MedMij:V2020.01/FHIR VitalSigns: verschil tussen versies

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Regel 1: Regel 1:
 
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{{DISPLAYTITLE:MedMij FHIR Implementation Guide Vital Signs {{VersieInfo|Zelfmetingen}}}}
 
{{DISPLAYTITLE:MedMij FHIR Implementation Guide Vital Signs {{VersieInfo|Zelfmetingen}}}}
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{{MedMij:Vprepub/Issuebox_FHIR_IG}}
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{{MedMij:V2020.01/Issuebox_FHIR_IG}}
  
 
[[Bestand:MedMij2.png |link=https://www.medmij.nl/|rechts|Naar medmij.nl]]
 
[[Bestand:MedMij2.png |link=https://www.medmij.nl/|rechts|Naar medmij.nl]]
Regel 7: Regel 7:
 
<imagemap>Bestand:Leeswijzer-technisch-banner 03 white.png|center|400px|alt=Afspraken-Functioneel-Technisch   
 
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circle 241 216 211 [https://www.medmij.nl/afsprakenstelsel Afsprakenstelsel]                 
 
circle 241 216 211 [https://www.medmij.nl/afsprakenstelsel Afsprakenstelsel]                 
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circle 1013 224 212 [[MedMij:Vprepub/OntwerpZelfmetingen|Functioneel]]                 
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circle 1013 224 212 [[MedMij:V2020.01/OntwerpZelfmetingen|Functioneel]]                 
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circle 1787 230 212 [[MedMij:Vprepub/FHIR_IG|Technisch]]                 
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circle 1787 230 212 [[MedMij:V2020.01/FHIR_IG|Technisch]]                 
 
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Regel 15: Regel 15:
  
 
=Introduction=
 
=Introduction=
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[[Bestand:Functioneel-02.png|link=MedMij:Vprepub/Ontwerpen |100px|rechts|Functional design|Go to functional design]]
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[[Bestand:Functioneel-02.png|link=MedMij:V2020.01/Ontwerpen |100px|rechts|Functional design|Go to functional design]]
  
 
This use case is mainly based on the HL7 FHIR vital signs specification - http://hl7.org/fhir/STU3/observation-vitalsigns.html. The HL7 FHIR vital signs specification is extended with profiles of zib concepts that represent vital signs. These profiles are derived from the official [http://hl7.org/fhir/observation-vitalsigns.html HL7 Vital Signs profiles]. The purpose of these profiles is to add additional concepts that are not in the vital sign profiles but are provided in the corresponding zib. Moreover, these derived profiles include zib to FHIR mappings.  
 
This use case is mainly based on the HL7 FHIR vital signs specification - http://hl7.org/fhir/STU3/observation-vitalsigns.html. The HL7 FHIR vital signs specification is extended with profiles of zib concepts that represent vital signs. These profiles are derived from the official [http://hl7.org/fhir/observation-vitalsigns.html HL7 Vital Signs profiles]. The purpose of these profiles is to add additional concepts that are not in the vital sign profiles but are provided in the corresponding zib. Moreover, these derived profiles include zib to FHIR mappings.  
  
−
'''Technical note:'''
+
'''Note''': This implementation guide builds on the general guidelines described in the [[MedMij:V2020.01/FHIR_IG#Use case overarching principles|use case overarching principles]].
  
 
Because the base [http://hl7.org/fhir/vitalsigns.html vital signs] profile constrains the <code>.code</code> and the <code>.component.code</code> to the datatype quantity it is not possible to add additional zib concepts. A GForge [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=13796 issue] is created to address this problem. This issue will most likely be resolved with FHIR version STU4. However, to address this problem now the base vital signs panel is copied, the datatype constrains removed and published under a different canonical URL. The HL7 vital sign profiles bloodpressure, bodyweight, and oxygensaturation are copied, the StructureDefinition.baseDefinition adjusted and published under a different canonical URL because they are in the chain of derived profiles and the component.code needs to be used for these vital signs.
 
Because the base [http://hl7.org/fhir/vitalsigns.html vital signs] profile constrains the <code>.code</code> and the <code>.component.code</code> to the datatype quantity it is not possible to add additional zib concepts. A GForge [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=13796 issue] is created to address this problem. This issue will most likely be resolved with FHIR version STU4. However, to address this problem now the base vital signs panel is copied, the datatype constrains removed and published under a different canonical URL. The HL7 vital sign profiles bloodpressure, bodyweight, and oxygensaturation are copied, the StructureDefinition.baseDefinition adjusted and published under a different canonical URL because they are in the chain of derived profiles and the component.code needs to be used for these vital signs.
  
