<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="AMA-IHMI-observation-blood-pressure-3" />
  <meta>
    <versionId value="7" />
    <lastUpdated value="2019-02-07T20:57:47.445+00:00" />
  </meta>
  <url value="http://www.ama-ihmi.org/fhir/StructureDefinition/AMA-IHMI-observation-blood-pressure-3" />
  <name value="AMA-IHMI-observation-blood-pressure-3" />
  <status value="draft" />
  <publisher value="American Medical Association" />
  <description value="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. &#xD;&#xA;This 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 value="Copyright 2016-2019 American Medical Association. All rights reserved." />
  <fhirVersion value="3.0.1" />
  <kind value="resource" />
  <abstract value="false" />
  <type value="Observation" />
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Observation" />
  <derivation value="constraint" />
  <differential>
    <element id="Observation.extension">
      <path value="Observation.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.extension:bodyPosition">
      <path value="Observation.extension" />
      <sliceName value="bodyPosition" />
      <short value="The body position during the observation." />
      <definition value="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 value="1" />
      <type>
        <code value="Extension" />
        <profile value="http://hl7.org/fhir/StructureDefinition/observation-bodyPosition" />
      </type>
    </element>
    <element id="Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept">
      <path value="Observation.extension.valueCodeableConcept" />
      <sliceName value="valueCodeableConcept" />
      <min value="1" />
    </element>
    <element id="Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept.coding">
      <path value="Observation.extension.valueCodeableConcept.coding" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept.coding.system">
      <path value="Observation.extension.valueCodeableConcept.coding.system" />
      <min value="1" />
      <fixedUri value="http://ihmi.termspace.com/api/uri?uri=http://snomed.info/sct/3881000207102" />
    </element>
    <element id="Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept.coding.code">
      <path value="Observation.extension.valueCodeableConcept.coding.code" />
      <min value="1" />
      <fixedCode value="33586001" />
    </element>
    <element id="Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept.coding.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.extension.valueCodeableConcept.coding.display" />
      <min value="1" />
      <fixedString value="Sitting position (finding)" />
    </element>
    <element id="Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept.coding.userSelected">
      <path value="Observation.extension.valueCodeableConcept.coding.userSelected" />
      <max value="0" />
    </element>
    <element id="Observation.extension:bodyPosition.valueCodeableConcept:valueCodeableConcept.text">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.extension.valueCodeableConcept.text" />
      <max value="0" />
    </element>
    <element id="Observation.extension:exertionalStatus">
      <path value="Observation.extension" />
      <sliceName value="exertionalStatus" />
      <min value="1" />
      <type>
        <code value="Extension" />
        <profile value="http://www.ama-ihmi.org/fhir/StructureDefinition/observation-exertionalStatus" />
      </type>
    </element>
    <element id="Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept">
      <path value="Observation.extension.valueCodeableConcept" />
      <sliceName value="valueCodeableConcept" />
      <min value="1" />
    </element>
    <element id="Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept.coding">
      <path value="Observation.extension.valueCodeableConcept.coding" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept.coding.system">
      <path value="Observation.extension.valueCodeableConcept.coding.system" />
      <min value="1" />
      <fixedUri value="http://ihmi.termspace.com/api/uri?uri=http://snomed.info/sct/3881000207102" />
    </element>
    <element id="Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept.coding.code">
      <path value="Observation.extension.valueCodeableConcept.coding.code" />
      <min value="1" />
      <fixedCode value="128975004" />
    </element>
    <element id="Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept.coding.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.extension.valueCodeableConcept.coding.display" />
      <min value="1" />
      <fixedString value="Resting state (finding)" />
    </element>
    <element id="Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept.coding.userSelected">
      <path value="Observation.extension.valueCodeableConcept.coding.userSelected" />
      <max value="0" />
    </element>
    <element id="Observation.extension:exertionalStatus.valueCodeableConcept:valueCodeableConcept.text">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.extension.valueCodeableConcept.text" />
      <max value="0" />
    </element>
    <element id="Observation.basedOn">
      <path value="Observation.basedOn" />
      <max value="0" />
    </element>
    <element id="Observation.status">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
        <valueString value="default: final" />
      </extension>
      <path value="Observation.status" />
      <fixedCode value="final" />
    </element>
    <element id="Observation.category">
      <path value="Observation.category" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="coding.system" />
        </discriminator>
        <discriminator>
          <type value="value" />
          <path value="coding.code" />
        </discriminator>
        <rules value="open" />
      </slicing>
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.category:vitalSigns">
      <path value="Observation.category" />
