fhirsmith 0.7.6 → 0.8.0

package/CHANGELOG.md

@@ -5,6 +5,32 @@ All notable changes to the Health Intersections Node Server will be documented i
 The format is based on [Keep a Changelog](https://keepachangelog.com/en/1.0.0/),
 and this project adheres to [Semantic Versioning](https://semver.org/spec/v2.0.0.html).
 
+## [v0.8.0] - 2026-03-27
+
+### Added
+
+- XIG: add JSON and CSV downloads
+- TX: Add snomed filter support for inactive, moduleId, and properties
+
+### Changed
+
+- Improve Dashboard Presentation
+- Make docker image platform compatible with apple silicon (arm)
+- TX: update rxnorm version for tx.fhir.org
+- TX: Improve VSAC information page
+
+### Fixed
+
+- XIG: fix valueset source filter
+- TX: Fix bug in language processing looking up country codes
+- TX: Fix up terminology search for LOINC and generally 
+- TX: fix rxnorm property support and search performance
+- Publisher: fix status display when building draft IG
+
+### Tx Conformance Statement
+
+FHIRsmith passed all 1498 HL7 terminology service tests (modes tx.fhir.org+omop+general+snomed, tests v1.9.1, runner v6.9.4)
+
 ## [v0.7.6] - 2026-03-25
 
 ### Added

package/library/languages.js

@@ -455,6 +455,16 @@ class Languages {
     return true;
   }
 
+  includesLanguage(code) {
+    const llang = new Language(code);
+    for (const lang of this.languages) {
+      if (lang.matches(llang)) {
+        return true;
+      }
+    }
+    return false;
+  }
+
   /**
    * Convert to string representation (similar to Accept-Language header format)
    */

package/package.json

@@ -1,6 +1,6 @@
 {
   "name": "fhirsmith",
-  "version": "0.7.6",
+  "version": "0.8.0",
   "description": "A Node.js server that provides a collection of tools to serve the FHIR ecosystem",
   "main": "server.js",
   "engines": {

package/packages/package-crawler.js

@@ -120,7 +120,7 @@ class PackageCrawler {
       this.log.info(`Web crawler completed successfully in ${runTime}ms`);
       this.log.info(`Total bytes processed: ${this.totalBytes}`);
 
-      this.stats.task('Package Crawler', 'Complete');
+      this.stats.taskDone('Package Crawler', 'Complete');
       return this.crawlerLog;
 
     } catch (error) {
@@ -128,7 +128,7 @@ class PackageCrawler {
       this.crawlerLog.runTime = `${runTime}ms`;
       this.crawlerLog.fatalException = error.message;
       this.crawlerLog.endTime = new Date().toISOString();
-      this.stats.task('Package Crawler', 'Error: '+error.message);
+      this.stats.taskError('Package Crawler', 'Error: '+error.message);
 
       this.log.error('Web crawler failed: '+ error);
       throw error;

package/publisher/publisher.js

@@ -481,7 +481,7 @@ class PublisherModule {
 
     // Record the log file path and local folder immediately so they're accessible
     // even if the build fails later
-    await this.updateTaskStatus(task.id, task.status, {
+    await this.updateTaskStatus(task.id, 'building', {
       build_output_path: logFile,
       local_folder: taskDir
     });

package/registry/registry.js

@@ -163,10 +163,10 @@ class RegistryModule {
         `Found ${newData.registries.length} registries, ` +
         `${metadata.errors.length} errors, ` +
         `downloaded ${this.crawler.formatBytes(metadata.totalBytes)}`);
-      this.stats.task('TxRegistry', 'Crawling Finished');
+      this.stats.taskDone('TxRegistry', 'Crawling Finished');
     } catch (error) {
       this.logger.error('Crawl failed:', error);
-      this.stats.task('TxRegistry', 'Crawling Error: '+error.message);
+      this.stats.taskError('TxRegistry', 'Crawling Error: '+error.message);
     } finally {
       this.crawlInProgress = false;
     }

package/root-bare-template.html

@@ -57,11 +57,10 @@
             	<div class="inner-wrapper">
  <div class="col-9">
 
-  <h2><img border="0" src="/FHIRsmith32.png" style="vertical-align: text-bottom"/> FHIRsmith: [%title%] </h2>
+  <h2>[%title%] </h2>
 
 [%content%]
 
-[%about%]
 
