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{
  "resourceType": "StructureDefinition",
  "id": "ObservationVitalsMERT",
  "url": "https://intrahealth.com/fhir/mert/StructureDefinition/ObservationVitalsMERT",
  "name": "ObservationVitalsMERT",
  "title": "Observation (Vitals) (MERT)",
  "status": "draft",
  "description": "MERT vital signs Observation. Restricted to a small set of LOINC codes, with special handling for blood pressure panel.",
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "Observation",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Observation",
        "path": "Observation",
        "constraint": [
          {
            "key": "mert-vitals-bp-panel-structure",
            "severity": "error",
            "human": "If code is blood pressure panel (LOINC 85354-9), Observation.value SHALL be absent and at least one component (systolic and/or diastolic) SHALL be present.",
            "expression": "code.coding.where(system='http://loinc.org' and code='85354-9').empty() or (value.empty() and component.where(code.coding.where(system='http://loinc.org' and (code='8480-6' or code='8462-4')).exists()).exists())",
            "source": "https://intrahealth.com/fhir/mert/StructureDefinition/ObservationVitalsMERT"
          },
          {
            "key": "mert-vitals-nonbp-requires-quantity",
            "severity": "error",
            "human": "If code is not blood pressure panel (LOINC 85354-9), Observation.valueQuantity SHALL be present.",
            "expression": "code.coding.where(system='http://loinc.org' and code='85354-9').exists() or value.ofType(Quantity).exists()",
            "source": "https://intrahealth.com/fhir/mert/StructureDefinition/ObservationVitalsMERT"
          }
        ]
      },
      {
        "id": "Observation.status",
        "path": "Observation.status",
        "comment": "MERT transmits vitals as final observations.",
        "patternCode": "final",
        "mustSupport": true
      },
      {
        "id": "Observation.category",
        "path": "Observation.category",
        "comment": "MERT uses the vital-signs category.",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "Observation.category.coding",
        "path": "Observation.category.coding",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.category.coding.system",
        "path": "Observation.category.coding.system",
        "min": 1,
        "patternUri": "http://terminology.hl7.org/CodeSystem/observation-category"
      },
      {
        "id": "Observation.category.coding.code",
        "path": "Observation.category.coding.code",
        "min": 1,
        "patternCode": "vital-signs"
      },
      {
        "id": "Observation.code",
        "path": "Observation.code",
        "comment": "Only the MERT-supported vital sign LOINC codes are permitted.",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://intrahealth.com/fhir/mert/ValueSet/mert-vitals-code-vs"
        }
      },
      {
        "id": "Observation.subject",
        "path": "Observation.subject",
        "min": 1,
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://intrahealth.com/fhir/mert/StructureDefinition/PatientMERT"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.encounter",
        "path": "Observation.encounter",
        "mustSupport": true
      },
      {
        "id": "Observation.effective[x]",
        "path": "Observation.effective[x]",
        "mustSupport": true
      },
      {
        "id": "Observation.value[x]",
        "path": "Observation.value[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ],
          "ordered": false,
          "rules": "open"
        },
        "comment": "For non-blood-pressure vitals, valueQuantity is required. For BP panel (85354-9), value is absent and components carry the values.",
        "mustSupport": true
      },
      {
        "id": "Observation.value[x]:valueQuantity",
        "path": "Observation.value[x]",
        "sliceName": "valueQuantity",
        "comment": "For BMI (LOINC 39156-5), represent the result as valueQuantity in kg/m2.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.note",
        "path": "Observation.note",
        "mustSupport": true
      },
      {
        "id": "Observation.hasMember",
        "path": "Observation.hasMember",
        "mustSupport": true
      },
      {
        "id": "Observation.component",
        "path": "Observation.component",
        "comment": "Used for blood pressure panel (LOINC 85354-9) to carry systolic/diastolic components. Other vitals generally have no components.",
        "mustSupport": true
      },
      {
        "id": "Observation.component.code",
        "path": "Observation.component.code",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://intrahealth.com/fhir/mert/ValueSet/mert-bp-component-code-vs"
        }
      },
      {
        "id": "Observation.component.value[x]",
        "path": "Observation.component.value[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ],
          "ordered": false,
          "rules": "open"
        },
        "mustSupport": true
      },
      {
        "id": "Observation.component.value[x]:valueQuantity",
        "path": "Observation.component.value[x]",
        "sliceName": "valueQuantity",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "mustSupport": true
      }
    ]
  }
}