 
Use cases:
 
Use cases:
−
* [[MedMij:Vprepub/FHIR_VitalSigns#Use_case:_Retrieve_Vital_Signs|Retrieve vital signs]]
+
* [[MedMij:V2020.01/FHIR_VitalSigns#Use_case:_Retrieve_Vital_Signs|Retrieve vital signs]]
−
* [[MedMij:Vprepub/FHIR_VitalSigns#Use_case:_Send_Vital_Signs|Send vital signs]]
+
* [[MedMij:V2020.01/FHIR_VitalSigns#Use_case:_Send_Vital_Signs|Send vital signs]]
  
 
=Actors involved=
 
=Actors involved=
Regel 56: Regel 56:
  
 
=Use case: Retrieve Vital Signs=
 
=Use case: Retrieve Vital Signs=
 +
[[Bestand:Afsprakenstelsel-01.png|link=https://www.medmij.nl/afsprakenstelsel/|rechts |100px|Go to Afsprakenstelsel]]
 
{{FHIR-IG-Afsprakenstelsel-Note}}
 
{{FHIR-IG-Afsprakenstelsel-Note}}
  
Regel 88: Regel 89:
 
'''Search'''
 
'''Search'''
  
−
The PHR executes an HTTP GET conform to the FHIR [http://hl7.org/fhir/http.html RESTfull] and [http://hl7.org/fhir/search.html search] specification against the XIS's Observation endpoint. This search query URL is configurable by the PHR and has the following format.  
+
The PHR executes an HTTP GET conform to the FHIR [http://hl7.org/fhir/http.html RESTful] and [http://hl7.org/fhir/search.html search] specification against the XIS's Observation endpoint. This search query URL is configurable by the PHR and has the following format.
−
 
 
 
   
 
   
 
<pre>
 
<pre>
−
GET [base]/Observation?[parameters]{&_format=[mime-type]}
+
GET [base]/Observation{/$lastn}{?[parameters]}
 
</pre>
 
</pre>
  
 
'''Search Parameters'''
 
'''Search Parameters'''
  
−
The PHR may supply, and the XIS shall be capable of processing, all query parameters listed below. These search parameters are a selection of the defined search parameters by the HL7 FHIR specification search parameters of [http://hl7.org/fhir/STU3/observation.html#search Observation].  
+
The PHR may supply, and the XIS shall be capable of processing, all query parameters listed below. These search parameters are a selection of the defined search parameters by the HL7 FHIR specification search parameters of [http://hl7.org/fhir/STU3/observation.html#search Observation].
  
 
{| class="wikitable"  
 
{| class="wikitable"  
−
! colspan="3" style="font-weight: bold; text-align:left;" | Observation
+
! colspan="4" style="font-weight: bold; text-align:left;" | Observation
 
|-
 
|-
 
| style="font-weight: bold;" | Name
 
| style="font-weight: bold;" | Name
 
| style="font-weight: bold;" | Type
 
| style="font-weight: bold;" | Type
 
| style="font-weight: bold;" | Description
 
| style="font-weight: bold;" | Description
 +
| style="font-weight: bold;" | Example
 
|-
 
|-
−
| category
+
| [https://www.hl7.org/fhir/stu3/observation.html#search <code>category</code>]
 
| token
 
| token
−
| The classification of the type of observation
+
| The classification of the type of observation.
 +
 
 +
Within this context this will be {{term|vital-signs}} (from code system <code><nowiki>http://hl7.org/fhir/observation-category</nowiki></code>)
 +
|
 +
Retrieve all Observation resources that are considered a vital sign observation:
 +
<pre>GET [base]/Observation?category=vital-signs</pre>
 
|-
 
|-
−
| code
+
| [https://www.hl7.org/fhir/stu3/observation.html#search <code>code</code>]
 
| token
 
| token
−
| The code of the observation type
+
| The code of the observation type.
 +
 
