US Core Implementation Guide
6.1.0 - STU6 United States of America flag

This page is part of the US Core (v6.1.0: STU6 Update) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: US Core Blood Pressure Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure Version: 6.1.0
Active as of 2022-04-20 Computable Name: USCoreBloodPressureProfile

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

To promote interoperability and adoption through common implementation, this profile sets minimum expectations for the Observation resource to record, search, and fetch diastolic and systolic blood pressure observations with standard LOINC codes and UCUM units of measure. It is based on the US Core Vital Signs Profile and identifies which additional core elements, extensions, vocabularies, and value sets SHALL be present and constrains the way the elements are used when using the profile. It provides the floor for standards development for specific use cases.

Example Usage Scenarios:

The following are example usage scenarios for this profile:

  • Query for blood pressure observation belonging to a pediatric patient
  • Record or update pressure belonging to a pediatric patient

Mandatory and Must Support Data Elements

In addition to the Mandatory and Must Support data elements in the US Core Vital Signs Profile, the following data-elements must always be present (Mandatory definition) 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 Views below provides the formal summary, definitions, and terminology requirements.
Note that the “Differential Table” displays elements unique to this profile and the “Key Elements Table” displays a combined view of elements for this profile and the US Core Vital Signs Profile.

Each Observation Must Have:

  1. a patient
  2. a fixed code for systolic and diastolic blood pressure panel
  3. a fixed component code for systolic blood pressure
  4. a fixed component code for diastolic blood pressure

Each Observation Must Support: healt

  1. a result value for systolic blood pressure
  2. a result value for diastolic blood pressure

Profile Specific Implementation Guidance:

  • Note that this profile also conforms to the base FHIR Vital Signs Profile.
  • The observations MAY have additional codes that translate or map to the Observation code or category codes. For example:
    • providing a local system specific code
    • providing 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.

    a code system value SHOULD be supplied for each additional code.

  • The observations MAY have component observations. For example, to qualify the vital sign observation 8310-5 - Body temperature, 8327-9 - Body temperature measurement site (oral, forehead, rectal, etc.) may be used as a component observation. Several of these are provided in the FHIR core specification vital signs table.
  • Implementers may use this profile as a base for other vital signs in addition to those in this guide.
  • Because the blood pressure values are communicated in the mandatory systolic and diastolic components:
    • the Observation.value[x] element SHOULD be omitted
    • an Observation without a systolic or diastolic result value, SHALL include a reason why the data is absent in Observation.component.dataAbsentReason
    • all server systems - including those that never provide a component observation without a value - SHALL support Observation.component.dataAbsentReason for the components.

Usage:

Formal Views of Profile Content

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

This structure is derived from USCoreVitalSignsProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*USCoreVitalSignsProfileUS Core Blood Pressure Profile
... code S1..1CodeableConcept(USCDI) Blood Pressure
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: 85354-9
... Slices for component S2..*BackboneElement(USCDI) Component observations
Slice: Unordered, Open by pattern:code
.... component:systolic S1..1BackboneElement(USCDI) Systolic Blood Pressure
..... code S1..1CodeableConcept(USCDI) Systolic Blood Pressure Code
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: 8480-6
..... valueQuantity S0..1Quantity(USCDI) Vital Sign Component Value
...... value S1..1decimal(USCDI) Numerical value (with implicit precision)
...... unit S1..1string(USCDI) Unit representation
...... system S1..1uri(USCDI) System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
...... code S1..1code(USCDI) Coded form of the unit
Fixed Value: mm[Hg]
.... component:diastolic S1..1BackboneElement(USCDI) Diastolic Blood Pressure
..... code S1..1CodeableConcept(USCDI) Diastolic Blood Pressure Code
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: 8462-4
..... valueQuantity S0..1Quantity(USCDI) Vital Sign Component Value
...... value S1..1decimal(USCDI) Numerical value (with implicit precision)
...... unit S1..1string(USCDI) Unit representation
...... system S1..1uri(USCDI) System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
...... code S1..1code(USCDI) Coded form of the unit
Fixed Value: mm[Hg]