      <sliceName value="vitalSigns" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.category:vitalSigns.coding">
      <path value="Observation.category.coding" />
      <min value="1" />
    </element>
    <element id="Observation.category:vitalSigns.coding.system">
      <path value="Observation.category.coding.system" />
      <min value="1" />
      <fixedUri value="http://hl7.org/fhir/observation-category" />
    </element>
    <element id="Observation.category:vitalSigns.coding.code">
      <path value="Observation.category.coding.code" />
      <min value="1" />
      <fixedCode value="vital-signs" />
    </element>
    <element id="Observation.category:vitalSigns.coding.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.category.coding.display" />
      <min value="1" />
      <fixedString value="Vital Signs" />
    </element>
    <element id="Observation.category:vitalSigns.coding.userSelected">
      <path value="Observation.category.coding.userSelected" />
      <max value="0" />
    </element>
    <element id="Observation.category:vitalSigns.text">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.category.text" />
      <max value="0" />
    </element>
    <element id="Observation.code.coding">
      <path value="Observation.code.coding" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.code.coding.system">
      <path value="Observation.code.coding.system" />
      <min value="1" />
      <fixedUri value="http://ihmi.termspace.com/api/uri?uri=http://snomed.info/sct/3881000207102" />
    </element>
    <element id="Observation.code.coding.code">
      <path value="Observation.code.coding.code" />
      <min value="1" />
      <fixedCode value="4011000207100" />
    </element>
    <element id="Observation.code.coding.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.code.coding.display" />
      <min value="1" />
      <fixedString value="Measurement of blood pressure (procedure)" />
    </element>
    <element id="Observation.code.coding.userSelected">
      <path value="Observation.code.coding.userSelected" />
      <max value="0" />
    </element>
    <element id="Observation.code.text">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.code.text" />
      <max value="0" />
    </element>
    <element id="Observation.subject">
      <path value="Observation.subject" />
      <short value="Who this is about" />
      <definition value="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 value="1" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
      </type>
    </element>
    <element id="Observation.context">
      <path value="Observation.context" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter" />
      </type>
    </element>
    <element id="Observation.effective[x]:effectiveDateTime">
      <path value="Observation.effectiveDateTime" />
      <sliceName value="effectiveDateTime" />
      <min value="1" />
      <type>
        <code value="dateTime" />
      </type>
    </element>
    <element id="Observation.issued">
      <path value="Observation.issued" />
      <max value="0" />
    </element>
    <element id="Observation.performer">
      <path value="Observation.performer" />
      <short value="Who/what is responsible for the observation" />
      <definition value="Who or what was responsible for asserting the observed value as &quot;true&quot;." />
    </element>
    <element id="Observation.value[x]">
      <path value="Observation.value[x]" />
      <max value="0" />
    </element>
    <element id="Observation.dataAbsentReason">
      <path value="Observation.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.interpretation">
      <path value="Observation.interpretation" />
      <max value="0" />
    </element>
    <element id="Observation.comment">
      <path value="Observation.comment" />
      <max value="0" />
    </element>
    <element id="Observation.bodySite">
      <path value="Observation.bodySite" />
      <min value="1" />
    </element>
    <element id="Observation.bodySite.coding">
      <path value="Observation.bodySite.coding" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.bodySite.coding.system">
      <path value="Observation.bodySite.coding.system" />
      <min value="1" />
      <fixedUri value="http://ihmi.termspace.com/api/uri?uri=http://snomed.info/sct/3881000207102" />
    </element>
    <element id="Observation.bodySite.coding.code">
      <path value="Observation.bodySite.coding.code" />
      <min value="1" />
      <binding>
        <strength value="required" />
        <valueSetReference>
          <reference value="http://www.ama-ihmi.org/fhir/ValueSet/AMA-IHMI-valueSet-body-structure-1-instance" />
        </valueSetReference>
      </binding>
    </element>
    <element id="Observation.bodySite.coding.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.bodySite.coding.display" />
      <min value="1" />
      <fixedString value="American Medical Association Integrated Health Model Initiative, body structure, refset 1, simple type reference set (foundation metadata concept)" />
    </element>
    <element id="Observation.bodySite.text">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.bodySite.text" />
      <max value="0" />
    </element>
    <element id="Observation.method">
      <path value="Observation.method" />
      <max value="0" />
    </element>
    <element id="Observation.method.text">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.method.text" />
      <max value="0" />
    </element>
    <element id="Observation.specimen">
      <path value="Observation.specimen" />
      <max value="0" />
    </element>
    <element id="Observation.device">
      <path value="Observation.device" />
      <min value="1" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://www.ama-ihmi.org/fhir/StructureDefinition/AMA-IHMI-device-blood-pressure-1" />
      </type>
    </element>
    <element id="Observation.referenceRange">
      <path value="Observation.referenceRange" />
      <max value="0" />
    </element>
    <element id="Observation.related">
