{
  "resourceType": "StructureDefinition",
  "id": "AMA-IHMI-observation-blood-pressure-3",
  "meta": {
    "versionId": "7",
    "lastUpdated": "2019-02-07T20:57:47.445+00:00"
  },
  "url": "http://www.ama-ihmi.org/fhir/StructureDefinition/AMA-IHMI-observation-blood-pressure-3",
  "name": "AMA-IHMI-observation-blood-pressure-3",
  "status": "draft",
  "publisher": "American Medical Association",
  "description": "This profile supports the use case of individuals who are self-measuring blood pressure at home via an automatic blood pressure monitor. The profile constrains paired systolic and diastolic blood pressure measurement observations. The profile requires the elements (bodySite, device, bodyPosition, and exertionalStatus). Blood pressure measurement observations that adhere to this profile will, necessarily, conform to stricter constraints (also referred to here as “clinically valid blood pressures”) which specify that the measurements should only be at the brachial artery (with laterality), in sitting position, at rest, using an automatic blood pressure monitor with cuff size specified. \r\nThis profile allows the Observation Resource to be extended to include body position and exertional status as Observation extensions (i.e., Observation.extension bodyPosition and Observation.extension exertionalStatus).",
  "copyright": "Copyright 2016-2019 American Medical Association. All rights reserved.",
  "fhirVersion": "3.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "Observation",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Observation.extension",
        "path": "Observation.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Observation.extension:bodyPosition",
        "path": "Observation.extension",
        "sliceName": "bodyPosition",
        "short": "The body position during the observation.",
        "definition": "The position of the body when the observation was done, e.g. standing, sitting. To be used only when the body position is not precoordinated in the observation code.",
        "min": 1,
        "type": [
          {
            "code": "Extension",
            "profile": "http://hl7.org/fhir/StructureDefinition/observation-bodyPosition"
          }
        ]
      },
      {
        "id": "Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept",
        "path": "Observation.extension.valueCodeableConcept",
        "sliceName": "valueCodeableConcept",
        "min": 1
      },
      {
        "id": "Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept.coding",
        "path": "Observation.extension.valueCodeableConcept.coding",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept.coding.system",
        "path": "Observation.extension.valueCodeableConcept.coding.system",
        "min": 1,
        "fixedUri": "http://ihmi.termspace.com/api/uri?uri=http://snomed.info/sct/3881000207102"
      },
      {
        "id": "Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept.coding.code",
        "path": "Observation.extension.valueCodeableConcept.coding.code",
        "min": 1,
        "fixedCode": "33586001"
      },
      {
        "id": "Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept.coding.display",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.extension.valueCodeableConcept.coding.display",
        "min": 1,
        "fixedString": "Sitting position (finding)"
      },
      {
        "id": "Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept.coding.userSelected",
        "path": "Observation.extension.valueCodeableConcept.coding.userSelected",
        "max": "0"
      },
      {
        "id": "Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept.text",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.extension.valueCodeableConcept.text",
        "max": "0"
      },
      {
        "id": "Observation.extension:exertionalStatus",
        "path": "Observation.extension",
        "sliceName": "exertionalStatus",
        "min": 1,
        "type": [
          {
            "code": "Extension",
            "profile": "http://www.ama-ihmi.org/fhir/StructureDefinition/observation-exertionalStatus"
          }
        ]
      },
      {
        "id": "Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept",
        "path": "Observation.extension.valueCodeableConcept",
        "sliceName": "valueCodeableConcept",
        "min": 1
      },
      {
        "id": "Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept.coding",
        "path": "Observation.extension.valueCodeableConcept.coding",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept.coding.system",
        "path": "Observation.extension.valueCodeableConcept.coding.system",
        "min": 1,
        "fixedUri": "http://ihmi.termspace.com/api/uri?uri=http://snomed.info/sct/3881000207102"
      },
      {
        "id": "Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept.coding.code",
        "path": "Observation.extension.valueCodeableConcept.coding.code",
