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

NEWS (National Early Warning Score)

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: 2024-11-27

Care Pathway Overview

  • Accessibility: Reachable during office hours.

  • Patient Criteria:

    • Signed informed consent
    • Ability to sustainably implement telemonitoring
    • Lives within the geographically defined region
    • Patient has no psychosocial issues
    • Patient without non-compliance
    • Patient is willing to wear wearables during the hospital stay and in the home environment
    • Patient is over 16 years old
    • Patient was not admitted to intensive care
    • Patient is medically stable
    • Patient is no longer receiving oxygen therapy at discharge (EWS calculation)
  • Accessibility: Reachable during office hours.

Process and Workflow Description

Start-Up

  • Screening and risk Assessment: performed by the attending physician.
  • Informed consent: Collected and securely stored.
  • Tele Care Center: Involved in the workflow.

  • Parameters monitored:

    • Heart Rate (HR)
    • Systolic Blood Pressure (BP)
    • Saturation
    • Temperature
    • Respiratory Rate
    • Oxygen
    • ACVPU
    • NEWS
      • Frequency: Daily, 3 times per day, 10 days.

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

  • (N)EWS and/or single vital sign alarm thresholds are predefined on the digital platform.
  • The RRT/tele care center checks the collected data daily during working hours.
  • In case of alarms, the tele care center will inform the home nurse as soon as possible.

Integration Modules for EPD

Outcome Module - PDF

  • Daily Updates: Updated hourly.
  • 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 1 update per minute.
  • LOINC Codes:
    Description Code(s) Possible answers
    Heart rate (HR) measurement LOINC 8867-4 Not applicable
    Blood pressure (BP) measurement LOINC 8480-6 / 8462-4 Not applicable
    Body weight (BW) measurement LOINC 29463-7 Not applicable
    Respiratory (RESP) measurement LOINC 9279-1 Not applicable
    Temperature (TEMP) measurement LOINC 8310-5 Not applicable
    Oxygen Saturation (SPO2) measurement LOINC 2708-6 (sub 59408-5) Not applicable
    Patient on oxygen SNOMED 371825009 SNOMED
    - 373066001 (yes)
    - 373067005 (no)
    Inhaled oxygen flow rate LOINC 3151-8 Not applicable
    Level of responsiveness (ACVPU scale) LOINC 67775-7 LOINC
    - LA9340-6 (Alert)
    - LA6560-2 (Confused)
    - LA17108-4 (Verbal)
    - LA17107-6 (Painful)
    - LA9343-0 (Unresponsive)
    National Early Warning Score (NEWS) SNOMED 1287358002 Not applicable

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

  • Blood Pressure BodySite
    Location SNOMED-CT Code(s)
    Right Arm SNOMED 368209003
    Left Arm SNOMED 368208006
  • Blood Pressure Specifics
    Type SNOMED-CT Code(s)
    Standing diastolic blood pressure 400975005
    Lying diastolic blood pressure 407557002
    Sitting diastolic blood pressure 407555005
    Diastolic blood pressure 271650006
       
    Standing systolic blood pressure 400974009
    Lying systolic blood pressure 407556006
    Sitting systolic blood pressure 407554009
    Systolic blood pressure 271649006
  • Temperature BodySite
    Location SNOMED-CT Code(s)
    Ear 117590005
    Forehead 52795006
    Oral cavity (sublingual) 74262004
    Axillary fossa 422543003
Specification:

For detailed specifications, refer to the