Blood Pressure Cross-Country Cross-Language Cross-Paradigm (Demo) IG, published by FO. This guide is not an authorized publication; it is the continuous build for version 0.2.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/frankoemig/bloodpressure/ and changes regularly. See the Directory of published versions

Process

What is the process to get to product family specific artefacts?

Step 1: MindMap

The following mindmap collects and sorts all aspects around blood pressure that are necessary for a correct interpretation and clinical use. It has to be recognized that some artifacts (eg. reference range) are abbreviated, and the corresponding details must be duplicated. Unfortunately, PlantUML mindmaps do not allow for cross-links to denote that.

The following diagram aggregates all aspects that can be found somewhere. It tries to arrange them in a way that helps to understand the semantics, and to sort them. For the moment, additional explanatory text has not been duplicated from other sources for copyright and IP reasons. It can be expected, that this will be done later on.

Special Aspects for "Profile Subsets"

• generic/advanced set allowing to convey all types of blood pressurements
• constrained to "standard measurements" that are commonly used on panels (so excluding specific ones), eg. at arm + sitting + in rest
• special clinical measurements, eg. artery
• average values
• …

Step 2: Information Model

The aforementioned details are now aggregated in form of classes and linked together. The important items are in bold:

• information model

Step 3: Hierarchy for Blood Pressure Profiles with regard to Vital Signs (informative)

The possible values for blood pressure measurements have to be instantiated in different ways. In combination with vital signs it forms a hierarchy:

The general blood pressure profile on top accumulates all possible details in one profile. It allows for capturing every blood pressure measurement.

Discussions has revealed that not every blood pressure measurement belongs to the vital sign category. Only specific measurements, eg. in rest with no exertion, can be used as vital signs as it is shown in a panel. Therefore, the BP panel is a specialisation of vital signs but not all other BP measurements.

It is also questionable whether the country-specific core is really necessary?!

Step 4: Technology Binding (ITS)

How to represent the same information in different standards?

Step 4a: Profile (with FHIR)

Please see FHIR page.

Step 4b: Template (with CDA)

Please see CDA page.

Step 4c: OBX Segment Group profile (with v2.x)

Please see v2 page.

Step 4d: Other Standards

In order to enable interoperability also other standards have to be included into the technology binding (ITS):

• openEHR
• xDT (for Germany)

Pre- and Post-Coordination Mapping

An important aspect is the transformation between pre- and postcoordinated forms. A single precoordinated concept can express and convey the same semantics as postcoordinated terms, or using the logical models from above, the combination of certain attributes.

Therefore, the attributes have to be values whether they are relevant for a correct interpretation or not. The following table provides an (draft) overview:

relevant	not relevant	questionable
exertion	cuff size	method
position	cuff type
tilt	location

Consequently, a transformation in between becomes necessary. It is expressed as a formula to indicate the idea:

f (concept1, position1, tilt1, exertion1) = f (concept2, position2, tilt2, exertion2)

Maybe more parameters are necessary. If the relevance shown above is not correct then modifications are necessary to this formula are necessary as well.

Country-specific Derivations

.. are not necessary so far.