HL7 FHIR® US Core Implementation Guide STU3 Release 3.1.1

This page is part of the US Core (v3.1.1: STU3) based on FHIR R4. The current version which supercedes this version is 5.0.1. For a full list of available versions, see the Directory of published versions

StructureDefinition-pediatric-bmi-for-age

This profile sets minimum expectations for the Observation resource to record, search, and fetch pediatric body mass index (BMI) per age and gender observations associated with a patient. It is based on the FHIR Vital Signs Profile and identifies the additional mandatory core elements, extensions, vocabularies and value sets which SHALL be present in the Observation resource when using this profile.

Example Usage Scenarios:

The following are example usage scenarios for the US Core Pediatric BMI for Age Observation Profile:

  • Query for BMI observations belonging to a pediatric patient
  • Record or update BMI observations belonging to a pediatric patient

Mandatory and Must Support Data Elements

In addition to the mandatory and must support data elements in the FHIR Vital Signs Profile, the following data-elements are mandatory (i.e data MUST be present) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Profile Definition below provides the formal summary, definitions, and terminology requirements.

Each Observation must have:

  1. a patient
  2. a fixed code for pediatric BMI per age and gender measurement

Each Observation must support:

  1. a result value

Profile specific implementation guidance:

  • An Observation without a value, SHALL include a reason why the data is absent unless there are component observations, or references to other Observations that are grouped within it.
  • Information about the growth chart tables used to determine percentiles should be supplied in Observation.note.text (for example, ‘CDC Males, 2-20 years Chart’).

Examples

Formal Views of Profile Content

Description of Profiles, Differentials, and Snapshots.

The official URL for this profile is: http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age

Published on Sat Jun 27 00:00:00 AEST 2020 as active by the HL7 US Realm Steering Committee.

This profile builds on observation-vitalsigns

Observation

Summary of the Mandatory Requirements

  1. A Patient Reference in Observation.subject
  2. A CodeableConcept in Observation.code with an extensible binding to Vital Signs
    • which must have one or more Coding values in Observation.code.coding
    • which must have at least a Coding value in Observation.code.coding
      • which must have a fixed Observation.code.coding.system = http://loinc.org
      • which must have a fixed Observation.code.coding.code = 59576-9

Summary of the Must Support Requirements

  1. A Quantity in Observation.valueQuantity
    • which must have a decimal value in Observation.valueQuantity.value
    • which must have a string value in Observation.valueQuantity.unit
    • which must have a fixed Observation.valueQuantity.system = http://unitsofmeasure.org
    • which must have a fixed Observation.valueQuantity.code = %

Summary of Constraints

  1. If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
  2. dataAbsentReason SHALL only be present if Observation.value[x] is not present
  3. If there is no component or hasMember element then either a value[x] or a data absent reason must be present.
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*observation-vitalsignsFHIR Vital Signs Profile
... code S1..1CodeableConceptBMI percentile per age and sex for youth 2-20
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://loinc.org
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 59576-9
... subject S1..1Reference(US Core Patient Profile)Who and/or what the observation is about
... valueQuantity S0..1QuantityVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
.... value S1..1decimalNumerical value (with implicit precision)
.... unit S1..1stringUnit representation
.... system S1..1uriSystem that defines coded unit form
Fixed Value: http://unitsofmeasure.org
.... code S1..1codeCoded responses from the common UCUM units for vital signs value set.
Fixed Value: %

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*observation-vitalsignsFHIR Vital Signs Profile
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierBusiness Identifier for observation
... basedOn ΣI0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf ΣI0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣI1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
... category SI1..*(Slice Definition)Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred)
.... category:VSCat SI1..1CodeableConceptClassification of type of observation
Binding: ObservationCategoryCodes (preferred)
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣI1..*CodingCode defined by a terminology system
...... id 0..1stringUnique id for inter-element referencing
...... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣI1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version ΣI0..1stringVersion of the system - if relevant
...... code SΣI1..1codeSymbol in syntax defined by the system
Fixed Value: vital-signs
...... display ΣI0..1stringRepresentation defined by the system
...... userSelected ΣI0..1booleanIf this coding was chosen directly by the user
..... text ΣI0..1stringPlain text representation of the concept
... code SΣI1..1CodeableConceptBMI percentile per age and sex for youth 2-20
Binding: VitalSigns (extensible)
Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://loinc.org
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 59576-9
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subject SΣI1..1Reference(US Core Patient Profile)Who and/or what the observation is about
... focus ΣI0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter ΣI0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] SΣI1..1Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... issued ΣI0..1instantDate/Time this version was made available
... performer ΣI0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)Who is responsible for the observation
... value[x] SΣI0..1(Slice Definition)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
.... value[x]:valueQuantity SΣI0..1QuantityVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣI1..1decimalNumerical value (with implicit precision)
..... comparator ?!ΣI0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required)
..... unit SΣI1..1stringUnit representation
..... system SΣI1..1uriSystem that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣI1..1codeCoded responses from the common UCUM units for vital signs value set.
Fixed Value: %
... dataAbsentReason SI0..1CodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible)
... interpretation I0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible)
... note I0..*AnnotationComments about the observation
... bodySite I0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example)
... method I0..1CodeableConceptHow it was done
Binding: ObservationMethods (example)
... specimen I0..1Reference(Specimen)Specimen used for this observation
... device I0..1Reference(Device | DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
obs-3: Must have at least a low or a high or text
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type I0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred)
.... appliesTo I0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example)
.... age I0..1RangeApplicable age range, if relevant
.... text I0..1stringText based reference range in an observation
... hasMember ΣI0..*Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile)Used when reporting vital signs panel components
... derivedFrom ΣI0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile)Related measurements the observation is made from
... component SΣI0..*BackboneElementUsed when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code SΣI1..1CodeableConceptType of component observation (code / type)
Binding: VitalSigns (extensible)
.... value[x] SΣI0..1Vital Sign Value recorded with UCUM
Binding: VitalSignsUnits (required)
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason SI0..1CodeableConceptWhy the component result is missing
Binding: DataAbsentReason (extensible)
.... interpretation I0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible)
.... referenceRange I0..*See referenceRangeProvides guide for interpretation of component result

