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Finnish PHR Implementation Guide STU3

Finnish PHR Fitness Profiles

All fitness profiles defined in this Finnish PHR Implementation Guide constrain and extend FHIR® Observation resource.

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

The profiles based on the Finnish PHR Fitness Base profile:

  • Finnish PHR Steps Taken profile: Finnish PHR profile for observation used in measuring taken steps.
  • Finnish PHR Moderate to Vigorous Physical Activity Time profile: Finnish PHR profile for observation used in measuring moderate to vigorous physical activity time.
  • Finnish PHR Distance profile: Finnish PHR profile for fitness device measurement or patient-reported distance reached over a time period.
  • Finnish PHR Calories Burned profile: Finnish PHR profile for observation used in fitness measurements made about a patient.

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Finnish PHR Fitness Base Profile

The Finnish PHR Fitness Base Profile has been partly derived from FHIR® Vital Signs STU3 profile for FHIR® Observation in order to create a base for citizen's self-measured and -reported fitness related observations available in marketplace today, but not yet supported by observation categories in the FHIR® global standard. There are cases where automatically collected or self-reported citizen data may include observations belonging to both Fitness and Vital Signs categories (e.g. active time and resting heart rate on a given day), thus the two base profiles should be treated rather as siblings.

Finnish PHR Fitness Base 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 fitness 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 Fitness data

Mandatory elements table for all Finnish PHR Fintess 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 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 FHIR Observation Status ValueSet).
Category of the observation category Indicates to what category the observation belongs to.
All fitness data SHALL have the category 'fitness' (from Finnish PHR Fitness Category ValueSet).
Code of the observation code Determines what the observation is (ie. steps taken, calories burned, etc.). All the allowed codes can be found in Finnish PHR Fitness Result 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 effective[x] Clinically relevant time or time-period 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. In some cases, a time-period may be given.
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 fo all Fitness Base profiles

Optional elements table for all Finnish PHR Fintess profiles
Content Name in structure Description / Type of information
Actual result value[x]/
component		 Includes the observation result, for example in a steps taken observation the actual number of measured steps.
In some observations, the actual result may have multiple components. In these kind of observations, the actual result is stored under the component structure.

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 example whether the result is normal or abnormal, or high or low. If a coding is provided, the code SHALL be from FHIR Observation Interpretation ValueSet.
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 Guidance on how to interpret the value by comparison to a normal or recommended range. (ie. range for the normal ammount of steps taken for some age group).

Elements in the profile filled by the Kanta PHR platform

Table for elements in the profile filled by 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 Steps Taken Profile

Finnish PHR profile for FHIR® Observation used in step count measurements. Either the amount of steps taken in 24 hours or in one week can be stored using this profile.

The profile is based on the Finnish PHR Fitness 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 Steps Taken Profile constrains the Finnish PHR Fitness Base Profile as follows:

Mandatory elements for Steps Taken

Mandatory elements table for steps taken
Content Name in structure Description / Type of information
Code for steps taken code All the codes are from the LOINC code system.
- A general code 66334-4 Steps taken SHALL always be given.
- In addition, one of the following optional codes MAY be given:
41950-7 Number of steps in 24 hour Measured.
41952-3 Number of steps in 1 week Measured.
Time for the observation effectiveDateTime/
effectivePeriod		 - When storing the amount of steps taken in 24 hours, the date during which the steps were taken SHALL be given.
- When storing the amount of steps taken in one week, the starting date and the end date of that week SHALL be given.
Actual result valueQuantity The amount of steps taken as an integer.

Elements not in use for Finnish PHR Steps Taken

  • 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> or <Observation.effectiveTimePeriod> (when reporting a weekly value)
  • Result: <Observation.valueQuantity.value>

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: Daily steps (41950-7)
Time: 18.9.2017
Result: 6491

Examples of Finnish PHR Steps Taken resources in Simplifier


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Moderate to Vigorous Physical Activity Time Profile

Finnish PHR profile for FHIR® Observation used in the measurements of physically active time in minutes (MET >=3) over a time period. Either the amount of physical activity in 24 hours or in one week can be stored using this profile.

