FHIR IG Statistics: StructureDefinition/NICE-BloodPressure

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{
  "resourceType": "StructureDefinition",
  "id": "NICE-BloodPressure",
  "meta": {
    "versionId": "2",
    "lastUpdated": "2022-08-04T14:42:54.4396215+00:00"
  },
  "url": "https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-BloodPressure-2022Q1",
  "version": "1",
  "name": "NICE-BloodPressure",
  "title": "NICE-BloodPressure",
  "status": "active",
  "date": "2022-04-11T11:23:38.96159Z",
  "publisher": "NICE",
  "contact": [
    {
      "name": "NICE",
      "telecom": [
        {
          "system": "email",
          "value": "vragen@stichting-nice.nl"
        }
      ]
    }
  ],
  "description": "The NICE submission requires the highest and lowest values within the first 24 hours of ICU admission for two blood pressure types:\r\n- The systolic blood pressure \r\n    - Do not count short term blood pressure change due to exchange of pump, unless clinically relevant.\r\n- The average blood pressure\r\n    - In case the average blood pressure is not recorded, it may be calculated using (2*diastolic+systolic)/3\r\nNOTE: The values need to be inserted in a slice under the 'components' section of the profile",
  "purpose": "A profile derived from the HL7 Vital Signs profile for Blood Pressure in order to add mappings from the Dutch Health and Care Information models (HCIM; Dutch: Zorginformatiebouwsteen or ZIB) BloodPressure version 3.1, release 2017.\r\nBlood pressure is measured to gain an indication of the health condition of the patient’s cardiovascular system.",
  "copyright": "CC0",
  "fhirVersion": "3.0.2",
  "mapping": [
    {
      "identity": "hcim-bloodpressure-v1.2-2015EN",
      "uri": "https://zibs.nl/wiki/BloodPressure-v1.2(2015EN)",
      "name": "HCIM BloodPressure-v1.2(2015EN)"
    },
    {
      "identity": "hcim-bloodpressure-v3.0-2016EN",
      "uri": "https://zibs.nl/wiki/BloodPressure-v3.0(2016EN)",
      "name": "HCIM BloodPressure-v3.0(2016EN)"
    },
    {
      "identity": "hcim-bloodpressure-v3.1-2017EN",
      "uri": "https://zibs.nl/wiki/BloodPressure-v3.1(2017EN)",
      "name": "HCIM BloodPressure-v3.1(2017EN)"
    },
    {
      "identity": "hcim-basicelements-v1.0-2017EN",
      "uri": "https://zibs.nl/wiki/BasicElements-v1.0(2017EN)",
      "name": "HCIM BasicElements-v1.0(2017EN)"
    },
    {
      "identity": "NICE-Datadictionary-MDS",
      "uri": "https://www.stichting-nice.nl/dd/#528",
      "name": "NICE-Datadictionary-MDS",
      "comment": "The Minimal Data Set (MDS) module"
    },
    {
      "identity": "NICE-Datadictionary-SOFA",
      "uri": "https://www.stichting-nice.nl/dd/#547",
      "name": "NICE-Datadictionary-SOFA",
      "comment": "The Sequential Organ Failure Assessment (SOFA) module"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "Observation",
  "baseDefinition": "http://nictiz.nl/fhir/StructureDefinition/zib-VitalSigns",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Observation",
        "path": "Observation",
        "short": "BloodPressure",
        "definition": "The FHIR BloodPressure profile sets a minimum expectations for the Observation Resource to record, search and fetch the blood pressure associated with a patient.",
        "alias": [
          "Bloeddruk"
        ],
        "mapping": [
          {
            "identity": "hcim-bloodpressure-v1.2-2015EN",
            "map": "NL-CM:12.4.1",
            "comment": "BloodPressure"
          },
          {
            "identity": "hcim-bloodpressure-v3.0-2016EN",
            "map": "NL-CM:12.4.1",
            "comment": "BloodPressure"
          },
          {
            "identity": "hcim-bloodpressure-v3.1-2017EN",
            "map": "NL-CM:12.4.1",
            "comment": "BloodPressure"
          }
        ]
      },
      {
        "id": "Observation.extension",
        "path": "Observation.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        },
        "min": 2
      },
      {
        "id": "Observation.extension:ExtremeValueType",
        "path": "Observation.extension",
        "sliceName": "ExtremeValueType",
        "min": 0,
        "type": [
          {
            "code": "Extension",
