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AMA IHMI Profiles SMBP

AMA IHMI Naming Conventions

This section provides guidance on naming conventions for AMA IHMI profiles, examples and instances.

Naming conventions for profiles

Over time, the number of AMA IHMI profiles will increase and profile names alone cannot fully represent the intent and use case(s) of each profile in a way that will allow differentiation of profiles based on names alone. Therefore, profile names are at a very high-level. The Implementation Guide should be referenced for full details of each profile.

AMA IHMI profile names contain the following segments separated by hyphens:

  • Begins with: AMA
  • Followed by: IHMI
  • Followed by: HL7 FHIR standard resource name (e.g., observation, goal, etc.)
  • Followed by: A very high-level indication of the content category that the profile addresses (e.g., blood pressure, body weight, etc.).
  • Followed by: A profile number to distinguish separate profiles that address similar high-level content categories. All profiles will have a profile number. Even if there is only one profile for a given high-level content category, the profile name will still end in "1". Profiles with similar numbers do not necessarily correspond to each other in any way.

Examples of profile names

  • AMA-IHMI-observation-blood-pressure-1
  • AMA-IHMI-observation-blood-pressure-2
  • AMA-IHMI-observation-body-weight-1
  • AMA-IHMI-goal-body-weight-1
  • AMA-IHMI-device-heart-rate-1

Naming conventions for examples and instances

AMA IHMI example and instance names mirror the profile names and append "-example" or "-instance" to the end.

Examples of example names

  • AMA-IHMI-observation-blood-pressure-1-example
  • AMA-IHMI-observation-blood-pressure-2-example
  • AMA-IHMI-observation-body-weight-1-example

Examples of instance names

  • AMA-IHMI-valueSet-body-structure-1-instance
  • AMA-IHMI-valueSet-body-structure-2-instance

Additional Guidance for Observation Profiles

Profiles with Observation Codes and Component Codes that bind to SNOMED CT

The observation profiles allow the use of high-level SNOMED CT concepts (of similar granularity to the US Core LOINC codes) for the Observation Code and Component Codes. Additional granularity (e.g. body site, body position, exertional status and device) can be added using FHIR elements bound to SNOMED CT concepts or SNOMED CT refsets (released as value sets in FHIR). This can enable transformation of the high-level SNOMED CT blood pressure, heart rate and body weight concepts used as Observation Codes or Component codes (e.g., 4131000207105 Measurement of diastolic blood pressure (procedure), 5271000207102 Measurement of heart rate (procedure), etc.) in the profiles to more granular precoordinated SNOMED CT concepts in the AMA IHMI SNOMED CT Extension.

(Note: HL7, FHIR, and the FHIR flame design are registered trademarks of Health Level Seven International. The AMA IHMI implementation guides are derived from the FHIR standard, but are not endorsed, approved, sponsored by, or affiliated with HL7.)

Where transformation to a more granular precoordinated SNOMED CT code is possible, guidance about the transformation is included with the observation element. One possible use for this transformation might be to provide a more human-readable representation of the blood pressure observation.

Example

The systolic and diastolic component codes (i.e., Measurement of systolic blood pressure (procedure) and Measurement of diastolic blood pressure (procedure)) of a blood pressure observation could be transformed to:

  • Measurement of systolic blood pressure in brachial artery, in sitting position, at rest, using automatic blood pressure monitor with medium adult cuff (procedure): 120 mm Hg
  • Measurement of diastolic blood pressure in brachial artery, in sitting position, at rest, using automatic blood pressure monitor with medium adult cuff (procedure): 80 mm Hg

Observation Profiles with "Preferred" and "Alternative" Options

The two profiles in each set of profiles listed below are intended to represent identical information using different FHIR approaches. In each set, one option is designated as the AMA IHMI preferred option and the other as an alternative option. The rationale for offering a preferred and alternative option for these profiles is also provided below.

Set 1: Two options for representing the same blood pressure observation

  • AMA-IHMI-observation-blood-pressure-2 (preferred over AMA-IHMI-observation-blood-pressure-1)
  • AMA-IHMI-observation-blood-pressure-1 (alternative to AMA-IHMI-observation-blood-pressure-2)

Set 2: Two options for representing the same heart rate observation

  • AMA-IHMI-observation-heart-rate-pressure-2 (preferred over AMA-IHMI-observation-heart-rate-1)
  • AMA-IHMI-observation-heart-rate-pressure-1 (alternative to AMA-IHMI-observation-heart-rate-2)

Rationale for offering preferred and alternative options for select profiles

The AMA IHMI blood pressure and heart rate profiles listed below can be extended to include body position and exertional status.

  • AMA-IHMI-observation-blood-pressure-1
  • AMA-IHMI-observation-blood-pressure-2
  • AMA-IHMI-observation-blood-pressure-3
  • AMA-IHMI-observation-heart-rate-1
  • AMA-IHMI-observation-heart-rate-2
  • AMA-IHMI-observation-heart-rate-3

HL7 FHIR standard STU 3 (v3.0.1) allows the Observation Resource to be extended by using Observation extensions (e.g., Observation.extension bodyPosition and Observation.extension exertionalStatus) or by using Observation components (e.g., Observation.component bodyPosition and Observation.component exertionalStatus).

The AMA IHMI preferred approach for extending the Observation Resource is to include body position and exertional status as Observation extensions (i.e., Observation.extension bodyPosition and Observation.extension exertionalStatus). This approach was used for the following profiles:

  • AMA-IHMI-observation-blood-pressure-2
  • AMA-IHMI-observation-blood-pressure-3
  • AMA-IHMI-observation-heart-rate-2
  • AMA-IHMI-observation-heart-rate-3

Some implementers have expressed a preference for using Observation components to extend the Observation Resource (e.g., to include body position and exertional status as Observation.component bodyPosition and Observation.component exertionalStatus). This is not the AMA IHMI preferred approach because body position and exertional status are not components of a blood pressure observation result in the same way that systolic and diastolic blood pressure are components of a blood pressure result. Rather, body position and exertional status are similar to body site and device in that they clarify circumstances related to taking the blood pressure measurement. However, to allow implementer feedback on this alternative approach, the two profiles below were also created.

  • AMA-IHMI-observation-blood-pressure-1 (alternative to AMA-IHMI-observation-blood-pressure-2)
  • AMA-IHMI-observation-heart-rate-pressure-1 (alternative to AMA-IHMI-observation-heart-rate-2)

List of AMA IHMI Profiles SMBP

Authors

Name Email
HL7 International - Patient Care