        "min": 1,
        "fixedCode": "128975004"
      },
      {
        "id": "Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept.coding.display",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.extension.valueCodeableConcept.coding.display",
        "min": 1,
        "fixedString": "Resting state (finding)"
      },
      {
        "id": "Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept.coding.userSelected",
        "path": "Observation.extension.valueCodeableConcept.coding.userSelected",
        "max": "0"
      },
      {
        "id": "Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept.text",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.extension.valueCodeableConcept.text",
        "max": "0"
      },
      {
        "id": "Observation.basedOn",
        "path": "Observation.basedOn",
        "max": "0"
      },
      {
        "id": "Observation.status",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
            "valueString": "default: final"
          }
        ],
        "path": "Observation.status",
        "fixedCode": "final"
      },
      {
        "id": "Observation.category",
        "path": "Observation.category",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "coding.system"
            },
            {
              "type": "value",
              "path": "coding.code"
            }
          ],
          "rules": "open"
        },
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.category:vitalSigns",
        "path": "Observation.category",
        "sliceName": "vitalSigns",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.category:vitalSigns.coding",
        "path": "Observation.category.coding",
        "min": 1
      },
      {
        "id": "Observation.category:vitalSigns.coding.system",
        "path": "Observation.category.coding.system",
        "min": 1,
        "fixedUri": "http://hl7.org/fhir/observation-category"
      },
      {
        "id": "Observation.category:vitalSigns.coding.code",
        "path": "Observation.category.coding.code",
        "min": 1,
        "fixedCode": "vital-signs"
      },
      {
        "id": "Observation.category:vitalSigns.coding.display",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.category.coding.display",
        "min": 1,
        "fixedString": "Vital Signs"
      },
      {
        "id": "Observation.category:vitalSigns.coding.userSelected",
        "path": "Observation.category.coding.userSelected",
        "max": "0"
      },
      {
        "id": "Observation.category:vitalSigns.text",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.category.text",
        "max": "0"
      },
      {
        "id": "Observation.code.coding",
        "path": "Observation.code.coding",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.code.coding.system",
        "path": "Observation.code.coding.system",
        "min": 1,
        "fixedUri": "http://ihmi.termspace.com/api/uri?uri=http://snomed.info/sct/3881000207102"
      },
      {
        "id": "Observation.code.coding.code",
        "path": "Observation.code.coding.code",
        "min": 1,
        "fixedCode": "4011000207100"
      },
      {
        "id": "Observation.code.coding.display",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.code.coding.display",
        "min": 1,
        "fixedString": "Measurement of blood pressure (procedure)"
      },
      {
        "id": "Observation.code.coding.userSelected",
        "path": "Observation.code.coding.userSelected",
        "max": "0"
      },
      {
        "id": "Observation.code.text",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.code.text",
        "max": "0"
      },
      {
        "id": "Observation.subject",
        "path": "Observation.subject",
        "short": "Who this is about",
        "definition": "The patient whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed.  Comments: Indirect characteristics may be those of a specimen, fetus, donor,  other observer (for example a relative or EMT), or any observation made about the subject.",
        "min": 1,
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient"
          }
        ]
      },
      {
        "id": "Observation.context",
        "path": "Observation.context",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Encounter"
          }
        ]
      },
      {
        "id": "Observation.effective[x]:effectiveDateTime",
        "path": "Observation.effectiveDateTime",
        "sliceName": "effectiveDateTime",
        "min": 1,
        "type": [
          {
            "code": "dateTime"
          }
        ]
      },
      {
        "id": "Observation.issued",
        "path": "Observation.issued",
        "max": "0"
      },
      {
        "id": "Observation.performer",
        "path": "Observation.performer",
        "short": "Who/what is responsible for the observation",
        "definition": "Who or what was responsible for asserting the observed value as \"true\"."
