From 39fb654947cc5929d60d39f8d4eeb5efb4a44e61 Mon Sep 17 00:00:00 2001
From: "Surya,M" <87635660+Surya-Rnsit@users.noreply.github.com>
Date: Thu, 24 Aug 2023 17:28:42 +0530
Subject: [PATCH] Updated documentation for observation create and update with
Blood Pressure and Pulse-ox (#949)
---
.../r4/clinical/diagnostics/observation.md | 31 +-
.../example_json/r4_examples_observation.rb | 535 ++++++++++++++++++
lib/resources/r4/observation.yaml | 160 +++++-
3 files changed, 724 insertions(+), 2 deletions(-)
diff --git a/content/millennium/r4/clinical/diagnostics/observation.md b/content/millennium/r4/clinical/diagnostics/observation.md
index 197ccc205..7f9f1c90b 100644
--- a/content/millennium/r4/clinical/diagnostics/observation.md
+++ b/content/millennium/r4/clinical/diagnostics/observation.md
@@ -237,7 +237,7 @@ Create a new Observation.
_Implementation Notes_
* See [Understand Supported Vital Signs in the FHIR Observation Resource](https://wiki.cerner.com/pages/releaseview.action?spaceKey=reference&title=Understand%20Supported%20Vital%20Signs%20in%20the%20FHIR%20Observation%20Resource) for a list of vital signs that are supported for the create operation.
-* Components are not currently supported when writing Blood Pressures.
+* Components are supported only when writing Observation Blood Pressure and Pulse Oximetry Profiles.
* Individual systolic and diastolic components will be paired upon subsequent search or read as long as the blood
pressures are paired in Millennium. See [Configure Blood Pressure Event Set Pairing Hierarchy].
* Only the body fields mentioned below are supported. Unsupported fields will be ignored.
@@ -270,6 +270,14 @@ _Note_:
<%= json(:R4_OBSERVATION_CREATE) %>
+#### Vitals - Blood Pressure Body Example
+<%= beta_tag(action: true) %>
+<%= json(:R4_OBSERVATION_BP_CREATE) %>
+
+#### Vitals - Pulse Oximetry Body Example
+<%= beta_tag(action: true) %>
+<%= json(:R4_OBSERVATION_PO_CREATE) %>
+
#### Labs Body Example
<%= json(:R4_OBSERVATION_LABS_CREATE) %>
@@ -308,6 +316,7 @@ _Implementation Notes_
* Currently only `laboratory` and `vital-signs` are supported.
* Both read and write scopes are required.
* Updates on patient and category are not supported.
+* Components are only supported for vital-sign blood pressure and pulse oximetry profiles
* See [FHIR® Update] for additional details about update operations.
### Authorization Types
@@ -336,10 +345,30 @@ _Note_:
<%= json(:R4_OBSERVATION_LABS_UPDATE) %>
+#### Request
+
+ PUT https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Observation/VS-197356031
+
#### Vitals Body Example
<%= json(:R4_OBSERVATION_VITALS_UPDATE) %>
+#### Request
+
+ PUT https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Observation/BP-59857018-59857020
+
+#### Vitals - Blood Pressure Body Example
+<%= beta_tag(action: true) %>
+<%= json(:R4_OBSERVATION_VITALS_BP_UPDATE) %>
+
+#### Request
+
+ PUT https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Observation/VS-CV-78693473-SECT-8098
+
+#### Vitals - Pulse Oximetry Body Example
+<%= beta_tag(action: true) %>
+<%= json(:R4_OBSERVATION_VITALS_PO_UPDATE) %>
+
#### Response
<%= headers status: 200 %>
diff --git a/lib/resources/example_json/r4_examples_observation.rb b/lib/resources/example_json/r4_examples_observation.rb
index 62c337b71..6c0ce663d 100644
--- a/lib/resources/example_json/r4_examples_observation.rb
+++ b/lib/resources/example_json/r4_examples_observation.rb
@@ -806,6 +806,254 @@ module Resources
]
}.freeze
+ R4_OBSERVATION_BP_CREATE ||= {
+ "resourceType": 'Observation',
+ "status": 'final',
+ "category": [
+ {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/observation-category',
+ "code": 'vital-signs',
+ "display": 'Vital Signs'
+ }
+ ],
+ "text": 'Vital Signs'
+ }
+ ],
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '85354-9'
+ }
+ ],
+ "text": 'Blood pressure'
+ },
+ "subject": {
+ "reference": 'Patient/12457981'
+ },
+ "encounter": {
+ "reference": 'Encounter/97845408'
+ },
+ "effectiveDateTime": '2022-06-04T08:00:38.000Z',
+ "issued": '2022-06-04T08:00:38Z',
+ "component": [
+ {
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '8480-6'
+ }
+ ],