  </div>
 

package/server.js

@@ -267,60 +267,8 @@ async function loadTemplates() {
   }
 }
 
-async function buildDashboardContent() {
-  // Calculate uptime
-  const uptimeMs = Date.now() - stats.startTime;
-  const uptimeSeconds = Math.floor(uptimeMs / 1000);
-  const uptimeDays = Math.floor(uptimeSeconds / 86400);
-  const uptimeHours = Math.floor((uptimeSeconds % 86400) / 3600);
-  const uptimeMinutes = Math.floor((uptimeSeconds % 3600) / 60);
-  const uptimeSecs = uptimeSeconds % 60;
-  let uptimeStr = '';
-  if (uptimeDays > 0) uptimeStr += `${uptimeDays}d `;
-  if (uptimeHours > 0 || uptimeDays > 0) uptimeStr += `${uptimeHours}h `;
-  if (uptimeMinutes > 0 || uptimeHours > 0 || uptimeDays > 0) uptimeStr += `${uptimeMinutes}m `;
-  uptimeStr += `${uptimeSecs}s`;
-
-  // Memory usage
-  const memUsage = process.memoryUsage();
-  const heapUsedMB = (memUsage.heapUsed / 1024 / 1024).toFixed(2);
-  const heapAvailableMB = ((memUsage.heapTotal - memUsage.heapUsed) / 1024 / 1024).toFixed(2);
-  const rssMB = (memUsage.rss / 1024 / 1024).toFixed(2);
-  const freeMemMB = (os.freemem() / 1024 / 1024).toFixed(0);
-  const totalMemMB = (os.totalmem() / 1024 / 1024).toFixed(0);
-
-  let content = '';
-  content += '<table class="grid">';
-  content += '<tr>';
-  content += `<td><strong>Uptime:</strong> ${escape(uptimeStr)}</td>`;
-  content += `<td><strong>Request Count:</strong> ${stats.requestCount} (static: ${stats.staticRequestCount})</td>`;
-  content += `<td><strong>Free Memory:</strong> ${freeMemMB} MB of ${totalMemMB} MB</td>`;
-  content += '</tr>';
-  content += '<tr>';
-  content += `<td><strong>Heap Used:</strong> ${heapUsedMB} MB</td>`;
-  content += `<td><strong>Heap Available:</strong> ${heapAvailableMB} MB</td>`;
-  content += `<td><strong>Process Memory:</strong> ${rssMB} MB</td>`;
-  content += '</tr>';
-  content += getLogStats();
-  content += '</table>';
-
-  // ===== Metrics Graphs =====
-  const liquid = new Liquid({
-    root: path.join(__dirname, 'tx', 'html'),
-    extname: '.liquid'
-  });
-  content += await liquid.renderFile('home-metrics', {
-    historyJson: JSON.stringify(stats.history),
-    startTime: stats.startTime
-  });
-  content += stats.taskDetails();
-
-  return content;
-}
-
 async function buildRootPageContent() {
   stats.requestCount++;
-  let mc = 0;
   let content = '<div class="row mb-4">';
   content += '<div class="col-12">';
 
@@ -329,35 +277,30 @@ async function buildRootPageContent() {
 
   // Check which modules are enabled and add them to the list
   if (config.modules.packages.enabled) {
-    mc++;
     content += '<li class="list-group-item">';
     content += '<a href="/packages" class="text-decoration-none">Package Server</a>: Browse and download FHIR Implementation Guide packages';
     content += '</li>';
   }
 
   if (config.modules.xig.enabled) {
-    mc++;
     content += '<li class="list-group-item">';
     content += '<a href="/xig" class="text-decoration-none">FHIR IG Statistics</a>: Statistics and analysis of FHIR Implementation Guides';
     content += '</li>';
   }
 
   if (config.modules.shl.enabled) {
-    mc++;
     content += '<li class="list-group-item">';
     content += '<a href="/shl" class="text-decoration-none">SHL Server</a>: SMART Health Links management and validation';
     content += '</li>';
   }
 
   if (config.modules.vcl.enabled) {
-    mc++;
     content += '<li class="list-group-item">';
     content += '<a href="/VCL" class="text-decoration-none">VCL Server</a>: ValueSet Compose Language expression parsing';
     content += '</li>';
   }
 