      },
      {
        "id": "Observation.value[x]",
        "path": "Observation.value[x]",
        "max": "0"
      },
      {
        "id": "Observation.dataAbsentReason",
        "path": "Observation.dataAbsentReason",
        "max": "0"
      },
      {
        "id": "Observation.interpretation",
        "path": "Observation.interpretation",
        "max": "0"
      },
      {
        "id": "Observation.comment",
        "path": "Observation.comment",
        "max": "0"
      },
      {
        "id": "Observation.bodySite",
        "path": "Observation.bodySite",
        "min": 1
      },
      {
        "id": "Observation.bodySite.coding",
        "path": "Observation.bodySite.coding",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.bodySite.coding.system",
        "path": "Observation.bodySite.coding.system",
        "min": 1,
        "fixedUri": "http://ihmi.termspace.com/api/uri?uri=http://snomed.info/sct/3881000207102"
      },
      {
        "id": "Observation.bodySite.coding.code",
        "path": "Observation.bodySite.coding.code",
        "min": 1,
        "binding": {
          "strength": "required",
          "valueSetReference": {
            "reference": "http://www.ama-ihmi.org/fhir/ValueSet/AMA-IHMI-valueSet-body-structure-1-instance"
          }
        }
      },
      {
        "id": "Observation.bodySite.coding.display",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.bodySite.coding.display",
        "min": 1,
        "fixedString": "American Medical Association Integrated Health Model Initiative, body structure, refset 1, simple type reference set (foundation metadata concept)"
      },
      {
        "id": "Observation.bodySite.text",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.bodySite.text",
        "max": "0"
      },
      {
        "id": "Observation.method",
        "path": "Observation.method",
        "max": "0"
      },
      {
        "id": "Observation.method.text",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.method.text",
        "max": "0"
      },
      {
        "id": "Observation.specimen",
        "path": "Observation.specimen",
        "max": "0"
      },
      {
        "id": "Observation.device",
        "path": "Observation.device",
        "min": 1,
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://www.ama-ihmi.org/fhir/StructureDefinition/AMA-IHMI-device-blood-pressure-1"
          }
        ]
      },
      {
        "id": "Observation.referenceRange",
        "path": "Observation.referenceRange",
        "max": "0"
      },
      {
        "id": "Observation.related",
        "path": "Observation.related",
        "max": "0"
      },
      {
        "id": "Observation.component",
        "path": "Observation.component",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "code"
            }
          ],
          "rules": "open"
        },
        "min": 2,
        "max": "2"
      },
      {
        "id": "Observation.component:SBP",
        "path": "Observation.component",
        "sliceName": "SBP",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.component:SBP.code.coding",
        "path": "Observation.component.code.coding",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.component:SBP.code.coding.system",
        "path": "Observation.component.code.coding.system",
        "min": 1,
        "fixedUri": "http://ihmi.termspace.com/api/uri?uri=http://snomed.info/sct/3881000207102"
      },
      {
        "id": "Observation.component:SBP.code.coding.code",
        "path": "Observation.component.code.coding.code",
        "min": 1,
        "fixedCode": "4351000207102"
      },
      {
        "id": "Observation.component:SBP.code.coding.display",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.component.code.coding.display",
        "min": 1,
        "fixedString": "Measurement of systolic blood pressure (procedure)"
      },
      {
        "id": "Observation.component:SBP.code.coding.userSelected",
        "path": "Observation.component.code.coding.userSelected",
        "max": "0"
      },
      {
        "id": "Observation.component:SBP.code.text",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.component.code.text",
        "max": "0"
      },
      {
        "id": "Observation.component:SBP.value[x]:valueQuantity",
        "path": "Observation.component.valueQuantity",
        "sliceName": "valueQuantity",
        "min": 1,
        "type": [
          {
