AU Core Blood Pressure - AU Core Implementation Guide v0.3.0-ballot

This page is part of the AU Core (v0.3.0-ballot: AU Core R1 Ballot 5) based on FHIR (HL7® FHIR® Standard) R4. . For a full list of available versions, see the Directory of published versions

Resource Profile: AU Core Blood Pressure

Official URL: http://hl7.org.au/fhir/core/StructureDefinition/au-core-bloodpressure

Version: 0.3.0-ballot

Standards status: Draft

Maturity Level: 0

Computable Name: AUCoreBloodPressure

This resource includes SNOMED Clinical Terms™ (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO). All rights reserved. SNOMED CT®, was originally created by The College of American Pathologists. “SNOMED” and “SNOMED CT” are registered trademarks of the IHTSDO. The rights to use and implement or implementation of SNOMED CT content are limited to the extent it is necessary to allow for the end use of this material. No further rights are granted in respect of the International Release and no further use of any SNOMED CT content by any other party is permitted.

This material contains content from LOINC (http://loinc.org). LOINC is copyright © 1995-2021, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://loinc.org/license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.

All copies of this resource must include this copyright statement and all information contained in this statement.

This profile sets minimum expectations for an Observation resource to record, search, and fetch blood pressure observations with standard coding and units of measure. It is based on the FHIR Blood Pressure Profile and identifies the additional mandatory core elements, extensions, vocabularies and value sets that SHALL be present in the Observation resource when conforming to this profile. It provides the floor for standards development for specific uses cases in an Australian context.

Usage scenarios

The following are supported usage scenarios for this profile:

Query for observations of blood pressure associated with a patient
Record or update an observation of blood pressure associated with a patient

Comparison with other national and international specifications

A resource conforming to this profile is conformant to:

observation-bp
- and therefore conformant to International Patient Summary
IPA-Observation
US Core Blood Pressure

Conformance in reverse is not guaranteed, i.e. a resource conforming to International Patient Access, International Patient Summary, or US Core MAY NOT conform to AU Core.

Profile specific implementation guidance

Observation.category provides an efficient way of supporting system interactions, e.g. restricting searches. Implementers need to understand that data categorisation is somewhat subjective. The categorisation applied by the source may not align with a receiver’s expectations.
Observations MAY have additional codes that translate or map to the Observation code or category codes. For example:
- providing a local code
- providing a more specific codes such as 8306-3 - Body height - lying in addition to 8302-2 - Body height. Several additional observation codes are provided in the FHIR core specification vital signs table.
Observations MAY have [component] observations to qualify the vital sign observation. For example, 8478-0 - Mean blood pressure, 8887-2 - Heart rate device type, 8326-1 - Type of body temperature device. Several of these are provided in the FHIR core specification vital signs table.
Because blood pressure values are communicated in the mandatory systolic and diastolic components:
- Observation.value[x] element SHOULD be omitted
- an Observation without a systolic or diastolic result value, SHOULD include a reason why the data is absent in Observation.component.dataAbsentReason

Feedback is requested on the proposal to remove Must Support from Observation.performer element across AU Core Vital Signs profiles. Please comment on HL7 Jira FHIR-44786.

Usage:

Examples for this Resource Profile: Observation/bloodpressure-1 and Observation/bloodpressure-data-absent

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from observation-bp

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	observation-bp	Blood pressure
status		1..1	code	registered \| preliminary \| final \| amended + Fixed Value: final
code
coding		2..*	Coding	Code defined by a terminology system
coding:snomedBPCode		1..1	Coding	SNOMED CT Blood Pressure
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 75367002
subject		1..1	Reference(AU Core Patient)	Who and/or what the observation is about
encounter	S	0..1	Reference(AU Core Encounter)	Healthcare event during which this observation is made
effective[x]	C	1..1	dateTime	Date, and optionally time, the observation was performed au-core-obs-01: Date shall be at least to day
performer	S	0..*	Reference(AU Core Practitioner \| AU Core PractitionerRole \| AU Core Organization \| AU Core Patient \| RelatedPerson)	Who is responsible for the observation
dataAbsentReason		0..1	CodeableConcept	Why the result is missing
bodySite	C	0..1	CodeableConcept	Observed body part Binding: Body Site (extensible) au-core-obs-04: If a coded body site is provided, at least one code shall be from SNOMED CT
component:SystolicBP		1..1	BackboneElement	Systolic Blood Pressure
code
coding:snomedSBP		1..1	Coding	SNOMED CT Systolic Blood Pressure
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 271649006
dataAbsentReason	S	0..1	CodeableConcept	Why the component result is missing
component:DiastolicBP		1..1	BackboneElement	Diastolic Blood Pressure
code
coding:snomedDBP		1..1	Coding	SNOMED CT Diastolic Blood Pressure
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 271650006
dataAbsentReason	S	0..1	CodeableConcept	Why the component result is missing
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.bodySite	extensible	BodySite `https://healthterminologies.gov.au/fhir/ValueSet/body-site-1` from https://tx.ontoserver.csiro.au/fhir