doco Documentation for this format

Observation

Summary of the Mandatory Requirements

  1. A Patient Reference in Observation.subject
  2. A CodeableConcept in Observation.code with an extensible binding to Vital Signs
    • which must have one or more Coding values in Observation.code.coding
    • which must have at least a Coding value in Observation.code.coding
      • which must have a fixed Observation.code.coding.system = http://loinc.org
      • which must have a fixed Observation.code.coding.code = 59576-9

Summary of the Must Support Requirements

  1. A Quantity in Observation.valueQuantity
    • which must have a decimal value in Observation.valueQuantity.value
    • which must have a string value in Observation.valueQuantity.unit
    • which must have a fixed Observation.valueQuantity.system = http://unitsofmeasure.org
    • which must have a fixed Observation.valueQuantity.code = %

Summary of Constraints

  1. If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
  2. dataAbsentReason SHALL only be present if Observation.value[x] is not present
  3. If there is no component or hasMember element then either a value[x] or a data absent reason must be present.

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*observation-vitalsignsFHIR Vital Signs Profile
... code S1..1CodeableConceptBMI percentile per age and sex for youth 2-20
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://loinc.org
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 59576-9
... subject S1..1Reference(US Core Patient Profile)Who and/or what the observation is about
... valueQuantity S0..1QuantityVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
.... value S1..1decimalNumerical value (with implicit precision)
.... unit S1..1stringUnit representation
.... system S1..1uriSystem that defines coded unit form
Fixed Value: http://unitsofmeasure.org
.... code S1..1codeCoded responses from the common UCUM units for vital signs value set.
Fixed Value: %

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*observation-vitalsignsFHIR Vital Signs Profile
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierBusiness Identifier for observation
... basedOn ΣI0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf ΣI0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣI1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
... category SI1..*(Slice Definition)Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred)
.... category:VSCat SI1..1CodeableConceptClassification of type of observation
Binding: ObservationCategoryCodes (preferred)
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣI1..*CodingCode defined by a terminology system
...... id 0..1stringUnique id for inter-element referencing
...... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣI1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version ΣI0..1stringVersion of the system - if relevant
...... code SΣI1..1codeSymbol in syntax defined by the system
Fixed Value: vital-signs
...... display ΣI0..1stringRepresentation defined by the system
...... userSelected ΣI0..1booleanIf this coding was chosen directly by the user
..... text ΣI0..1stringPlain text representation of the concept
... code SΣI1..1CodeableConceptBMI percentile per age and sex for youth 2-20
Binding: VitalSigns (extensible)
Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://loinc.org
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: 59576-9
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subject SΣI1..1Reference(US Core Patient Profile)Who and/or what the observation is about
... focus ΣI0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter ΣI0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] SΣI1..1Often just a dateTime for Vital Signs
vs-1: if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... issued ΣI0..1instantDate/Time this version was made available
... performer ΣI0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)Who is responsible for the observation
... value[x] SΣI0..1(Slice Definition)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
.... value[x]:valueQuantity SΣI0..1QuantityVital Signs value are recorded using the Quantity data type. For supporting observations such as Cuff size could use other datatypes such as CodeableConcept.
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣI1..1decimalNumerical value (with implicit precision)
..... comparator ?!ΣI0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required)
..... unit SΣI1..1stringUnit representation
..... system SΣI1..1uriSystem that defines coded unit form
Fixed Value: http://unitsofmeasure.org
..... code SΣI1..1codeCoded responses from the common UCUM units for vital signs value set.
Fixed Value: %
... dataAbsentReason SI0..1CodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible)
... interpretation I0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible)
... note I0..*AnnotationComments about the observation
... bodySite I0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example)
... method I0..1CodeableConceptHow it was done
Binding: ObservationMethods (example)
... specimen I0..1Reference(Specimen)Specimen used for this observation
... device I0..1Reference(Device | DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
obs-3: Must have at least a low or a high or text
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type I0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred)
.... appliesTo I0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example)
.... age I0..1RangeApplicable age range, if relevant
.... text I0..1stringText based reference range in an observation
... hasMember ΣI0..*Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile)Used when reporting vital signs panel components
... derivedFrom ΣI0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile)Related measurements the observation is made from
... component SΣI0..*BackboneElementUsed when reporting systolic and diastolic blood pressure.
vs-3: If there is no a value a data absent reason must be present
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code SΣI1..1CodeableConceptType of component observation (code / type)
Binding: VitalSigns (extensible)
.... value[x] SΣI0..1Vital Sign Value recorded with UCUM
Binding: VitalSignsUnits (required)
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason SI0..1CodeableConceptWhy the component result is missing
Binding: DataAbsentReason (extensible)
.... interpretation I0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible)
.... referenceRange I0..*See referenceRangeProvides guide for interpretation of component result

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON), Schema: XML Schematron


Quick Start

Below is an overview of the required set of Server RESTful FHIR interactions - for example, search and read operations - for this profile. See the Conformance requirements for a complete list of supported RESTful interactions for this IG.

See the Vital Signs Quick Start section for how to search by vital signs.