
       "valueDate": "2024-08-06"
      }
     ],
     "linkId": "vd"
    },
    {
     "text": "Blood Pressure",
     "answer": [
      {
       "valueString": "110/70"
      }
     ],
     "linkId": "blood_pr"
    },
    {
     "text": "Temperature ",
     "answer": [
      {
       "valueQuantity": {
        "unit": "C",
        "value": 37
       }
      }
     ],
     "linkId": "tempr"
    }
   ],
   "linkId": "group_1"
  },
  {
   "item": [
    {
     "text": "Visit Date",
     "answer": [
      {
       "valueDate": "2024-08-07"
      }
     ],
     "linkId": "vd"
    },
    {
     "text": "Blood Pressure",
     "answer": [
      {
       "valueString": "100/60"
      }
     ],
     "linkId": "blood_pr"
    },
    {
     "text": "Temperature ",
     "answer": [
      {
       "valueQuantity": {
        "unit": "C",
        "value": 37
       }
      }
     ],
     "linkId": "tempr"
    }
   ],
   "linkId": "group_1"
  }
 ],
 "status": "in-progress",
 "subject": {
  "reference": "Patient/morgan"
 },
 "questionnaire": "http://forms.aidbox.io/questionnaire/vitals-sign-test-form",
 "id": "[75177295-2edf-45f7-b57e-0b1a0fd71fb7](https://forms220724.edge.aidbox.app/ui/console#/rest?req=GET%20/QuestionnaireResponse/75177295-2edf-45f7-b57e-0b1a0fd71fb7)",
 "resourceType": "QuestionnaireResponse",
 "meta": {
  "lastUpdated": "2024-08-07T14:12:51.846100Z",
  "versionId": "320",
  "extension": [
   {
    "url": "https://fhir.aidbox.app/fhir/StructureDefinition/created-at",
    "valueInstant": "2024-08-07T14:11:58.571600Z"
   }
  ]
 }
}

Incoming Data

• Vitals Sign Test Form - url http://forms.aidbox.io/questionnaire/vitals-sign-test-form

• Data Fields in QuestionnaireResponse:

  • Visit Date - linkID: vd

  • Blood Pressure - linkID: blood_pr

  • Group containing these fields - linkID: group_1

• Patient id - morgan

Purpose

To build a report of how blood pressure changes from visit to visit for a specific patient.

Flow

1. Create ViewDefinition for QuestionnaireResponse of Vitals Signs Test Form using ViewDefinition Designer

2. POST ViewDefinition resource in Aidbox

3. Create AidboxQuery for this ViewDefinition

4. Use $query endpoint to get the required data for reporting

1. Create ViewDefinition for QuestionnaireResponse of Vitals Signs Test Form using ViewDefinition Designer

SQL on FHIR utilizes ViewDefinition resources to describe the structure of flat views. To create a ViewDefinition resource for a specific QuestionnaireResponse follow these steps:

1. Sign in to the ViewDefinition Designer
2. Connect to your current instance on the Settings page (if your instance is in Aidbox cloud)

3. Go to the View Definition page and click on the +ViewDefinition button to create a new resource or import an existing resource.

Example of ViewDefinition for the QuestionnaireResponses of Vitals Signs Test Form in which we filter data of two fields:

// {
  "name": "vs_test",
  "where": [
    {
      "path": "questionnaire = 'http://forms.aidbox.io/questionnaire/vitals-sign-test-form'"
    }
  ],
  "select": [
    {
      "select": [
        {
          "column": [
            {
              "name": "date",
              "path": "item.where(linkId='vd').answer.value.ofType(date)"
            },
            {
              "name": "blood_pressure",
              "path": "item.where(linkId='blood_pr').answer.value.ofType(string)"
            }
          ]
        }
      ],
      "forEach": "item.where(linkId='group_1')"
    },
    {
      "column": [
        {
          "name": "pid",
          "path": "subject.id"
        }
      ]
    }
  ],
  "status": "unknown",
  "resource": "QuestionnaireResponse",
  "id": "c8153197-79de-4555-a2f3-3d08df3cec24",
  "resourceType": "ViewDefinition",
  "meta": {
    "lastUpdated": "2024-08-07T15:22:56.659712Z",
    "createdAt": "2024-08-07T14:37:54.879920Z",
    "versionId": "341"
  }
}

Once you have created and tested the new resource (ViewDefinition), click the save button and the resource will be saved to your Aidbox instance.

2. POST ViewDefinition resource in Aidbox

There are two options for saving the ViewDefinition resource in the Aidbox instance:

• Click the save button on View Definition Designer to save the resource to your Aidbox instance connected to View Definition Designer.

• Copy the JSON file from View Definition Designer and POST it in Aidbox.

Once saved, the corresponding flat view will be created in the database in the sof schema (e.g., sof.vs_test).

3. Create AidboxQuery for this ViewDefinition

Create an AidboxQuery resource for the ViewDefinition parameterized by a patient to turn your SQL query into a REST Endpoint.

Example:

// PUT /AidboxQuery/vs_test
content-type: text/yaml
accept: text/yaml

params:
  pid:
    isRequired: true
    type: string
query: 'select * from sof.vs_test where pid = {{params.pid}}'

4. Use $query endpoint to get the required data

After creating the AidboxQuery, you can use it to fetch the data.

Example:

GET /$query/vs_test?pid=morgan

Where

pid - patient id

vs_test - AidboxQuery id

This approach allows you to flatten nested FHIR resources (QuestionnaireResponse) and use them to build reports and analytics more easily.