+ "text": 'Systolic Blood Pressure Invasive'
+ },
+ "valueQuantity": {
+ "value": 120,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "interpretation": [
+ {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation',
+ "code": 'N'
+ }
+ ]
+ }
+ ],
+ "referenceRange": [
+ {
+ "low": {
+ "value": 45.0,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "high": {
+ "value": 75.0,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "type": {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/referencerange-meaning',
+ "code": 'normal'
+ }
+ ],
+ "text": 'Normal Range'
+ }
+ }
+ ]
+ },
+ {
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '8462-4'
+ }
+ ],
+ "text": 'Diastolic Blood Pressure Invasive'
+ },
+ "valueQuantity": {
+ "value": 80,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "interpretation": [
+ {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation',
+ "code": 'N'
+ }
+ ]
+ }
+ ],
+ "referenceRange": [
+ {
+ "low": {
+ "value": 35.8,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "high": {
+ "value": 37.3,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "type": {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/referencerange-meaning',
+ "code": 'normal'
+ }
+ ],
+ "text": 'Normal Range'
+ }
+ }
+ ]
+ }
+ ]
+ }.freeze
+
+ R4_OBSERVATION_PO_CREATE ||= {
+ "resourceType": 'Observation',
+ "status": 'final',
+ "category": [
+ {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/observation-category',
+ "code": 'vital-signs',
+ "display": 'Vital Signs'
+ }
+ ],
+ "text": 'Vital Signs'
+ }
+ ],
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '59408-5'
+ }
+ ],
+ "text": 'SpO2'
+ },
+ "subject": {
+ "reference": 'Patient/12457981'
+ },
+ "encounter": {
+ "reference": 'Encounter/97845408'
+ },
+ "effectiveDateTime": '2022-06-05T08:00:38.004Z',
+ "issued": '2022-06-05T08:00:34Z',
+ "performer": [
+ {
+ "extension": [
+ {
+ "valueCodeableConcept": {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/v3-ParticipationType',
+ "code": 'LA',
+ "display": 'legal authenticator'
+ }
+ ],
+ "text": 'legal authenticator'
+ },
+ "url": 'http://hl7.org/fhir/StructureDefinition/event-performerFunction'
+ }
+ ],
+ "reference": 'Practitioner/15441459'
+ }
+ ],
+ "component": [
+ {
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '3151-8',
+ "display": 'Inhaled oxygen flow rate'
+ }
+ ],
+ "text": 'Oxygen Flow Rate'
+ },
+ "valueQuantity": {
+ "value": 7,
+ "unit": 'L/min',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'L/min'
+ }
+ },
+ {
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '3150-0'
+ }
+ ],
+ "text": 'FIO2'
+ },
+ "valueQuantity": {
+ "value": 21,
+ "unit": '%',
+ "system": 'http://unitsofmeasure.org',
+ "code": '%'
+ }
+ },
+ {
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '59408-5'
+ }
+ ],
+ "text": 'SpO2'
+ },
+ "valueQuantity": {
+ "value": 96,
+ "unit": '%',
+ "system": 'http://unitsofmeasure.org',
+ "code": '%'
+ }
+ }
+ ]
+ }.freeze
+
R4_OBSERVATION_LABS_CREATE ||= {
"resourceType": 'Observation',
"status": 'final',
@@ -1046,6 +1294,293 @@ module Resources
}
}.freeze
+ R4_OBSERVATION_VITALS_BP_UPDATE ||= {
+ "resourceType": 'Observation',
+ "id": 'BP-59857018-59857020',
+ "identifier": [
+ {
+ "system": 'https://fhir.cerner.com/ceuuid',
+ "value": 'CEfda49233-ccfa-4ed4-afbc-9f5082c2bf0c-59857018-2022111805415000'
+ },
+ {
+ "system": 'https://fhir.cerner.com/ceuuid',
+ "value": 'CEfda49233-ccfa-4ed4-afbc-9f5082c2bf0c-59857020-2022111805415000'
+ }
+ ],
+ "status": 'corrected',
+ "category": [
+ {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/observation-category',
+ "code": 'vital-signs',
+ "display": 'Vital Signs'
+ }
+ ],
+ "text": 'Vital Signs'
+ }
+ ],
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '85354-9',
+ "display": 'Blood pressure panel with all children optional'
+ }
+ ],
+ "text": 'Blood pressure'
+ },
+ "subject": {
+ "reference": 'Patient/15116458'
+ },
+ "encounter": {
+ "reference": 'Encounter/15687784'
+ },
+ "effectiveDateTime": '2022-06-09T08:00:58.000Z',
+ "issued": '2022-06-09T08:00:58.000Z',
+ "performer": [
+ {
+ "extension": [
+ {
