CapabilityStatement prototype for MHV as a FHIR Client

A profile on the AllergyIntolerance that declares how MHV will Create in PGHD for allergy or intolerance.

Given that MyHealtheVet has access to the medical record (Vista and Cerner), there should be logic keeping a patient from entering a duplicate allergy or intolerance.

• Derived off of US-Core Allergy
• must be marked with MHV app tag
• must point at the patient
• must indicate patient is the asserter
• may have recorder be the user (e.g. delegate)
• must have clinicalStatus of active
• may have type set to allergy or intolerance (default blank)
• must have a recordedDate of the date entered
• must have a onsetDateTime from the UI
• must have a code.text or code.coding from a valueset from the UI
• may have a category from the UI
• may have a severity from the UI
• must have a reaction.note or reaction.manifestation from the UI
• may have a comments note from the UI
• once created will or might have an id, versionId, lastUpdated, text, and identifier
• DSTU2 uses slightly different element names (e.g., substance and onset)

A profile on the Observation that declares how MHV will Read/Create in PGHD for blood Oxygen Saturation measurements (aka Pulse Ox).

This profile is consistent with FHIR core Vital-Signs for Oxygen Saturation

• must be marked with MHV app tag
• must have vital-signs category
• must have LOINC#59408-5 code AND LOINC#2708-6
  • Argonaut and VCM use 59408-5
  • FHIR Core R4 also adds 2708-6
• must have effectiveDateTime
  • others might use effectivePeriod
• must have a valueQuantity with UCUM ‘%’ units
  • must be between 50% <= n <= 100%
• must have status at final or preliminary
• must point at the patient
• may have a hasMember of a heart-rate and/or respiration-rate
• may have a note (comment)
• MHV captures Oxygen Setting, but this is not captured or stored in PGHD
• once created will or might have an id, versionId, lastUpdated, text, and identifier
• DSTU2 use comment rather than note

A profile on the Observation that declares how MHV will Create/Read in PGHD for blood pressure measurements.

Note: This profile is not aligned with FHIR core Vital-Signs. FHIR Core Vital-Signs would prefer we use LOINC 85354-9 - Blood pressure panel with all children optional. This was not agreed by Mobile.

• must be marked with MHV app tag
• must have vital-signs category
• must have LOINC#55284-4 code AND LOINC#8716-3
  • 8716-3 was added as some mobile apps searched on this
• must have effectiveDateTime
  • others might use effectivePeriod
• must not have a value[x]
• must have two components
• must have systolic and diastolic component values in mm[Hg]
  • systolic must be between 20 <= s <= 300
  • diastolic must be between 20 <= d <= 250
• may have a related has-member heart-rate observation
• must have status at final
• must point at the patient
• may have a note (comment)
• once created will or might have an id, versionId, lastUpdated, text, and identifier

Later may have a position component (sitting, standing, supline, and resting)

A profile on the Observation that declares how MHV could Create in PGHD for blood sugar measurements. Indicate fasting status as a code.

Switched to this with the move to R4

Note that Blood Sugar is not part of FHIR core vital-signs.

• must be marked with MHV app tag
• must have laboratory category
• must have LOINC#2339-0 code
  • no longer using LOINC#2345-7 with move to FHIR R4
• may have indication of fasting (LOINC#88365-2), or 2-hours after meal (LOINC#87422-2)
• must have effectiveDateTime
  • others might use effectivePeriod
• must have valueQuantity with units only of mg/dL
  • must be between 10 <= n <= 1000
• must have status at final
• must point at the patient
• may have a method of clinical lab test, sterile lancet, transcutaneous, implant, or other
• may have a note (comment)
• once created will or might have an id, versionId, lastUpdated, text, and identifier

A profile on the Bundle that declares how MHV will Create in PGHD for BlueButton report.

This is a work in progress. It is not agreed to, and it is not ready for review.

• must be a document type Bundle
• must have a timestamp of when this was created
• must have a MHV Bluebutton type of a Composition
• must include Patient Resource
• must include all Resources referenced by Composition
• DSTU2 use comment rather than note

A profile on the Composition that declares how MHV will Create/Update in PGHD for BlueButton report.

This is a work in progress. It is not agreed to, and it is not ready for review.

• must be marked with MHV app tag
• must be status final
• must have a title explaining the content - for example: all vital-signs from past 60 days
• must have date stamp of when created (now)
• must be LOINC 55188-7 Patient data Document
• must point at the patient for both subject and author
• DSTU2 use comment rather than note

A profile on the Observation that declares how MHV will Create/Read in PGHD for body temperature measurements.

Note this is compliant with FHIR core vital-signs.

