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Finnish PHR Vital Signs Profiles

Vital signs profiles define data contents of the vital signs measurements self-made by citizen.

All vital signs profiles defined in this Finnish PHR Implementation Guide constrain and extend FHIR® Observation resource. The FHIR Observation resource is not profiled directly. The Finnish PHR Vital Signs Profiles are based on the FHIR R4 Vital Signs profile for the FHIR Observation resource.

Finnish PHR Vital Signs Base profile defines profiled elements used in all vital signs observations. This base profile can not be used as a resource instance, it is a base definition for other vital signs profiles.


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Finnish PHR Vital Signs Base profile

The Finnish PHR Vital Signs Base Profile constrains and extends the FHIR® Vital Signs profile for FHIR® Observation.
Read more about the FHIR® Vital Signs profile
Read more about the FHIR® Observation

This Finnish PHR profile defines profiled elements used in all other Finnish PHR profiles derived from this profile. This base profile can not be used as a resource instance, it is a base definition (abstract) for other Finnish PHR vital signs profiles.

A full list of the extensions, constraints and a structured definition of this profile can be found in Simplifier. There are also different views of the profile (details, mappings, table, XML, JSON).

Mandatory elements for all Finnish PHR vital signs

Mandatory elements for all Finnish PHR vital signs
Content Name in structure Description / Type of information
Language language Language used in the observation stored in Kanta PHR.
Language SHALL be chosen from the FHIR languages ValueSet. Read more about the FHIR languages ValueSet.
Narrative text A text summary of the observation. SHALL include all content for a human to understand the essential clinical and business information of the observation.

A narrative guide will be provided for each of the derived profiles.
Unique identifier identifier At least one globally unique identifier has to be provided for the observation, in addition other identifiers may be given as well.

This identifier may be used to uniquely identify the observation if the application doesn't receive an id for the observation provided by Kanta PHR.
Status status The status of the observation.
Only completed observations are stored in Kanta PHR, thus the status SHALL always be 'final' from the FHIR Observation Status ValueSet. Read more about the FHIR Observation Status ValueSet.
Category of the observation category Indicates to what category the observation belongs to.
All vital signs SHALL have the category 'vital-signs' from the FHIR Observation Category ValueSet. Read more about the FHIR Observation Category ValueSet.

In addition, other codes for the same meaning from other codesystems can be used.
Code of the observation code Determines what the observation is (ie. a measurement of blood pressure, blood glucose, height, etc.).

The exaxt code(s) to be used will be determined in the derived profile for each kind of an observation.

In addition, other codes for the same meaning from other codesystems can be used.
Subject of the observation subject Who this observation is about. The reference SHALL be to a Patient resource stored in Kanta PHR that conforms to the Finnish PHR Patient profile. Read more about the Finnish PHR Patient profile.
Time for the observation effectiveDateTime Clinically relevant time for the observation.

The precision of time will vary depending on what kind of an observation is in question. For example in some cases, the time for the observation may include the exact date and time when the observation was made. In other cases, only the date will be stored.
Storing date issued The date and time the observation was stored in Kanta PHR.
Who is responsible for the observation performer This may be the same as the subject, or this may be another person for example when someone is using Kanta PHR on behalf of the subject. The reference SHALL be to a Patient resource stored in Kanta PHR that conforms to the Finnish PHR Patient profile. Read more about the Finnish PHR Patient profile.

Optional elements for all Finnish PHR vital signs

Optional elements table for all Finnish PHR vital signs
Content Name in structure Description / Type of information
Actual result value[x]/
component
Includes the observation result, for example in a height observation the actual measured height, or in a blood glucose observation the actual measured blood glucose level.
In some observations, the actual result has multiple components (for example a blood pressure measurement has a systolic and a diastolic value). In these kind of observations, the actual result is stored under the component structure.
Either the actual result or a reason for why the (structured) result is missing (see below) SHALL be provided.

