{"type":"doc","content":[{"type":"extension","attrs":{"layout":"default","extensionType":"com.atlassian.confluence.macro.core","extensionKey":"toc","parameters":{"macroParams":{"style":{"value":"none"}},"macroMetadata":{"macroId":{"value":"f2613bc4-b61f-47f6-8ad3-ef41bf725752"},"schemaVersion":{"value":"1"},"title":"Table of Contents"}},"localId":"26707097-adec-4930-a6a2-25d5a2003001"}},{"type":"paragraph","content":[{"text":"Upon creating a CarePlan for a particular Patient (see ","type":"text"},{"type":"inlineCard","attrs":{"url":"https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/1661141027"}},{"text":"), the CarePlan’s ServiceRequest resources inherit a copy of any measurement ranges defined in the PlanDefinition’s ActivityDefinition resources, see ","type":"text"},{"type":"inlineCard","attrs":{"url":"https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/1696137281/Managing+Telemedicine+Packages#Defining-measurement-ranges"}},{"text":". It is expected that a Practitioner performs or considers Patient-specific adjustment of the measurement ranges in ServiceRequest resources beyond this point, possibly continuously going forward.","type":"text"}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"Please refer to the description of ","type":"text"},{"text":"measurement ranges","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/1706229761"}}]},{"text":" for details on how to define adjacent and possibly (but not typically) overlapping measurement ranges. ","type":"text"}]}]},{"type":"paragraph","content":[{"text":"The following describes how to set up a measurement range on a single ServiceRequest. In case the CarePlan contains multiple ServiceRequest for the same activity code, copying changes to measurement ranges can be relevant. Multiple ServiceRequest in the same CarePlan or sub-CarePlan can refer to the same ActivityDefinition (through ","type":"text"},{"text":"ServiceRequest.definition","type":"text","marks":[{"type":"code"}]},{"text":"), and/or each can refer to an individual ActivityDefinition with the same ","type":"text"},{"text":"ActivityDefinition.code","type":"text","marks":[{"type":"code"}]},{"text":".","type":"text"}]},{"type":"panel","attrs":{"panelType":"warning"},"content":[{"type":"paragraph","content":[{"text":"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.","type":"text"}]}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Preparing Details for Setting Measurement Ranges","type":"text"}]},{"type":"paragraph","content":[{"text":"In the descriptions below, measurement ranges can be expressed in the same measurement unit (","type":"text"},{"text":"system","type":"text","marks":[{"type":"code"}]},{"text":", ","type":"text"},{"text":"code","type":"text","marks":[{"type":"code"}]},{"text":", and displayable ","type":"text"},{"text":"unit","type":"text","marks":[{"type":"code"}]},{"text":") as the measurement would be submitted with. The proper measurement unit in this case can be determined using the approach outlined in ","type":"text"},{"type":"inlineCard","attrs":{"url":"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"}},{"text":".","type":"text"}]},{"type":"panel","attrs":{"panelType":"warning"},"content":[{"type":"paragraph","content":[{"text":"If the used measurement unit in existing measurement ranges expressed in the same measurement unit differs 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.","type":"text"}]}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Setting up Absolute Measurement Ranges","type":"text"}]},{"type":"paragraph","content":[{"text":"An absolute measurement range is set up by adding an ","type":"text"},{"text":"ehealth-referenceRange","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/StructureDefinition-ehealth-referenceRange.html"}}]},{"text":" structure to ","type":"text"},{"text":"ServiceRequest.ehealth-referenceRange","type":"text","marks":[{"type":"code"}]},{"text":" where:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"ehealth-referenceRange.type","type":"text","marks":[{"type":"code"}]},{"text":" is a ","type":"text"},{"text":"Coding","type":"text","marks":[{"type":"link","attrs":{"href":"https://build.fhir.org/ig/fut-infrastructure/implementation-guide/CodeSystem-ehealth-goal-description.html"}}]},{"text":" with:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"system","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"http://ehealth.sundhed.dk/cs/reference-range-type","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"code","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"RAL","type":"text","marks":[{"type":"code"}]},{"text":" or ","type":"text"},{"text":"GAL","type":"text","marks":[{"type":"code"}]},{"text":", for red alarm absolute measurement range and yellow alarm absolute measurement range, respectively.","type":"text"}]}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"ehealth-referenceRange.low","type":"text","marks":[{"type":"code"}]},{"text":" and/or ","type":"text"},{"text":".high","type":"text","marks":[{"type":"code"}]},{"text":" is a:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"a SimpleQuantity where:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"value","type":"text","marks":[{"type":"code"}]},{"text":": the integer or decimal value for the low/high boundary","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"unit","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"system","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"code","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"","type":"text","marks":[{"type":"code"}]}]}]}]}]}]}]}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Setting up Component-based Measurement