+ "valueCodeableConcept": {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/v3-ParticipationType',
+ "code": 'LA',
+ "display": 'legal authenticator'
+ }
+ ],
+ "text": 'legal authenticator'
+ },
+ "url": 'http://hl7.org/fhir/StructureDefinition/event-performerFunction'
+ }
+ ],
+ "reference": 'Practitioner/15441459'
+ }
+ ],
+ "component": [
+ {
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '8480-6'
+ }
+ ],
+ "text": 'Systolic Blood Pressure Sitting'
+ },
+ "valueQuantity": {
+ "value": 99,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "interpretation": [
+ {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation',
+ "code": 'N',
+ "display": 'Normal'
+ }
+ ]
+ }
+ ],
+ "referenceRange": [
+ {
+ "low": {
+ "value": 35,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "high": {
+ "value": 37,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "type": {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/referencerange-meaning',
+ "code": 'normal',
+ "display": 'Normal Range'
+ }
+ ],
+ "text": 'Normal Range'
+ }
+ }
+ ]
+ },
+ {
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '8462-4'
+ }
+ ],
+ "text": 'Diastolic Blood Pressure Sitting'
+ },
+ "valueQuantity": {
+ "value": 66,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "interpretation": [
+ {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation',
+ "code": 'N',
+ "display": 'Normal'
+ }
+ ]
+ }
+ ],
+ "referenceRange": [
+ {
+ "low": {
+ "value": 35,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "high": {
+ "value": 37,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "type": {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/referencerange-meaning',
+ "code": 'normal',
+ "display": 'Normal Range'
+ }
+ ],
+ "text": 'Normal Range'
+ }
+ }
+ ]
+ }
+ ]
+ }.freeze
+
+ R4_OBSERVATION_VITALS_PO_UPDATE ||= {
+ "resourceType": 'Observation',
+ "id": 'VS-CV-83059963-SECT-8098',
+ "identifier": [
+ {
+ "system": 'https://fhir.cerner.com/cvuuid',
+ "value": '8344a9b7-b1b7-406e-b303-1009edd66459'
+ }
+ ],
+ "status": 'amended',
+ "category": [
+ {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/observation-category',
+ "code": 'vital-signs',
+ "display": 'Vital Signs'
+ }
+ ],
+ "text": 'Vital Signs'
+ }
+ ],
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '2708-6',
+ "display": 'Oxygen saturation in Arterial blood'
+ },
+ {
+ "system": 'http://loinc.org',
+ "code": '59408-5',
+ "display": 'Oxygen saturation in Arterial blood by Pulse oximetry'
+ }
+ ],
+ "text": 'SpO2'
+ },
+ "subject": {
+ "reference": 'Patient/12457979'
+ },
+ "encounter": {
+ "reference": 'Encounter/97787491'
+ },
+ "effectiveDateTime": '2022-06-05T08:00:38.022Z',
+ "issued": '2022-06-05T08:00:56Z',
+ "performer": [
+ {
+ "extension": [
+ {
+ "valueCodeableConcept": {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/v3-ParticipationType',
+ "code": 'LA',
+ "display": 'legal authenticator'
+ }
+ ],
+ "text": 'legal authenticator'
+ },
+ "url": 'http://hl7.org/fhir/StructureDefinition/event-performerFunction'
+ }
+ ],
+ "reference": 'Practitioner/15441459'
+ }
+ ],
+ "valueQuantity": {
+ "value": 44,
+ "unit": '%',
+ "system": 'http://unitsofmeasure.org',
+ "code": '%'
+ },
+ "component": [
+ {
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '3151-8',
+ "display": 'Inhaled oxygen flow rate'
+ }
+ ],
+ "text": 'Oxygen Flow Rate'
+ },
+ "valueQuantity": {
+ "value": 55,
+ "unit": 'L/min',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'L/min'
+ }
+ },
+ {
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '3150-0',
+ "display": 'Inhaled oxygen concentration'
+ }
+ ],
+ "text": 'FIO2'
+ },
+ "valueQuantity": {
+ "value": 66,
+ "unit": '%',
+ "system": 'http://unitsofmeasure.org',
+ "code": '%'
+ }
+ }
+ ]
+ }.freeze
+
R4_OBSERVATION_REVINCLUDE_BUNDLE ||= {
'resourceType': 'Bundle',
'id': '79c71e5b-2793-4ace-bc5e-190e38784e80',
diff --git a/lib/resources/r4/observation.yaml b/lib/resources/r4/observation.yaml
index e26ca7577..49cbd7f73 100644
--- a/lib/resources/r4/observation.yaml
+++ b/lib/resources/r4/observation.yaml
@@ -625,7 +625,7 @@ fields:
- - Laboratory support `valueQuantity`, `valueCodeableConcept`, `valueString` and `valueDateTime`.