   if (config.modules.registry && config.modules.registry.enabled) {
-    mc++;
     content += '<li class="list-group-item">';
     content += '<a href="/tx-reg" class="text-decoration-none">Terminology Server Registry</a>: ';
     content += 'Discover and query FHIR terminology servers for code system and value set support';
@@ -365,7 +308,6 @@ async function buildRootPageContent() {
   }
 
   if (config.modules.publisher && config.modules.publisher.enabled) {
-    mc++;
     content += '<li class="list-group-item">';
     content += '<a href="/publisher" class="text-decoration-none">FHIR Publisher</a>: ';
     content += 'Manage FHIR Implementation Guide publication tasks and approvals';
@@ -373,7 +315,6 @@ async function buildRootPageContent() {
   }
 
   if (config.modules.token && config.modules.token.enabled) {
-    mc++;
     content += '<li class="list-group-item">';
     content += '<a href="/token" class="text-decoration-none">Token Server</a>: ';
     content += 'OAuth authentication and API key management for FHIR services';
@@ -381,7 +322,6 @@ async function buildRootPageContent() {
   }
 
   if (config.modules.npmprojector && config.modules.npmprojector.enabled) {
-    mc++;
     content += '<li class="list-group-item">';
     content += '<a href="/npmprojector" class="text-decoration-none">NpmProjector</a>: ';
     content += 'Hot-reloading FHIR server with FHIRPath-based search indexes';
@@ -389,7 +329,6 @@ async function buildRootPageContent() {
   }
 
   if (config.modules?.['ext-tracker']?.enabled) {
-    mc++;
     content += '<li class="list-group-item">';
     content += '<a href="/ext-tracker" class="text-decoration-none">Extension Tracker</a>: ';
     content += 'View of Extension Usage';
@@ -404,7 +343,6 @@ async function buildRootPageContent() {
     content += '<ul class="mt-2 mb-0">';
     for (const fc of folders) {
       if (fc.enabled === false) continue;
-      mc++;
       content += '<li>';
       content += `<a href="${fc.url}" class="text-decoration-none">${fc.name}</a>: `;
       content += 'File folder with write control';
@@ -421,7 +359,6 @@ async function buildRootPageContent() {
     if (config.modules.tx.endpoints && config.modules.tx.endpoints.length > 0) {
       content += '<ul class="mt-2 mb-0">';
       for (const endpoint of config.modules.tx.endpoints) {
-        mc++;
         content += `<li><a href="${endpoint.path}" class="text-decoration-none">${endpoint.path}</a> (FHIR v${endpoint.fhirVersion}${endpoint.context ? ', context: ' + endpoint.context : ''})</li>`;
       }
       content += '</ul>';
@@ -433,8 +370,51 @@ async function buildRootPageContent() {
 
   content += '<hr/>';
 
+  // Calculate uptime
+  const uptimeMs = Date.now() - stats.startTime;
+  const uptimeSeconds = Math.floor(uptimeMs / 1000);
+  const uptimeDays = Math.floor(uptimeSeconds / 86400);
+  const uptimeHours = Math.floor((uptimeSeconds % 86400) / 3600);
+  const uptimeMinutes = Math.floor((uptimeSeconds % 3600) / 60);
+  const uptimeSecs = uptimeSeconds % 60;
+  let uptimeStr = '';
+  if (uptimeDays > 0) uptimeStr += `${uptimeDays}d `;
+  if (uptimeHours > 0 || uptimeDays > 0) uptimeStr += `${uptimeHours}h `;
+  if (uptimeMinutes > 0 || uptimeHours > 0 || uptimeDays > 0) uptimeStr += `${uptimeMinutes}m `;
+  uptimeStr += `${uptimeSecs}s`;
 