 +
The different types of measurements are specified using the following LOINC codes:
 +
* Respiration: 9279-1
 +
* BloodPressure: 85354-9
 +
* BodyWeight: 29463-7
 +
* BodyHeight: 8302-2
 +
* BodyTemperature: 8310-5
 +
* Oxygenation, saturation, SpO2: 59408-5
 +
* HeartRate: 8867-4
 +
* PulseRate: 8889-8
 +
* BloodGlucose
 +
** fasting: 14770-2
 +
** general: 14743-9
 +
** post-meal: 14760-3
 +
|
 +
Retrieve all Observation resources that are a blood pressure observation:
 +
<pre>GET [base]/Observation?code=http://loinc.org|85354-9</pre>
 +
Retrieve the most recent body height and the most recent body weight observation:
 +
<pre>GET [base]/Observation/$lastn?code=http://loinc.org|8302-2&code=http://loinc.org|29463-7</pre>
 
|-
 
|-
−
| date
+
| [https://www.hl7.org/fhir/stu3/observation.html#search <code>date</code>]
 
| date
 
| date
 
| Obtained date/time. If the obtained element is a period, a date that falls in the period
 
| Obtained date/time. If the obtained element is a period, a date that falls in the period
−
|}
+
|
−
 
+
Retrieve all Observation resources that are a blood pressure observation and have an effective date between 01-01-2010 and 31-12-2010:
−
'''Example searches'''
+
<pre>GET [base]/Observation?code=http://loinc.org|85354-9&date=ge2010-01-01&date=le2011-01-01</pre>
−
 
+
Retrieve at most four temperature observations that have an effective date greater than 01-06-2012:
−
The PHR should be able to fetch all of a patient's vital signs by searching on:
+
<pre>GET [base]/Observation/$lastn?max=4&code=http://loinc.org|8310-5&date=ge2012-06-01</pre>
−
# category (all vital signs),
 
−
# category and date,
 
−
# code (specific vital sign),
 
−
# code and date,
 
−
# code and Last N.
 
−
 
 
−
<pre>1. GET [base]/Observation?category=vital-signs
 
−
2. GET [base]/Observation?category=vital-signs&date=[date]{&date=[date]}
 
−
3. GET [base]/Observation?code[vital sign LOINC{,LOINC2,LOINC3,...}]
 
−
4. GET [base]/Observation?code=[vital sign LOINC{,LOINC2,LOINC3,...}]&date=[date]{&date=[date]}
 
−
5. GET [base]/Observation/$lastn?code[vital sign LOINC{,LOINC2,LOINC3,...}
 
−
</pre>
 
−
The following table lists vital signs that have a corresponding zib. The column 'LOINC code' shows the LOINC code that can be used in the search query. Other possible codes, including the codes mentioned here, can be found [http://hl7.org/fhir/STU3/observation-vitalsigns.html#vitals-table here].
 
−
 
 
−
{| class="wikitable"
 
−
|-style="font-weight: bold; "
 
−
||Zib ||LOINC code
 
−
|-
 
−
|BloodPressure||85354-9
 
−
|-
 
−
| BodyWeight||29463-7
 
−
|-
 
−
| BodyHeight||8302-2
 
−
|-
 
−
| BodyTemperature||8310-5
 
−
|-
 
−
| Oxygenation, saturation, SpO2||59408-5
 
−
|-
 
−
| HeartRate||8867-4
 
−
|-
 
−
| PulseRate||8889-8
 
−
|-
 
−
| BloodGlucose|| 14770-2 (fasting) <br/> 14743-9 (general) <br/> 14760-3 (post-meal)
 
 
|}
 
|}
  
Regel 167: Regel 159:
  
 
====Message Semantics====
 
====Message Semantics====
−
Based on the retrieve vital signs request message processing results, the XIS will either return an error or success. When the XIS needs to report an error, it shall use HTTP error response codes and shall include a FHIR OperationOutcome resource with more details on the failure. If the request message is processed successfully, whether or not vital signs are found or generated, the HTTP status code shall be 200.  
+
The body of the response message shall be a Bundle of type "''searchset''" containing all matching vital sign Observations as entries. If no Observations are found, a Bundle of type "''searchset''" shall be returned without any Observation as entries.
  
−
''Response Class:''
+
In the table below, the vital sign zibs and their respective profiles are listed. Zibs that MUST be supported are marked with (M). Other vital signs profiles, without a corresponding zib, are can be found in the [http://hl7.org/fhir/STU3/observation-vitalsigns.html HL7 FHIR specification.]
−
* Status 200: successful operation
 
−
* Status 400: invalid parameter
 
−
* Status 401/4xx: unauthorized request
 
−
* Status 403: insufficient scope
 
  
−
If the XIS is sending warnings, the Bundle resource shall also contain a FHIR OperationOutcome resource that contains those warnings. The FHIR specification describes the relevant sections:
+
{{MedMij:V2020.01/NoteBoxPackage|p1=nictiz.fhir.nl.stu3.zib2017|v1Min=2.0.0}}
−
*[http://hl7.org/fhir/STU3/observation-vitalsigns.html Vital Signs Profile]
 