• must be marked with MHV app tag
• must have vital-signs category
• must have LOINC#8310-5 code
• must have effectiveDateTime
  • others might use effectivePeriod
• must have valueQuantity with units from the MHV body temperatures (F and C)
  • must be value between 80 <= n <= 110 Fahrenheit
• must have status at final
• must point at the patient
• may have a bodySite from MHV body temperature sites (tongue, underarm, ear, mouth, or rectum)
• may have a note (comment)
• once created will or might have an id, versionId, lastUpdated, text, and identifier

A profile on the Observation that declares how MHV will Create in PGHD for body weight measurements.

Note this is compliant with FHIR core vital-signs.

• must be marked with MHV app tag
• must have vital-signs category
• must have LOINC#29463-7 code
• must have effectiveDateTime
  • others might use effectivePeriod
• must have valueQuantity with units from the MHV body weights (lbs and kg)
  • must be value 0.25 <= n <= 999 lbs
• must have status at final
• must point at the patient
• may have a note (comment)
• once created will or might have an id, versionId, lastUpdated, text, and identifier

A profile on the FamilyMemberHistory that declares how MHV will Create in PGHD for an family member history record.

Proposed mapping not yet approved for implementation

Given that MyHealtheVet has access to medical record (Vista and Cerner) of FamilyMemberHistory, there should be logic keeping a patient from entering a duplicate details.

• For each relative of the Patient there will be a FamilyMemberHistory instance
  • Thus a query of the FamilyMemberHistory instances for a given Patient will give you all the relatives for which medical history is known.
  • Each FamilyMemberHistory record would be updated when new medical conditions/problems are learned
  • Thus FamilyMemberHistory needs to have support for Create/Read/Update/Delete
• once created will or might have an id, versionId, lastUpdated, text, and identifier
• must be marked with MHV app tag
• must point at the patient
• must indicate the date this record is being recorded into PGHD
• should have a name of the family member
• must have the relationship this family member has with the Patient
• should have the sex/gender (birth sex) of this family member
• should have the age or date-of-birth
  • should use a valueSet for date ranges on decades
  • indicate estimatedAge if the age is estimated
• should have indication when patient has died with the age of death or date
  • should use a valueSet for date ranges on decades
• may have extension indication of twin (multiple-birth) using
• may have extension indicate Race
• may have extension indicate Ethnicity
• may have extension indicate Adopted
• should have 0..* conditions
  • condition.code should be from a given valueSet
  • condition.outcome should indicate the outcome of this condition
  • condition.onset[x] should indicate when this condition first manifested
  • condition.note may include a freetext note
• should have a note

A profile on the Observation that declares how MHV will Create in PGHD for heart rate measurements.

Note this is compliant with FHIR core vital-signs.

• must be marked with MHV app tag
• must have vital-signs category
• must have LOINC#8867-4 code
• must have effectiveDateTime
  • others might use effectivePeriod
• must have valueQuantity with units only of beats per minute
  • must be value 10 <= n <= 250
• must have status at final
• must point at the patient
• may have a note (comment)
• once created will or might have an id, versionId, lastUpdated, text, and identifier

A profile on the Immunization that declares how MHV will Create in PGHD for an immunization.

Proposed mapping not yet approved for implementation

Given that MyHealtheVet has access to medical record (Vista and Cerner) of immunizations, there should be logic keeping a patient from entering a duplicate immunization.

• Derived off of US-Core Immunization
• must be marked with MHV app tag
• must point at the patient
• must have status of completed (can not enter not-done or entered-in-error)
• must have a code.text or code.coding from a valueset from the UI
  • codes from given valueSet
• must have a date (occuranceDateTime) the vaccine was administered from the UI
• must indicate the date this record is being recorded into PGHD
• must be indicated this data are not official record (primarySource=false)
• must indicate this is being recorded from patient recollection
• any reaction is recorded as a contained observation
• may have a comment note
• once created will or might have an id, versionId, lastUpdated, text, and identifier
• DSTU2 uses slightly different element names (e.g., substance and onset)

A profile on the MedicationStatement that declares how MHV will Create in PGHD.

Proposed mapping not yet approved for implementation

• NOT Derived off of US-Core as there is no MedicationStatement in US-Core
• must be marked with MHV app tag
• must have a medication name
• must have a strength per dose
• must have a reason for use
• must have effectiveDateTime
• must have status at final, stopped, or complete
• must point at the patient
• may have a note
• may have quantity
• may have frequency
• may have method of taking
• may have a rx number
• may indicate where it was filled
• may indicate who prescribed
• may indicate if side affects or none
• once created will or might have an id, versionId, lastUpdated, text, and identifier

A profile on the Observation that declares how MHV will Create in PGHD for pain measurements.

Note that Pain is not part of FHIR core vital-signs.

• must be marked with MHV app tag
• must have vital-signs category
• must have both LOINC#72514-3 and SCT#225908003 code
• must have effectiveDateTime
  • others might use effectivePeriod
• must have valueQuantity with no units
  • must have integer between 0-10
• must have status at final
• must point at the patient
• may have a note (comment)
• once created will or might have an id, versionId, lastUpdated, text, and identifier

A profile on the Observation that declares how MHV will Read/Create in PGHD for respiration rate measurements. This is mostly used in conjunction with Blood Oxygen Saturation (aka PulseOx).

