IE (Ireland) Core Implementation Guide
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Resource Profile: IE Core Average Blood Pressure Profile

Official URL: http://iehr.ai/fhir/ie/core/StructureDefinition/ie-core-average-blood-pressure Version: 1.0.0-ballot
Standards status: Trial-use Maturity Level: 3 Computable Name: IECoreAverageBloodPressureProfile
Other Identifiers: OID:1.3.6.1.4.1.54392.5.2690.42.5

Copyright/Legal: iEHR.ai, all rights reserved Creative Commons License

The IE Core Average Blood Pressure Profile inherits from the Observation resource; refer to it for scope and usage definitions. This profile sets minimum expectations for recording, searching, and fetching average diastolic and systolic blood pressure observations with standard LOINC codes and UCUM units of measure. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

Example Usage Scenarios:

The following are example usage scenarios for this profile:

  • Query for average blood pressure observations belonging to a patient
  • Record or update average blood pressure observations belonging to a patient

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.

Each Observation Must Have:

  1. a status
  2. a category code of "vital-signs"
  3. a fixed code for average systolic and diastolic blood pressure panel
  4. a fixed component code for average systolic blood pressure
  5. a fixed component code for average diastolic blood pressure
  6. a patient

Each Observation Must Support:

  1. clinically relevant time-period for the average of blood pressure readings
  2. a performer
  3. a result value for the average systolic blood pressure
  4. a result value for the average diastolic blood pressure
  5. a reason if the value is absent*

*see guidance below

Profile Specific Implementation Guidance:

  • The category "vital-signs" aligns with the IECDI Data Class and Elements and provides a convenient and consistent grouping of the clinical concepts. Implementers can group them differently based on their clinical needs.
  • 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

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

  • *Because the blood pressure values are communicated in the mandatory systolic and diastolic components:
    • the Observation.value[x] element SHALL 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.
  • This Profile is not dependent on any specific protocol. Information about the protocol used SHOULD be supplied in either:
  • Information about the number of measurements used to determine the average SHOULD be supplied as an Observation.component using the SNOMED CT code "246432004 Number of occurrences (qualifier value)". The example shows how this component can be used.
  • The observation MAY use an extension defined by other profiles such as Vital Signs with Qualifying Elements: Average Blood Pressure Profile.

Usage:

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* Observation IE Core Average Blood Pressure Profile
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-3: 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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... status ?!SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Codes providing the status of an observation.


ele-1: All FHIR elements must have a @value or children
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by value:coding.code, value:coding.system
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


ele-1: All FHIR elements must have a @value or children
.... category:VSCat S 1..1 CodeableConcept Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


ele-1: All FHIR elements must have a @value or children
..... coding SΣ 1..* Coding Code defined by a terminology system
ele-1: All FHIR elements must have a @value or children
...... system Σ 1..1 uri Identity of the terminology system
ele-1: All FHIR elements must have a @value or children
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... code Σ 1..1 code Symbol in syntax defined by the system
ele-1: All FHIR elements must have a @value or children
Fixed Value: vital-signs
... code SΣ 1..1 CodeableConcept Blood Pressure
Binding: LOINCCodes (example): Codes identifying names of simple observations.


ele-1: All FHIR elements must have a @value or children
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 96607-7
... subject SΣ 0..1 Reference(IE Core Patient Profile) Who and/or what the observation is about
ele-1: All FHIR elements must have a @value or children
... effective[x] SΣ 1..1 clinically relevant time-period for the average of blood pressure (BP) readings
ele-1: All FHIR elements must have a @value or children
.... effectivePeriod Period
... performer SΣ 0..* Reference(IE Core Practitioner Profile | IE Core Organization Profile | IE Core Patient Profile | PractitionerRole | IE Core CareTeam Profile | IE Core RelatedPerson Profile) Who is responsible for the observation
ele-1: All FHIR elements must have a @value or children
... Slices for component SΣC 2..* BackboneElement Average systolic and diastolic blood pressure and other qualifiers.
Slice: Unordered, Open by pattern:code
ele-1: All FHIR elements must have a @value or children
ie-core-26: If there is no value a data absent reason must be present
.... component:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... code Σ 1..1 CodeableConcept Type of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.


ele-1: All FHIR elements must have a @value or children
..... value[x] SΣ 0..1 Vital Sign Component Value
ele-1: All FHIR elements must have a @value or children
...... valueQuantity Quantity
..... dataAbsentReason SC 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.


ele-1: All FHIR elements must have a @value or children
.... component:systolic SΣ 1..1 BackboneElement Systolic Average Blood Pressure
ele-1: All FHIR elements must have a @value or children
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... code SΣ 1..1 CodeableConcept Systolic Average Blood Pressure Code
Binding: LOINCCodes (example): Codes identifying names of simple observations.