            "code": "Quantity"
          }
        ]
      },
      {
        "id": "Observation.component:SBP.value[x]:valueQuantity.value",
        "path": "Observation.component.valueQuantity.value",
        "min": 1
      },
      {
        "id": "Observation.component:SBP.value[x]:valueQuantity.comparator",
        "path": "Observation.component.valueQuantity.comparator",
        "max": "0"
      },
      {
        "id": "Observation.component:SBP.value[x]:valueQuantity.unit",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.component.valueQuantity.unit",
        "min": 1
      },
      {
        "id": "Observation.component:SBP.value[x]:valueQuantity.system",
        "path": "Observation.component.valueQuantity.system",
        "min": 1,
        "fixedUri": "http://unitsofmeasure.org"
      },
      {
        "id": "Observation.component:SBP.value[x]:valueQuantity.code",
        "path": "Observation.component.valueQuantity.code",
        "min": 1,
        "fixedCode": "mm[Hg]"
      },
      {
        "id": "Observation.component:SBP.dataAbsentReason",
        "path": "Observation.component.dataAbsentReason",
        "max": "0"
      },
      {
        "id": "Observation.component:SBP.interpretation",
        "path": "Observation.component.interpretation",
        "max": "0"
      },
      {
        "id": "Observation.component:SBP.referenceRange",
        "path": "Observation.component.referenceRange",
        "max": "0"
      },
      {
        "id": "Observation.component:DBP",
        "path": "Observation.component",
        "sliceName": "DBP",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.component:DBP.code.coding",
        "path": "Observation.component.code.coding",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.component:DBP.code.coding.system",
        "path": "Observation.component.code.coding.system",
        "min": 1,
        "fixedUri": "http://ihmi.termspace.com/api/uri?uri=http://snomed.info/sct/3881000207102"
      },
      {
        "id": "Observation.component:DBP.code.coding.code",
        "path": "Observation.component.code.coding.code",
        "min": 1,
        "fixedCode": "4131000207105"
      },
      {
        "id": "Observation.component:DBP.code.coding.display",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.component.code.coding.display",
        "min": 1,
        "fixedString": "Measurement of diastolic blood pressure (procedure)"
      },
      {
        "id": "Observation.component:DBP.code.coding.userSelected",
        "path": "Observation.component.code.coding.userSelected",
        "max": "0"
      },
      {
        "id": "Observation.component:DBP.code.text",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.component.code.text",
        "max": "0"
      },
      {
        "id": "Observation.component:DBP.value[x]:valueQuantity",
        "path": "Observation.component.valueQuantity",
        "sliceName": "valueQuantity",
        "min": 1,
        "type": [
          {
            "code": "Quantity"
          }
        ]
      },
      {
        "id": "Observation.component:DBP.value[x]:valueQuantity.value",
        "path": "Observation.component.valueQuantity.value",
        "min": 1
      },
      {
        "id": "Observation.component:DBP.value[x]:valueQuantity.comparator",
        "path": "Observation.component.valueQuantity.comparator",
        "max": "0"
      },
      {
        "id": "Observation.component:DBP.value[x]:valueQuantity.unit",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Observation.component.valueQuantity.unit",
        "min": 1
      },
      {
        "id": "Observation.component:DBP.value[x]:valueQuantity.system",
        "path": "Observation.component.valueQuantity.system",
        "min": 1,
        "fixedUri": "http://unitsofmeasure.org"
      },
      {
        "id": "Observation.component:DBP.value[x]:valueQuantity.code",
        "path": "Observation.component.valueQuantity.code",
        "min": 1,
        "fixedCode": "mm[Hg]"
      },
      {
        "id": "Observation.component:DBP.dataAbsentReason",
        "path": "Observation.component.dataAbsentReason",
        "max": "0"
      },
      {
        "id": "Observation.component:DBP.interpretation",
        "path": "Observation.component.interpretation",
        "max": "0"
      },
      {
        "id": "Observation.component:DBP.referenceRange",
        "path": "Observation.component.referenceRange",
        "max": "0"
      }
    ]
  }
}