0.7.8 - ballotNormative-1
0.7.8 - ballotNormative-1
NoDomainVitalSigns - Local Development build (v0.7.8) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
In FHIR vital-signs, the LOINC codes (magic value) are mandatory to indicate what category of measurement the given observation is. Until release R5 the magic value was mandatory in the Observation.code element. This is problematic in for use in Norway as LOINC is not generally used in clinical systems in Norway. The magic value codes are to be considered as category codes and if more precise coding is needed SNOMED or other terminology are recommended to use in addition to the magic value.
R6 makes several changes to the use of magic values in vital-signs observations. First of the magic value is placed in the Observation.category which better represents our interpretation of the magic value, as a high level category that makes it easy to find similar measurements. Secondly there are valuesets for the Observation.code values that the vital-signs category should be used for. At the moment these valuesets only contains LOINC codes, which is problematic for use in Norway.
In most cases pulse rate and heart rate values are considered to be clinically the same; pulse rate is treated as a “proxy” of the actual heart rate. However there are several cases where pulse rate and heart rate are treated as different measurements and differences have clinical importance. In most cases a general LOINC heart rate code to indicate both pulse rate and heart rate is good enough. For systems and clinical processes that need to differentiate the different concepts, the use of more specific SNOMED codes indicated in Observation.code slices in the no-domain-pulse and no-domain-heartrate profiles are recommended. Additional information about method and bodySite of the heart rate observation can also indicate pulse or heart rate observation.
The model depicts the differences in conceptual and FHIR vital signs model, including the meaning of different use of codes for handling the complex conceptual model where pulse rate and heart rate are to be differentiated.