−
*[http://hl7.org/fhir/STU3/http.html RESTful API framework]
 
−
*[http://hl7.org/fhir/STU3/search.html Search]
 
−
*[http://hl7.org/fhir/STU3/bundle.html Bundle resource]
 
−
*[http://hl7.org/fhir/STU3/operationoutcome.html OperationOutcome resource]
 
−
 
 
−
=====Message Resource content=====
 
−
The body of the response message shall be a Bundle of type 'searchset' containing all matching vital sign Observations as entries. If no Observations are found, a Bundle of type 'searchset' shall be returned without any Observation as entries.
 
−
 
 
−
In the table below, the vital sign zibs and their respective profiles are listed. Other vital signs profiles, without a corresponding zib, are can be found in the [http://hl7.org/fhir/STU3/observation-vitalsigns.html HL7 FHIR specification.]
 
−
 
 
−
{{MedMij:NoteBoxPackage|p1=nictiz.fhir.nl.stu3.zib2017}}
 
  
 
{| class="wikitable"  
 
{| class="wikitable"  
 
|-style="background-color: #1F497D; color: white; font-weight: bold; "
 
|-style="background-color: #1F497D; color: white; font-weight: bold; "
−
|style="width:150px;"|Zib name NL||style="width:150px;"|Zib name EN||style="width:150px;"|FHIR Resource||style="width:450px;"|FHIR profile
+
|style="width:150px;"|Zib NL||style="width:150px;"|HCIM EN||style="width:150px;"|FHIR Resource||style="width:450px;"|FHIR Profile
−
|-style="vertical-align:top; background-color: #E3E3E3;  
+
|-style="vertical-align:top; background-color: #E3E3E3;
 +
|-
 +
| Patiënt (M)||Patient||Patient||{{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017}}
 +
|-
 +
| Zorgverlener (M)||HealthProfessional||Practitioner||{{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner|nictiz.fhir.nl.stu3.zib2017}}
 
|-
 
|-
−
| Bloeddruk||BloodPressure||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BloodPressure|nictiz.fhir.nl.stu3.zib2017}}  
+
| Ademhaling||Respiration||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Respiration|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
−
| LichaamsGewicht||BodyWeight||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyWeight|nictiz.fhir.nl.stu3.zib2017}}  
+
| Bloeddruk (M)||BloodPressure [[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BloodPressure|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
−
| LichaamsLengte||BodyHeight||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyHeight|nictiz.fhir.nl.stu3.zib2017}}
+
| LichaamsGewicht (M)||BodyWeight[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyWeight|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
−
| Lichaamstemperatuur||BodyTemperature||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyTemperature|nictiz.fhir.nl.stu3.zib2017}}  
+
| LichaamsLengte||BodyHeight[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyHeight|nictiz.fhir.nl.stu3.zib2017}}
 
|-
 
|-
−
| O2Saturatie||oxygenation, saturation, SpO2||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-OxygenSaturation|nictiz.fhir.nl.stu3.zib2017}}  
+
| Lichaamstemperatuur||BodyTemperature[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyTemperature|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
−
| Hartfrequentie||HeartRate||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-HeartRate|nictiz.fhir.nl.stu3.zib2017}}  
+
| O2Saturatie||oxygenation, saturation, SpO2[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-OxygenSaturation|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
−
| Polsfrequentie||PulseRate||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-PulseRate|nictiz.fhir.nl.stu3.zib2017}}  
+
| Hartfrequentie (M)||HeartRate[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-HeartRate|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
−
| LaboratoriumUitslag (based on)||LaboratoryTestResult (based on)||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/vitalsign-bloodglucose|nictiz.fhir.nl.stu3.zib2017}}  
+
| Polsfrequentie||PulseRate[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-PulseRate|nictiz.fhir.nl.stu3.zib2017}}
 +
|-
 +
| LaboratoriumUitslag (based on) (M)||LaboratoryTestResult (based on)||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/vitalsign-bloodglucose|nictiz.fhir.nl.stu3.zib2017}}  
 
|}
 
|}
−
{{Sjabloon:Voorbeelden}}
+
 
 +
<span id="MustSupportFlag"></span>{{NoteBox|The Vital Signs FHIR profiles contain "Must Support" flags for various elements. The "Must Support" flags are inherited from FHIR core, but no particular meaning has been specified for the interpretation of these flags. Therefore, the "Must Support" flags also have no particular meaning within this context and can be ignored.}}
 +
 
 
====Expected Actions====
 
====Expected Actions====
 
The PHR processes the results according to application-defined rules.
 