The profile is based on the Finnish PHR Fitness 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 Moderate to Vigorous Physical Activity Time Profile constrains the Finnish PHR Fitness Base Profile as follows:

Mandatory elements for Finnis PHR Moderate to Vigorous Physical Activity Time

Mandatory elements table for Moderate to Vigorous Physical Activity Time
Content Name in structure Description / Type of information
Code for moderate to vigorous physical activity time code One of the following codes SHALL be given
- The amount of moderate to vigorous physical activity minutes in a week SHALL have the code 82290-8 Frequency of moderate to vigorous aerobic physical activity from the LOINC code system .
- The amount of moderate to vigorous pgysical activity minutes in 24 hours SHALL have code 82290-8-24h Daily moderate to vigorous physical activity in minutes from the Finnish PHR Fitness Result ValueSet.
Time for observation effectiveDateTime/
effectivePeriod		 - When storing the amount of physical activity in a week, the starting date and the end date of that week SHALL be given.
- When storing the amount of physical activity in 24 hours, the date during which measurement was done SHALL be given.
Actual result valueQuantity The amount of physical activity time. SHALL always be provided with the unit of measurement min.

Elements not in use for Finnish PHR Moderate to Vigorous Physical Activity Time

  • 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> or <Observation.effectiveTimePeriod> (when reporting a weekly value)
  • 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: Moderate to vigorous physical activity minutes in 24 hours (82290-8-24h)
Time: 16.3.2018
Result: 76 min

Examples of Finnish PHR Moderate to Vigorous Physical Activity Time resources in Simplifier


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Finnish PHR Calories Burned Profile

Finnish PHR profile for FHIR® Observation used in measurements of calories burned. Either the amount of calories burned in 24 hours or in one week can be stored using this profile.

The profile is based on the Finnish PHR Fitness 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 Calories Burned Profile constrains the Finnish PHR Fitness Base Profile as follows:

Mandatory elements for Finnish PHR Calories Burned

Mandatory elements table for in Calories Burned
Content Name in structure Description / Type of information
Code for calories burned code All the codes are from the LOINC code system .
- A general code 55421-2 Calories burned Machine estimate SHALL always be given.
- In addition, one of the following optional codes MAY be given:
41979-6 Calories burned in 24 hour Calculated
41980-4 Calories burned in 1 week Calculated
Time for the observation effectiveDateTime/
effectivePeriod		 - When storing the amount of calories burned in 24 hours, the date during which the measurement was done SHALL be given.
- When storing the amount of calories burned in one week, the starting date and the end date of that week SHALL be given.
Actual result valueQuantity The amount of the calories burned. SHALL always provided with the unit of measurement kcal.

Elements not in use for Finnish PHR Calories burned

  • 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> or <Observation.effectiveTimePeriod> (when reporting a weekly value)
  • 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: Calories burned (55421-2)
Time: 25.6.2019
Result: 2491kcal

Examples of Calories Burned resources


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Finnish PHR Distance Profile

Finnish PHR profile for FHIR® Observation used in measurements of distance reached. Either the amount of distance reached in 24 hours or in one week can be stored using this profile.

The profile is based on the Finnish PHR Fitness 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 Distance Profile constrains the Finnish PHR Fitness Base Profile as follows:

Mandatory elements for Finnish PHR Distance

Mandatory elements table for in Distance
Content Name in structure Description / Type of information
Code for distance code All the codes are from the LOINC code system.
- A general code 55430-3 Distance walked SHALL always be given.
- In addition, one of the following optional codes MAY be given:
41953-1 Distance walked in 24 hour
41955-6 Distance walked in 1 week.
Time for the observation effectiveDateTime/
effectivePeriod		 - When storing the distance reached in 24 hours, the date during which the measurement was done SHALL be given.
- When storing the distance reached in one week, the starting date and the end date of that week SHALL be given.
Actual result valueQuantity The measured distance reached. SHALL always be provided with the unit of measurement m.

Elements not in use for Finnish PHR Distance

  • 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> or <Observation.effectiveTimePeriod> (when reporting a weekly value)
  • 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: Walk distance  (55430-3)
Time: 25.6.2019
Result: 6491m

Examples of Distantce resources


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MET by Standard RMR profile

Finnish PHR profile for FHIR® Observation used in measurements of MET by Standard Resting Metabolic Rate.