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*USCoreVitalSignsProfileUS Core Blood Pressure Profile
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1code(USCDI) registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S1..*CodeableConcept(USCDI) 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 S1..1CodeableConcept(USCDI) Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


..... coding SΣ1..*Coding(USCDI) Code defined by a terminology system
...... system SΣ1..1uri(USCDI) Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code SΣ1..1code(USCDI) Symbol in syntax defined by the system
Fixed Value: vital-signs
... code SΣ1..1CodeableConcept(USCDI) Blood Pressure
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.


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: 85354-9
... subject SΣ1..1Reference(US Core Patient Profile)(USCDI) Who and/or what the observation is about
... effective[x] SΣC1..1(USCDI) Often just a dateTime for Vital Signs
.... effectiveDateTimedateTime
... value[x] SΣC0..1(USCDI) Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

.... valueQuantityQuantity
... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... Slices for component SΣC2..*BackboneElement(USCDI) Component observations
Slice: Unordered, Open by pattern:code
.... component:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code SΣ1..1CodeableConcept(USCDI) Type of component observation (code / type)
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

..... value[x] SΣC0..1(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

...... valueQuantityQuantity
..... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... component:systolic SΣC1..1BackboneElement(USCDI) Systolic Blood Pressure
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code SΣ1..1CodeableConcept(USCDI) Systolic Blood Pressure Code
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.


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: 8480-6
..... value[x] SΣC0..1Quantity(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

...... value SΣ1..1decimal(USCDI) Numerical value (with implicit precision)
...... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... unit SΣ1..1string(USCDI) Unit representation
...... system SΣC1..1uri(USCDI) System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
...... code SΣ1..1code(USCDI) Coded form of the unit
Fixed Value: mm[Hg]
..... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... component:diastolic SΣC1..1BackboneElement(USCDI) Diastolic Blood Pressure
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code SΣ1..1CodeableConcept(USCDI) Diastolic Blood Pressure Code
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.


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: 8462-4
..... value[x] SΣC0..1Quantity(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

...... value SΣ1..1decimal(USCDI) Numerical value (with implicit precision)
...... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... unit SΣ1..1string(USCDI) Unit representation
...... system SΣC1..1uri(USCDI) System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
...... code SΣ1..1code(USCDI) Coded form of the unit
Fixed Value: mm[Hg]
..... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.category:VSCatpreferredObservationCategoryCodes
Observation.codeextensiblePattern: LOINC code 85354-9
Observation.value[x]extensibleVitalSignsUnits
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.component.codeextensibleUsCoreVitalSigns
Observation.component.value[x]extensibleVitalSignsUnits
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component:systolic.codeextensiblePattern: LOINC code 8480-6
Observation.component:systolic.value[x]extensibleVitalSignsUnits
Observation.component:systolic.value[x].comparatorrequiredQuantityComparator
Observation.component:systolic.dataAbsentReasonextensibleDataAbsentReason
Observation.component:diastolic.codeextensiblePattern: LOINC code 8462-4
Observation.component:diastolic.value[x]extensibleVitalSignsUnits
Observation.component:diastolic.value[x].comparatorrequiredQuantityComparator
Observation.component:diastolic.dataAbsentReasonextensibleDataAbsentReason

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorObservationIf 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-4errorObservationIf 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-5errorObservationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceObservationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
obs-6errorObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
obs-7errorObservationIf 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-1errorObservation.effective[x]if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
: ($this as dateTime).toString().length() >= 8
vs-2errorObservationIf 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-3errorObservation.component, Observation.component:systolic, Observation.component:diastolicIf there is no a value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*USCoreVitalSignsProfileUS Core Blood Pressure Profile
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣ1..1code(USCDI) registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S1..*CodeableConcept(USCDI) 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 S1..1CodeableConcept(USCDI) Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ1..*Coding(USCDI) Code defined by a terminology system
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ1..1uri(USCDI) Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1code(USCDI) Symbol in syntax defined by the system
Fixed Value: vital-signs
...... display Σ0..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text Σ0..1stringPlain text representation of the concept
... code SΣ1..1CodeableConcept(USCDI) Blood Pressure
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.