Ranges","type":"text"}]},{"type":"paragraph","content":[{"text":"For component-based measurements (e.g. systolic/diastolic blood pressure), it is necessary to specify which component a reference range belongs to. This is done by adding Coding to ","type":"text"},{"text":"ehealth-referenceRange.type","type":"text","marks":[{"type":"code"}]},{"text":" from ","type":"text"},{"type":"inlineCard","attrs":{"url":"https://ehealth.sundhed.dk/fhir/ValueSet-ehealth-observation-codes.html"}},{"text":" ","type":"text"}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Setting up Relative Measurement Ranges and a Reference Base","type":"text"}]},{"type":"paragraph","content":[{"text":"A relative measurement range is set up by adding an ","type":"text"},{"text":"ehealth-referenceRange","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/StructureDefinition-ehealth-referenceRange.html"}}]},{"text":" structure to ","type":"text"},{"text":"ServiceRequest.ehealth-referenceRange","type":"text","marks":[{"type":"code"}]},{"text":" 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relative change compared to the reference base where:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"value","type":"text","marks":[{"type":"code"}]},{"text":": the integer or decimal value for the low/high boundary","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"unit","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"system","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"code","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"","type":"text","marks":[{"type":"code"}]}]}]}]}]}]}]}]},{"type":"paragraph"},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"A relative 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 measurement range into account.","type":"text"}]},{"type":"paragraph","content":[{"text":"There are several ways to find a reference base:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"searching for a prior, measured value, say, the highest/lowest/most recent/oldest value in some given period","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"a derivative, say, an average of measured values in some given period","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"a designated value, either copied from or referencing a measured value","type":"text"}]}]}]}]},{"type":"paragraph","content":[{"text":"To add a designated reference base, create a ","type":"text"},{"text":"FHIR Goal","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/StructureDefinition-ehealth-goal.html"}}]},{"text":" resource with:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":" ","type":"text"},{"text":"status","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"accepted","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"description","type":"text","marks":[{"type":"code"}]},{"text":": A Coding with:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"code","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"reference-value","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"system","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"http://ehealth.sundhed.dk/cs/goal-description","type":"text","marks":[{"type":"code"}]}]}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"subject","type":"text","marks":[{"type":"code"}]},{"text":": Reference to Patient","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"startDate","type":"text","marks":[{"type":"code"}]},{"text":": A datetime representing the starting point at which this reference base is applicable.","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"target.measure","type":"text","marks":[{"type":"code"}]},{"text":": Coding (the same as ","type":"text"},{"text":"code","type":"text","marks":[{"type":"code"}]},{"text":" in the ServiceRequest, as the relative measurement range is defined 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to:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"CarePlan.goal","type":"text","marks":[{"type":"code"}]}]}]}]},{"type":"paragraph","content":[{"text":"Over time, the relative measurement ranges can change and new Goal resources can be created and added to the CarePlan.","type":"text"}]},{"type":"paragraph"},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"Example use of relative measurement range stated in percentage points.","type":"text"}]},{"type":"paragraph","content":[{"text":"A measurement of oxygen saturation is submitted as an Observation where the ","type":"text"},{"text":"Observation.valueQuantity","type":"text","marks":[{"type":"code"}]},{"text":" is a Quantity with:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"value","type":"text","marks":[{"type":"code"}]},{"text":": 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","type":"text"},{"text":"http://ehealth.sundhed.dk/cs/ehealth-unit-code","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"code","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"percentpoint","type":"text","marks":[{"type":"code"}]}]}]}]}]}]},{"type":"paragraph","content":[{"text":"A reference base could be defined as a Goal where ","type":"text"},{"text":"Goal.target.detailQuantity","type":"text","marks":[{"type":"code"}]},{"text":" is a Quantity with:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"value","type":"text","marks":[{"type":"code"}]},{"text":": ","type":"text"},{"text":"92","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"unit","type":"text","marks":[{"type":"code"}]},{"text":": 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range.","type":"text"}]}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Expressing Exclusiveness of Measurement Range Boundaries","type":"text"}]},{"type":"paragraph","content":[{"text":"The Common workplace UI solution supports