Blood Glucose Observation

Profile (bg-observation)

Measurement informing about a patient’s glucose level. These are clinical observations that can be measured by the patient or the device.

Below is the category used for this Observation:

The code of blood glucose observations is mentioned below:

BG observation resource subject element will be mapped to Patient because this observation is about and into who record the observation is placed.

device element will be mapped to DeviceMetric resource.

Blood glucose measurements are captured in the valueQuantity element. effectiveDateTime element shows the time the observation has been taken place, at the current time zone.

The related element is used to capture related Observations, such as Carbs Intake Observations, Carbs Advice Observations, Health Events Observations, EWM Observations. It has defined the relation type, with value has-member, and also has a reference to the related Observation.

Note : For edited use case, If there is any update on any entry, application shall send the updated resource. use shall see the updated details through history. In case of deleted use case the status shall be updated from 'final' to 'cancelled'

• Blood Glucose Observation
• Overview
• Details
• Table
• XML
• JSON
• Example
• BG sample
• BG (fasting) sample

Carbohydrate Observation

Carbs associated to the observation; Carbohydrate measurements are represented by the Related Observation pattern, related to the coincident blood glucose reading, and also linked to a Device as the capture source. This observation could be related with a Carbohydrate Advice Observation (if exists).

Carbohydrate measurements are represented by the Related Observation pattern, related to the coincident blood glucose reading, and also linked to a Device as the capture source. This observation could be related with a Carbohydrate Advice Observation (if exists).

• Below is the category used for this Observation

  System	Code	Display
  http://roche.com/fhir/rdc/cs	carb-observation	Carbohydrate intake Observation

• Below is a list of possible values of code for this Observation (The valueset ObservationCodes has all the Observation codes, the below list only shows the codes that are relevant to this profile)

  System	Code	Display
  http://loinc.org	9059-7	Carbohydrate intake Estimated

• Below code is used for new Implementations like confidence for modelling carbs data point. More details about this code is available in nutritional value Observation

  System	Code	Display
  http://loinc.org	9060-5	Carbohydrate intake Measured

• This observation can be performed by a Patient so subject element will be mapped to Patient resource.

• device element will be mapped to Device resource. A diagram that depicts Carbohydrate Observation structure and relationships is showed below:

Note : For edited use case, If there is any update on any entry, application shall send the updated resource. use shall see the updated details through history. In case of deleted use case the status shall be updated from 'final' to 'cancelled'

Carbohydrate Advice Observation

Advised carbs may occur as a result of an advising application, indicating the patient should ingest carbohydrates.

Advised carbs may occur as a result of an advising application, indicating the patient should ingest carbohydrates. This is provided in the PHD/PHG by a related result to a BG result and estimates the carbohydrates (in Grams) that should be ingested. The actual patient estimate of Carbs ingested as a result is represented as an additional related result for carbohydrates.

Carbohydrate advice is represented as an observation with adviced value of carbohydrates by using valueQuantity and the profile used for this is "observation-carb-advice"

• Below is the category used for this Observation

  System	Code	Display
  http://roche.com/fhir/rdc/cs	carb-advice	Carbohydrate advice observation

• Below is a list of possible values of code for this Observation (The valueset ObservationCodes has all the Observation codes, the below list only shows the codes that are relevant to this profile)

  System	Code	Display
  http://snomed.info/sct	285390004	Recommendation to change carbohydrate intake (procedure)

• This observation is generated based on the adviced carbs suggested from device so subject and device element will be mapped to Device resource.

• BG-Observation should be related with Carbs Intake Observation

• BG-Observation should be related with Carbs Advice Observation

• Carbs Intake Observation should to be related with Carbs Advice Observation if exists.

Source ACSPIX tag example:

<BG Val="111" Dt="2005-04-27" Tm="12:04" Carb="37" D="1">

<ADVICED_CARBS Carb="42"/>

A diagram that depicts Carbohydrate Advice Observation structure and relationships is showed below:

Note : For edited use case, If there is any update on any entry, application shall send the updated resource. use shall see the updated details through history. In case of deleted use case the status shall be updated from 'final' to 'cancelled'

Nutritional value Observation

Nutritional value observation profile is used to record data related to the nutritional value of a particular food or source of nutrition. For example - fat, carbohydrate etc.