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: 85354-9
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subject SΣ1..1Reference(US Core Patient Profile)(USCDI) Who and/or what the observation is about
... focus ΣTU0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter Σ0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] SΣC1..1(USCDI) Often just a dateTime for Vital Signs
.... effectiveDateTimedateTime S
.... effectivePeriodPeriod
... issued Σ0..1instantDate/Time this version was made available
... performer Σ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)Who is responsible for the observation
... value[x] SΣC0..1(USCDI) Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

.... valueQuantityQuantity S
.... valueCodeableConceptCodeableConcept
.... valueStringstring
.... valueBooleanboolean
.... valueIntegerinteger
.... valueRangeRange
.... valueRatioRatio
.... valueSampledDataSampledData
.... valueTimetime
.... valueDateTimedateTime
.... valuePeriodPeriod
... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


... note 0..*AnnotationComments about the observation
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

... method 0..1CodeableConceptHow it was done
Binding: ObservationMethods (example): Methods for simple observations.

... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 0..1Reference(Device | DeviceMetric)(Measurement) Device
... referenceRange C0..*BackboneElementProvides guide for interpretation
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low C0..1SimpleQuantityLow Range, if relevant
.... high C0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

.... appliesTo 0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember Σ0..*Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile)Used when reporting vital signs panel components
... derivedFrom Σ0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile)Related measurements the observation is made from
... Slices for component SΣC2..*BackboneElement(USCDI) Component observations
Slice: Unordered, Open by pattern:code
.... component:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code SΣ1..1CodeableConcept(USCDI) Type of component observation (code / type)
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

..... value[x] SΣC0..1(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

...... valueQuantityQuantity S
...... valueCodeableConceptCodeableConcept
...... valueStringstring
...... valueBooleanboolean
...... valueIntegerinteger
...... valueRangeRange
...... valueRatioRatio
...... valueSampledDataSampledData
...... valueTimetime
...... valueDateTimedateTime
...... valuePeriodPeriod
..... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

..... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


..... referenceRange 0..*See referenceRange (Observation)Provides guide for interpretation of component result
.... component:systolic SΣC1..1BackboneElement(USCDI) Systolic Blood Pressure
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code SΣ1..1CodeableConcept(USCDI) Systolic Blood Pressure Code
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.


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: 8480-6
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value[x] SΣC0..1Quantity(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... value SΣ1..1decimal(USCDI) Numerical value (with implicit precision)
...... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... unit SΣ1..1string(USCDI) Unit representation
...... system SΣC1..1uri(USCDI) System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
...... code SΣ1..1code(USCDI) Coded form of the unit
Fixed Value: mm[Hg]
..... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

..... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


..... referenceRange 0..*See referenceRange (Observation)Provides guide for interpretation of component result
.... component:diastolic SΣC1..1BackboneElement(USCDI) Diastolic Blood Pressure
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code SΣ1..1CodeableConcept(USCDI) Diastolic Blood Pressure Code
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.


