Guidance for populating and consuming the Observation profile for blood pressure

Introduction

The headings below list the elements of the Observation profile and describe how to populate and consume them for blood pressure data.

Observation elements

id

Data type: Id Optionality: Mandatory Cardinality: 1..1

The logical identifier of the uncategorised data Observation profile.

meta.profile

Data type: uri Optionality: Mandatory Cardinality: 1..1

The Observation profile URL.

Fixed value https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1

identifier

Data type: Identifier Optionality: Mandatory Cardinality: 1..*

This MUST be populated with a globally unique and persistent identifier (that is, it doesn’t change between requests and is therefore stored with the source data). This MUST be scoped by a provider specific namespace for the identifier.

There may be more than one identifier where data has been migrated across practices or provider systems and different provider specific identifiers have been assigned.

Where consuming systems are integrating data from this resource to their local system, they MUST also persist this identifier at the same time.

status

Data type: status Optionality: Mandatory Cardinality: 1..1

Fixed value of final.

code

Data type: CodeableConcept Optionality: Mandatory Cardinality: 1..1

The clinical code that represents the header or panel of the blood pressure.

Where there is an appropriate header code for a recognised triple recorded in the providing GP system this MUST be populated here.

If there is no header/panel code and only the code(s) for systolic and/or diastolic components are recorded, then this MUST be populated with the SNOMED codes conceptID ‘75367002’ and the descriptionID of the preferred term ‘125176019’ which has the description ‘Blood pressure’ and is an observable entity.

subject

Data type: Reference(Patient) Optionality: Mandatory Cardinality: 1..1

Reference to Patient profile representing the patient against whom the data was recorded.

context

Data type: Reference(Encounter) Optionality: Required Cardinality: 0..1

Optional reference to the Encounter profile representing the consultation context in which the blood pressure was recorded.

effectiveDateTime

Data type: DateTime, Period Optionality: Required Cardinality: 0..1

Clinically relevant time/time-period for observation

issued

Data type: Instance Optionality: Mandatory Cardinality: 1..1

The audit trail timestamp representing when the data was recorded.

performer

Data type: Reference(Practitioner) Optionality: Mandatory Cardinality: 1..*

The Practitioner profile representing the clinician responsible for making the observation.

Where the observation was performed at another organisation and an organisation profile can be populated, then that MUST be populated here. This will be in addition to the clinical practitioner if both are available.

If neither the performing organisation or the clinical practitioner is known then this MUST be populated with the details of the person that recorded the data in the system.

interpretation

Data type: CodeableConcept Optionality: Required Cardinality: 0..1

This element is populated where there is an explicit, clinical interpretation for the overall blood pressure reading which is not specific to the systolic and / or diastolic readings. Populate the component.interpretation where the interpretation relates to the systolic or diastolic reading.

comment

Data type: String Optionality: Required Cardinality: 0..1

This MUST include any qualifiers to the code element that were present in the sending system. These should be reported as a code and value pair as specified in the uncategorised data guidance.

It MUST also include any text relating to the observation.

bodysite

Data type: CodeableConcept Optionality: Required Cardinality: 0..1

Bodysite from which the observation was taken.

Data type: BackboneElement Optionality: Required Cardinality: 0..*

Contains any hierarchical information between uncategorised data items.

  • Populate related.target with a reference to the related item of uncategorised data
  • Where the related item is a child of this item set related.type to has-member
  • Where the related item is a parent of this item set related.type to derived-from

systolic component

component.code

Data type: CodeableConcept Optionality: Mandatory Cardinality: 1..1

The clinical code that represents systolic part of the blood pressure.

A list of the systolic blood pressure codes is included in the uncategorised guidance page here.

component.valueQuantity

Data type: Quantity Optionality: Required Cardinality: 0..1

The value of the observation. This MUST be a ‘quantity’ data type and the units used MUST be ‘mm[Hg]’.

component.dataAbsentReason

Data type: CodableConcept Optionality: Required Cardinality: 0..1

If there is no code or value in this component, then a data absent reason may be populated.

component.interpretation

Data type: CodeableConcept Optionality: Required Cardinality: 0..1

A human-readable clinical summary relating to a test result and/or additional notes provided by the laboratory - for example, the specimen has haemolysed or has leaked.

component.referenceRange

Data type: BackboneElement Optionality: Required Cardinality: 0..*

The reference range provides a guide for interpretation of the results.

Where a reference range contains a less than ‘<’ or greater than ‘>’ operator it should be written to the referenceRange.text element as these operators are not supported in this context.

diastolic component

component.code

Data type: CodeableConcept Optionality: Mandatory Cardinality: 1..1

The clinical code that represents diastolic part of the blood pressure.

A list of the systolic blood pressure codes is included in the uncategorised guidance page here.

component.valueQuantity

Data type: Quantity Optionality: Required Cardinality: 0..1

The value of the observation. This MUST be a ‘quantity’ data type and the units used MUST be ‘mm[Hg]’.

component.dataAbsentReason

Data type: CodableConcept Optionality: Required Cardinality: 0..1

If there is no value in this component then a data absent reason may be populated.

component.interpretation

Data type: CodeableConcept Optionality: Required Cardinality: 0..1

A human-readable clinical summary relating to a test result and/or additional notes provided by the laboratory - for example, the specimen has haemolysed or has leaked.

component.referenceRange

Data type: BackboneElement Optionality: Required Cardinality: 0..*

The reference range provides a guide for interpretation of the results.

Where a reference range contains a less than ‘<’ or greater than ‘>’ operator it should be written to the referenceRange.text element as these operators are not supported in this context.


Elements not in use

The following elements MUST NOT be populated:

basedOn

Data type: Reference

category

Data type: CodeableConcept

method

Data type: CodeableConcept

specimen

Data type: Reference

device

Data type: BackboneElement


The following elements MUST NOT be populated at the panel/header level:

value

Data type: Many

referenceRange

Data type: CodeableConcept