The unit of measurement that SHALL be used will be determined in the derived profiles for each different kind of an observation.
A reason why the (structured) result is missing dataAbsentReason Indicates the reason why the (structured) result is missing. The code for the reason from the FHIR Observation Data Absent Reason ValueSet SHALL be used. Read more about the FHIR Observation Value Absent Reason ValueSet.

In addition, other codes for the same meaning from other codesystems can be used.

This might be used for example when a device or an application is for some reason unable to provide the result in a structured form and has to store it only in the Narrative.
Interpretation interpretation The assessment made based on the result of the observation, for example whether the result is normal or abnormal, or high or low. If a coding is provided, the code be from the FHIR Observation Interpretation ValueSet SHALL be used. Read more about the FHIR Observation Interpretation ValueSet.

In addition, other codes for the same meaning from other codesystems can be used.
Comments about the result comment May include for example statements about significant, unexpected or unreliable values, or information about the source of the value where this may be relevant to the interpretation of the result.
Reference range referenceRange A reference range may be given to provide guidance on how to interpret the value by comparison to a normal or recommended range.

Elements in the profile filled by the Kanta PHR platform

Table for elements in the profile filled by the Kanta PHR platform
Content Name in structure Description / Type of information
Application that created or updated the observation extension:
creatingApplication
Is used to represent information about the application (id and name) that created or updated resource. See the definition for the Finnish PHR Application Information extension.

Kanta PHR platform will fill in this data automatically to each stored observation (if the application has entered some data in this extension, it will be overwitten).


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Finnish PHR Blood Glucose profile

Finnish PHR profile for FHIR® Observation used in blood glucose measurements. Read more about the FHIR® Observation (hl7.org).

This profile is based on the Finnish PHR Vital Signs Base Profile. This profile alone does not describe all the elements needed and most of the elements are visible only in the page of the base profile. This profile describes only the changes made to the base profile, and the implementers must also familiarize themself with the base profile. Read more about the Finnish PHR Vital Signs Base Profile.

A full list of the extensions, constraints and a structured definition of this profile can be found in Simplifier. There are also different views of the profile (details, mappings, table, XML, JSON).

The Finnish PHR Blood Glucose Profile constrains the Finnish PHR Vital Signs Base Profile as follows:

Mandatory elements for Finnish PHR Blood Glucose

Mandatory elements table Finnish PHR Blood Glucose profile
Content Name in structure Description / Type of information
Code for blood glucose code The following codes from the LOINC code system SHALL be used. Read more about the LOINC code system.
- Home glucometer readings SHALL have both of the codes 15074-8 Glucose (mmol/l) in Blood and 14743-9 Glucose (mmol/l) in Capillary blood by Glucometer.
- CGM readings SHALL have the code 14745-4 Glucose (mmol/l) in Body fluid.
- At least one code SHALL be given.

- In addition, other codes for the same meaning from other codesystems can be used.

Optional elements for Finnish PHR Blood Glucose

Mandatory elements table Finnish PHR Blood Glucose profile
Content Name in structure Description / Type of information
Meal context extension:
hoursAfterMeal
Describes how many hours after meal the measurement is done. See the definition for Finnish PHR UnsignedInt extension.

Used when interpreting the result.
Actual result valueQuantity The measured blood glucose level.
SHALL always be provided with the unit of measurement mmol/l.

A comparator (< / <= / >= / >) from the FHIR Quantity Comparator ValueSet may be used, if the result is out of the device's measurement scale. Read more about the FHIR Quantity Comparator ValueSet.
Actual result in an alternative unit valueQuantity.extension:
alternativeQuantity
The measured result with an alternative unit of measurement mg/dl.