      <path value="Observation.related" />
      <max value="0" />
    </element>
    <element id="Observation.component">
      <path value="Observation.component" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code" />
        </discriminator>
        <rules value="open" />
      </slicing>
      <min value="2" />
      <max value="2" />
    </element>
    <element id="Observation.component:SBP">
      <path value="Observation.component" />
      <sliceName value="SBP" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:SBP.code.coding">
      <path value="Observation.component.code.coding" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:SBP.code.coding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="http://ihmi.termspace.com/api/uri?uri=http://snomed.info/sct/3881000207102" />
    </element>
    <element id="Observation.component:SBP.code.coding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
      <fixedCode value="4351000207102" />
    </element>
    <element id="Observation.component:SBP.code.coding.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <min value="1" />
      <fixedString value="Measurement of systolic blood pressure (procedure)" />
    </element>
    <element id="Observation.component:SBP.code.coding.userSelected">
      <path value="Observation.component.code.coding.userSelected" />
      <max value="0" />
    </element>
    <element id="Observation.component:SBP.code.text">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.text" />
      <max value="0" />
    </element>
    <element id="Observation.component:SBP.value[x]:valueQuantity">
      <path value="Observation.component.valueQuantity" />
      <sliceName value="valueQuantity" />
      <min value="1" />
      <type>
        <code value="Quantity" />
      </type>
    </element>
    <element id="Observation.component:SBP.value[x]:valueQuantity.value">
      <path value="Observation.component.valueQuantity.value" />
      <min value="1" />
    </element>
    <element id="Observation.component:SBP.value[x]:valueQuantity.comparator">
      <path value="Observation.component.valueQuantity.comparator" />
      <max value="0" />
    </element>
    <element id="Observation.component:SBP.value[x]:valueQuantity.unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.valueQuantity.unit" />
      <min value="1" />
    </element>
    <element id="Observation.component:SBP.value[x]:valueQuantity.system">
      <path value="Observation.component.valueQuantity.system" />
      <min value="1" />
      <fixedUri value="http://unitsofmeasure.org" />
    </element>
    <element id="Observation.component:SBP.value[x]:valueQuantity.code">
      <path value="Observation.component.valueQuantity.code" />
      <min value="1" />
      <fixedCode value="mm[Hg]" />
    </element>
    <element id="Observation.component:SBP.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:SBP.interpretation">
      <path value="Observation.component.interpretation" />
      <max value="0" />
    </element>
    <element id="Observation.component:SBP.referenceRange">
      <path value="Observation.component.referenceRange" />
      <max value="0" />
    </element>
    <element id="Observation.component:DBP">
      <path value="Observation.component" />
      <sliceName value="DBP" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:DBP.code.coding">
      <path value="Observation.component.code.coding" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:DBP.code.coding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="http://ihmi.termspace.com/api/uri?uri=http://snomed.info/sct/3881000207102" />
    </element>
    <element id="Observation.component:DBP.code.coding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
      <fixedCode value="4131000207105" />
    </element>
    <element id="Observation.component:DBP.code.coding.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <min value="1" />
      <fixedString value="Measurement of diastolic blood pressure (procedure)" />
    </element>
    <element id="Observation.component:DBP.code.coding.userSelected">
      <path value="Observation.component.code.coding.userSelected" />
      <max value="0" />
    </element>
    <element id="Observation.component:DBP.code.text">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.text" />
      <max value="0" />
    </element>
    <element id="Observation.component:DBP.value[x]:valueQuantity">
      <path value="Observation.component.valueQuantity" />
      <sliceName value="valueQuantity" />
      <min value="1" />
      <type>
        <code value="Quantity" />
      </type>
    </element>
    <element id="Observation.component:DBP.value[x]:valueQuantity.value">
      <path value="Observation.component.valueQuantity.value" />
      <min value="1" />
    </element>
    <element id="Observation.component:DBP.value[x]:valueQuantity.comparator">
      <path value="Observation.component.valueQuantity.comparator" />
      <max value="0" />
    </element>
    <element id="Observation.component:DBP.value[x]:valueQuantity.unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.valueQuantity.unit" />
      <min value="1" />
    </element>
    <element id="Observation.component:DBP.value[x]:valueQuantity.system">
      <path value="Observation.component.valueQuantity.system" />
      <min value="1" />
      <fixedUri value="http://unitsofmeasure.org" />
    </element>
    <element id="Observation.component:DBP.value[x]:valueQuantity.code">
      <path value="Observation.component.valueQuantity.code" />
      <min value="1" />
      <fixedCode value="mm[Hg]" />
    </element>
    <element id="Observation.component:DBP.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:DBP.interpretation">
      <path value="Observation.component.interpretation" />
      <max value="0" />
    </element>
    <element id="Observation.component:DBP.referenceRange">
      <path value="Observation.component.referenceRange" />
      <max value="0" />
    </element>
  </differential>
</StructureDefinition>