            "profile": "https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-ExtremeValueType-2022Q1"
          }
        ]
      },
      {
        "id": "Observation.extension:ScoreDay",
        "path": "Observation.extension",
        "sliceName": "ScoreDay",
        "short": "Score day",
        "definition": "Extension that is used to indicate either the day of scoring.\r\nThe first 24 hours after admission count as day 1. The next day starts from the first morning shift and lasts 24 hours, so until the start of the next morning shift. Note: Score day 1 can overlap with score day 2, and 'the first morning shift' is specified locally can differ between hospitals.",
        "min": 1,
        "type": [
          {
            "code": "Extension",
            "profile": "https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-ScoreDay-2022Q1"
          }
        ]
      },
      {
        "id": "Observation.extension:Verified",
        "path": "Observation.extension",
        "sliceName": "Verified",
        "short": "Is the instance validated by a medical professional?",
        "definition": "Extension that is used to indicate whether the entire instance has been validated.\r\n\r\nEvery instance shall be validated by a hospital member / datamanager. However, this is not always feasible in case of automated submission of NICE data elements. This extensions shall be used to indicate the validation status of the instance.",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-Verified-2022Q1"
          }
        ]
      },
      {
        "id": "Observation.status",
        "path": "Observation.status",
        "short": "Validated (final)",
        "definition": "Needs to have the \"final\" value, because everything needs to be validated.",
        "fixedCode": "final"
      },
      {
        "id": "Observation.code.coding",
        "path": "Observation.code.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "system"
            },
            {
              "type": "value",
              "path": "code"
            }
          ],
          "rules": "open"
        },
        "min": 1
      },
      {
        "id": "Observation.code.coding:bloodPressureCode",
        "path": "Observation.code.coding",
        "sliceName": "bloodPressureCode",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.code.coding:bloodPressureCode.system",
        "path": "Observation.code.coding.system",
        "min": 1,
        "fixedUri": "http://loinc.org"
      },
      {
        "id": "Observation.code.coding:bloodPressureCode.code",
        "path": "Observation.code.coding.code",
        "comment": "Please note: the zib/HCIM uses the LOINC code 55284-4 rather than 85354-9. However, this latter code is used in the VitalSigns profile, and it has been chosen to align to this commonly used profile. Future versions of the zib/HCIM will use this code as well.",
        "min": 1,
        "fixedCode": "85354-9"
      },
      {
        "id": "Observation.code.coding:bloodPressureCode.display",
        "path": "Observation.code.coding.display",
        "defaultValueString": "Blood pressure panel with all children optional"
      },
      {
        "id": "Observation.subject",
        "path": "Observation.subject",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-Patient-2022Q1"
          }
        ]
      },
      {
        "id": "Observation.context",
        "path": "Observation.context",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "https://fhir.stichting-nice.nl/STU3/StructureDefinition/NICE-Encounter-2022Q1"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.effective[x]:effectiveDateTime",
        "path": "Observation.effectiveDateTime",
        "sliceName": "effectiveDateTime",
        "short": "BloodPressureDateTime",
        "alias": [
          "BloeddrukDatumTijd"
        ],
        "type": [
          {
            "code": "dateTime"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-bloodpressure-v1.2-2015EN",
            "map": "NL-CM:12.4.5",
            "comment": "BloodPressureDateTime"
          },
          {
            "identity": "hcim-bloodpressure-v3.0-2016EN",
            "map": "NL-CM:12.4.5",
            "comment": "BloodPressureDateTime"
          },
          {
            "identity": "hcim-bloodpressure-v3.1-2017EN",