The PHR processes the results according to application-defined rules.
  
−
==Interactions, operations, search parameters==
+
===The {{fhir|$lastn}} operation===
−
===Interactions===
 
−
The following logical interactions are needed for the retrieve medication information transaction:
 
−
* [http://hl7.org/fhir/STU3/http.html#search Search]
 
−
 
 
−
===Operations===
 
 
The following [http://hl7.org/fhir/STU3/operations.html operation] is needed for this use case.
 
The following [http://hl7.org/fhir/STU3/operations.html operation] is needed for this use case.
 
* [http://hl7.org/fhir/STU3/observation-operations.html#lastn Last N Observations Query]
 
* [http://hl7.org/fhir/STU3/observation-operations.html#lastn Last N Observations Query]
  
−
The lastn query meets the common need for searching for the most recent or last n=number of observations for a subject. For example, retrieving the last 5 temperatures for a patient to view trends or fetching the most recent laboratory results or vital signs. The link will provide more detailed information and examples regarding this operation.
+
The {{fhir|$lastn}} query meets the common need for searching for the most recent or last n=number of observations for a subject. For example, retrieving the last 5 temperatures for a patient to view trends or fetching the most recent laboratory results or vital signs. The link will provide more detailed information and examples regarding this operation.
−
 
 
−
The [http://hl7.org/fhir/STU3/observation-operations.html#lastn FHIR STU3] specification is vague regarding the sorting mechanism of lastn. In [http://hl7.org/fhir/R4/observation-operation-lastn.html FHIR R4] however, this has been clarified and can be read as follows: when using lastn, the <code>effective[x]</code> element is used for sorting of Observations, sorted from most recent to the oldest.
 
  
−
===Search parameters===
+
The [http://hl7.org/fhir/STU3/observation-operations.html#{{fhir|$lastn}} FHIR STU3] specification is vague regarding the sorting mechanism of {{fhir|$lastn}}. In [http://hl7.org/fhir/R4/observation-operation-lastn.html FHIR R4] however, this has been clarified and can be read as follows: when using {{fhir|$lastn}}, the {{fhir|effective[x]}} element is used for sorting of Observations, sorted from most recent to the oldest.
−
The following search parameter types and search result parameters need to be supported for this transaction.  
 
  
−
Search parameter types:
+
{{NoteBox|The {{fhir|$lastn}} operation applies differently to the blood glucose measurements, as it may return up to three Observation resources instead of just one. This is due to the fact that blood glucose measurements have three different categories (fasting, general and post-meal), resulting in three possible values for {{fhir|Observation.code}}. To query on blood glucose, the {{fhir|$lastn}} query on blood glucose Observations should include all these three values, but this will result in the latest Observation for ''each'' of these values.}}
−
* [http://hl7.org/fhir/STU3/search.html#token token]
 
−
* [http://hl7.org/fhir/STU3/search.html#date date]
 
  
 
=Use case: Send Vital Signs=
 
=Use case: Send Vital Signs=
Regel 264: Regel 238:
  
 
====Message Semantics====
 
====Message Semantics====
−
Because sending vital signs will most likely consist of multiple Observations, a batch/transaction transaction is used. This allows for creating a set of resources in a single interaction.
+
Because sending vital signs will most likely consist of multiple Observations, a {{fhir|batch}} operation is used. This allows for creating a set of resources in a single interaction and makes it possible to [[MedMij:V2020.01/FHIR_IG#Referring other resources when sending information|include referenced secondary resources]] if needed.
 +
 
 +
A {{fhir|batch}} interaction is performed by an HTTP POST command as shown:
 +
 
 +
<pre>POST [base]</pre>
 +
 
 +
The body of the post submission is a Bundle with {{fhir|Bundle.type}}={{term|batch}}. Each entry carries request details ({{fhir|Bundle.entry.request}}) that provides the HTTP details of the action in order to inform the system processing the batch or what to do for the entry. (Note: {{fhir|.request}} is optional, but SHALL be present, even for the resources which aren't Observations. See [[MedMij:V2020.01/FHIR_IG#Referring other resources when sending information|the overarching principles]] for more information.)
  
