Add home blood pressure vital sign

[kbertodatti]

"Patient reported blood pressure"

Out home blood pressures are all mapped. PT Reported Blood pressure- LOINC 72076-3 They are 8716-3 These are standard LOINC Codes for USCDI2708-6 Oxygen saturation in arterial blood 2710-2 Oxygen saturation in capillary blood by oximetry 29463-7 Body weight 3141-9 Body weight measured 3150-0 Inhaled oxygen concentration 3151-8 Inhaled oxygen flow rate 59408-5 Oxygen saturation in arterial blood by pulse oximetry (SpO2) 8287-5 Head occipital-frontal circumference by tape measure 8302-2 Body height 8306-3 Body height --lying 8310-5 Body temperature 8462-4 Diastolic blood pressure 8480-6 Systolic blood pressure 85354-9 Blood pressure systolic and diastolic 8716-3 Vital signs 8867-4 Heart rate 9279-1 Respiratory rate

https://fhir.epic.com/Specifications?api=968

__ FROM MATT

Fanny Mae vitals obtained by the following query: https://epicmobile.ohsu.edu/FHIRDEV/api/FHIR/R4/Observation?category=vital-signs&patient=emtdn7BOQKN-4PoCaQ0KPwGVh4BgvW62HzahJMDVmS7k3 fanny mae vitals.txt

[drdavec]

I’ve encountered several complications along the way.. Matt, thanks for the complete FHIR data from Epic for home BP, these were essential for understanding and resolving this issue.

First, a question for Dave D:

• I assume you’d like Home Blood Pressure displayed in the app as one result row with systolic/diastolic value, not two separate rows for systolic and diastolic?

The question is based on the complications: Your query for LOINC 72076-3 returns separate Observation resources for systolic and diastolic values, not one Observation with components as required by US Core. I understand that these values come from Epic flowsheet rows, so this is probably unavoidable. The coding for these Observations use Epic proprietary terminology (see below). I’ll use these for now, but would be preferred to map to standard LOINC codes for systolic and diastolic. Because I can no longer search for only the one most recent Observation for Home BP, I will need to search for a larger number of results for LOINC 72076-3 to assure of getting matching systolic and diastolic Observations. I will restrict this to 1 year history for now; does that seem reasonable? I verified that the matching systolic and diastolic have exactly the same effectiveTime, so I can use this date to find and combine these into a single systolic/diastlic for display to patients in the app.

Here is a snippet of the coding in these Observations. This OID is an Epic-specific identifier. I will use the Epic OID system to identify systolic and diastolic results. From Epic docs, the flowsheet-id is different between Epic sites, and also different between your production and non-production environment, which would not work for your testing.

                <coding>
                    <system value="urn:oid:1.2.840.114350.1.13.135.3.7.2.707679" />
                    <code value="7586" />
                    <display value="Blood Pressure - Diastolic" />
                </coding>
                <coding>
                    <system value="http://open.epic.com/FHIR/StructureDefinition/observation-flowsheet-id" />
                    <code value="tECLRiIpjH.USz.EjjqvT3g0" />
                    <display value="Blood Pressure - Diastolic" />
                </coding>

[drdavec]

I went ahead and combined the Home BP systolic and diastolic observations into a single summary for display in MyCarePlanner. I also updated the app vitals display to include any notes on the FHIR Observation (which were not previously displayed). OHSU has notes in the home BP observations, on each of the separate Observations. Only challenge I have remaining is that the notes are both listed, and it’s not entirely clear which of systolic or diastolic that a note applies to. Here is the screenshot. I’ll get this committed to be included in the next release for OHSU.

I copied 2 of OHSU Home BP vitals (4 total Observations) from the file Matt sent, and modified to use in our MELD sandbox. This allowed me to confirm that it used the most recent of these 2 readings. Yes, I know that you’d like to show multiple responses, especially for Home BP. Design work is needed to consider how to collapse/expand related observations. For now, the most recent.