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

Holter Monitoring

⚠️ Draft Notice
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: 2025-07-14

Carepath Identifier: https://hl7belgium.org/fhir/patient-monitoring/carepath/holter-monitoring

Carepath Version: 1.0.0

Care Pathway Overview

  • Monitoring Duration: 24–72 hours
  • Facility Type: Hospital or diagnostic center
  • Device Type: Holter ECG (1–3 lead, continuous)
  • Data Review: By cardiologist or certified ECG analyst

Patient Eligibility

  • Indications: Suspected arrhythmias (e.g., palpitations, syncope, bradycardia)
  • Consent: Signed informed consent prior to monitoring
  • Referral: Required from physician (GP or specialist)

Process & Workflow

Start-Up

  • Device Placement: On-site or outpatient setting
  • Instructions: Provided on wearing and returning the device

Data Collection

  • Recording: Locally on Holter device
  • Upload & Analysis: Uploaded securely and interpreted using CE-certified tools
  • Validation: All abnormal events confirmed by a reviewer

Alarm & Escalation

  • Thresholds: System flags critical findings (e.g. AFib, VT, pauses)
  • Human Review: All flagged findings are clinically reviewed

📄 Outcome : PDF

  • Generated After Review
  • Contents: Summary, rhythm findings, annotated ECG strips
  • File Size: ±1–5MB depending on duration and findings

🧬 Outcome : FHIR

This Implementation Guide defines two core profiles for representing structured Holter ECG monitoring results:

📄 Holter Diagnostic Report

The Holter Diagnostic Report is a profile based on the FHIR DiagnosticReport resource. It serves as the container for a complete ambulatory cardiac rhythm analysis, such as a 24- or 48-hour Holter ECG report.

Key elements:

  • status: The lifecycle status of the report (e.g., final, amended)
  • code: Fixed to LOINC 18754-2, identifying this as a Holter rhythm report
  • effectivePeriod: The time range over which ECG monitoring was performed
  • result: References to one or more HolterObservation resources, each representing a specific rhythm event or episode
  • conclusion: An optional free-text summary by the reporting clinician or algorithm

📌 This report acts as the entry point for interpreting a Holter study and links to all rhythm-related findings detected during the monitoring period.

📈 Holter Observation

The Holter Observation profile is based on the FHIR Observation resource and represents an individual rhythm event or episode detected during the Holter recording, such as an atrial fibrillation episode, ventricular tachycardia, pause, or supraventricular run.

Each observation includes:

  • status: Typically final once confirmed
  • code: A SNOMED CT code identifying the arrhythmia type (e.g., atrial fibrillation)
  • valueCodeableConcept: Also constrained to SNOMED CT, representing the same event type as code
  • effectivePeriod: The start and end time of the arrhythmia episode
  • component (optional):
    • Average heart rate, using LOINC:8867-4 (expressed in beats per minute)
    • Additional metrics like burden, duration, or RR intervals may be included in the future

🫀 Each HolterObservation provides structured, time-specific detail about one episode — for example, “an atrial fibrillation episode from 14:03 to 14:07 with an average HR of 79 bpm”.

🧩 Relationship between Report and Observations

  • The HolterDiagnosticReport references one or more HolterObservation entries.
  • This design enables systems to access both a summary report and a complete list of structured, time-stamped rhythm events.
  • This supports:
    • Visualization of arrhythmia timelines
    • Quantitative reporting (e.g., total burden)
    • Decision support and auditability

Terminology

Example References

These FHIR resources are designed to support structured, interoperable Holter Report data exchange. Each finding is encoded using HL7 Belgium and standard terminologies to promote clarity and consistency in digital health environments.