−
A batch interaction is performed by an HTTP POST command as shown:
+
{{NoteBox|Sending systems are expected to use an internal reference to the Patient resource included in the request Bundle if they cannot refer to the subject in any other way (see [[MedMij:V2020.01/FHIR_IG#Referring other resources when sending information|the overarching principles]]). This contradicts the FHIR specification, which states that internal references cannot be used for {{fhir|batch}} operations. This is a known issue which will be addressed in the future versions of this information standard. See [https://bits.nictiz.nl/browse/MM-1620 MM-1620] for more information.}}
  
−
<pre>POST [base] {?_format=[mime-type]}</pre>
+
'''Identification:'''
  
−
The body of the post submission is a Bundle with Bundle.type = batch. Each entry carries request details (Bundle.entry.request) that provides the HTTP details of the action in order to inform the system processing the batch or what to do for the entry (note: the request is optional, but SHOULD be present). Every bundle.entry creates a resource using an HTTP POST method. The resource of this entry shall be the vital sign observation.
+
Sending systems are strongly encouraged to assign a stable identifier to the {{fhir|.identifier}} element when sending vital signs, this helps receiving systems with detecting duplicates and re-identification of Observation resources. For more information on dealing with identifiers, see the [[MedMij:V2020.01/FHIR_IG#When_is_.identifier_expected.3F|general MedMij FHIR IG]].
  
 
'''Links:'''
 
'''Links:'''
Regel 279: Regel 259:
 
The vital signs data send to the XIS SHALL conform to the matching vital sign profile. The table below lists profiles that represent zibs that can be used for vital sign information exchange. If no matching vital sign zib profile is present, vital sign profiles listed in the [http://hl7.org/fhir/STU3/observation-vitalsigns.html FHIR specification] can be used. Other vital sign concepts are currently out of scope for this use case.   
 
The vital signs data send to the XIS SHALL conform to the matching vital sign profile. The table below lists profiles that represent zibs that can be used for vital sign information exchange. If no matching vital sign zib profile is present, vital sign profiles listed in the [http://hl7.org/fhir/STU3/observation-vitalsigns.html FHIR specification] can be used. Other vital sign concepts are currently out of scope for this use case.   
  
−
{{MedMij:NoteBoxPackage|p1=nictiz.fhir.nl.stu3.zib2017}}
+
{{MedMij:V2020.01/NoteBoxPackage|p1=nictiz.fhir.nl.stu3.zib2017}}
  
−
{| class="wikitable" width="1200px"
+
{| class="wikitable"  
 
|-style="background-color: #1F497D; color: white; font-weight: bold; "
 
|-style="background-color: #1F497D; color: white; font-weight: bold; "
−
|style="width:150px;"|Zib name NL||style="width:150px;"|Zib name EN||style="width:150px;"|FHIR Resource||style="width:450px;"|FHIR Profile
+
|style="width:150px;"|Zib NL||style="width:150px;"|HCIM EN||style="width:150px;"|FHIR Resource||style="width:450px;"|FHIR Profile
−
|-style="vertical-align:top; background-color: #E3E3E3;  
+
|-style="vertical-align:top; background-color: #E3E3E3;
 
|-
 
|-
−
| Bloeddruk||BloodPressure||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BloodPressure|nictiz.fhir.nl.stu3.zib2017}}  
+
| Patiënt (M)||Patient||Patient||{{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-patient|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
−
| LichaamsGewicht||BodyWeight||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyWeight|nictiz.fhir.nl.stu3.zib2017}}  
+
| Zorgverlener (M)||HealthProfessional||Practitioner||{{Simplifier|http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
−
| LichaamsLengte||BodyHeight||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyHeight|nictiz.fhir.nl.stu3.zib2017}}  
+
| Ademhaling||Respiration||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-Respiration|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
−
| Lichaamstemperatuur||BodyTemperature||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyTemperature|nictiz.fhir.nl.stu3.zib2017}}  
+
| Bloeddruk (M)||BloodPressure[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BloodPressure|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
−
| O2Saturatie||oxygenation, saturation, SpO2||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-OxygenSaturation|nictiz.fhir.nl.stu3.zib2017}}  
+
| LichaamsGewicht (M)||BodyWeight[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyWeight|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
−
| Hartfrequentie||HeartRate||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-HeartRate|nictiz.fhir.nl.stu3.zib2017}}
+
| LichaamsLengte||BodyHeight[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyHeight|nictiz.fhir.nl.stu3.zib2017}}
 
|-
 
|-
−
| Polsfrequentie||PulseRate||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-PulseRate|nictiz.fhir.nl.stu3.zib2017}}
+
| Lichaamstemperatuur||BodyTemperature[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-BodyTemperature|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
−
| LaboratoriumUitslag (based on)||LaboratoryTestResult (based on)||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/vitalsign-bloodglucose|nictiz.fhir.nl.stu3.zib2017}}
+
| O2Saturatie||oxygenation, saturation, SpO2[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-OxygenSaturation|nictiz.fhir.nl.stu3.zib2017}}  
 