            "map": "NL-CM:12.4.5",
            "comment": "BloodPressureDateTime"
          }
        ]
      },
      {
        "id": "Observation.comment",
        "path": "Observation.comment",
        "short": "Comment",
        "definition": "Comments on the measured blood pressure. Here, an explanation could be given, for example, of circumstances that may have influenced the patient’s blood pressure, such as pain, stress, exertion and sleep/wake cycles.",
        "alias": [
          "Toelichting"
        ],
        "mapping": [
          {
            "identity": "hcim-bloodpressure-v1.2-2015EN",
            "map": "NL-CM:12.4.6",
            "comment": "Explanation"
          },
          {
            "identity": "hcim-bloodpressure-v3.0-2016EN",
            "map": "NL-CM:12.4.6",
            "comment": "Explanation"
          },
          {
            "identity": "hcim-bloodpressure-v3.1-2017EN",
            "map": "NL-CM:12.4.6",
            "comment": "Comment"
          }
        ]
      },
      {
        "id": "Observation.bodySite",
        "path": "Observation.bodySite",
        "short": "MeasuringLocation",
        "definition": "Anatomical location where the blood pressure was measured.",
        "alias": [
          "MeetLocatie"
        ],
        "binding": {
          "strength": "extensible",
          "description": "MeetLocatieCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.4--20171231000000",
            "display": "MeetLocatieCodelijst"
          }
        },
        "mapping": [
          {
            "identity": "hcim-bloodpressure-v1.2-2015EN",
            "map": "NL-CM:12.4.10",
            "comment": "MeasuringLocation"
          },
          {
            "identity": "hcim-bloodpressure-v3.0-2016EN",
            "map": "NL-CM:12.4.10",
            "comment": "MeasuringLocation"
          },
          {
            "identity": "hcim-bloodpressure-v3.1-2017EN",
            "map": "NL-CM:12.4.10",
            "comment": "MeasuringLocation"
          }
        ]
      },
      {
        "id": "Observation.method",
        "path": "Observation.method",
        "short": "MeasuringMethod",
        "definition": "The type of method used to measure blood pressure.",
        "alias": [
          "Meetmethode"
        ],
        "binding": {
          "strength": "extensible",
          "description": "MeetmethodeCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.4.1--20171231000000",
            "display": "MeetmethodeCodelijst"
          }
        },
        "mapping": [
          {
            "identity": "hcim-bloodpressure-v1.2-2015EN",
            "map": "NL-CM:12.4.7",
            "comment": "MeasuringMethod"
          },
          {
            "identity": "hcim-bloodpressure-v3.0-2016EN",
            "map": "NL-CM:12.4.7",
            "comment": "MeasuringMethod"
          },
          {
            "identity": "hcim-bloodpressure-v3.1-2017EN",
            "map": "NL-CM:12.4.7",
            "comment": "MeasuringMethod"
          }
        ]
      },
      {
        "id": "Observation.component",
        "path": "Observation.component",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "code.coding.code"
            },
            {
              "type": "value",
              "path": "code.coding.system"
            }
          ],
          "ordered": false,
          "rules": "open"
        },
        "min": 1
      },
      {
        "id": "Observation.component:SystolicBP",
        "path": "Observation.component",
        "sliceName": "SystolicBP",
        "max": "1",
        "mapping": [
          {
            "identity": "NICE-Datadictionary-MDS",
            "map": "https://www.stichting-nice.nl/dd/#403",
            "comment": "Highest systolic blood pressure"
          },
          {
            "identity": "NICE-Datadictionary-MDS",
            "map": "https://www.stichting-nice.nl/dd/#404",
            "comment": "Lowest systolic blood pressure"
          }
        ]
      },
      {
        "id": "Observation.component:SystolicBP.code",
        "path": "Observation.component.code",
        "comment": "additional codes that translate or map to this code are allowed. For example a more granular LOINC code or code that is used locally in a system."