inclusive (>=, <=) and exclusive (<, >) range, even though the underlying FHIR model only supports inclusive representation.","type":"text"}]},{"type":"paragraph","content":[{"text":"The exclusive ranges are handled by having seven decimals in the FHIR model. This is done by adding or subtracting 0,0000001 depending on <, > and sign (+, -). ","type":"text"}]},{"type":"paragraph","content":[{"text":"As a result, the UI solutions must implement logic for transforming in both directions (read and write). ","type":"text"}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"The FHIR model only supports inclusive representation. To support exclusivity it has been decided to use the seventh decimal for determining exclusiveness. Precision is supported up to 6 decimals as the seventh is used for comparator logic.","type":"text"}]}]},{"type":"panel","attrs":{"panelType":"warning"},"content":[{"type":"paragraph","content":[{"text":"It is recommended that UI solutions implement the same solution for consistency.","type":"text"}]}]},{"type":"heading","attrs":{"level":3},"content":[{"text":"Algorithm","type":"text"}]},{"type":"paragraph","content":[{"text":"Read scenario:","type":"text","marks":[{"type":"strong"}]}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"If upper bound","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"and a positive number, then add 0,0000001 if the seventh decimal is 9. Comparator type is < less than.","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"and a negative number, then add 0,0000001 if the seventh decimal is 1. 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Comparator type is >= larger than Or Equal.","type":"text"}]}]}]}]}]},{"type":"paragraph","content":[{"text":"Write scenario:","type":"text","marks":[{"type":"strong"}]}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"If the comparator type is < less than, then subtract 0,0000001.","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"If the comparator type is > larger than, then add 0,0000001.","type":"text"}]}]}]},{"type":"paragraph"},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"Algorithm example 1: Positive range","type":"text","marks":[{"type":"strong"}]}]},{"type":"paragraph","content":[{"text":"Range UI: > 1,4578 to < 2,7858","type":"text"}]},{"type":"paragraph","content":[{"text":"Write range:","type":"text","marks":[{"type":"underline"}]}]},{"type":"paragraph","content":[{"text":"lower bound: 1,4578 + 0,0000001 = 1,4578001 (when comparator type is > larger than, then add 0,0000001)","type":"text"}]},{"type":"paragraph","content":[{"text":"Upper bound: 2,7858 - 0,0000001 = 2,7857999 (when comparator type is < less than, then subtract 0,0000001)","type":"text"}]},{"type":"paragraph","content":[{"text":"Read range from FHIR:","type":"text","marks":[{"type":"underline"}]}]},{"type":"paragraph","content":[{"text":"lower bound: 1,4578001 - 0,0000001 = 1,4578 and comparator type > larger than. (When lower bound and a positive number, then subtract 0,0000001 if the seventh decimal is 1) ","type":"text"}]},{"type":"paragraph","content":[{"text":"Upper bound: 2,7857999 + 0,0000001 = 2,7858 and comparator type < less than. (When the upper bound and a positive number, then add 0,0000001 if the seventh decimal is 9)","type":"text"}]},{"type":"paragraph"}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"Algorithm example 2: Positive range","type":"text","marks":[{"type":"strong"}]}]},{"type":"paragraph","content":[{"text":"Range UI: >= 1,4578 to <= 2,7858","type":"text"}]},{"type":"paragraph","content":[{"text":"Write range:","type":"text","marks":[{"type":"underline"}]}]},{"type":"paragraph","content":[{"text":"lower bound: 1,4578 (when comparator type is not < less or > larger than, then use value as is)","type":"text"}]},{"type":"paragraph","content":[{"text":"Upper bound: 2,7858 (when comparator type is not < less or > larger than, then use value as is)","type":"text"}]},{"type":"paragraph","content":[{"text":"Read range from FHIR:","type":"text","marks":[{"type":"underline"}]}]},{"type":"paragraph","content":[{"text":"lower bound: 1,4578 and comparator type >= equal or larger than. (when not matching the first two scenarios for the lower bound, then use the original value)","type":"text"}]},{"type":"paragraph","content":[{"text":"Upper bound: 2,7858 and comparator type <= equal or less than. (when not matching the first two scenarios for the upper bound, then use the original value)","type":"text"}]}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"Algorithm example 3: Negative range","type":"text","marks":[{"type":"strong"}]}]},{"type":"paragraph","content":[{"text":"Range UI: > -7,4365 to < -3,4520","type":"text"}]},{"type":"paragraph","content":[{"text":"Write range:","type":"text","marks":[{"type":"underline"}]}]},{"type":"paragraph","content":[{"text":"lower bound: -7,4365 + 0,0000001 = -7,4364999 (when comparator type is > larger than, then add 0,0000001)","type":"text"}]},{"type":"paragraph","content":[{"text":"Upper bound: -3,4520 - 0,0000001 = -3,4520001 (when comparator type is < less than, then subtract 0,0000001)","type":"text"}]},{"type":"paragraph","content":[{"text":"Read range from FHIR:","type":"text","marks":[{"type":"underline"}]}]},{"type":"paragraph","content":[{"text":"lower bound: -7,4364999 - 0,0000001 = -7,4365 (When lower bound and a negative number, then subtract 0,0000001 if the seventh decimal is 9) ","type":"text"}]},{"type":"paragraph","content":[{"text":"Upper bound: -3,4520001 + 0,0000001 = -3,4520 (When upper bound and a negative number, then add 0,0000001 if the seventh decimal is 1)","type":"text"}]}]}],"version":1}

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