-  content += await buildDashboardContent();
+  // Memory usage
+  const memUsage = process.memoryUsage();
+  const heapUsedMB = (memUsage.heapUsed / 1024 / 1024).toFixed(2);
+  const heapAvailableMB = ((memUsage.heapTotal - memUsage.heapUsed) / 1024 / 1024).toFixed(2);
+  const rssMB = (memUsage.rss / 1024 / 1024).toFixed(2);
+  const freeMemMB = (os.freemem() / 1024 / 1024).toFixed(0);
+  const totalMemMB = (os.totalmem() / 1024 / 1024).toFixed(0);
+
+  content += '<table class="grid">';
+  content += '<tr>';
+  content += `<td><strong>Uptime:</strong> ${escape(uptimeStr)}</td>`;
+  content += `<td><strong>Request Count:</strong> ${stats.requestCount} (static: ${stats.staticRequestCount})</td>`;
+  content += `<td><strong>Free Memory:</strong> ${freeMemMB} MB of ${totalMemMB} MB</td>`;
+  content += '</tr>';
+  content += '<tr>';
+  content += `<td><strong>Heap Used:</strong> ${heapUsedMB} MB</td>`;
+  content += `<td><strong>Heap Available:</strong> ${heapAvailableMB} MB</td>`;
+  content += `<td><strong>Process Memory:</strong> ${rssMB} MB</td>`;
+  content += '</tr>';
+  content += getLogStats();
+  content += '</table>';
+
+  // ===== Metrics Graphs =====
+  const liquid = new Liquid({
+    root: path.join(__dirname, 'tx', 'html'),
+    extname: '.liquid'
+  });
+  content += await liquid.renderFile('home-metrics', {
+    historyJson: JSON.stringify(stats.history),
+    startTime: stats.startTime
+  });
+  content += stats.taskDetails();
 
   content += '</div>';
   return content;
@@ -546,8 +526,52 @@ app.get('/dashboard', async (req, res) => {
     }
 
     const startTime = Date.now();
-    const dashContent = await buildDashboardContent();
-    const content = '<div class="row mb-4"><div class="col-12">' + dashContent + '</div></div>';
+    // Calculate uptime
+    const uptimeMs = Date.now() - stats.startTime;
+    const uptimeSeconds = Math.floor(uptimeMs / 1000);
+    const uptimeDays = Math.floor(uptimeSeconds / 86400);
+    const uptimeHours = Math.floor((uptimeSeconds % 86400) / 3600);
+    const uptimeMinutes = Math.floor((uptimeSeconds % 3600) / 60);
+    const uptimeSecs = uptimeSeconds % 60;
+    let uptimeStr = '';
+    if (uptimeDays > 0) uptimeStr += `${uptimeDays}d `;
+    if (uptimeHours > 0 || uptimeDays > 0) uptimeStr += `${uptimeHours}h `;
+    if (uptimeMinutes > 0 || uptimeHours > 0 || uptimeDays > 0) uptimeStr += `${uptimeMinutes}m `;
+    uptimeStr += `${uptimeSecs}s`;
+
+    // Memory usage
+    const memUsage = process.memoryUsage();
+    const heapUsedPCT =  (memUsage.heapUsed * 100) / memUsage.heapTotal;
+    const freeMemMB = (os.freemem() / 1024 / 1024).toFixed(0);
+    const totalMemMB = (os.totalmem() / 1024 / 1024).toFixed(0);
+    const usedMemPCT = 100 - ((freeMemMB * 100) / totalMemMB);
+    const fstats = fs.statfsSync(folders.logsDir());
+    const diskPCT = (fstats.bavail * 100) / fstats.blocks;
+
+    let content = '';
+    content += '<table border="1">';
+    content += '<tr>';
+    content += `<td><strong>Uptime:</strong> ${escape(uptimeStr)}</td>`;
+    content += `<td><strong>Request Count:</strong> ${stats.requestCount} (static: ${stats.staticRequestCount})</td>`;
+    content += `<td style="background-color:${pctColor(usedMemPCT)}"><strong>Memory:</strong> ${usedMemPCT.toFixed(0)}%</td>`;
+    content += `<td style="background-color:${pctColor(heapUsedPCT)}"><strong>Heap:</strong> ${heapUsedPCT.toFixed(0)}%</td>`;
+    content += `<td style="background-color:${pctColor(diskPCT)}"><strong>Disk:</strong> ${diskPCT.toFixed(0)}%</td>`;
+    content += '</tr>';
+    content += '</table>';
+
+    // ===== Metrics Graphs =====
+    const liquid = new Liquid({
+      root: path.join(__dirname, 'tx', 'html'),
+      extname: '.liquid'
+    });
+    content += await liquid.renderFile('dash-metrics', {
+      historyJson: JSON.stringify(stats.history),
+      startTime: stats.startTime
+    });
+    content += stats.taskDetails();
+    content += `<p>Data: ${folders.dataDir()}</p>`;
+
+    content = '<div class="row mb-4"><div class="col-12">' + content + '</div></div>';
 
     const pageStats = {
       version: packageJson.version,
@@ -565,6 +589,12 @@ app.get('/dashboard', async (req, res) => {
   }
 });
 
+function pctColor(pct) {
+  const r = Math.round(pct * 2.55);
+  const g = Math.round((100 - pct) * 2.55);
+  return `rgb(${r}, ${g}, 100)`;  // the 100 keeps it pastel/light
+}
+
 // Health check endpoint
 app.get('/health', async (req, res) => {
   const healthStatus = {
@@ -611,10 +641,10 @@ function getLogStats() {
     let diskInfo = '';
     try {
       // statfs available in Node 18.15+
-      const stats = fs.statfsSync(logDir);
-      const blockSize = stats.bsize;
-      const freeSpace = stats.bavail * blockSize;
-      const totalSpace = stats.blocks * blockSize;
+      const fstats = fs.statfsSync(logDir);
+      const blockSize = fstats.bsize;
+      const freeSpace = fstats.bavail * blockSize;
+      const totalSpace = fstats.blocks * blockSize;
       const freeGB = (freeSpace / 1024 / 1024 / 1024).toFixed(2);
       const totalGB = (totalSpace / 1024 / 1024 / 1024).toFixed(2);
       diskInfo = `<td><strong>Disk Space:</strong> ${freeGB} GB of ${totalGB} GB</td>`;

package/stats.js

@@ -84,6 +84,7 @@ class ServerStats {
     this.taskMap.set(name, info);
     info.frequency = frequency;
     info.state = "Started";
+    info.status = "started"
   }
 
   task(name, state) {
@@ -91,6 +92,25 @@ class ServerStats {
     if (info) {
       info.date = Date.now();
       info.state = state;
+      info.status = 'working';
+    }
+  }
+
+  taskDone(name, state) {
+    let info = this.taskMap.get(name);
+    if (info) {
+      info.date = Date.now();
+      info.state = state;
+      info.status = 'resting';
+    }
+  }
+
+  taskError(name, state) {
+    let info = this.taskMap.get(name);
+    if (info) {
+      info.date = Date.now();
+      info.state = state;
+      info.status = 'error';
     }
   }
 
@@ -98,17 +118,19 @@ class ServerStats {
     if (this.taskMap.size == 0) {
       return "";
     }
-    let html = '<table class="grid"><tr style="background-color: #EEEEEE"><th colspan="4">Background Tasks</th></tr>';
-    html += "<tr><th>Task</th><th>Status</th><th>Frequency</th><th>Last Seen</th></tr>";
+    let html = '<table class="grid">';
+    html += "<tr><th>Background Task</th><th>Status</th><th>Frequency</th><th>Last Seen</th></tr>";
     for (let m of this.taskMap.keys()) {
-      html += "<tr><td>";
+      let mm = this.taskMap.get(m);
+      let color = this.getTaskColor(mm.status);
+      html += `<tr style="background-color: ${color}"><td>`;
       html += escape(m);
       html += "</td><td>";
-      html += escape(this.taskMap.get(m).state);
+      html += escape(mm.state);
       html += "</td><td>";
-      html += this.taskMap.get(m).frequency;
+      html += mm.frequency;
       html += "</td><td>";
-      html += Utilities.formatDuration(this.taskMap.get(m).date, Date.now());
+      html += Utilities.formatDuration(mm.date, Date.now());
       html += "</td></tr>";
     }
     html += "</table>";
@@ -130,5 +152,14 @@ class ServerStats {
     return { idle, total };
   }
 
+  getTaskColor(status) {
+    switch (status) {
+      case "started": return "LightGrey";
+      case "working": return "LightGreen";
+      case "resting": return "White";
+      case "error": return "LightRed";
+      default: return "DarkBlue"; // should not happen
+    }
+  }
 }
 module.exports = ServerStats;

package/tx/cs/cs-loinc.js

@@ -5,6 +5,7 @@ const { Language, Languages} = require('../../library/languages');
 const { CodeSystemFactoryProvider} = require('./cs-api');
 const { validateOptionalParameter, validateArrayParameter} = require("../../library/utilities");
 const {BaseCSServices} = require("./cs-base");
+const {sqlEscapeString} = require("../../xig/xig");
 
 // Context kinds matching Pascal enum
 const LoincProviderContextKind = {
@@ -657,13 +658,17 @@ class LoincServices extends BaseCSServices {
   }
 
   async filter(filterContext, prop, op, value) {
-
-
     const filter = new LoincFilterHolder();
     await this.#executeFilterQuery(prop, op, value, filter);
     filterContext.filters.push(filter);
   }
 
