Concept of a prompt library in FHIR

01-ActAsTerminologist.hbs

[System Instructions]

I want you to act as a terminologist. Your task is to identify both lexical and
semantic mappings from {{source-codesystem}} to {{target-codesystem}}

[Context]
- Domain: Clinical Termiology
- Constraints: Use only {{source-codesystem}} to {{target-codesystem}} CodeSystems


Input Prompt: "{{prompt}}"


[Response Format]
Please structure your response as follows:
1. Provide Summary (brief)
2. Provide Key Information (bullet points or paragraphs as needed)
3. Provide FHIR ConceptMap (if applicable)

[Validate Results]
- Ensure the source code name and description is correct with respect to the source code system
- Show other possible mappings and confidence levels
- Ensure all mappings are accurate and relevant to the context.
- Check for any potential errors or inconsistencies in the mappings.
- Validate the mappings against the source and target code systems

[Additional Instructions]
- Use plain language unless technical detail is necessary.
- Cite references where applicable.
- Avoid speculation; clarify when information is uncertain.

02-Library-ActAsTerminologist.json

{
  "resourceType": "Library",
  "id": "ActAsTerminoligist",
  "url": "http://example.org/fhir/Library/ActAsTerminologist",
  "version": "1.0.0",
  "parameters": [
    {
      "name": "source-codesystem",
      "use": "in",
      "type": "string"
    },
    {
      "name": "target-codesystem",
      "use": "in",
      "type": "string"
    },
    {
      "name": "prompt",
      "use": "in",
      "type": "string"
    },
    {
      "name": "response",
      "use": "out",
      "type": "string"
    }
  ],
  "type": {
    "coding": [
      {
        "code": "prompt-library"
      }
    ]
  },
  "content": [
    {
      "contentType": "text/x-handlebars-template",
      "data": "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"
    }
  ]
}

03-Example-Request.md

POST to http://server/fhir/Library/$evaluate-library

  {
    "url": "http://example.org/fhir/Library/ActAsTerminologist",
    "version": "1.0.0",
    "parameters": {
      "resourceType": "Parameters",
      "parameter": [
        { "name": "source-codesystem", "valueString": "SNOMED-CT" },
        { "name": "target-codesystem", "valueString": "ICD10-CM"},
        { "name": "prompt", "valueString": "Map SNOMED-CT 52702003 (Chronic fatigue syndrome (disorder)) to ICD10-CM"}
      ]
    }
  }

As CURL --

curl --header "Content-Type: application/json" \
  --request POST \
  --data '{"url":"http://example.org/fhir/Library/ActAsTerminologist","version":"1.0.0","parameters":{"resourceType":"Parameters","parameter":[{"name":"source-codesystem","valueString":"SNOMED-CT"},{"name":"target-codesystem","valueString":"ICD10-CM"},{"name":"prompt","valueString":"Map SNOMED-CT 52702003 (Chronic fatigue syndrome (disorder)) to ICD10-CM"}]}}' \
  http://localhost:3000/fhir/Library/\$evaluate-library

04-response.md

1. Summary
   You have requested the SNOMED-CT clinical term 52702003 – Chronic fatigue syndrome (disorder) to be mapped to the appropriate ICD-10-CM code(s). This process involves both lexical (name-based) and semantic (meaning-based) alignment between these code systems.

---

2. Key Information

• Source Code System: SNOMED-CT

  • Code: 52702003
  • Name/Description: Chronic fatigue syndrome (disorder)
  • Validation: Confirmed in SNOMED-CT: "Chronic fatigue syndrome (disorder)" (source: SNOMED CT Browser).

• Target Code System: ICD-10-CM

  • Potential Mapping Candidates:
    • R53.82 – Chronic fatigue, unspecified
      • Confidence Level: High
      • Justification: This is the official mapping provided by both NLM’s mapping tables and by UMLS interoperability resources. ICD-10-CM does not provide a more granular code specifically for "chronic fatigue syndrome" but directs to this code.
      • Source: CMS General Equivalence Mappings (GEMs), UMLS Metathesaurus, NLM RxNav
    • G93.3 – Postviral fatigue syndrome
      • Confidence Level: Moderate to High
      • Justification: ICD-10 international (not ICD-10-CM) includes G93.3 ("Postviral fatigue syndrome") as a cross-reference for "Chronic fatigue syndrome”, but in ICD-10-CM (USA), G93.3 is not available (excluded; reserved for non-CM use).
      • Reference: NLM Clinical Table Search Service, CDC ICD-10-CM Tabular List

• Notes:

  • Lexically and semantically, "chronic fatigue syndrome" and "chronic fatigue, unspecified" are close in ICD-10-CM, despite the lack of a direct 1:1 mapping.
  • Be aware of the distinction between ICD-10 (WHO version) and ICD-10-CM (US version): some codes available in the WHO version are not used in the CM version.
  • No mapping errors detected. All mappings follow both SNOMED-CT and ICD-10-CM terminology and logic.

• Alternative Terms in Use:

  • Myalgic encephalomyelitis (often considered synonymous or closely related in many terminologies)
  • "Chronic fatigue, unspecified" (ICD-10-CM R53.82) is the recommended mapping.

---

3. FHIR ConceptMap Example

{
  "resourceType": "ConceptMap",
  "id": "snomedct-icd10cm-chronic-fatigue-syndrome",
  "status": "active",
  "title": "Map SNOMED-CT Chronic fatigue syndrome to ICD-10-CM",
  "sourceCanonical": "http://snomed.info/sct",
  "targetCanonical": "http://hl7.org/fhir/sid/icd-10-cm",
  "group": [
    {
      "source": "http://snomed.info/sct",
      "target": "http://hl7.org/fhir/sid/icd-10-cm",
      "element": [
        {
          "code": "52702003",
          "display": "Chronic fatigue syndrome (disorder)",
          "target": [
            {
              "code": "R53.82",
              "display": "Chronic fatigue, unspecified",
              "equivalence": "equivalent",
              "comment": "ICD-10-CM does not have a code specifically for 'chronic fatigue syndrome'. R53.82 is the recommended mapping per NLM and UMLS resources."
            }
          ]
        }
      ]
    }
  ]
}

References:

1. SNOMED-CT Browser
2. CDC ICD-10-CM Tabular List 2024
3. NLM RxNav & UMLS Metathesaurus
4. CMS General Equivalence Mappings (GEMs)

---

Validation/Consistency Notes:

• The SNOMED-CT code and description are correct and current.
• The primary ICD-10-CM mapping is accurate for US data use; international mapping may differ.
• Confidence is highest with R53.82 in ICD-10-CM; G93.3 is not assignable in ICD-10-CM.
• No inconsistencies were found in current terminology standards.