      },
      {
        "id": "Observation.component:SystolicBP.code.coding",
        "path": "Observation.component.code.coding",
        "min": 1
      },
      {
        "id": "Observation.component:SystolicBP.code.coding.system",
        "path": "Observation.component.code.coding.system",
        "min": 1,
        "fixedUri": "http://loinc.org"
      },
      {
        "id": "Observation.component:SystolicBP.code.coding.code",
        "path": "Observation.component.code.coding.code",
        "min": 1,
        "fixedCode": "8480-6"
      },
      {
        "id": "Observation.component:SystolicBP.code.coding.display",
        "path": "Observation.component.code.coding.display",
        "defaultValueString": "Systolic blood pressure"
      },
      {
        "id": "Observation.component:SystolicBP.value[x]:valueQuantity",
        "path": "Observation.component.valueQuantity",
        "sliceName": "valueQuantity",
        "short": "SystolicBloodPressure recorded with UCUM",
        "definition": "The highest (peak) systematic arterial blood pressure - measured in the contraction stage or systole of the cardiac cycle.",
        "alias": [
          "SystolischeBloeddruk"
        ],
        "min": 1,
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-bloodpressure-v1.2-2015EN",
            "map": "NL-CM:12.4.2",
            "comment": "SystolicBloodPressure"
          },
          {
            "identity": "hcim-bloodpressure-v3.0-2016EN",
            "map": "NL-CM:12.4.2",
            "comment": "SystolicBloodPressure"
          },
          {
            "identity": "hcim-bloodpressure-v3.1-2017EN",
            "map": "NL-CM:12.4.2",
            "comment": "SystolicBloodPressure"
          }
        ]
      },
      {
        "id": "Observation.component:SystolicBP.value[x]:valueQuantity.value",
        "path": "Observation.component.valueQuantity.value",
        "minValueDecimal": 0,
        "maxValueDecimal": 300,
        "constraint": [
          {
            "key": "valueExtremes",
            "severity": "error",
            "human": "The value of Blood Pressure cannot be lower than 0.0 or higher than 300.0",
            "expression": "$this >= 0.0 and $this <= 300.0"
          }
        ]
      },
      {
        "id": "Observation.component:SystolicBP.value[x]:valueQuantity.unit",
        "path": "Observation.component.valueQuantity.unit",
        "fixedString": "mm[Hg]"
      },
      {
        "id": "Observation.component:SystolicBP.value[x]:valueQuantity.code",
        "path": "Observation.component.valueQuantity.code",
        "fixedCode": "mm[Hg]"
      },
      {
        "id": "Observation.component:AverageBloodPressureLOINC",
        "path": "Observation.component",
        "sliceName": "AverageBloodPressureLOINC",
        "max": "1",
        "mapping": [
          {
            "identity": "NICE-Datadictionary-MDS",
            "map": "https://www.stichting-nice.nl/dd/#179",
            "comment": "Highest average blood pressure"
          },
          {
            "identity": "NICE-Datadictionary-MDS",
            "map": "https://www.stichting-nice.nl/dd/#180",
            "comment": "Lowest average blood pressure"
          },
          {
            "identity": "NICE-Datadictionary-SOFA",
            "map": "https://www.stichting-nice.nl/dd/#389",
            "comment": "Lowest average arterial blood pressure"
          }
        ]
      },
      {
        "id": "Observation.component:AverageBloodPressureLOINC.code",
        "path": "Observation.component.code",
        "comment": "additional codes that translate or map to this code are allowed.  For example a more granular LOINC code or code that is used locally in a system."
      },
      {
        "id": "Observation.component:AverageBloodPressureLOINC.code.coding",
        "path": "Observation.component.code.coding",
        "min": 1
      },
      {
        "id": "Observation.component:AverageBloodPressureLOINC.code.coding.system",
        "path": "Observation.component.code.coding.system",
        "min": 1,
        "fixedUri": "http://loinc.org"
      },
      {
        "id": "Observation.component:AverageBloodPressureLOINC.code.coding.code",
        "path": "Observation.component.code.coding.code",
        "min": 1,
        "fixedCode": "8478-0"
      },
      {
        "id": "Observation.component:AverageBloodPressureLOINC.code.coding.display",
        "path": "Observation.component.code.coding.display",
        "defaultValueString": "Mean blood pressure"
      },
      {
        "id": "Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity",
        "path": "Observation.component.valueQuantity",
        "sliceName": "valueQuantity",
        "short": "AverageBloodPressure recorded with UCUM",
        "definition": "Average blood pressure during one cycle of the heart contracting and relaxing.\nEstimated based on systolic and diastolic blood pressure. This estimate is unreliable in cases of circulatory disorders. This value can only be reliably determined when invasive blood pressure is measured.",
