Stream: implementers
Topic: Vital Signs Profile - clarity on applicability
Javier Espina (Aug 04 2021 at 16:53):
Hi there. Time and again I've witnessed discussions on when the Vital Signs profile is of mandatory use or not for expressing certain vital signs (IMHO hinting at insufficient guidance). Reviewing this again, I've noticed something that looks confusing and contradictory to me:
Basically https://www.hl7.org/fhir/observation.html#core states that the Vital Signs Profile is mandatory for certain vital signs (side note: called "core" profile, a concept I could not find a definition for...). Despite the mandatory statement, the section does not clearly specify when it is applicable (only list examples: "(e.g. temperature, blood pressure, respiration rate, etc.) ". To find that out one needs to dive into https://www.hl7.org/fhir/observation-vitalsigns.html. This last page is however informative while containing requirements, which seems like a contradiction. According to https://www.hl7.org/fhir/versions.html#std-process, an informative part of FHIR is "provided for implementer assistance and does not make rules that implementers are required to follow". Any views on this (issue)?
dsh (Aug 04 2021 at 17:10):
IMO, a profile in an Implementation Guide will make certain resources and elements mandatory. So the question is which profile/IG are you following?
Yunwei Wang (Aug 05 2021 at 15:12):
@Javier Espina Where does it say that vital sign profile is "mandatory"?
Lloyd McKenzie (Aug 05 2021 at 15:16):
This text: When a FHIR implementation supports any of the vital signs listed below, the implementation SHALL conform to this profile for the vital sign observation.
Lloyd McKenzie (Aug 05 2021 at 15:18):
I agree that it being labeled "informative" is confusing and an error - it should have been marked as STU. Can you submit a change request @Javier Espina ?
Javier Espina (Aug 05 2021 at 16:30):
@Lloyd McKenzie , sure. I have just done it. See https://jira.hl7.org/browse/FHIR-33145
Javier Espina (Sep 21 2021 at 17:40):
Javier Espina said:
Lloyd McKenzie , sure. I have just done it. See https://jira.hl7.org/browse/FHIR-33145
@Nathan Davis
Nathan Davis (Sep 21 2021 at 20:32):
@Javier Espina I agree with the above discussion, it should be labeled as STU.
Regarding your question about the CIMI Blood Pressure Panel profile vs. the "core" BP profile;
If I may paraphrase, the question I think you're asking is "why doesn't the CIMI blood pressure profile follow the core BP profile"?
According to the requirement, quoted by Lloyd above, the profile that an implementation shall be conformant to is the VitalSigns profile.
It doesn't state that if implementing a blood pressure, the BP profile must be used. We created a profile for Blood Pressure Panel, based on the VitalSigns profile because we needed to be able to make the cardinality of diastolic pressure 0..1. Something we can't do if the BP profile is the basis for our Blood Pressure Panel profile.
I do realize that this can create massive headaches for implementers but, we are still conformant to the requirement. We hope to have the diastolic cardinality debate in the near future.
Javier Espina (Sep 22 2021 at 07:45):
Thanks @Nathan Davis . When commenting on BP component cardinality, I understand you are reacting to my comment at https://chat.fhir.org/#narrow/stream/179256-Orders-and.20Observation.20WG/topic/Vital.20Signs.20IG/near/254248727. I now see two more unclear areas:
(1) whether the requirement to comply with the Vital Signs Profile does not automatically require to additionally comply with its more-specific "child" profile for a given vital sign;
(2) the Vital Sign Profile itself [not even going to the "child" BP Profile] states "...if you have a blood pressure observation, you must have both a systolic and a diastolic component, though one or both may have dataAbsentReason instead of a value.". Interestingly this seem to contradict the statements on the very same page about the "child" BP Profile: "Blood pressure panel with all children optional - This is a component observation. It has no value in Observation.valueQuantity and contains at least one component (systolic and/or diastolic).".
Last updated: Apr 12 2022 at 19:14 UTC
