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Note

It is likely to be expected from a Telemedicine Solution used by an employee that it addresses copying of changes in measurement ranges to other ServiceRequest in the same CarePlan/sub-Careplan having the same activity code. As copying is not always the desired effect, prompting of user when to do that should be considered.

Preparing Details for Setting

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Measurement Ranges

In the descriptions below, measurement ranges can be expressed in the same measurement unit (system, code, and displayable unit) as the measurement would be submitted with. The proper measurement unit in this case can be determined using the approach outlined in https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2235432961/Interactions+with+the+Terminology+Service#Determining-the-proper-code%2C-system-and-unit-for-Quantity.

Note

If the used measurement unit existing measurement ranges expressed in the same measurement unit differ from what can be determined with the approach referenced above, the measurement unit of existing measurement ranges should be used. There is little sense in expressing, say, an absolute red alarm type (see below) measurement range in multiple measurement units.

Setting up Absolute Measurement Ranges

An absolute reference measurement range is set up by adding a ehealth-referenceRange structure to ServiceRequest.ehealth-referenceRange where:

  • ehealth-referenceRange.type is a Coding with:

    • system: http://ehealth.sundhed.dk/cs/reference-range-type

    • code: RAL or GAL, for red alarm absolute reference measurement range and yellow alarm absolute reference measurement range, respectively.

  • ehealth-referenceRange.low and/or .high is a:

    • a SimpleQuantity where:

      • value: the integer or decimal value for the low/high boundary

      • unit: <same unit as measured value is expressed with>

      • system: <same system as measured value is expressed with>

      • code: <same code as measured value is expressed with>

Setting up Relative

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Measurement Ranges and a Reference Base

A relative reference measurement range is set up by adding a ehealth-referenceRange structure to ServiceRequest.ehealth-referenceRange where:

  • ehealth-referenceRange.type is a Coding with:

    • system: http://ehealth.sundhed.dk/cs/reference-range-type

    • code: RELRAL or RELGAL, for red alarm relative reference measurement range and yellow alarm relative reference measurement range, respectively.

  • ehealth-referenceRange.low and/or .high is either of:

    • a SimpleQuantity for a percentage change (stated as percent point change to measurement already expressed in percent) compared to the reference base where:

      • value: the integer or decimal value for the low/high boundary

      • unit: percent point

      • system: http://ehealth.sundhed.dk/cs/ehealth-unit-code

      • code: percentpoint

    • a SimpleQuantity for a percentage change (stated as percent change to measurement not already expressed in percent) compared to the reference base where:

      • value: the integer or decimal value for the low/high boundary

      • unit: percent

      • system: http://unitsofmeasure.org

      • code: %

    • a SimpleQuantity for a relative change compared to the reference base where:

      • value: the integer or decimal value for the low/high boundary

      • unit: <same unit as measured value is expressed with>

      • system: <same system as measured value is expressed with>

      • code: <same code as measured value is expressed with>

Info

A relative reference measurement range states a change relative to some reference base. This way, a measured value can be compared to a reference base taking the relative reference measurement range into account.

There are several ways to find a reference base:

  • searching for a prior, measured value, say, the highest/lowest/most recent/oldest value in some given period of time

  • a derivate, say, an average of measured values in some given period of time

  • a designated value, either copied from and/or referencing a measured value

To add a designated reference base, create a FHIR Goal ressource resource with:

  • status: accepted

  • description: A Coding with:

    • code: reference-value

    • system: http://ehealth.sundhed.dk/cs/goal-description

  • subject: Reference to Patient

  • startDate: A datetime representing the starting point at which this reference base is applicable

  • target.measure: Coding (the same as code in the ServiceRequest as the relative reference measurement range is defined in)

  • target.detailQuantity: A Quantity containing the reference base value

  • addresses: Reference to ServiceRequest (the same ServiceRequest as the relative reference measurement range is defined in)

  • addresses: Reference to the Observation from which the value in target.detailQuantity has been copied (if that is the case)

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  • CarePlan.goal

Over time, the relative reference measurement ranges can change and new Goal resources can be created and added to the CarePlan.

Info

Example use of relative reference measurement range stated in percent point.

A measurement of oxygen saturation is submitted as an Observation where the Observation.valueQuantity is a Quantity with:

  • value: 88

  • unit: percent

  • system: http://unitsofmeasure.org

  • code: %

A red alarm relative reference measurement range given as zero to -5 percent point is stated as:

  • ehealth-referenceRange.type is a Coding with:

    • system: http://ehealth.sundhed.dk/cs/reference-range-type

    • code: RELRAL for red alarm relative reference measurement range type

  • ehealth-referenceRange.low is a SimpleQuantity with:

    • value: -5.0

    • unit: percent point

    • system: http://ehealth.sundhed.dk/cs/ehealth-unit-code

    • code: percentpoint

  • ehealth-referenceRange.high is a SimpleQuantity with:

    • value: -2.0

    • unit: percent point

    • system: http://ehealth.sundhed.dk/cs/ehealth-unit-code

    • code: percentpoint

A reference base could be defined as a Goal where Goal.target.detailQuantity is a Quantity with:

  • value: 92

  • unit: percent

  • system: http://unitsofmeasure.org

  • code: %

Because the measured value 88% is within a range of [-5; -2] percent point relative to the reference base value 92%, this would constitute a value which lies within the red alarm relative reference measurement range.

If the designated reference base was instead 95%, the measured value of 88% would not be within the red alarm relative reference measurement range.

Expressing Exclusiveness of Measurement Range Boundaries