        "alias": [
          "GemiddeldeBloeddruk"
        ],
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-bloodpressure-v1.2-2015EN",
            "map": "NL-CM:12.4.4",
            "comment": "AverageBloodPressure"
          },
          {
            "identity": "hcim-bloodpressure-v3.0-2016EN",
            "map": "NL-CM:12.4.4",
            "comment": "AverageBloodPressure"
          },
          {
            "identity": "hcim-bloodpressure-v3.1-2017EN",
            "map": "NL-CM:12.4.4",
            "comment": "AverageBloodPressure"
          }
        ]
      },
      {
        "id": "Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity.value",
        "path": "Observation.component.valueQuantity.value",
        "minValueDecimal": 0,
        "maxValueDecimal": 300,
        "constraint": [
          {
            "key": "valueExtremeLow",
            "severity": "error",
            "human": "The value of Blood Pressure cannot be lower than 0.0",
            "expression": "SystolicBP.valueQuantity.value >= 0.0"
          },
          {
            "key": "valueExtremeHigh",
            "severity": "error",
            "human": "The value of Blood Pressure cannot be higher than 300.0",
            "expression": "SystolicBP.valueQuantity.value <= 300.0"
          }
        ]
      },
      {
        "id": "Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity.unit",
        "path": "Observation.component.valueQuantity.unit",
        "fixedString": "mm[Hg]"
      },
      {
        "id": "Observation.component:AverageBloodPressureLOINC.value[x]:valueQuantity.code",
        "path": "Observation.component.valueQuantity.code",
        "fixedCode": "mm[Hg]"
      },
      {
        "id": "Observation.component:AverageBloodPressureSNOMED",
        "path": "Observation.component",
        "sliceName": "AverageBloodPressureSNOMED",
        "max": "1"
      },
      {
        "id": "Observation.component:AverageBloodPressureSNOMED.code",
        "path": "Observation.component.code",
        "comment": "additional codes that translate or map to this code are allowed.  For example a more granular SNOMED code or code that is used locally in a system."
      },
      {
        "id": "Observation.component:AverageBloodPressureSNOMED.code.coding.system",
        "path": "Observation.component.code.coding.system",
        "min": 1,
        "fixedUri": "http://snomed.info/sct"
      },
      {
        "id": "Observation.component:AverageBloodPressureSNOMED.code.coding.code",
        "path": "Observation.component.code.coding.code",
        "min": 1,
        "fixedCode": "6797001"
      },
      {
        "id": "Observation.component:AverageBloodPressureSNOMED.code.coding.display",
        "path": "Observation.component.code.coding.display",
        "defaultValueString": "Mean blood pressure"
      },
      {
        "id": "Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity",
        "path": "Observation.component.valueQuantity",
        "sliceName": "valueQuantity",
        "short": "AverageBloodPressure recorded with UCUM",
        "definition": "Average blood pressure during one cycle of the heart contracting and relaxing.\nEstimated based on systolic and diastolic blood pressure. This estimate is unreliable in cases of circulatory disorders. This value can only be reliably determined when invasive blood pressure is measured.",
        "alias": [
          "GemiddeldeBloeddruk"
        ],
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-bloodpressure-v1.2-2015EN",
            "map": "NL-CM:12.4.4",
            "comment": "AverageBloodPressure"
          },
          {
            "identity": "hcim-bloodpressure-v3.0-2016EN",
            "map": "NL-CM:12.4.4",
            "comment": "AverageBloodPressure"
          },
          {
            "identity": "hcim-bloodpressure-v3.1-2017EN",
            "map": "NL-CM:12.4.4",
            "comment": "AverageBloodPressure"
          }
        ]
      },
      {
        "id": "Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity.value",
        "path": "Observation.component.valueQuantity.value",
        "minValueDecimal": 0,
        "maxValueDecimal": 300,
        "constraint": [
          {
            "key": "valueExtremes",
            "severity": "error",
            "human": "The value of Blood Pressure cannot be lower than 0.0 or higher than 300.0",
            "expression": "SystolicBP.valueQuantity.value >= 0.0 and SystolicBP.valueQuantity.value <= 300.0"
          }
        ]
      },
      {
        "id": "Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity.unit",
        "path": "Observation.component.valueQuantity.unit",
        "fixedString": "mm[Hg]"
      },
      {
        "id": "Observation.component:AverageBloodPressureSNOMED.value[x]:valueQuantity.code",
        "path": "Observation.component.valueQuantity.code",
        "fixedCode": "mm[Hg]"
      }
    ]
  }
}