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: 8462-4
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value[x] SΣC0..1Quantity(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... value SΣ1..1decimal(USCDI) Numerical value (with implicit precision)
...... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... unit SΣ1..1string(USCDI) Unit representation
...... system SΣC1..1uri(USCDI) System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
...... code SΣ1..1code(USCDI) Coded form of the unit
Fixed Value: mm[Hg]
..... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

..... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


..... referenceRange 0..*See referenceRange (Observation)Provides guide for interpretation of component result

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.category:VSCatpreferredObservationCategoryCodes
Observation.codeextensiblePattern: LOINC code 85354-9
Observation.value[x]extensibleVitalSignsUnits
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.interpretationextensibleObservationInterpretationCodes
Observation.bodySiteexampleSNOMEDCTBodyStructures
Observation.methodexampleObservationMethods
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
Observation.component.codeextensibleUsCoreVitalSigns
Observation.component.value[x]extensibleVitalSignsUnits
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component.interpretationextensibleObservationInterpretationCodes
Observation.component:systolic.codeextensiblePattern: LOINC code 8480-6
Observation.component:systolic.value[x]extensibleVitalSignsUnits
Observation.component:systolic.value[x].comparatorrequiredQuantityComparator
Observation.component:systolic.dataAbsentReasonextensibleDataAbsentReason
Observation.component:systolic.interpretationextensibleObservationInterpretationCodes
Observation.component:diastolic.codeextensiblePattern: LOINC code 8462-4
Observation.component:diastolic.value[x]extensibleVitalSignsUnits
Observation.component:diastolic.value[x].comparatorrequiredQuantityComparator
Observation.component:diastolic.dataAbsentReasonextensibleDataAbsentReason
Observation.component:diastolic.interpretationextensibleObservationInterpretationCodes

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
obs-3errorObservation.referenceRangeMust have at least a low or a high or text
: low.exists() or high.exists() or text.exists()
vs-1errorObservation.effective[x]if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
: ($this as dateTime).toString().length() >= 8
vs-3errorObservation.component, Observation.component:systolic, Observation.component:diastolicIf there is no a value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()

This structure is derived from USCoreVitalSignsProfile

Summary

Mandatory: 4 elements (8 nested mandatory elements)
Must-Support: 16 elements
Fixed Value: 4 elements

Slices

This structure defines the following Slices:

  • The element Observation.component is sliced based on the value of pattern:code

Differential View

This structure is derived from USCoreVitalSignsProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*USCoreVitalSignsProfileUS Core Blood Pressure Profile
... code S1..1CodeableConcept(USCDI) Blood Pressure
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: 85354-9
... Slices for component S2..*BackboneElement(USCDI) Component observations
Slice: Unordered, Open by pattern:code
.... component:systolic S1..1BackboneElement(USCDI) Systolic Blood Pressure
..... code S1..1CodeableConcept(USCDI) Systolic Blood Pressure Code
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: 8480-6
..... valueQuantity S0..1Quantity(USCDI) Vital Sign Component Value
...... value S1..1decimal(USCDI) Numerical value (with implicit precision)
...... unit S1..1string(USCDI) Unit representation
...... system S1..1uri(USCDI) System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
...... code S1..1code(USCDI) Coded form of the unit
Fixed Value: mm[Hg]
.... component:diastolic S1..1BackboneElement(USCDI) Diastolic Blood Pressure
..... code S1..1CodeableConcept(USCDI) Diastolic Blood Pressure Code
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: 8462-4
..... valueQuantity S0..1Quantity(USCDI) Vital Sign Component Value
...... value S1..1decimal(USCDI) Numerical value (with implicit precision)
...... unit S1..1string(USCDI) Unit representation
...... system S1..1uri(USCDI) System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
...... code S1..1code(USCDI) Coded form of the unit
Fixed Value: mm[Hg]

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*USCoreVitalSignsProfileUS Core Blood Pressure Profile
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1code(USCDI) registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S1..*CodeableConcept(USCDI) 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 S1..1CodeableConcept(USCDI) Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


..... coding SΣ1..*Coding(USCDI) Code defined by a terminology system
...... system SΣ1..1uri(USCDI) Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code SΣ1..1code(USCDI) Symbol in syntax defined by the system
Fixed Value: vital-signs
... code SΣ1..1CodeableConcept(USCDI) Blood Pressure
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.


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: 85354-9
... subject SΣ1..1Reference(US Core Patient Profile)(USCDI) Who and/or what the observation is about
... effective[x] SΣC1..1(USCDI) Often just a dateTime for Vital Signs
.... effectiveDateTimedateTime
... value[x] SΣC0..1(USCDI) Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

.... valueQuantityQuantity
... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... Slices for component SΣC2..*BackboneElement(USCDI) Component observations
Slice: Unordered, Open by pattern:code
.... component:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code SΣ1..1CodeableConcept(USCDI) Type of component observation (code / type)
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

..... value[x] SΣC0..1(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

...... valueQuantityQuantity
..... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... component:systolic SΣC1..1BackboneElement(USCDI) Systolic Blood Pressure
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code SΣ1..1CodeableConcept(USCDI) Systolic Blood Pressure Code
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.


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: 8480-6
..... value[x] SΣC0..1Quantity(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

...... value SΣ1..1decimal(USCDI) Numerical value (with implicit precision)
...... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... unit SΣ1..1string(USCDI) Unit representation
...... system SΣC1..1uri(USCDI) System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
...... code SΣ1..1code(USCDI) Coded form of the unit
Fixed Value: mm[Hg]
..... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... component:diastolic SΣC1..1BackboneElement(USCDI) Diastolic Blood Pressure
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code SΣ1..1CodeableConcept(USCDI) Diastolic Blood Pressure Code
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.


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: 8462-4
..... value[x] SΣC0..1Quantity(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

...... value SΣ1..1decimal(USCDI) Numerical value (with implicit precision)
...... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... unit SΣ1..1string(USCDI) Unit representation
...... system SΣC1..1uri(USCDI) System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
...... code SΣ1..1code(USCDI) Coded form of the unit
Fixed Value: mm[Hg]
..... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.category:VSCatpreferredObservationCategoryCodes
Observation.codeextensiblePattern: LOINC code 85354-9
Observation.value[x]extensibleVitalSignsUnits
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.component.codeextensibleUsCoreVitalSigns
Observation.component.value[x]extensibleVitalSignsUnits
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component:systolic.codeextensiblePattern: LOINC code 8480-6
Observation.component:systolic.value[x]extensibleVitalSignsUnits
Observation.component:systolic.value[x].comparatorrequiredQuantityComparator
Observation.component:systolic.dataAbsentReasonextensibleDataAbsentReason
Observation.component:diastolic.codeextensiblePattern: LOINC code 8462-4
Observation.component:diastolic.value[x]extensibleVitalSignsUnits
Observation.component:diastolic.value[x].comparatorrequiredQuantityComparator
Observation.component:diastolic.dataAbsentReasonextensibleDataAbsentReason

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorObservationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorObservationIf 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-4errorObservationIf 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-5errorObservationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceObservationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
obs-6errorObservationdataAbsentReason SHALL only be present if Observation.value[x] is not present
: dataAbsentReason.empty() or value.empty()
obs-7errorObservationIf 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-1errorObservation.effective[x]if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
: ($this as dateTime).toString().length() >= 8
vs-2errorObservationIf 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-3errorObservation.component, Observation.component:systolic, Observation.component:diastolicIf there is no a value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C0..*USCoreVitalSignsProfileUS Core Blood Pressure Profile
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣ1..1code(USCDI) registered | preliminary | final | amended +
Binding: ObservationStatus (required)
... Slices for category S1..*CodeableConcept(USCDI) 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 S1..1CodeableConcept(USCDI) Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ1..*Coding(USCDI) Code defined by a terminology system
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ1..1uri(USCDI) Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1code(USCDI) Symbol in syntax defined by the system
Fixed Value: vital-signs
...... display Σ0..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text Σ0..1stringPlain text representation of the concept
... code SΣ1..1CodeableConcept(USCDI) Blood Pressure
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.


