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  1. FHIR Specification Feedback
  2. FHIR-43960

CLONE - Clarify that the LOINC 85354-9 is used for all blood pressure measurements

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive with Modification
    • Icon: Medium Medium
    • FHIR Core (FHIR)
    • Orders & Observations
    • Observation
    • 10.1.1.1
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      Motion to find not persuasive.

      Average Blood Pressure represents a different concept than a point in time Blood Pressure.   LOINC defined different codes for these concepts: three point in time (PT) BP related codes (85354-9, 8480-6, 8462-4) and three mean (XXX^mean) BP related codes (96607-7, 96608-5, 96609-3).  (Note that the LOINC term of "mean" does not refer to mean arterial pressure as it would be a point-in-time vital signs.)

      Considering that, while also wanting to ease the way to find actual vital signs and related observations:

      1. An Average Blood Pressure profile as an average measure, cannot be derived from the FHIR Core Vital Signs profile or any profile derived directly or indirectly from the FHIR Core Vital Signs profile (https://hl7.org/fhir/R4/vitalsigns.html)
      2. An Average Blood Pressure profile may use Observation.category="vital-signs", but an implementation may opt to use another category.
      3. The slices in Observation.code and Observation.component.code representing the point in time BP concepts must be removed so that only the average/mean BP LOINC codes are identified as fixed bindings.

      and address updates to the FHIR US Core profile to clarify scope including this guidance.

      Note a separate Jira will address specific changes that need to be considered and finalized.  Considerations, not yet decisions, are documented in the comments attached to this Jira and carried into a new JIRA.

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      Motion to find not persuasive. Average Blood Pressure represents a different concept than a point in time Blood Pressure.   LOINC defined different codes for these concepts: three point in time (PT) BP related codes (85354-9, 8480-6, 8462-4) and three mean (XXX^mean) BP related codes ( 96607-7 , 96608-5 , 96609-3 ).  (Note that the LOINC term of "mean" does not refer to mean arterial pressure as it would be a point-in-time vital signs.) Considering that, while also wanting to ease the way to find actual vital signs and related observations: An Average Blood Pressure profile as an average measure, cannot be derived from the FHIR Core Vital Signs profile or any profile derived directly or indirectly from the FHIR Core Vital Signs profile ( https://hl7.org/fhir/R4/vitalsigns.html ) An Average Blood Pressure profile may use Observation.category="vital-signs", but an implementation may opt to use another category. The slices in Observation.code and Observation.component.code representing the point in time BP concepts must be removed so that only the average/mean BP LOINC codes are identified as fixed bindings. and address updates to the FHIR US Core profile to clarify scope including this guidance. Note a separate Jira will address specific changes that need to be considered and finalized.  Considerations, not yet decisions, are documented in the comments attached to this Jira and carried into a new JIRA.
    • Nathan Davis / Dan Rutz: 12-0-0
    • Correction
    • Non-compatible

    Description

      To avoid confusion from the reader, explain that the average blood pressure (or other types of blood pressure measurements) is treated as a further refinement of the blood pressure profile and, therefore use the LOINC 85354-9 is used for all blood pressure measurements and additional LOINC codings to represent the types of blood pressure measurement such as average value.   this is an inherited constraint from the FHIR Core Blood Pressure Profile https://hl7.org/fhir/R4/observation.html
       

      implementations use this Resource when expressing the profile-specific concepts as structured data, they SHALL conform to the following profiles:

       
      (edit final version)

       

      Discussed this issue in  January 2024 Virtual WGM  Tuesday Q3 Call.

      in relation to 

      1. FHIR-43538 Confusing use of Observation.code values (hbuitendijk)

      Which include Hans Buitendijk and Grahame Grieve. Summarizing:

      1. Not clear in the Profile documentation if the "magic codes" include component codes
      2. Currently, the FHIR validator enforces that rule clients get average BP measurements when they use the BP "magic code".  There was disagreement on whether they should.
      3. Some systems may actually calculate average blood pressure on the fly when blood pressure are fetched. ( unclear on context )

      Cloned tracker from US Core FHIR-43959

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            ehaas Eric Haas
            ehaas Eric Haas
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              Updated:
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