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Finnish PHR Implementation Guide STU3

Finnish PHR Urinary Monitoring Profiles

Urinary monitoring profiles define data contents of the urinary monitoring measurements self-made by citizen.

All urinary monitoring 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 Urinary Monitoring Profiles are based on the FHIR STU3 Urinary Monitoring profile for the FHIR Observation resource.

Finnish PHR Urinary Monitoring Base profile defines profiled elements used in all urinary monitoring observations. This base profile can not be used as a resource instance, it is a base definition for other urinary monitoring profiles.

The profiles based on the Finnish PHR Urinary Monitoring Base profile:

  • Finnish PHR Urine Output profile: Finnish PHR profile for observation used in urine output measurements.
  • Finnish PHR Urine Flow Max profile: Finnish PHR profile for observation used in urine flow max measurements.
  • Finnish PHR Urinary Incontinence profile: Finnish PHR profile for observation used in urine incontinence measurements.

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Finnish PHR Urinary Monitoring Base Profile

The Finnish PHR Urinary Monitoring Base Profile for FHIR® Observation 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 urinary monitoring related 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 Urinary Monitoring profiles

Table of Mandatory elements for all Finnish PHR Urinary Monitoring profiles
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.
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

One globally unique identifier SHALL be provided for the observation. NB! Will be updated to match the Finnish PHR Vital Signs UPDATED profile

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 FHIR Observation Status ValueSet).
Category of the observation category Indicates to what category the observation belongs to.
All urinary monitoring related data SHALL have the category 'urinary-monitoring' (from Finnish PHR Observation Category ValueSet).
Code of the observation code

Determines what the observation is (ie. measurement of urine output, urine flow max, etc.). Codes are allowed only from the LOINC code system, all the allowed codes can be found in Finnish PHR Urinary Monitoring ValueSet.

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

Optional elements for all Finnish PHR Urinary Monitoring profiles

Table of Optional elements for all Finnish PHR Urinary Monitoring profiles
Content Name in structure Description / Type of information
Actual result value[x]

Includes the observation result, for example in a urine output observation the actual measured amount of urine output.

The unit of measurement that SHALL be used will be determined in the derived profiles for each different type of observation.
Interpretation interpretation The assessment made based on the result of the observation, for exapmle whether the result is normal or abnormal, or high or low. If a coding is provided, the code SHALL be from FHIR Observation Interpretation.
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.

Elements in the profile filled by the Kanta PHR platform

Table of 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 the 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 Urine Output Profile

Finnish PHR profile for FHIR® Observation used in urine output measurements.

The profile is based on the Finnish PHR Urinary Monitoring Base profile. 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 himself 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 Urine Output Profile constrains the Finnish PHR Urinary Monitoring Base Profile as follows:

Mandatory elements for Finnish PHR Urine Output

Table of Mandatory elements for Finnish PHR Urine Output
Content Name in structure Description / Type of information
Code for urine output code A urine output observation SHALL have the code 9187-6 Urine output from the LOINC code system.
Actual result valueQuantity The measured amount of the urine output. SHALL always be provided with the unit of measurement ml.

Finnish PHR Urine Flow Max Profile 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>)
  • Comment: <Observation.comment>
  • Method: <Observation.method>
  • Device: <Observation.device>
  • Reference range: <Observation.referenceRange>

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

Example:

Code: Maximum Urine flow by Uroflowmetry (80519-2)
Time: 18.11.2018 12:03
Result: 9 ml/s

Examples of Urine Output resources


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Finnish PHR Urine Flow Max Profile

Finnish PHR profile for FHIR® Observation used in urine flow max measurements.

The profile is based on the Finnish PHR Urinary Monitoring Base profile. 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 himself 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 Urine Flow Max Profile constrains the Finnish PHR Urinary Monitoring Base Profile as follows:

Mandatory elements for Finnish PHR Urine Max Flow

Table of Mandatory elements for Finnish PHR Urine Flow Maximum
Content Name in structure Description / Type of information
Code for urine flow max code A urine flow max observation SHALL have the code 80519-2 Maximum Urine flow by Uroflowmetry from the LOINC code system.
Actual result valueQuantity The measured urine flow max. SHALL always be provided with the unit of measurement ml/s.

Finnish PHR Urine Flow Max Profile 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>)
  • Comment: <Observation.comment>
  • Method: <Observation.method>
  • Device: <Observation.device>
  • Reference range: <Observation.referenceRange>

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

Example:

Code: Maximum Urine flow by Uroflowmetry (80519-2)
Time: 18.11.2018 12:03
Result: 9 ml/s

Example of Urine Flow Max resources


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Finnish PHR Urinary Incontinence Profile

Finnish PHR profile for FHIR® Observation used in urinary incontinence evaluations.

The profile is based on the Finnish PHR Urinary Monitoring Base profile. 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 himself 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 Urinary Incontience Profile constrains the Finnish PHR Urinary Monitoring Base Profile as follows:

Mandatory elements for Finnish PHR Urine Incontience

Mandatory elements table for Finnish PHR Urinary Incontinence profile
Content Name in structure Description / Type of information
Code for urinary incontience code A urinary incontinence observation SHALL have the code 9185-0 Fluid output urinary incontinence Estimation from the LOINC code system.
Actual result valueCodeableConcept The self-estimated amount of urine incontience. The estimation SHALL always be provided with the scale + (minor), ++ (moderate) or +++ (substantial).

Finnish PHR Urinarinary Incontinence Profile 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.valueCodeableConcept.code>

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

  • Interpretation: <Observation.interpretation.coding.display> (<Observation.interpretation.coding.code>)
  • Comment: <Observation.comment>
  • Method: <Observation.method>
  • Device: <Observation.device>
  • Reference range: <Observation.referenceRange>

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

Example:

Code: Fluid output urinary incontinence Estimated (9185-0)
Time: 18.11.2018 12:03
Result: ++

Examples of Finnish PHR Urinanry incontinence resources in Simplifier


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