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: 85354-9
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... subject SΣ1..1Reference(US Core Patient Profile)(USCDI) Who and/or what the observation is about
... focus ΣTU0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter Σ0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] SΣC1..1(USCDI) Often just a dateTime for Vital Signs
.... effectiveDateTimedateTime S
.... effectivePeriodPeriod
... issued Σ0..1instantDate/Time this version was made available
... performer Σ0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)Who is responsible for the observation
... value[x] SΣC0..1(USCDI) Vital Signs Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

.... valueQuantityQuantity S
.... valueCodeableConceptCodeableConcept
.... valueStringstring
.... valueBooleanboolean
.... valueIntegerinteger
.... valueRangeRange
.... valueRatioRatio
.... valueSampledDataSampledData
.... valueTimetime
.... valueDateTimedateTime
.... valuePeriodPeriod
... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


... note 0..*AnnotationComments about the observation
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

... method 0..1CodeableConceptHow it was done
Binding: ObservationMethods (example): Methods for simple observations.

... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 0..1Reference(Device | DeviceMetric)(Measurement) Device
... referenceRange C0..*BackboneElementProvides guide for interpretation
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low C0..1SimpleQuantityLow Range, if relevant
.... high C0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

.... appliesTo 0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... hasMember Σ0..*Reference(QuestionnaireResponse | MolecularSequence | Vital Signs Profile)Used when reporting vital signs panel components
... derivedFrom Σ0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile)Related measurements the observation is made from
... Slices for component SΣC2..*BackboneElement(USCDI) Component observations
Slice: Unordered, Open by pattern:code
.... component:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code SΣ1..1CodeableConcept(USCDI) Type of component observation (code / type)
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.

..... value[x] SΣC0..1(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

...... valueQuantityQuantity S
...... valueCodeableConceptCodeableConcept
...... valueStringstring
...... valueBooleanboolean
...... valueIntegerinteger
...... valueRangeRange
...... valueRatioRatio
...... valueSampledDataSampledData
...... valueTimetime
...... valueDateTimedateTime
...... valuePeriodPeriod
..... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

..... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


..... referenceRange 0..*See referenceRange (Observation)Provides guide for interpretation of component result
.... component:systolic SΣC1..1BackboneElement(USCDI) Systolic Blood Pressure
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code SΣ1..1CodeableConcept(USCDI) Systolic Blood Pressure Code
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.


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: 8480-6
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value[x] SΣC0..1Quantity(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... value SΣ1..1decimal(USCDI) Numerical value (with implicit precision)
...... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... unit SΣ1..1string(USCDI) Unit representation
...... system SΣC1..1uri(USCDI) System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
...... code SΣ1..1code(USCDI) Coded form of the unit
Fixed Value: mm[Hg]
..... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

..... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


..... referenceRange 0..*See referenceRange (Observation)Provides guide for interpretation of component result
.... component:diastolic SΣC1..1BackboneElement(USCDI) Diastolic Blood Pressure
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code SΣ1..1CodeableConcept(USCDI) Diastolic Blood Pressure Code
Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.


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: 8462-4
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... value[x] SΣC0..1Quantity(USCDI) Vital Sign Component Value
Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.

...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... value SΣ1..1decimal(USCDI) Numerical value (with implicit precision)
...... comparator ?!Σ0..1code< | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.

...... unit SΣ1..1string(USCDI) Unit representation
...... system SΣC1..1uri(USCDI) System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
...... code SΣ1..1code(USCDI) Coded form of the unit
Fixed Value: mm[Hg]
..... dataAbsentReason SC0..1CodeableConcept(USCDI) Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

..... interpretation 0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


..... referenceRange 0..*See referenceRange (Observation)Provides guide for interpretation of component result

