HL7.FHIR.US.CORE\US Core Vital Signs Profile

US Core Implementation Guide
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This page is part of the US Core (v6.0.0: STU6) 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 Vital Signs Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs				Version: 6.0.0
Active as of 2020-11-17				Computable Name: USCoreVitalSignsProfile
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

To promote interoperability and adoption through common implementation, this profile is based on the base FHIR Vital Signs Profile and defines additional constraints on the Observation resource to represent vital signs observations. It identifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains the way the elements are used when using this profile. It provides the floor for standards development for specific use cases. This US Core profiles that are derived from this profile are listed below.

Mandatory and Must Support Data Elements

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. The “Snapshot Table (Must Support)” tab below displays all the Mandatory and Must Support data elements for this profile and those inherited from the US Core Vital Signs Profile.

Each Observation Must Have:

a status
a category code of “vital-signs”
a LOINC code, if available, which tells you what is being measured
a patient
a clinically relevant time

Each Observation Must Support:

a result value
- if the result value is a numeric quantity, a standard UCUM unit
a reason if the value is absent*
component results

*see guidance below

Profile Specific Implementation Guidance:

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.
*An Observation without a value, SHALL include a reason why the data is absent unless there are 1) component observations, or 2) reporting panel observations using Observation.hasMember.
- For further guidance see the Observation Grouping section in FHIR Specification.
- Systems that never provide an observation without a value are not required to support Observation.dataAbsentReason.
*An Observation.component without a value, SHALL include a reason why the data is absent.
- Systems that never provide a component observation without a component value are not required to support Observation.component.dataAbsentReason.
Implementers may use this profile as a base for other vital signs in addition to those in this guide.

Usage:

Derived from this Resource Profile: US Core Pediatric Head Occipital Frontal Circumference Percentile Profile, US Core Pediatric BMI for Age Observation Profile, US Core Pediatric Weight for Height Observation Profile, US Core Blood Pressure Profile... Show 8 more

Formal Views of Profile Content

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

Differential Table
Key Elements Table
Snapshot Table
Statistics/References
All

This structure is derived from observation-vitalsigns

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	observation-vitalsigns	US Core Vital Signs Profile
status	S	1..1	code	(USCDI) registered \| preliminary \| final \| amended +
Slices for category	S	1..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system
category:VSCat	S	1..1	CodeableConcept	(USCDI) Classification of type of observation
coding	S	1..*	Coding	(USCDI) Code defined by a terminology system
system	S	1..1	uri	(USCDI) Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code	S	1..1	code	(USCDI) Symbol in syntax defined by the system Fixed Value: vital-signs
code	S	1..1	CodeableConcept	(USCDI) Coded Responses from C-CDA Vital Sign Results Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.
subject	S	1..1	Reference(US Core Patient Profile)	(USCDI) Who and/or what the observation is about
effective[x]	S	1..1		(USCDI) Often just a dateTime for Vital Signs
effectiveDateTime			dateTime S
effectivePeriod			Period
value[x]	S	0..1		(USCDI) Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity			Quantity S
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	S	0..1	CodeableConcept	(USCDI) Why the result is missing
component	S	0..*	BackboneElement	(USCDI) Component observations
code	S	1..1	CodeableConcept	(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]	S	0..1		(USCDI) Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity			Quantity S
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	S	0..1	CodeableConcept	(USCDI) Why the component result is missing
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.code	extensible	UsCoreVitalSigns
Observation.value[x]	extensible	VitalSignsUnits
Observation.component.code	extensible	UsCoreVitalSigns
Observation.component.value[x]	extensible	VitalSignsUnits

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	observation-vitalsigns	US Core Vital Signs Profile
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	(USCDI) registered \| preliminary \| final \| amended + Binding: ObservationStatus (required)
Slices for category	S	1..*	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	S	1..1	CodeableConcept	(USCDI) Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
coding	SΣ	1..*	Coding	(USCDI) Code defined by a terminology system
system	SΣ	1..1	uri	(USCDI) Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code	SΣ	1..1	code	(USCDI) Symbol in syntax defined by the system Fixed Value: vital-signs
code	SΣ	1..1	CodeableConcept	(USCDI) Coded Responses from C-CDA Vital Sign Results Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who and/or what the observation is about
effective[x]	SΣC	1..1		(USCDI) Often just a dateTime for Vital Signs
effectiveDateTime			dateTime
value[x]	SΣC	0..1		(USCDI) Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity			Quantity
dataAbsentReason	SC	0..1	CodeableConcept	(USCDI) Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
component	SΣC	0..*	BackboneElement	(USCDI) Component observations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	(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]	SΣC	0..1		(USCDI) Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.
valueQuantity			Quantity
dataAbsentReason	SC	0..1	CodeableConcept	(USCDI) 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
Observation.status	required	ObservationStatus
Observation.category	preferred	ObservationCategoryCodes
Observation.category:VSCat	preferred	ObservationCategoryCodes
Observation.code	extensible	UsCoreVitalSigns
Observation.value[x]	extensible	VitalSignsUnits
Observation.dataAbsentReason	extensible	DataAbsentReason
Observation.component.code	extensible	UsCoreVitalSigns
Observation.component.value[x]	extensible	VitalSignsUnits
Observation.component.dataAbsentReason	extensible	DataAbsentReason

Constraints

Id	Grade	Path(s)	Details	Requirements
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 as dateTime).toString().length() >= 8
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	If there is no a value a data absent reason must be present : value.exists() or dataAbsentReason.exists()