+ - Laboratory support `valueQuantity`, `valueCodeableConcept`, `valueString`, `valueAttachment` and `valueDateTime`.
url: https://hl7.org/fhir/R4/observation-definitions.html#Observation.value[x]
@@ -1105,3 +1105,161 @@ fields:
- display: v4 data absentreason
system: http://terminology.hl7.org/CodeSystem/data-absent-reason
info_link: https://hl7.org/fhir/R4/valueset-data-absent-reason.html
+
+- name: component
+ required: 'No'
+ type: List of BackboneElement
+ description:
+ Some observations have multiple component observations. These component observations are expressed as separate code
+ value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood
+ pressure measurement and multiple component observations for genetics observations.
+ action:
+ - create
+ - update
+ example: |
+ {
+ "code": {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '8480-6'
+ }
+ ],
+ "text": 'Systolic Blood Pressure Invasive'
+ },
+ "valueQuantity": {
+ "value": 120,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "interpretation": [
+ {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation',
+ "code": 'N'
+ }
+ ]
+ }
+ ],
+ "referenceRange": [
+ {
+ "low": {
+ "value": 45.0,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "high": {
+ "value": 75.0,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "type": {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/referencerange-meaning',
+ "code": 'normal'
+ }
+ ],
+ "text": 'Normal Range'
+ }
+ }
+ ]
+ }
+ url: https://hl7.org/fhir/R4/observation-definitions.html#Observation.component
+ note: |
+
+ - Component is required to create blood pressure.
+
+ children:
+
+ - name: code
+ required: 'Yes'
+ type: CodeableConcept
+ description: Describes what was observed. Sometimes this is called the observation "name".
+ example: |
+ {
+ "coding": [
+ {
+ "system": 'http://loinc.org',
+ "code": '8480-6'
+ }
+ ],
+ "text": 'Systolic Blood Pressure Invasive'
+ }
+ url: https://hl7.org/fhir/R4/observation-definitions.html#Observation.component.code
+
+ - name: value[x]
+ required: 'No'
+ type: List of CodeableConcept
+ description: The information determined as a result of making the observation, if the information has a simple value.
+ example: |
+ {
+ "value": 120,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ }
+ note: |
+
+ - Supports writing observations with only valueQuantity.
+
+ url: https://hl7.org/fhir/R4/observation-definitions.html#Observation.component.value[x]
+
+ - name: interpretation
+ required: 'No'
+ type: List of CodeableConcept
+ description: A categorical assessment of an observation value. For example, high, low, normal.
+ example: |
+ {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation',
+ "code": 'N'
+ }
+ ],
+ "text": 'NORMAL'
+ }
+ note: |
+
+ - Only one interpretation may be supplied.
+
+ url: https://hl7.org/fhir/R4/observation-definitions.html#Observation.component.interpretation
+
+ - name: referenceRange
+ required: 'No'
+ type: CodeableConcept
+ description: Guidance on how to interpret the value by comparison to a normal or recommended range.
+ example: |
+ {
+ "low": {
+ "value": 45.0,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "high": {
+ "value": 75.0,
+ "unit": 'mmHg',
+ "system": 'http://unitsofmeasure.org',
+ "code": 'mm[Hg]'
+ },
+ "type": {
+ "coding": [
+ {
+ "system": 'http://terminology.hl7.org/CodeSystem/referencerange-meaning',
+ "code": 'normal'
+ }
+ ],
+ "text": 'Normal Range'
+ }
+ }
+ note: |
+
+ - Only one referenceRange is supported
+ - `ReferenceRange.text` is not supported when `referenceRange.high` and/or `referenceRange.low` are provided. Only a referenceRange.type of `normal` is supported.
+
+ url: https://hl7.org/fhir/R4/observation-definitions.html#Observation.component.referenceRange