ele-1: All FHIR elements must have a @value or children
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 96608-5
..... Slices for value[x] Σ 0..1 Actual component result
Slice: Unordered, Open by type:$this
ele-1: All FHIR elements must have a @value or children
...... valueQuantity Quantity
...... valueCodeableConcept CodeableConcept
...... valueString string
...... valueBoolean boolean
...... valueInteger integer
...... valueRange Range
...... valueRatio Ratio
...... valueSampledData SampledData
...... valueTime time
...... valueDateTime dateTime
...... valuePeriod Period
...... value[x]:valueQuantity SΣC 0..1 Quantity Systolic Average Blood Pressure Value
ele-1: All FHIR elements must have a @value or children
....... value Σ 1..1 decimal Numerical value (with implicit precision)
ele-1: All FHIR elements must have a @value or children
....... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.


ele-1: All FHIR elements must have a @value or children
....... unit Σ 1..1 string Unit representation
ele-1: All FHIR elements must have a @value or children
....... system ΣC 1..1 uri System that defines coded unit form
ele-1: All FHIR elements must have a @value or children
Fixed Value: http://unitsofmeasure.org
....... code Σ 1..1 code Coded form of the unit
ele-1: All FHIR elements must have a @value or children
Fixed Value: mm[Hg]
.... component:diastolic SΣ 1..1 BackboneElement Diastolic Average Blood Pressure
ele-1: All FHIR elements must have a @value or children
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... code SΣ 1..1 CodeableConcept Diastolic Average Blood Pressure Code
Binding: LOINCCodes (example): Codes identifying names of simple observations.


ele-1: All FHIR elements must have a @value or children
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 96609-3
..... Slices for value[x] Σ 0..1 Actual component result
Slice: Unordered, Open by type:$this
ele-1: All FHIR elements must have a @value or children
...... valueQuantity Quantity
...... valueCodeableConcept CodeableConcept
...... valueString string
...... valueBoolean boolean
...... valueInteger integer
...... valueRange Range
...... valueRatio Ratio
...... valueSampledData SampledData
...... valueTime time
...... valueDateTime dateTime
...... valuePeriod Period
...... value[x]:valueQuantity SΣC 0..1 Quantity Diastolic Average Blood Pressure Value
ele-1: All FHIR elements must have a @value or children
....... value Σ 1..1 decimal Numerical value (with implicit precision)
ele-1: All FHIR elements must have a @value or children
....... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.


ele-1: All FHIR elements must have a @value or children
....... unit Σ 1..1 string Unit representation
ele-1: All FHIR elements must have a @value or children
....... system ΣC 1..1 uri System that defines coded unit form
ele-1: All FHIR elements must have a @value or children
Fixed Value: http://unitsofmeasure.org
....... code Σ 1..1 code Coded form of the unit
ele-1: All FHIR elements must have a @value or children
Fixed Value: mm[Hg]

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Observation.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:VSCatpreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeexamplePattern: LOINC Code 96607-7
http://hl7.org/fhir/ValueSet/observation-codes
from the FHIR Standard
Observation.component.codeexampleLOINCCodes (a valid code from LOINC)
http://hl7.org/fhir/ValueSet/observation-codes
from the FHIR Standard
Observation.component.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.component:systolic.codeexamplePattern: LOINC Code 96608-5
http://hl7.org/fhir/ValueSet/observation-codes
from the FHIR Standard
Observation.component:systolic.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard
Observation.component:diastolic.codeexamplePattern: LOINC Code 96609-3
http://hl7.org/fhir/ValueSet/observation-codes
from the FHIR Standard
Observation.component:diastolic.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
ie-core-26errorObservation.componentIf there is no value a data absent reason must be present
: value.exists() or dataAbsentReason.exists()

 

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 IE Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only IE Core Profiles (Profile Only Support) are not required to support these interactions. See the IE Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

  • See the Scopes Format section for a description of the SMART scopes syntax.
  • See the Search Syntax section for a description of the IE Core search syntax.
  • 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.

IE Core Scopes

Servers providing access to vital signs data SHALL support these IE Core SMART Scopes:

  • resource level scopes: <patient|user|system>/Observation.rs

  • granular scopes: <patient|user|system>.Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs

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|85354-9,http://loinc.org|96607-7

    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 category and _lastUpdated search parameters:
    • including support for these _lastUpdated comparators: gt,lt,ge,le
    • including optional support for AND search on _lastUpdated (e.g._lastUpdated=[date]&_lastUpdated=[date]]&...)

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

    Example:

    1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs&_lastUpdated=ge2024-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category and _lastUpdated. See the IE Core General Guidance page for Searching Using lastUpdated. (how to search by reference and how to search by token and how to search by date)

  3. 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|85354-9,http://loinc.org|96607-7&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)