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drajer-health / uds-plus

HRSA UDS+ FHIR IG Repository.
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Blood Pressure Constraints #64

Closed anthonygalba closed 3 months ago

anthonygalba commented 4 months ago

There's seemingly another incompatibility between the base FHIR Observation - Vital Signs requirements (https://hl7.org/fhir/R4/observation-vitalsigns.html) and the eCQM specification for CMS-165 (https://ecqi.healthit.gov/ecqm/ec/2023/cms0165v11) when it comes to blood pressure.

Base FHIR requires that blood pressure be sent as one observation resource with two components - one for diastolic and one for systolic. The eCQM considers those two completely separate Physical Exam, Performed data entries. If translating 1:1 from QDM template to FHIR resource, you would end up with two UDS+ Lab Observations resources (one for systolic and one for diastolic), which would fail Inferno checks: image

How do we reconcile this difference? Should we be following the data structure defined in the eCQM, or base FHIR? Also, there is no reference to these requirements in the UDS+ FHIR IG, so if we need to follow these extra vital sign constraints, please call that out in the IG.

nbashyam commented 3 months ago

We recommend using the base FHIR specification, we will let the eCQM team know about this difference so that it could be aligned with the rest of the industry.