• Below is the category used for this Observation

  System	Code	Display
  http://snomed.info/sct	84626001	Nutritional value, function (observable entity)

• Below is the possible value of code for this Observation (The valueset ObservationCodes has all the Observation codes, the below list only shows the codes that are relevant to this profile)

  System	Code	Display
  http://loinc.org	9060-5	Carbohydrate intake Measured

• subject SHALL be referenced only to patient profile.

• performer SHALL be referenced only to patient profile.

• device SHALL be referenced to DeviceMetric profile.

• Nutritional value Observation
• Overview
• Details
• Table
• XML
• JSON
• Example

Vital Signs Observation

Vital Signs observations measure the body's basic functions such as blood pressure, heart rate, respiratory rate, height, weight, body mass index, head circumference, pulse oximetry, temperature, and body surface area.

• Below is the category used for this Observation

  System	Code	Display
  http://hl7.org/fhir/observation-category	vital-signs	Vital Signs

• Below is a list of possible values of code for this Observation (The valueset ObservationCodes has all the Observation codes, the below list only shows the codes that are relevant to this profile)

  System	Code	Display
  http://snomed.info/sct	434910001	Interstitial fluid glucose concentration (observable entity)

• subject SHALL be referenced only to patient profile.

• performer SHALL be referenced only to patient profile.

• device SHALL be referenced to DeviceMetric profile.

• Vitalsigns Observation
• Overview
• Details
• Table
• XML
• JSON
• Example

EWM Observation

Data related to the operation and behavior of the device itself rather than containing measurements against the patient. Personal Health Devices emit operational data such as Events, Warnings, and Status (sometimes referred to as "maintenance") (EWS) information during uploads of measurements.

• Below is the category used for this Observation

Below list shows some of the EMW codes that are relevant to this profile.

• subject element will be mapped to Device also device element will be mapped to Device resource.

• performer element will be mapped to Patient.

• The code indicates the EWS type (ValueSet - https://simplifier.net/rdc/upr-status-code-type

• value[x] records the concrete EWS using a codeableConcept (valueSet - https://simplifier.net/rdc/upr-ewm-codes) .

• EWM Observation
• Overview
• Details
• Table
• XML
• JSON
• Example

Observation resource - Edited use case

The "edit" approach for any observation resource will be the same. So this approach applies for "updation" of any data point that is modelled as an observation resource.

• effectiveDateTime - will have the timestamp of the measurement/observation made. This will remain the same unless the user updates also the measurement timestamp
• identifier - will have the same unique identifier with which it has been ingested already
• status - will always be "final" for the updated resource

Below is a sample for updating a BG observation with identifier "AAAAA-AAAAA-AAAAA":

The following bundle is generated on Step 2.

{
	"resourceType": "Observation",
	"identifier": [
		{
			"system": "http://roche.com/fhir/rdc/sid/observation/mySugr",
			"value": "AAAAA-AAAAA-AAAAA"
		}
	],
	"code": {
		"coding": [
			{
				"system": "http://loinc.org",
				"code": "41653-7",
				"display": "Glucose [Mass/volume] in Capillary blood by Glucometer"
			}
		]
	},
	"performer": [
		{
			"reference": "Patient/30d1355b-3705-4809-a3fa-d57dcd167f73"
		}
	],
	"effectiveDateTime": "2018-03-19T06:46:00+00:00",
	"meta": {
		"profile": [
			"http://roche.com/fhir/rdc/StructureDefinition/bg-observation"
		]
	},
	"subject": {
		"reference": "Patient/SandboxPat1"
	},
	"id": "821a82d5-6982-4768-8e0e-4d2a63aafd16",
	"category": [
		{
			"coding": [
				{
					"system": "http://roche.com/fhir/rdc/cs",
					"code": "clinical-observation",
					"display": "Clinical Observation"
				}
			]
		}
	],
	"device": {
		"reference": "DeviceMetric/57d99bc2-d1e4-4eb7-8dca-025a4e79466e"
	},
	"basedOn": [
		{
			"reference": "CarePlan/ab20a2dc-2a8c-4ea2-8629-8e9d8e72491e"
		}
	],
	"status": "final",
	"valueQuantity": {
		"unit": "mg/dL",
		"system": "http://unitsofmeasure.org",
		"code": "mg/dL",
		"value": 177
	}
}

The following bundle is generated on Step 3.