Constraints

Id	Grade	Path(s)	Details	Requirements
au-core-obs-01	error	Observation.effective[x]	Date shall be at least to day : $this is DateTime implies $this.toString().length() >= 10
au-core-obs-04	error	Observation.bodySite	If a coded body site is provided, at least one code shall be from SNOMED CT : coding.exists() implies coding.where(system='http://snomed.info/sct').exists()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	observation-bp	Blood pressure obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	registered \| preliminary \| final \| amended + Binding: ObservationStatus (required) Fixed Value: final
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:VSCat	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
coding	SΣ	1..*	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code	SΣ	1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
code	SΣ	1..1	CodeableConcept	Blood Pressure Binding: VitalSigns (extensible): This identifies the vital sign result type.
Slices for coding	Σ	2..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:code, value:system
coding:BPCode	Σ	1..1	Coding	Code defined by a terminology system
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 85354-9
coding:snomedBPCode	Σ	1..1	Coding	SNOMED CT Blood Pressure
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 75367002
subject	SΣ	1..1	Reference(AU Core Patient)	Who and/or what the observation is about
encounter	SΣ	0..1	Reference(AU Core Encounter)	Healthcare event during which this observation is made
effective[x]	SΣC	1..1	dateTime	Date, and optionally time, the observation was performed vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day au-core-obs-01: Date shall be at least to day
performer	SΣ	0..*	Reference(AU Core Practitioner \| AU Core PractitionerRole \| AU Core Organization \| AU Core Patient \| RelatedPerson)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1	Quantity	Vital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept. Slice: Unordered, Closed by type:$this
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
bodySite	C	0..1	CodeableConcept	Observed body part Binding: Body Site (extensible) au-core-obs-04: If a coded body site is provided, at least one code shall be from SNOMED CT
Slices for component	SΣC	2..*	BackboneElement	Used when reporting systolic and diastolic blood pressure. Slice: Unordered, Open by value:code.coding.code, value:code.coding.system vs-3: If there is no a value a data absent reason must be present
component:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: VitalSigns (extensible): This identifies the vital sign result type.
value[x]	SΣC	0..1		Vital Sign Value recorded with UCUM Binding: VitalSignsUnits (required): Common UCUM units for recording Vital Signs.
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
component:SystolicBP	SΣC	1..1	BackboneElement	Systolic Blood Pressure vs-3: If there is no a value a data absent reason must be present
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: VitalSigns (extensible): This identifies the vital sign result type.
Slices for coding	Σ	2..*	Coding	Systolic Blood Pressure Slice: Unordered, Open by value:code, value:system
coding:SBPCode	Σ	1..1	Coding	Systolic Blood Pressure
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 8480-6
coding:snomedSBP	Σ	1..1	Coding	SNOMED CT Systolic Blood Pressure
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 271649006
value[x]	SΣC	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: VitalSignsUnits (required): Common UCUM units for recording Vital Signs.
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< \| <= \| >= \| > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	1..1	string	Unit representation
system	SΣC	1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code	SΣ	1..1	code	Coded responses from the common UCUM units for vital signs value set. Fixed Value: mm[Hg]
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
component:DiastolicBP	SΣC	1..1	BackboneElement	Diastolic Blood Pressure vs-3: If there is no a value a data absent reason must be present
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: VitalSigns (extensible): This identifies the vital sign result type.
Slices for coding	Σ	2..*	Coding	Diastolic Blood Pressure Slice: Unordered, Open by value:code, value:system
coding:DBPCode	Σ	1..1	Coding	Diastolic Blood Pressure
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 8462-4
coding:snomedDBP	Σ	1..1	Coding	SNOMED CT Diastolic Blood Pressure
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 271650006
value[x]	SΣC	0..1	Quantity	Vital Sign Value recorded with UCUM Binding: VitalSignsUnits (required): Common UCUM units for recording Vital Signs.
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< \| <= \| >= \| > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	1..1	string	Unit representation
system	SΣC	1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code	SΣ	1..1	code	Coded responses from the common UCUM units for vital signs value set. Fixed Value: mm[Hg]
dataAbsentReason	SC	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.status	required	Fixed Value: final `http://hl7.org/fhir/ValueSet/observation-status\|4.0.1` from the FHIR Standard
Observation.category	preferred	ObservationCategoryCodes `http://hl7.org/fhir/ValueSet/observation-category` from the FHIR Standard
Observation.category:VSCat	preferred	ObservationCategoryCodes `http://hl7.org/fhir/ValueSet/observation-category` from the FHIR Standard
Observation.code	extensible	VitalSigns `http://hl7.org/fhir/ValueSet/observation-vitalsignresult` from the FHIR Standard
Observation.dataAbsentReason	extensible	DataAbsentReason `http://hl7.org/fhir/ValueSet/data-absent-reason` from the FHIR Standard
Observation.bodySite	extensible	BodySite `https://healthterminologies.gov.au/fhir/ValueSet/body-site-1` from https://tx.ontoserver.csiro.au/fhir
Observation.component.code	extensible	VitalSigns `http://hl7.org/fhir/ValueSet/observation-vitalsignresult` from the FHIR Standard
Observation.component.value[x]	required	VitalSignsUnits `http://hl7.org/fhir/ValueSet/ucum-vitals-common\|4.0.1` from the FHIR Standard
Observation.component.dataAbsentReason	extensible	DataAbsentReason `http://hl7.org/fhir/ValueSet/data-absent-reason` from the FHIR Standard
Observation.component:SystolicBP.code	extensible	VitalSigns `http://hl7.org/fhir/ValueSet/observation-vitalsignresult` from the FHIR Standard
Observation.component:SystolicBP.value[x]	required	VitalSignsUnits `http://hl7.org/fhir/ValueSet/ucum-vitals-common\|4.0.1` from the FHIR Standard
Observation.component:SystolicBP.value[x].comparator	required	QuantityComparator `http://hl7.org/fhir/ValueSet/quantity-comparator\|4.0.1` from the FHIR Standard
Observation.component:SystolicBP.dataAbsentReason	extensible	DataAbsentReason `http://hl7.org/fhir/ValueSet/data-absent-reason` from the FHIR Standard
Observation.component:DiastolicBP.code	extensible	VitalSigns `http://hl7.org/fhir/ValueSet/observation-vitalsignresult` from the FHIR Standard
Observation.component:DiastolicBP.value[x]	required	VitalSignsUnits `http://hl7.org/fhir/ValueSet/ucum-vitals-common\|4.0.1` from the FHIR Standard
Observation.component:DiastolicBP.value[x].comparator	required	QuantityComparator `http://hl7.org/fhir/ValueSet/quantity-comparator\|4.0.1` from the FHIR Standard
Observation.component:DiastolicBP.dataAbsentReason	extensible	DataAbsentReason `http://hl7.org/fhir/ValueSet/data-absent-reason` from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
au-core-obs-01	error	Observation.effective[x]	Date shall be at least to day : $this is DateTime implies $this.toString().length() >= 10
au-core-obs-04	error	Observation.bodySite	If a coded body site is provided, at least one code shall be from SNOMED CT : coding.exists() implies coding.where(system='http://snomed.info/sct').exists()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
vs-1	error	Observation.effective[x]	if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day : $this is dateTime implies $this.toString().length() >= 10
vs-2	error	Observation	If there is no component or hasMember element then either a value[x] or a data absent reason must be present. : (component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())
vs-3	error	Observation.component, Observation.component:SystolicBP, Observation.component:DiastolicBP	If there is no a value a data absent reason must be present : value.exists() or dataAbsentReason.exists()