|-
 
|-
 +
| Hartfrequentie (M)||HeartRate[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-HeartRate|nictiz.fhir.nl.stu3.zib2017}}
 +
|-
 +
| Polsfrequentie||PulseRate[[#MustSupportFlag|*]]||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/zib-PulseRate|nictiz.fhir.nl.stu3.zib2017}}
 +
|-
 +
| LaboratoriumUitslag (based on) (M)||LaboratoryTestResult (based on)||Observation||{{Simplifier|http://nictiz.nl/fhir/StructureDefinition/vitalsign-bloodglucose|nictiz.fhir.nl.stu3.zib2017}}
 
|}
 
|}
−
{{Sjabloon:Voorbeelden}}
 
 
=====Expected Actions=====
 
=====Expected Actions=====
−
On receipt of the submission, the XIS shall validate the resources and respond with an appropriate HTTP code. If the XIS encounters any errors or if validation fails, the XIS shall return an error as documented in the Message Semantics of the response message.
+
On receipt of the submission, the XIS shall validate the resources and respond with an appropriate HTTP code.
  
 
===XIS: response message===
 
===XIS: response message===
Regel 317: Regel 301:
  
 
A client may use the returned Bundle to track the outcomes of processing the entry, and the identities assigned to the resources by the server. Each entry element SHALL contain a response element which details the outcome of processing the entry - the HTTP status code, and the location and ETag header values, which are used for identifying and versioning the resources. In addition, a resource may be included in the entry, as specified by the Prefer header.
 
A client may use the returned Bundle to track the outcomes of processing the entry, and the identities assigned to the resources by the server. Each entry element SHALL contain a response element which details the outcome of processing the entry - the HTTP status code, and the location and ETag header values, which are used for identifying and versioning the resources. In addition, a resource may be included in the entry, as specified by the Prefer header.
−
 
−
When the resource syntax or data is incorrect or invalid, and cannot be used to create a new resource, the server returns a 400 Bad Request HTTP status code. When the server rejects the content of the resource because of business rules, the server returns a 422 Unprocessable Entity error HTTP status code. In either case, the server SHOULD include a response body containing an OperationOutcome with detailed error messages describing the reason for the error.
 
−
 
−
Common HTTP Status codes returned on FHIR-related errors (in addition to normal HTTP errors related to security, header and content type negotiation issues):
 
−
 
−
* 400 Bad Request - resource could not be parsed or failed basic FHIR validation rules
 
−
* 404 Not Found - resource type not supported, or not a FHIR end-point
 
−
* 422 Unprocessable Entity - the proposed resource violated applicable FHIR profiles or server business rules. This should be accompanied by an OperationOutcome resource providing additional detail
 
  
 
Read more:
 
Read more:
Regel 333: Regel 309:
 
The PHR processes the results according to application-defined rules.
 
The PHR processes the results according to application-defined rules.
  
−
==Interactions, operations, search parameters==  
+
====Handling Errors====
−
===Interactions===
+
The server may be unable to accept a Bundle due to errors or because of business rules (e.g. because of an unsupported code value in an Observation resource). Refer to the [https://informatiestandaarden.nictiz.nl/wiki/MedMij:V2020.01/FHIR_IG#Handling_errors Handling Errors section] in the MedMij FHIR IG for more information.
−
The following logical interactions are needed for the retrieve medication information transaction:
 
−
* [http://hl7.org/fhir/STU3/http.html#create create]
 
−
* [http://hl7.org/fhir/STU3/http.html#transaction batch/transaction]
 
−
 
 
−
===Operations===
 
−
No operations are defined or needed for this transaction.
 
−
 
 
−
===Search parameters===
 
−
No search parameters are defined or needed for this transaction.
 
−
 
 
−
=Terminology, NamingSystems, Mappings=
 
−
 
 
−
===Terminology===
 
−
Relevant ValueSets can be found through the ValueSet bindings in the listed StructureDefinitions. All ValueSets can be found here [https://simplifier.net/NictizSTU3-Zib2017/~resources?category=ValueSet here] and can be downloaded as a .zip in XML or JSON format.
 
−
 
 
−
===NamingSystems===
 
−
Relevant NamingSystems can be found [https://simplifier.net/NictizSTU3-Zib2017/~resources?category=NamingSystem here].
 