{
	"resourceType": "Observation",
	"identifier": [
		{
			"system": "http://roche.com/fhir/rdc/sid/observation/mySugr",
			"value": "AAAAA-AAAAA-AAAAA"
		}
	],
	"code": {
		"coding": [
			{
				"system": "http://loinc.org",
				"code": "41653-7",
				"display": "Glucose [Mass/volume] in Capillary blood by Glucometer"
			}
		]
	},
	"performer": [
		{
			"reference": "Patient/SandboxPat1"
		}
	],
	"effectiveDateTime": "2018-03-19T06:46:00+00:00",
	"meta": {
		"profile": [
			"http://roche.com/fhir/rdc/StructureDefinition/bg-observation"
		]
	},
	"subject": {
		"reference": "Patient/30d1355b-3705-4809-a3fa-d57dcd167f73"
	},
	"id": "821a82d5-6982-4768-8e0e-4d2a63aafd16",
	"category": [
		{
			"coding": [
				{
					"system": "http://roche.com/fhir/rdc/cs",
					"code": "clinical-observation",
					"display": "Clinical Observation"
				}
			]
		}
	],
	"device": {
		"reference": "DeviceMetric/57d99bc2-d1e4-4eb7-8dca-025a4e79466e"
	},
	"basedOn": [
		{
			"reference": "CarePlan/ab20a2dc-2a8c-4ea2-8629-8e9d8e72491e"
		}
	],
	"status": "final",
	"valueQuantity": {
		"unit": "mg/dL",
		"system": "http://unitsofmeasure.org",
		"code": "mg/dL",
		"value": 178
	}
}

Observation Delete use case

The "Delete" approach for observation resource will be as below. So this approach applies for any data point that is modelled as observation resource.

• effectiveDateTime - will have the timestamp of the measurement/observation made.
• identifier - will have the same unique identifier with which it has been ingested already
• status - will always be "cancelled" for the deleted resource

Below is a sample for deleting a BG observation with internal confidence ID "AAAAA-AAAAA-AAAAA":

The following bundle is generated on Step 3.

{
	"resourceType": "Observation",
	"identifier": [
		{
			"system": "http://roche.com/fhir/rdc/sid/observation/mySugr",
			"value": "AAAAA-AAAAA-AAAAA"
		}
	],
	"code": {
		"coding": [
			{
				"system": "http://loinc.org",
				"code": "41653-7",
				"display": "Glucose [Mass/volume] in Capillary blood by Glucometer"
			}
		]
	},
	"performer": [
		{
			"reference": "Patient/SandboxPat1"
		}
	],
	"effectiveDateTime": "2018-03-19T06:46:00+00:00",
	"meta": {
		"profile": [
			"http://roche.com/fhir/rdc/StructureDefinition/bg-observation"
		]
	},
	"subject": {
		"reference": "Patient/SandboxPat1"
	},
	"id": "821a82d5-6982-4768-8e0e-4d2a63aafd16",
	"category": [
		{
			"coding": [
				{
					"system": "http://roche.com/fhir/rdc/cs",
					"code": "clinical-observation",
					"display": "Clinical Observation"
				}
			]
		}
	],
	"device": {
		"reference": "DeviceMetric/57d99bc2-d1e4-4eb7-8dca-025a4e79466e"
	},
	"basedOn": [
		{
			"reference": "CarePlan/ab20a2dc-2a8c-4ea2-8629-8e9d8e72491e"
		}
	],
	"status": "cancelled",
	"valueQuantity": {
		"unit": "mg/dL",
		"system": "http://unitsofmeasure.org",
		"code": "mg/dL",
		"value": 177
	}
}