Description & Constraints

Observation

0..*

observation-bp

Blood pressure
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
vs-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present.

0..1

Logical id of this artifact

Terminology Bindings

Path Conformance ValueSet / Code URI

Observation.language

preferred

CommonLanguages

Additional Bindings

Purpose

AllLanguages

Max Binding

http://hl7.org/fhir/ValueSet/languages

from the FHIR Standard

Observation.status

required

Fixed Value: final

http://hl7.org/fhir/ValueSet/observation-status|4.0.1

from the FHIR Standard

Observation.category

preferred

ObservationCategoryCodes

http://hl7.org/fhir/ValueSet/observation-category

from the FHIR Standard

Observation.category:VSCat

preferred

ObservationCategoryCodes

http://hl7.org/fhir/ValueSet/observation-category

from the FHIR Standard

Observation.code

Parameter(s)	Conformance	Type(s)	Requirements (when used alone or in combination)
patient	SHALL	`reference`	The client SHALL provide at least an id value and MAY provide both the Type and id values. The server SHALL support both.
patient+category	SHALL	`reference`+`token`
patient+category+date	SHALL	`reference`+`token`+`date`
patient+code	SHALL	`reference`+`token`
patient+category+status	SHOULD	`reference`+`token`+`token`
patient+code+date	SHOULD	`reference`+`token`+`date`
patient.identifier	SHOULD	`reference`.`token`	The client SHALL provide both the system and code values. The server SHALL support both. The client SHOULD support search using IHI, Medicare Number, and DVA Number identifiers as defined in the AU Core Patient profile. The server SHOULD support search using the using IHI, Medicare Number, and DVA Number identifiers as defined in the AU Core Patient profile.
category	MAY	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. The client SHALL support search using the 'vital-signs' category defined in each profile. The server SHALL support search using the 'vital-signs' category defined in each profile.
code	MAY	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. The client SHALL support search using the LOINC codes defined in each profile. The server SHALL support search using the LOINC codes defined in each profile.
date	MAY	`date`	A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset.
status	MAY	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Resource Profile: AU Core Blood Pressure

Usage scenarios

Comparison with other national and international specifications

Profile specific implementation guidance

Formal Views of Profile Content

Terminology Bindings (Differential)

Constraints

Notes:

Mandatory Search Parameters:

Optional Search Parameters: