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D.4.1 StructureDefinition: DAF-core-vitalsigns

This profile sets minimum expectations for the Observation resource to record, search and fetch vital signs associated with a patient. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the resource when using this profile.

Example Usage Scenarios:

The following are example usage scenarios for the DAF-VitalSigns profile:

• Query for vital signs of a particular patient
• Query for patients with a particular type of vital sign measurement

Mandatory Data Elements and Terminology

The following data-elements are mandatory (i.e data MUST be present). These are presented below in a simple human-readable explanation. Profile specific guidance and an example are provided as well. The Formal Profile Definition below provides the formal summary, definitions, and terminology requirements.

Each Observation must have:

1. a status
2. a category code of ‘vital-signs’
3. a LOINC code which tells you what is being measured and is taken from the “LOINC Code” column in the table below.
   • note: If a more specific code is recorded, the generic code and the translated coded must be sent - e.g. method specific LOINC Codes, SNOMED CT concepts, system specific codes
4. a patient
5. a time indicating when the measurement was taken
6. a numeric result value and standard UCUM unit which is taken from the “LOINC Code” column in the table below.
   • note: if there is no numeric result then you have to supply a reason

Profile specific implementation guidance:

• This table represents a minimum set of vital sign concepts, the required LOINC codes, and UCUM units of measure codes used for representing vitals signs observations. These are extensible bindings and require that when a system support of any of these vital signs concepts, they must represent them using these codes. In addition, if you have a blood pressure observation, you must have both a systolic and a diastolic component, though one or both may have dataAbsentReason instead of a value.

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Vital Sign Name	LOINC Code	UCUM Unit Code	Notes	Examples
Vital Signs	8716-3	—	This is the top-level grouping structure for a set of vital signs. It has no value in Observation.valueQuantity ; instead, it just includes related links (with type=has-member) to the Observations in this set (e.g. respiratory rate, heart rate, BP). Note that querying for the panel may miss individual results that are not part of an actual panel.	Vital Signs Panel Example
Respiratory Rate	9279-1	/min		Vital Signs Respiratory Rate Example
Heart rate	8867-4	/min		Vital Signs Heart Rate Example
Oxygen saturation	59408-5	%	59408-5 (Oxygen saturation in Arterial blood by Pulse oximetry) replaces the deprecated code 2710-2 which had been listed in C-CDA.	Vital Signs Oxygen Saturation Example
Body temperature	8310-5	Cel, [degF]		Vital Signs Body Temperature Example
Body height	8302-2	cm, [in_i]		Vital Signs Body height Example
Body length	8306-3	cm, [in_i]	Like height, but lying down, typically this is used for infants	Vital Signs Body Length Example
Head circumference	8287-5	cm, [in_i]		Vital Signs Head Cirmcumference Example
Body weight	29463-7	g, kg,[lb_av]		Vital Signs Body Weight Example
Body mass index	39156-5	kg/m2		Vital Body Mass Example
Blood pressure systolic and diastolic	55284-4	—	This is a grouping structure. It has no value in Observation.valueQuantity but contains at least one component (systolic and/or diastolic).	Vital Signs Blood Pressure Example
Systolic blood pressure	8480-6	mm[Hg]	Observation.component code for a blood pressure Observation	Vital Signs Blood Pressure Example
Diastolic blood pressure	8462-4	mm[Hg]	Observation.component code for a blood pressure Observation	Vital Signs Blood Pressure Example

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• Alternate codes may be provided in addition to the standard LOINC and UCUM codes defined here.The examples illustrate using other codes as translations.

• Other profiles may make rules about which vital sign must be present or must be present as part of a panel.

Example: VitalSigns Example: example

D.4.1.1 Formal Views of Profile Content

The official URL for this profile is:

http://hl7.org/fhir/us/daf/StructureDefinition/daf-core-vitalsigns

This profile was published on Mon Aug 01 00:00:00 AEST 2016 as a draft by Health Level Seven International (FHIR-Infrastructure).

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

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

 

D.4.1.2 Terminology Bindings

Terminology Bindings

Path	Name	Conformance	ValueSet
Observation.language	Common Languages	extensible	Common Languages
Observation.status	ObservationStatus	required	ObservationStatus
Observation.category	Observation Category Codes	example	Observation Category Codes
Observation.code	DAF Vital Sign Codes	extensible	DAF Vital Sign Codes
Observation.valueQuantity	Vital Signs Units	required	Vital Signs Units
Observation.valueQuantity.comparator	QuantityComparator	required	QuantityComparator
Observation.dataAbsentReason	Observation Value Absent Reason	extensible	Observation Value Absent Reason
Observation.interpretation	Observation Interpretation Codes	extensible	Observation Interpretation Codes
Observation.bodySite	SNOMED CT Body Structures	example	SNOMED CT Body Structures
Observation.method	Observation Methods	example	Observation Methods
Observation.referenceRange.meaning	Observation Reference Range Meaning Codes	example	Observation Reference Range Meaning Codes
Observation.related.type	ObservationRelationshipType	required	ObservationRelationshipType
Observation.component.code	DAF Vital Sign Codes	extensible	DAF Vital Sign Codes
Observation.component.valueQuantity	Vital Signs Units	required	Vital Signs Units
Observation.component.valueQuantity.comparator	QuantityComparator	required	QuantityComparator
Observation.component.dataAbsentReason	Observation Value Absent Reason	extensible	Observation Value Absent Reason
Observation.component.interpretation	Observation Interpretation Codes	extensible	Observation Interpretation Codes

D.4.1.3 Constraints

Constraints

Id	Path	Details	Requirements
dom-2	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources XPath: not(parent::f:contained and f:contained)
dom-1	Observation	If the resource is contained in another resource, it SHALL NOT contain any narrative XPath: not(parent::f:contained and f:text)
dom-4	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated XPath: not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
dom-3	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource XPath: not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))
obs-7	Observation	If code is the same as a component code then the value element associated with the code SHALL NOT be present XPath: not(exists(f:value)) or not(count(for $coding in f:code/f:coding return parent::*/f:component/f:code/f:coding[f:code/@value=$coding/f:code/@value and f:system/@value=$coding/f:system/@value])=0)
obs-6	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present XPath: not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), 'value')])))
daf-2	Observation	If there is no component or related element then either a value[x] or a data absent reason must be present XPath: exists(f:component) or exists(f:related) or exists(f:*[starts-with(local-name(.), 'value)]) or exists(f:dataAbsentReason)
daf-1	Observation.effective[x]	Datetime must be at least to day. XPath: f:matches(effectiveDateTime,/\d{4}-[01]\d-[0-3]\dT[0-2]\d:[0-5]\d([+-][0-2]\d:[0-5]\d|Z)/)
obs-3	Observation.referenceRange	Must have at least a low or a high or text XPath: (exists(f:low) or exists(f:high)or exists(f:text))
daf-3	Observation.component	If there is no a value a data absent reason must be present XPath: exists(f:*[starts-with(local-name(.), 'value)]) or exists(f:dataAbsentReason)

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