This profile is consistent with FHIR core Vital-Signs for Respiration Rate

• must be marked with MHV app tag
• must have vital-signs category
• must have LOINC#9279-1 code
  • FHIR Core, Argonaut and VCM use 9279-1
• must have effectiveDateTime
  • others might use effectivePeriod
• must have valueQuantity with units only of breaths per minute
  • typical is 12-16 breaths per minute
  • must be a value 5 <= n <=120
• must have status at final or preliminary
• must point at the patient
• may have a note (comment)
• once created will or might have an id, versionId, lastUpdated, text, and identifier
• DSTU2 use comment rather than note

When this family member is Adopted.

What is the Ethnicity of this family member

Note would like to use the us-core defined extension, but it is not allowed in FamilyMemberHistory jira issue

When this family member is known to be part of a MultiBirth, indicate how many siblings.

What is the Race of this family member

Note would like to use us-core defined extension, but is not allowed in FamilyMemberHistory Jira issue

ValueSet of the Ages allowed

All valid App ID codes

These are the SNOMED body sites that MHV supports.

These are the UCUM types that MHV supports.

These are the UCUM types that MHV supports. This is a subset of the full bodyWeight types (which also brings in grams. Others might also include stone).

These are the loinc body positions that MHV supports on blood pressure.

These are the SNOMED body sites that MHV supports.

These are the SNOMED-CT routes for medications that MHV supports.

Used when the Age is not known very well

App identifiers for use with PGD

Seems to be used by Mobile Kidney

Dummy patient example for completeness sake. No actual use of this resource other than an example target

holding typical values

Minimal details

• Johannes Yakub Schmidt
• Father
• Male
• born July 25, 1903 - estimated
• deceased
• note
• conditions: Anxiety and Choroidal

Minimal details

• Katherine Irene Schmidt
• Mother
• Female
• note
• conditions: Homiothermia and decreased hair growth

holding typical values

Maximal details

• John Jacob Schmidt
• Son
• twin
• born 7/25/1943
• Male
• not adopted
• not hispanic or latino
• Irish
• note
• conditions: Meningitis leading to Meningoccermia at age 50s
• conditions: bipolar

Minimal details

• John Jacob Schmidt
• Son
• twin
• age 78
• Male
• note
• conditions: scrotum wound and bladder continence

Minimal details

• Jania Luise Schmidt
• Wife
• Female
• note
• conditions: Pharyngitis and normal peripheral vision

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding invalid values

holding invalid values

holding invalid values

holding a value that is too high (1001) value

holding typical values

This observation does not use a dateTime, but rather a period.

This is similar to how Apple data looks.

• note no category
• note effectivePeriod with start and end that are equal

holding typical values

holding typical values

holding Apple like values of 140/90 with a heart-rate

Note

• apple does not populate the category
• apple only uses one code of LOINC#55284-4
• apple uses effectivePeriod (seemingly to have start and end the same)
• has meta.source populated with unknown identifier (presume some link back to apple, although this could be PGHD and not SMHD)

holding typical values of 140/90

holding typical values of 140/90 with a heart-rate

holding typical values of 140/90 with a heart-rate, using only a end Period time/date

holding typical values of 140/90 with a heart-rate, using only a start Period time/date

holding atypical values

holding typical values

holding typical values

holding atypical values

holding typical values

holding a value that is too high (1001) value

holding a value that is too low (1) value

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

• 185 pounds

Heart Rate holding typical values

Heart Rate holding typical values

Heart Rate holding typical values

holding typical values

holding typical values

Oxygen Saturation holding high value of 99.4%

Heart Rate holding typical values

Heart Rate holding typical values

Heart Rate holding typical values

Oxygen Saturation holding typical values

Oxygen Saturation holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

holding typical values

Respiration Rate holding typical values

Respiration Rate holding typical values

Respiration Rate holding typical values

This is not coded as oxygen sat, but has a text. Rumored to be what SMHD might create.

holding typical values

holding atypical values

holding atypical values

holding atypical values

holding atypical values

holding atypical values

holding atypical values

holding atypical values

Heart Rate holding typical values

holding typical values. Should be close to the example body weight in the FHIR core specification

This observation does not use a dateTime, but rather a period.

This is similar to how Apple data looks.

• note no category
• note effectivePeriod with start and end that are equal

holding typical values. Should be close to the example body weight in the FHIR core specification. This observation does not use a dateTime, but rather a period with just a start.

holding typical values. Should be close to the example body weight in the FHIR core specification. This observation does not use a dateTime, but rather a period with just an end.

holding typical value but NOT using ucum units of measure.

holding typical stone values.

holding typical value in a string.