2nd DSTU Draft For Comment

This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

U.S. Data Access Framework (DAF) Vital Signs Profile (Conformance Package)

Scope and Usage

This profile sets expectations for use of the Observation resource to record Vital Signs of a patient within the Data Access Framework (DAF) Implementation Guide. This profile identifies which core elements,extensions,vocabularies and value sets must be supported by DAF actors.

For the purposes of this profile, Supported means the following:

    SearchParameters:

  • DAF Query Requestor (client) SHALL be capable of querying the Observation resource using one or more of the search parameters for data elements tagged as MUST SUPPORT in this profile.
  • DAF Query Responder (server) SHALL be capable of receiving the queries submitted by the DAF Query Requestor and provide Query Results or error responses per the FHIR specifications.
  • DAF Query Responder MAY provide valid or error responses when the query parameters submitted contain data elements which are not tagged as MUST SUPPORT by this profile.

    • Query Results:

  • Query Results returned by DAF Query Responder SHOULD contain the data elements identified as MUST SUPPORT in the profile.
  • Query Results returned MAY contain data elements not tagged as MUST SUPPORT by the this profile.
  • Query Requestor SHALL process the Query Results containing additional data elements without indicating that the response is an erroneous response.

    • Missing Information:

  • When Query Results do not contain a particular data element identified as MUST SUPPORT, Query Requestors SHALL interpret the results to mean that the Query Responder did not have information and there is no further qualifying information as to why the information is missing.
  • In cases, where the Query Responder knows precisely the reason why the data is missing (e.g notasked in the data-absent-reason value set), then Query Responders MAY provide this additional information using the extension element as part of the data element. Query Requestors SHALL correctly process the data-absent-reason extension without rejecting the response as an erroneous response.
  • DAF Query Responders SHALL use Observation.dataAbsentReason with the appropriate code to represent the absence of Vital Signs information. NOTE: Only one of either Observation.valueQuantity or Observation.dataAbsentReason can be present in an DAFVitalSigns instance.

Relationship to Meaningful Use

The DAF Vital Signs profile provides a mapping for the following derived Meaningful Use data elements to FHIR data elements.


Meaningful Use Data Element Name FHIR Resource Mapping
Patient for whom Vital Signs are being measured Observation.subject
Vital Sign being Measured Observation.name
Vital Signs value Observation.valueQuantity
Vital Signs reference range Observation.referenceRange

Boundaries and Relationships

This profile relies on the use of other profiles, some required, others available for use "when necessary":

  • DAFPatient which defines DAF Patient profile used by Observation.subject.
  • DAFEncounter which defines DAF Encounter profile used by Observation.encounter
  • US Core which defines common properties related to Patient such as race and ethnicity.
  • FHIR Extensibility defines how extensions can be applied to FHIR resources and data types. Specifically the data-absent-reason extension is used to code data elements with missing information when appropriate.

Profile Details

Profiles:
DAFVitalSignsDefines constraints and extensions on the Observation resource for use in querying and retrieving Vital Signs information. : U.S. Data Access Framework (DAF) Vital Signs Profile

Example Usage Scenarios

The following are example usage scenarios for the DAFVitalSigns profile:

  • Query for vital signs of a particular patient
  • Query for all patients whose vital signs are out of the reference range
  • Query for patients with a particular type of vital sign measurement

Additional Implementation Guidance

Implementers need to be mindful of the following during their implementation

    Specifying Patients as part of the Vital Signs Queries: DAFVitalSigns profile supports the querying the vital signs for a particular patient. In order to achieve this in implementation, it is recommended to use Patient.identifier field to precisely identify the observations relevant to the patient. While other parameters such as Patient.name, Patient.given could be used this could lead to incorrect Patient matching and/or inefficient queries when systems are not tuned.

    Patient Matching: Patient Matching rules and criteria have to be evaluated by the implementing organization and have to comply with local policies and regulations. Query Requestors will have to deal with result sets that can return zero,one or more Observation Resources in response to a query.