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Observation.statusrequiredObservationStatus
Observation.categorypreferredObservationCategoryCodes
Observation.category:VSCatpreferredObservationCategoryCodes
Observation.codeextensiblePattern: LOINC code 85354-9
Observation.value[x]extensibleVitalSignsUnits
Observation.dataAbsentReasonextensibleDataAbsentReason
Observation.interpretationextensibleObservationInterpretationCodes
Observation.bodySiteexampleSNOMEDCTBodyStructures
Observation.methodexampleObservationMethods
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
Observation.component.codeextensibleUsCoreVitalSigns
Observation.component.value[x]extensibleVitalSignsUnits
Observation.component.dataAbsentReasonextensibleDataAbsentReason
Observation.component.interpretationextensibleObservationInterpretationCodes
Observation.component:systolic.codeextensiblePattern: LOINC code 8480-6
Observation.component:systolic.value[x]extensibleVitalSignsUnits
Observation.component:systolic.value[x].comparatorrequiredQuantityComparator
Observation.component:systolic.dataAbsentReasonextensibleDataAbsentReason
Observation.component:systolic.interpretationextensibleObservationInterpretationCodes
Observation.component:diastolic.codeextensiblePattern: LOINC code 8462-4
Observation.component:diastolic.value[x]extensibleVitalSignsUnits
Observation.component:diastolic.value[x].comparatorrequiredQuantityComparator
Observation.component:diastolic.dataAbsentReasonextensibleDataAbsentReason
Observation.component:diastolic.interpretationextensibleObservationInterpretationCodes

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
obs-3errorObservation.referenceRangeMust have at least a low or a high or text
: low.exists() or high.exists() or text.exists()
vs-1errorObservation.effective[x]if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day
: ($this as dateTime).toString().length() >= 8
vs-3errorObservation.component, Observation.component:systolic, Observation.component:diastolicIf there is no a value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()

This structure is derived from USCoreVitalSignsProfile

Summary

Mandatory: 4 elements (8 nested mandatory elements)
Must-Support: 16 elements
Fixed Value: 4 elements

Slices

This structure defines the following Slices:

  • The element Observation.component is sliced based on the value of pattern:code

 

Other representations of profile: CSV, Excel, Schematron

Notes:

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

  • The syntax used to describe the interactions is described here.

  • Servers providing access to vital signs data can use US Core SMART Scopes for:
    • resource level scopes (for example, patient/Observation.rs)
    • granular scopes (for example, patient.Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs).
  • See the General Requirements section for additional rules and expectations when a server requires status parameters.
  • See the General Guidance section for additional guidance on searching for multiple patients.

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

  1. SHALL support searching using the combination of the patient and category search parameters:

    GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

    Example:

    1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and a category code = vital-signs (how to search by reference and how to search by token)

  2. SHALL support searching using the combination of the patient and code search parameters:
    • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)

    GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

    Example:

    1. GET [base]/Observation?patient=1186747&code=http://loinc.org|8867-4,http://loinc.org|9279-1,http://loinc.org|85354-9

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and observation code(s). SHOULD support search by multiple codes. The Observation code parameter searches `Observation.code only. (how to search by reference and how to search by token)

  3. SHALL support searching using the combination of the patient and category and date search parameters:
    • including support for these date comparators: gt,lt,ge,le
    • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

    GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&date=ge2020-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and a category code = vital-signs (how to search by reference and how to search by token and how to search by date)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

  1. SHOULD support searching using the combination of the patient and category and status search parameters:
    • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

    GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&status={system|}[code]{,{system|}[code],...}

    Example:

    1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&status=final

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category and status (how to search by reference and how to search by token)

  2. SHOULD support searching using the combination of the patient and code and date search parameters:
    • including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)
    • including support for these date comparators: gt,lt,ge,le
    • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

    GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/Observation?patient=1186747&code=http://loinc.org|8867-4,http://loinc.org|9279-1,http://loinc.org|85354-9&date=ge2020-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and report code(s). SHOULD support search by multiple codes. (how to search by reference and how to search by token and how to search by date)