Often devices used for measuring blood glucose levels provide the result with the unit of measurement mg/dl. This result may be stored in this extension, in addition to providing the result in the unit of measurement mmol/l as described above.
A comparator (< / <= / >= / >) from the FHIR Quantity Comparator ValueSet may be used, if the result is out of the device's measurement scale. Read more about the FHIR Quantity Comparator ValueSet.
A reason why the (structured) result is missing dataAbsentReason If the measured result cannot be stored in the valueQuantity structure, the reason for that SHALL be provided here. Code SHALL be from the FHIR Observation Data Absent Reason ValueSet. Read more about the FHIR Observation Value Absent Reason ValueSet.
- Code 'astext' SHALL be used when the result can still be presented in the Narrative.
- Code 'error' SHALL be used, if a device has been actively trying to measure the blood glucose, but has failed for some reason.
- No other codes are allowed.

Elements not in use for Finnish PHR Blood Glucose

  • component

Narrative guide

Narrative SHALL contain following mandatory information taken from the elements of the resource instance:

  • Code: <Observation.code.coding.display> (<Observation.code.coding.code>)< br>
    <Observation.code.coding.display> (<Observation.code.coding.code>)
  • Time: <Observation.effectiveDateTime>
  • Result: <Observation.valueQuantity.comparator><Observation.valueQuantity.value><Observation.valueQuantity.unit> NB! If the valueQuantity is missing and the code for dataAbsentReason is 'astext': the result SHALL be provided here in a human readable and understandable format. If the valueQuantity is missing and the code dataAbsentReason is 'error': <Observation.dataAbsentReason.coding.display>

Narrative SHOULD contain following optional information if given in the resource instance:

  • Hours After Meal: <Observation.extension:hoursAfterMeal >
  • Interpretation: <Observation.interpretation.coding.display> (<Observation.interpretation.coding.code>)
  • Note: <Observation.Note>
  • Reference range: <Observation.referenceRange.low.value> <Observation.referenceRange.high.value>

If an element is missing from the resource, it shall not be mentioned in narrative.

Narrative example:

Code: Glucose [mmol/l] in Blood (15074-8)
Glucose [mmol/l] in Capillary blood by Glucometer (14743-9)
Time: 18.9.2017 12:01
Result: 5,8 mmol/l
Hours After Meal: 2

Examples of Finnish PHR Blood Glucose resources in Simplifier



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Finnish PHR Blood Pressure profile

Finnish PHR profile for FHIR® Observation used in blood pressure measurements.

The profile is based on the Finnish PHR Vital Signs Base profile UPDATED. This profile alone does not describe all the elements needed and most of the elements are visible only in base profile. This profile describes changes to the base profile and the implementers must also familiarize themself with the base profile.

A full list of the extensions, constraints and a structured definition of this profile can be found in Simplifier. There are also different views of the profile (details, mappings, table, XML, JSON).

The Finnish PHR Blood Pressure profile constrains the Finnish PHR Vital Signs Base Profile as follows:

Mandatory elements for Finnish PHR Blood Pressure

Observation subject and performer has to reference to FinnishPatient.

Mandatory elements table for Finnish PHR Blood pressure profile
Content Name in structure Description / Type of information
Code for blood pressure code A blood pressure observation SHALL have the code 85354-9 Blood pressure panel with all children optional from theLOINC code system. Read more about the LOINC code system

- In addition, other codes for the same meaning from other codesystems can be used.
Actual result component The measured systolic and diastolic values of the blood pressure. The systolic value SHALL have the code 8480-6 Systolic blood pressure and the diastolic value the code 8462-4 Diastolic blood pressure from the LOINC code system. Read more about the LOINC code system. Both values SHALL be provided with the unit of measurement mm[Hg].

- In addition, other codes for the same meaning from other codesystems can be used.