The profile is based on the Finnish PHR Fitness 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 MET by Standard RMR Profile constrains the Finnish PHR Fitness Base Profile as follows:

Mandatory elements for Finnish PHR MET by standard RMR

Mandatory elements table for in MET Standard RMR
Content Name in structure Description / Type of information
Code for MET by Standard RMR code A MET by Standard RMR observation SHALL have the code 82260-1 MET by standard RMR panel from the LOINC code system.
Actual result component Slice standard-rmr SHALL be used with code 82284-1 Standard RMR from the LOINC code system and the value SHALL always be provided with the unit of measurement ml/kg/min.
In addition at least one of the following three combinations SHALL be used:
1. Measured-met slice SHALL have code 82261-9 Measured activity metabolic rate/Standard RMR from the LOINC code system and the value SHALL always be provided with the unit of measurement MET
2. Estimated-met slice SHALL have code 82262-7 Estimated activity metabolic rate/Standard RMR [Relative energy/Time] from the LOINC code system and the value SHALL always be provided with the unit of measurement MET. In addition code 82280-9 Source used to estimate activity metabolic rate from the LOINC code system SHOULD be used.
3. Reported-met slice SHALL have code 82263-5 Reported activity metabolic rate/Standard RMR [Relative energy/Time] from the LOINC code system and the value SHALL always be provided with the unit of measurement MET. In addition code 82281-7 Source used for reported activity metabolic rate from the LOINC code system SHOULD be used.

In addition slice adjusted-met MAY be used with code 82271-8 Activity metabolic rate/Standard resting metabolic rate [Relative Energy/Time] adjusted for age+sex+race+BMI 1 minute mean Estimated from the LOINC code system and the value SHALL always be provided with the unit of measurement MET. If the slice adjusted-met is used, adjusted-source slice SHOULD be used with code 82283-3 Source used to adjust activity MET from the LOINC code system.

Elements not in use for Finnish PHR MET by Standard RMR Profile

  • value[x]
  • interpretation
  • referenceRange

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> or <Observation.effectiveTimePeriod>
  • Result: <Observation.component[0].code.coding.display>(<Observation.component[0].code.coding.code>): <Observation.component[0].valueCodeableConcept.coding.display> etc.

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

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

Example:

Code: Exercise tracking (55409-7)
Time: 26.11.2019
Result: Exercise activity (73985-4): Orienteering, Exercise duration (55411-3): 60 min, Exercise intensity (74008-4): Vigorous, Caloried burned (55421-2): 709 kcal

Examples from MET by Standard RMR profile


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Finnish PHR Exercise Tracking profile

Finnish PHR profile for FHIR® Observation used in measurements of distance reached. Either the amount of distance reached in 24 hours or in one week can be stored using this profile.

The profile is based on the Finnish PHR Fitness 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 Exercise Tracking Profile constrains the Finnish PHR Fitness Base Profile as follows:

Mandatory elements for Finnish PHR Exercise Tracking

Table of Mandatory elements for all Finnish PHR Exercise Tracking
Content Name in structure Description / Type of information
Code for exercise tracking code A exercise tracking observation SHALL have the code 55409-7 Exercise tracking panel from the LOINC code system .
Actual result component At least one of the following slices SHALL be used
- Exercise-activity slice SHALL have code 73985-4 Exercise activity. Activity codes SHALL be from Finnish PHR Exercise Activity value set
- Exersice-duration slice SHALL have code 55411-3 Exercise activity. The amount of exercise duration SHALL always be provided with the unit of measurement min.
- Exercise-intennsity slice SHALL have code 74008-4 Exercise intensity. Intensity codes SHALL be from Finnish PHR Exercise Intensity value set
- Calories-burned slice SHALL have code 55421-2 Calories burned Machine estimate. The ammount of calories burned SHALL always be provided with the unit of measurement kcal.

Elements not in use for Finnish PHR Exercise Tracking Profile

  • value[x]
  • interpretation
  • referenceRange

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> or <Observation.effectiveTimePeriod>
  • Result: <Observation.component[0].code.coding.display>(<Observation.component[0].code.coding.code>): <Observation.component[0].valueCodeableConcept.coding.display> etc.

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

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

Example:

Code: Exercise tracking (55409-7)
Time: 26.11.2019
Result: Exercise activity (73985-4): Orienteering, Exercise duration (55411-3): 60 min, Exercise intensity (74008-4): Vigorous, Caloried burned (55421-2): 709 kcal

Examples from Exercise Tracking profile


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