+  async searchFilter(filterContext, filterText, sort) {
+    const filter = new LoincFilterHolder();
+    await this.#executeFilterQuery('$text', (sort ? '>' : '<'), filterText.filter, filter);
+    filterContext.filters.push(filter);
+  }
+
   async #executeFilterQuery(prop, op, value, filter) {
     let sql = '';
     let lsql = '';
@@ -913,6 +918,13 @@ class LoincServices extends BaseCSServices {
                 WHERE CodeKey IN (SELECT CodeKey FROM Properties WHERE PropertyTypeKey = 9)
                   AND CodeKey = `;
       }
+    } else if (prop === '$text' && (op === '>' || op === '<')) {
+      sql = `SELECT CodeKey as Key FROM Codes
+             WHERE Description like '%${sqlEscapeString(value)}%'
+             ORDER BY Description `+(op === '<' ? 'ASC' : 'DESC');
+      lsql = `SELECT COUNT(CodeKey) as Key FROM Codes
+             WHERE Codes.Description like '%${sqlEscapeString(value)}%'
+             AND TargetKey = `;
     }
 
     if (sql) {

package/tx/cs/cs-rxnorm.js

@@ -331,20 +331,20 @@ class RxNormServices extends CodeSystemProvider {
   async doesFilter(prop, op, value) {
     
 
-    prop = prop.toUpperCase();
+    let propUC = prop.toUpperCase();
 
     // TTY filters
-    if (prop === 'TTY' && ['=', 'in'].includes(op)) {
+    if (propUC === 'TTY' && ['=', 'in'].includes(op)) {
       return true;
     }
 
     // STY filter
-    if (prop === 'STY' && op === '=') {
+    if (propUC === 'STY' && op === '=') {
       return true;
     }
 
     // SAB filter
-    if (prop === 'SAB' && op === '=') {
+    if (propUC === 'SAB' && op === '=') {
       return true;
     }
 
@@ -370,12 +370,12 @@ class RxNormServices extends CodeSystemProvider {
     
 
     const filter = new RxNormFilterHolder();
-    prop = prop.toUpperCase();
+    let propUC = prop.toUpperCase();
 
     let sql = '';
     let params = {};
 
-    if (op === 'in' && prop === 'TTY') {
+    if (op === 'in' && propUC === 'TTY') {
       const values = value.split(',').map(v => v.trim()).filter(v => v);
       const placeholders = values.map((_, i) => `$tty${i}`).join(',');
       sql = `AND TTY IN (${placeholders})`;
@@ -383,13 +383,13 @@ class RxNormServices extends CodeSystemProvider {
         params[`tty${i}`] = this.#sqlWrapString(val);
       });
     } else if (op === '=') {
-      if (prop === 'STY') {
+      if (propUC === 'STY') {
         sql = `AND ${this.getCodeField()} IN (SELECT RXCUI FROM rxnsty WHERE TUI = $sty)`;
         params.sty = this.#sqlWrapString(value);
-      } else if (prop === 'SAB') {
+      } else if (propUC === 'SAB') {
         sql = `AND ${this.getCodeField()} IN (SELECT ${this.getCodeField()} FROM rxnconso WHERE SAB = $sab)`;
         params.sab = this.#sqlWrapString(value);
-      } else if (prop === 'TTY') {
+      } else if (propUC === 'TTY') {
         sql = `AND TTY = $tty`;
         params.tty = this.#sqlWrapString(value);
       } else if (this.rels.includes(prop)) {
@@ -429,7 +429,6 @@ class RxNormServices extends CodeSystemProvider {
   }
 
   async searchFilter(filterContext, filter, sort) {
-    
 
     if (!filter || !filter.stems || filter.stems.length === 0) {
       throw new Error('Invalid search filter');
@@ -709,6 +708,11 @@ class RxNormTypeServicesFactory extends CodeSystemFactoryProvider {
     const db = new sqlite3.Database(this.dbPath);
 
     try {
+      await new Promise((resolve, reject) => {
+        db.run(`CREATE INDEX IF NOT EXISTS idx_rxnstems_cui_stem ON RXNSTEMS(CUI, stem)`,
+          err => err ? reject(err) : resolve());
+      });
+
       this._sharedData = {
         version: '',
         rels: [],