Optional elements for Finnish PHR Blood Pressure

Optional elements table for Finnish PHR Blood pressure profile
Content Name in structure Description / Type of information
A reason why the (structured) result is missing component.dataAbsentReason If the measured result cannot be stored in the valueQuantity structure, the reason for that SHALL be provided here. Code SHALL be from the FHIR Observation Data Absent Reason ValueSet. Read more about the FHIR Observation Value Absent Reason ValueSet.
Interpretation component.interpretation The assessment made based on the result of the observation, for example whether the result is normal or abnormal, or high or low. If a coding is provided, the code be from the FHIR Observation Interpretation ValueSet SHALL be used. Read more about the FHIR Observation Interpretation ValueSet.

In addition, other codes for the same meaning from other codesystems can be used.
Reference range component.referenceRange A reference range may be given to provide guidance on how to interpret the value by comparison to a normal or recommended range.

Elements not in use for Finnish PHR Blood Pressure

  • value[ x]
  • dataAbsentReason

Narrative guide

Narrative SHALL contain following mandatory information taken from the elements of the resource instance:

  • Code: <Observation.code.coding.display>(<Observation.code.coding.code>)
  • Time: <Observation.effectiveDateTime>
  • Result: <Observation.component.code.coding.display>(<Observation.component.code.coding.code>) <Observation.component.valueQuantity.value><Observation.component.valueQuantity.unit> <Observation.component.code.coding.display>(<Observation.component.code.coding.code>) <Observation.component.valueQuantity.value><Observation.component.valueQuantity.unit>

Narrative SHOULD contain following optional information if given in the resource instance:

  • Interpretation: <Observation.interpretation.coding.display> (<Observation.interpretation.coding.code>)
  • Note: <Observation.Note>
  • Reference range: <Observation.component.referenceRange> per component

If element is missing from resource, it shall not be mentioned in narrative.

Example:

Code: Blood pressure (85354-9)
Time: 18.9.2017 12:01
Result: Systolic blood pressure (8480-6): 120 mm[Hg], Diastolic blood pressure (8462-4): 80  mm[Hg]

Examples of Finnish PHR Blood Pressure resources in Simplifier


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Finnish PHR Body Weight profile

Finnish PHR profile for FHIR® Observation used in body weight measurements. Read more about the FHIR® Observation (hl7.org).

This profile is based on the Finnish PHR Vital Signs Base Profile. This profile alone does not describe all the elements needed and most of the elements are visible only in the page of the base profile. This profile describes only the changes made to the base profile, and the implementers must also familiarize themself with the base profile. Read more about the Finnish PHR Vital Signs Base Profile.

A full list of the extensions, constraints and a structured definition of this profile can be found in Simplifier. There are also different views of the profile (details, mappings, table, XML, JSON).

The Finnish PHR Body Weight profile constrains the Finnish PHR Vital Signs Base Profile as follows:

Mandatory elements for Finnish PHR Body Weight

Mandatory elements table Finnish PHR Blood Glucose profile
Content Name in structure Description / Type of information
Code for body weight code A body weight observation SHALL have the code 29463-7 Body weight from the LOINC code system. Read more about the LOINC code system

- In addition, other codes for the same meaning from other codesystems can be used.
Actual result valueQuantity The measured body weight. SHALL always be provided with the unit of measurement kg.

Elements not in use for Finnish PHR Body Weight

  • dataAbsentReason
  • component

Narrative guide

Narrative SHALL contain following mandatory information taken from the elements of the resource instance:

  • Code: <Observation.code.coding.display>(<Observation.code.coding.code>)
  • Time: <Observation.effectiveDateTime>
  • Result: <Observation.valueQuantity.value><Observation.valueQuantity.unit>

Narrative SHOULD contain following optional information if given in the resource instance:

  • Interpretation: <Observation.interpretation.coding.display> (<Observation.interpretation.coding.code>)
  • Note: <Observation.Note>
  • Reference range: <Observation.referenceRange>

If element is missing from resource, it shall not be mentioned in narrative.

Example:

Code: Body weight (29463-7)
Time: 18.9.2017 12:01
Result: 95 kg

Examples of Finnish PHR Body Weight resources in Simplifier


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