Patient Monitoring Outcome FHIR Implementation Guide
0.1.0 - STU1 Belgium flag

Patient Monitoring Outcome FHIR Implementation Guide, published by My Organization. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/patient-monitoring/ and changes regularly. See the Directory of published versions

Heart failure

This FHIR implementation content is currently under development and may be subject to significant changes. Use this information with caution, as it may not yet reflect finalized or fully validated guidance. Always verify details before relying on them for production use.

DRAFT: 2025-02-10

Telemonitoring Hub Identifier

Carepath Identifier: https://hl7belgium.org/fhir/patient-monitoring/carepath/heart-failure Carepath Version: 1.0.0

Care Pathway Overview

  • Duration: 4 years
  • Central Care Facility: Specialized heart failure center with a telemonitoring team.
  • Minimal Capacity: 0.5 FTE heart failure nurse per 100 patients.
  • Educational Material: Available for self-management and adherence.
  • Accessibility: Reachable during office hours.

Patient Criteria

  • NYHA Classification: II or III (85% of all new patients, ~21,000 per year).
  • Informed Consent: Signed informed consent required.
  • Physical Consultation: At least 1 physical consultation 2 years before the start of telemonitoring.

Process and Workflow Description

Start-Up

  • Screening and Risk Assessment: Performed by the heart failure center.
  • Informed Consent: Collected and securely stored.
  • Involvement: General practitioner or home nurse involved in the workflow.
  • Parameters Monitored:
    • Heart Rate (HR)
    • Blood Pressure (BP)
    • Weight (BW)
  • Frequency: Daily, once per day, 7 days a week, 6 months.

Data Collection

  • Data is automatically collected via connected devices or manually entered into the system.
  • Technology is CE-certified, with end-to-end encryption and GDPR compliance.

Alarm Management

  • Thresholds: Heart failure alarm thresholds predefined on the digital platform.
  • Monitoring: Data checked daily during working hours by the heart failure team.
  • Alarm Notification:
    • General practitioner or home nurse informed within 5 working days (or within 48 hours if urgent).

Integration Modules for EPD

Outcome Module - PDF

  • Daily Updates: Updated daily per measurement.
  • Content: Overview of the questions and vital parameters.
  • File Size: ±100KB per PDF, max: 10MB per PDF.

Outcome Module - FHIR Integration

Vital Signs
  • Frequency: Maximum of 5 updates per day, on average 1 update per day (per measurement).
  • LOINC Codes:
    Description Code(s)
    Heart rate (HR) measurement LOINC 8867-4
    Blood pressure (BP) measurement LOINC 8480-6 / 8463-4
    Body weight (BW) measurement LOINC 29463-7
Symptoms
  • Frequency: As frequent as registered by the patient. Average of 1 per day per symptom.
  • Codes:
    Description Code(s) Possible answers
    Palpitations SNOMED 80313002 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Reduced appetite SNOMED 64379006 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Shortness of breath SNOMED 267036007 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Constipation SNOMED 14760008 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Diarrhea SNOMED 62315008 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Nocturnal shortness of breath SNOMED 248548009 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Disturbed sleep pattern SNOMED 26677001 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Tickly cough SNOMED 901000172101 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Social isolation SNOMED 422650009 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Oedema SNOMED 267038008 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Fatigue SNOMED 84229001 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Chest pain SNOMED 29857009 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Dizziness SNOMED 404640003 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Confusion SNOMED 40917007 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Foot swelling SNOMED 297142003 SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)
    Fear or depression ?? SNOMED
    - 2667000 (absent)
    - 255604002 (mild)
    - 1255665007 (moderate)
    - 24484000 (severe)

These FHIR modules ensure standardized data exchange between systems and guarantee consistency of the vital parameters.

Specification:

For detailed specifications, refer to the