GP Connect - Update Record (ITK3)

Part of the GP Connect product family

Handling observations

This specification uses the Profile: CareConnect-GPC-Organization-1 profile for clinical, and social history observations.

The information below describes the sort of information that is expected to flow.

Category: social history and vital signs

The Observation.category element within the Observation resource can be used to articulate the classification of type for the observation.

The code system contains numerous codes; however, this specification will only make use of the following:

Social history

The Social History Observations define the patient's occupational, personal (e.g. lifestyle), social, and environmental history and health risk factors, as well as administrative data such as marital status, race, ethnicity and religious affiliation.

Vital signs

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

Social history observations

These types of observations will only contain a code - typically SNOMED, and will not contain a value. For example: pregnancy status, or to indicate that an Ambulatory blood pressure recording has been declined.

There are only a few scenarios where this will be the case, and the Mapping PRSB headings to FHIR page provides examples of these.

Vital signs observations

The Community Pharmacy Standard v3 stipulates the following items that could be sent.


The table below outlines which of the items listed under Examination findings → Observations int he PRSB CP spec above, and whether or not this specification supports them.

Note: Text enclosed in curly braces { ... } is called an annotation.
Refer to sub-section 6 in 2.1 Character set and lexical rules of the UCUM specificaiton.
Observation Expected value Supported
Height / length
  • UCUM: cm
  • UCUM: [in_i]
 Yes
Weight
  • UCUM: g
  • UCUM: kg
  • UCUM: [lb_av]
 Yes
Body mass index (BMI) UCUM: kg/m2 Yes
Blood pressure - Systolic UCUM: mm[Hg] Yes
Blood pressure - Diastolic UCUM: mm[Hg] Yes
Heart rate UCUM: {beats}/min Yes
Temperature
  • UCUM: Cel
  • UCUM: [degF]
 Yes
Oxygen saturation UCUM: % No
Pain score UCUM: {ScoreOf} No
Level of consciousness CodeSystem: CareConnect-ACVPU-1 No
Respiratory rate UCUM: {breaths}/min No
Air and oxygen UCUM: % No
NEWS2 UCUM: {ScoreOf} No
    • ObservationHeight / length
    • Expected value
      • UCUM: cm
      • UCUM: [in_i]
    • SupportedYes
    • ObservationWeight
    • Expected value
      • UCUM: g
      • UCUM: kg
      • UCUM: [lb_av]
    • SupportedYes
    • ObservationBody mass index (BMI)
    • Expected valueUCUM: kg/m2
    • SupportedYes
    • ObservationBlood pressure - Systolic
    • Expected valueUCUM: mm[Hg]
    • SupportedYes
    • ObservationBlood pressure - Diastolic
    • Expected valueUCUM: mm[Hg]
    • SupportedYes
    • ObservationHeart rate
    • Expected valueUCUM: {beats}/min
    • SupportedYes
    • ObservationTemperature
    • Expected value
      • UCUM: Cel
      • UCUM: [degF]
    • SupportedYes
    • ObservationOxygen saturation
    • Expected valueUCUM: %
    • SupportedNo
      • ObservationPain score
      • Expected valueUCUM: {ScoreOf}
      • SupportedNo
      • ObservationRespiratory rate
      • Expected valueUCUM: {breaths}/min
      • SupportedNo
      • ObservationAir and oxygen
      • Expected valueUCUM: %
      • SupportedNo
      • ObservationNEWS2
      • Expected valueUCUM: {ScoreOf}
      • SupportedNo

    Conventions

    While the provider should make every effort to ensure they are providing accurate information, there are certain conventions that are preferred within GP practice which are shown hin the table below.

    Note: It is preferred that the value displayed to the user is rounded up if displaying to a decimal place that is less than the recorded value.

    All units of measure use the Value set: UCUM for vital-signs.

    Observation Preferred unit of measure Display decimal places
    Height cm (centimeter) 0 decimal places
    Weight kg (kilogram) 1 decimal place
    Pulse {beats}/min (beats per minute) 0 decimal places
    Blood pressure [mmHg] (millimeter of mercury) 0 decimal places
    Temperature Cel (Celsius) 1 decimal place
    Body Mass Index (BMI) kg/m^2 (kilogram per meter squared) 1 decimal place
      • ObservationHeight
      • Preferred unit of measurecm (centimeter)
      • Display decimal places0 decimal places
      • ObservationWeight
      • Preferred unit of measurekg (kilogram)
      • Display decimal places1 decimal place
      • ObservationPulse
      • Preferred unit of measure{beats}/min (beats per minute)
      • Display decimal places0 decimal places
      • ObservationBlood pressure
      • Preferred unit of measure[mmHg] (millimeter of mercury)
      • Display decimal places0 decimal places
      • ObservationTemperature
      • Preferred unit of measureCel (Celsius)
      • Display decimal places1 decimal place
      • ObservationBody Mass Index (BMI)
      • Preferred unit of measurekg/m^2 (kilogram per meter squared)
      • Display decimal places1 decimal place

    Blood pressure

    The following table outlines the valid combinations of SNOMED codes which can be used when recording a blood pressure.

    Header Valid systolic codes Valid diastolic codes
    Term SNOMED Term SNOMED Term ConceptId
    On examination - blood pressure reading 163020007 Systolic arterial pressure 72313002 Diastolic arterial pressure 1091811000000102
    163020007 Systolic arterial pressure 72313002 Diastolic blood pressure 271650006
    163020007 SAP - Systolic arterial pressure 271649006 Diastolic arterial pressure 271650006
    Lying blood pressure reading 163033001 Lying systolic blood pressure 407556006 Lying diastolic blood pressure 407557002
    Standing blood pressure reading 163034007 Standing systolic blood pressure 400974009 Standing diastolic blood pressure 400975005
    Sitting blood pressure reading 163035008 Sitting systolic blood pressure 407554009 Sitting diastolic blood pressure 407555005
    Baseline blood pressure 928021000000108 Baseline systolic blood pressure 716579001 Baseline diastolic blood pressure 716632005
    Average blood pressure 723232008 Average systolic blood pressure 314440001 Average diastolic blood pressure 314453003

    Reference ranges and interpretation

    Providers may supply a reference range along with the associated value - for example:

    <referenceRange>
    <low>
        <value value="3.5"/>
    </low>
    <high>
        <value value="11.0"/>
    </high>
</referenceRange>
    Note: 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.

    Similarly, a provider may wish to provide the interpretation to indicate whether the observation is abnormal (in line with Access Record: Structured).

    https://fhir.nhs.uk/STU3/CodeSystem/CareConnect-ObservationInterpretation-1

    <interpretation>
    <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0078"/>
        <code value="A"/>
        <display value="Abnormal"/>
    </coding>
    <text value="Abnormal"/>
</interpretation>

    The consumer may wish to observe this information, or they may chose to apply their own interpretation on the observation supplied.

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