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Mindre endringer tekst og lenker
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thomiz committed Dec 5, 2024
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4 changes: 2 additions & 2 deletions VitalSigns/input/pages/guidance.md
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### Use of LOINC codes

In [FHIR vital-signs](https://hl7.org/fhir/observation-vitalsigns.html), the LOINC codes (magic value) are mandatory to indicate what category of measurement the given observation is. Until release R5 the magic value was mandatory in the Observation.code element. This is problematic in Norway as LOINC is not generally used in clinical systems in Norway. The magic value codes are to be considered as category codes and if more precise coding is needed SNOMED or other terminology are recommended to use in addition to the magic value.
In [FHIR vital-signs](https://hl7.org/fhir/observation-vitalsigns.html), the [LOINC codes](https://loinc.org/) (*magic value*) are mandatory to indicate what category of measurement the given observation is. Until release R5 the *magic value* was mandatory in the Observation.code element. This is problematic in for use in Norway as LOINC is not generally used in clinical systems in Norway. The *magic value* codes are to be considered as category codes and if more precise coding is needed SNOMED or other terminology are recommended to use in addition to the *magic value*.

### FHIR R6 changes

R6 makes several changes to the use of magic values in vital-signs observations. First of the magic value is placed in the Observation.category which better represents our interpretation of the magic value, as a high level category that makes it easy to find similar measurements. Secondly there are valuesets for the Observation.code values that the vital-signs category should be used for. At the moment these valuesets only contains LOINC codes, which is problematic for use in Norway.
R6 makes several changes to the use of *magic values* in vital-signs observations. First of the *magic value* is placed in the Observation.category which better represents our interpretation of the *magic value*, as a high level category that makes it easy to find similar measurements. Secondly there are valuesets for the Observation.code values that the vital-signs category should be used for. At the moment these valuesets only contains LOINC codes, which is problematic for use in Norway.

### Pulse rate vs Heart rate

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2 changes: 1 addition & 1 deletion VitalSigns/input/pages/index.md
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Expand Up @@ -8,7 +8,7 @@ The initiative for the development of the profiles came from the regional health

<div>{% include verdikjede-vitalsigns.svg %}</div>

The profiles have been developed limited by the principle that all profiles should derive from the [international vital signs profiles](https://hl7.org/fhir/observation-vitalsigns.html) provided by HL7 International and then constrain or extend these as needed. Additionally, as Norway has adopted [SNOMED CT](https://www.snomed.org) as the standard healthcare related terminology system, the development has adopted the constraint that all ValueSets, "Magic Value", and model bindings should be expressed as SNOMED CT pre-coordinated codes.
The profiles have been developed limited by the principle that all profiles should derive from the [international vital signs profiles](https://hl7.org/fhir/observation-vitalsigns.html) provided by HL7 International and then constrain or extend these as needed. Additionally, as Norway has adopted [SNOMED CT](https://www.snomed.org) as the standard healthcare related terminology system, the development has adopted the constraint that all ValueSets, "*Magic Value*", and model bindings should be expressed as SNOMED CT pre-coordinated codes.

Since the EHR system in question ([DIPS Arena](https://www.dips.com/)) uses [OpenEHR](https://www.openehr.org) archetypes as its internal information model, and there are both international and Norwegian national archetypes for vital signs that are clinically validated, the [Norwegian national archetypes](https://arketyper.no/ckm/) for the relevant vital signs were chosen as the [logical model](https://fhirblog.com/2016/10/17/logical-models-in-fhir/) for the profiles. The electronic charting and medication system ([IMDsoft Metavision](https://www.imd-soft.com/)) uses a proprietary information model which will need to be mapped to the logical model expressed in the FHIR profiles, but was consulted in order to identify any impedances in the models.

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