This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Behavior: Capability Statements

The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems complying with the implementation guide are expected to declare conformance to one or more of the following capability statements.

CARIN Blue Button Client CapabilityStatement

The Section describes the expected capabilities of the CARIN Blue Button Client which is responsible for creating and initiating the queries for information about an individual patient. The complete list of FHIR profiles, RESTful operations, and search parameters supported by CARIN Blue Button Servers are defined in the [Conformance Requirements for Server](CapabilityStatement-carin-bb-server.html). CARIN Blue Button Clients have the option of choosing from this list to access necessary data based on their local use cases and other contextual requirements.

Structures: Resource Profiles

These define constraints on FHIR resources that need to be complied with by conformant implementations

US Core Organization Profile	Defines basic constraints and extensions on the Organization resource for use with other US Core resources
US Core Condition Profile	Defines constraints and extensions on the Condition resource for the minimal set of data to query and retrieve problems and health concerns information.
US Core Goal Profile	Defines constraints and extensions on the Goal resource for the minimal set of data to query and retrieve a patient's goal(s).
TestObservation2	## **AMA-IHMI-observation-blood-pressure-1 (alternative to AMA-IHMI-observation-blood-pressure-2)** ### **Additional Description** Blood pressure measurement observations that adhere to this profile may, but do not necessarily, conform to stricter constraints (also referred to in this document as "clinically valid blood pressures") which specify that the measurements should only be at the brachial artery (with laterality), in sitting position, at rest, using an automatic blood pressure monitor with cuff size specified. (Note: To constrain to only "clinically valid blood pressure" observations, use AMA-IHMI-observation-blood-pressure-3.) This profile allows the Observation Resource to be extended to include body position and exertional status as Observation components (i.e., Observation.component bodyPosition and Observation.component exertionalStatus). This is not the AMA IHMI preferred approach for extending the Observation Resource to include body position and exertional status. However, this option was provided based on feedback from some implementers who expressed a preference for using components to extend the Observation Resource. As an alternative option for implementer feedback, AMA-IHMI-observation-blood-pressure-2 is identical to AMA-IHMI-observation-blood-pressure-1 except that AMA-IHMI-observation-blood-pressure-2 includes body position and exertional status as Observation extension elements (i.e., Observation.extension bodyPosition and Observation.extension exertionalStatus). AMA-IHMI-observation-blood-pressure-1 is intended to be paired with AMA-IHMI-observation-heart-rate-1 which constrains heart rate measurements using a similar approach. ### **Additional Guidance** ##### **Observation.bodySite** This element references the SNOMED CT refset 5241000207108 American Medical Association Integrated Health Model Initiative, body structure, refset 2, simple type reference set (foundation metadata concept) as follows: - **Observation.bodySite.coding.code** - ElementDefinition.binding.valueSet[x]: [http://www.ama-ihmi.org/fhir/ValueSet/AMA-IHMI-valueSet-body-structure-2-instance](ValueSet-AMA-IHMI-valueSet-body-structure-2-instance.html) To transform the concept definition of a SNOMED CT blood pressure concept used as an Observation Code or Component Code in this profile (i.e., 4011000207100 Measurement of blood pressure (procedure), 4131000207105 Measurement of diastolic blood pressure (procedure) or 4351000207102 Measurement of systolic blood pressure (procedure)) to arrive at a more granular precoordinated SNOMED CT concept in the AMA IHMI SNOMED CT Extension, the concepts in the SNOMED CT refset for **Observation.body.Site** correspond to the two SNOMED CT attribute-value pairs as shown in the two right columns. | **Observation.bodySite SNOMED CT Refset Member** | **SNOMED CT attribute: 704319004 Inheres in (attribute)** | **SNOMED CT attribute: 405814001 Procedure site - Indirect (attribute)** | | --- | --- | --- | | 40983000 Upper arm structure (body structure) | 17137000 Structure of brachial artery (body structure) | 40983000 Upper arm structure (body structure) | | 368209003 Right upper arm structure (body structure) | 723962009 Structure of right brachial artery (body structure) | 368209003 Right upper arm structure (body structure) | | 368208006 Left upper arm structure (body structure) | 723961002 Structure of left brachial artery (body structure) | 368208006 Left upper arm structure (body structure) | | 8205005 Wrist region structure (body structure) | 45631007 Structure of radial artery (body structure) | 8205005 Wrist region structure (body structure) | | 9736006 Structure of right wrist (body structure) | 368503001 Structure of right radial artery (body structure) | 9736006 Structure of right wrist (body structure) | | 5951000 Structure of left wrist (body structure) | 368504007 Structure of left radial artery (body structure) | 5951000 Structure of left wrist (body structure) | ##### **Observation.device** This element references a URL for an AMA IHMI profile of Type Device as follows: - **ElementDefinition.type.targetProfile:** [http://www.ama-ihmi.org/fhir/StructureDefinition/AMA-IHMI-device-blood-pressure-2](StructureDefinition-AMA-IHMI-device-blood-pressure-2.html) The referenced AMA-IHMI-device-blood-pressure-2 profile's **Device.type.coding.code** references the SNOMED CT refset 5251000207105 American Medical Association Integrated Health Model Initiative, device, refset 2, simple type reference set (foundation metadata concept). To transform the concept definition of a SNOMED CT blood pressure concept used as an Observation Code or Component Code in this profile (i.e., 4011000207100 Measurement of blood pressure (procedure), 4131000207105 Measurement of diastolic blood pressure (procedure) or 4351000207102 Measurement of systolic blood pressure (procedure)) to arrive at a more granular precoordinated SNOMED CT concept in the AMA IHMI SNOMED CT Extension, the concepts in the SNOMED CT refset for **Device.type** correspond to the SNOMED CT attribute-value pairs as shown in the right column. | **Device.type SNOMED CT Refset Member** | **SNOMED CT attribute: 424226004 Using device (attribute)** | | --- | --- | | 3901000207100 Automatic blood pressure monitor (physical object) | 3901000207100 Automatic blood pressure monitor (physical object) | | 3941000207103 Automatic blood pressure monitor with small adult cuff (physical object) | 3941000207103 Automatic blood pressure monitor with small adult cuff (physical object) | | 3931000207106 Automatic blood pressure monitor with medium adult cuff (physical object) | 3931000207106 Automatic blood pressure monitor with medium adult cuff (physical object) | | 3921000207108 Automatic blood pressure monitor with large adult cuff (physical object) | 3921000207108 Automatic blood pressure monitor with large adult cuff (physical object) | | 4851000207105 Automatic blood pressure monitor with extra large adult cuff (physical object) | 4851000207105 Automatic blood pressure monitor with extra large adult cuff (physical object) | ##### **Observation.component (bodyPosition)** This element references the SNOMED CT concept 33586001 Sitting position (finding) as follows: - **Observation.component.valueCodeableConcept.coding.code** - ElementDefinition.fixed[x]: 33586001 - **Observation.component.valueCodeableConcept.coding.display** - ElementDefinition.fixed[x]: Sitting position (finding) To transform the concept definition of a SNOMED CT blood pressure concept used as an Observation Code or Component Code in this profile (i.e., 4011000207100 Measurement of blood pressure (procedure), 4131000207105 Measurement of diastolic blood pressure (procedure) or 4351000207102 Measurement of systolic blood pressure (procedure)) to arrive at a more granular precoordinated SNOMED CT concept in the AMA IHMI SNOMED CT Extension, the SNOMED CT concepts for **Observation.component.valueCodeableConcept** **(bodyPosition)** AND/OR **Observation.component.valueCodeableConcept** **(exertionalStatus)** correspond to the SNOMED CT attribute-value pairs as shown in the right column. | **Observation.component bodyPosition** | **Observation.component exertionalStatus** | **SNOMED CT attribute: 704326004 Precondition (attribute)** | | --- | --- | --- | | 33586001 Sitting position (finding) | | 33586001 Sitting position (finding) | | | 128975004 Resting state (finding) | 128975004 Resting state (finding) | | 33586001 Sitting position (finding) | 128975004 Resting state (finding) | 4001000207103 In sitting position at rest (finding) | ##### **Observation.component (exertionalStatus)** For exertionalStatus, the ElementDefinition.short and ElementDefinition.definition (below) were created and added by AMA IHMI. - **ElementDefinition.short:** The state of exertion preceding or during the observation. - **ElementDefinition.definition:** The state of exertion (e.g., resting state) preceding and/or during the observation. To be used only when the exertional state is not precoordinated in the observation code. **exertionalStatus** is an AMA IHMI Observation Component extension to capture associated exertional states that may impact the observation result. For example, a blood pressure measurement observation result that specifies "resting state" is intended to indicate that the individual was at rest (e.g., for 5 minutes) prior to the measurement. It is anticipated that this element might evolve or require refinement. For example, as AMA IHMI moves to FHIR R4 (v4.0.0), exertionalStatus could possibly be captured using the FHIR Observation Resource Extension: Precondition ([http://hl7.org/fhir/StructureDefinition/observation-precondition](http://hl7.org/fhir/StructureDefinition/observation-precondition)). This element references the SNOMED CT concept 128975004 Resting state (finding) as follows: - **Observation.component.valueCodeableConcept.coding.code** - ElementDefinition.fixed[x]: 128975004 - **Observation.component.valueCodeableConcept.coding.display** - ElementDefinition.fixed[x]: Resting state (finding) To transform the concept definition of a SNOMED CT blood pressure concept used as an Observation Code or Component Code in this profile (i.e., 4011000207100 Measurement of blood pressure (procedure), 4131000207105 Measurement of diastolic blood pressure (procedure) or 4351000207102 Measurement of systolic blood pressure (procedure)) to arrive at a more granular precoordinated SNOMED CT concept in the AMA IHMI SNOMED CT Extension, the SNOMED CT concepts for **Observation.component.valueCodeableConcept** **(bodyPosition)** AND/OR **Observation.component.valueCodeableConcept** **(exertionalStatus)** correspond to the SNOMED CT attribute-value pairs as shown in the right column. | **Observation.component bodyPosition** | **Observation.component exertionalStatus** | **704326004 Precondition (attribute)** | | --- | --- | --- | | 33586001 Sitting position (finding) | | 33586001 Sitting position (finding) | | | 128975004 Resting state (finding) | 128975004 Resting state (finding) | | 33586001 Sitting position (finding) | 128975004 Resting state (finding) | 4001000207103 In sitting position at rest (finding) |
Gravity_Observation_FoodInsecurity_1_test	This profile supports Gravity Project data elements that focus on the Food Insecurity domain. The profile constrains Observations related to: Food insecurity. It allows the creation of Observations of: Food insecurity unknown, Food insecurity absent (aka Food security present), Food insecurity present, Mild food insecurity present, Moderate food insecurity present, and Severe food insecurity present.
Gravity_Condition_FoodInsecurity_1_test	This profile supports Gravity Project data elements that focus on the Food Insecurity domain. The profile constrains Conditions related to: Food insecurity, Mild food insecurity, Moderate food insecurity, or Severe food insecurity.
Gravity_Goal_FoodInsecurity_1_test	This profile supports Gravity Project data elements that focus on the Food Insecurity domain. The profile constrains Goals related to: Food Security.

Structures: Extension Definitions

These define constraints on FHIR data types that need to be complied with by conformant implementations

exertionalStatus

The state of exertion (e.g., resting state) preceding and/or during the observation. To be used only when the exertional state is not precoordinated in the observation code.

Terminology: Value Sets

These define sets of codes used by systems conforming with this implementation guide

AMA IHMI valueSet body structure 1 instance
Gravity ValueSet Context 1
Gravity_ValueSet_ContextValue_1_test
Gravity_ValueSet_FoodInsecurity_1_test
Hunger Vital Sign

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like

Payer FHIR Endpoint
MaxMD Demo Payer Solutions