−
 
 
−
===Mappings===
 
−
A FHIR ConceptMap resource is provided when a FHIR value set is used instead of a HCIM value set. A ConceptMap maps the values between the two value sets. These ConceptMaps can be found [https://simplifier.net/NictizSTU3-Zib2017/~resources?category=ConceptMap here].
 
−
 
 
−
An explanation about mappings can be found at [[MedMij:Vprepub/FHIR_IG#Mapping_of_coded_concepts|Mapping of coded concepts]].
 
  
 
=Release notes=
 
=Release notes=
−
Release notes can be found on the [[MedMij:Vprepub/OntwerpZelfmetingen#Release_notes|functional design page]].
+
Release notes can be found on the [[MedMij:V2020.01/OntwerpZelfmetingen#Release_notes|functional design page]].

Huidige versie van 22 nov 2022 om 13:35



Naar medmij.nl
Self-Measurements
AfsprakenstelselFunctioneelTechnischAfspraken-Functioneel-Technisch

1 Introduction

Go to functional design

This use case is mainly based on the HL7 FHIR vital signs specification - http://hl7.org/fhir/STU3/observation-vitalsigns.html. The HL7 FHIR vital signs specification is extended with profiles of zib concepts that represent vital signs. These profiles are derived from the official HL7 Vital Signs profiles. The purpose of these profiles is to add additional concepts that are not in the vital sign profiles but are provided in the corresponding zib. Moreover, these derived profiles include zib to FHIR mappings.

Note: This implementation guide builds on the general guidelines described in the use case overarching principles.

Because the base vital signs profile constrains the .code and the .component.code to the datatype quantity it is not possible to add additional zib concepts. A GForge issue is created to address this problem. This issue will most likely be resolved with FHIR version STU4. However, to address this problem now the base vital signs panel is copied, the datatype constrains removed and published under a different canonical URL. The HL7 vital sign profiles bloodpressure, bodyweight, and oxygensaturation are copied, the StructureDefinition.baseDefinition adjusted and published under a different canonical URL because they are in the chain of derived profiles and the component.code needs to be used for these vital signs.

Use cases:

2 Actors involved

Persons Systems FHIR Capability Statements
Name Description Name Description Name Description
Patient The user of a personal healthcare environment. PHR Personal health record Verwijzing.png CapabilityStatement: Client Vital Signs client requirements
Healthcare professional The user of a XIS XIS Healthcare information system Verwijzing.png CapabilityStatement: Server Vital Signs server requirements

3 Use case: Retrieve Vital Signs

Go to Afsprakenstelsel

This FHIR implementation guide assumes that the PHR system is able to make a connection to the right XIS that contains the patient's information. It does not provide information on finding the right XIS nor does it provide information about security. Moreover, each transaction is performed in the context of a specific authenticated patient, for whose context (token) has been established using the authentication mechanisms described in the 'Afsprakenstelsel'. Each XIS Gateway is required to perform filtering based on the patient associated with the context for the request, so only the records associated with the authenticated patient are returned. For this reason, search parameters should not be included for patient identification.

3.1 Introduction

The retrieve vital signs transaction is used by the PHR to retrieve vital signs from the XIS.

3.2 Actors

Transaction group Transaction Actor Role
Retrieve Vital Signs(PULL) Retrieve vital signs request Patient (using a PHR) Request vital signs from the XIS
Retrieve vital signs response Healthcare professional (using a XIS) Serves vital signs to the PHR

3.3 Invocations

3.3.1 PHR: request message

The request message represents an HTTP GET parameterized query from the PHR to the XIS.

3.3.1.1 Trigger Events

When the patient(PHR) wants to obtain vital signs, it issues a retrieve vital signs request message.

3.3.1.2 Message Semantics

Search

The PHR executes an HTTP GET conform to the FHIR RESTful and search specification against the XIS's Observation endpoint. This search query URL is configurable by the PHR and has the following format. 

GET [base]/Observation{/$lastn}{?[parameters]}

Search Parameters

The PHR may supply, and the XIS shall be capable of processing, all query parameters listed below. These search parameters are a selection of the defined search parameters by the HL7 FHIR specification search parameters of Observation.

Observation
Name Type Description Example
category token The classification of the type of observation.

Within this context this will be vital-signs (from code system http://hl7.org/fhir/observation-category)

Retrieve all Observation resources that are considered a vital sign observation: 

GET [base]/Observation?category=vital-signs
code token The code of the observation type.

The different types of measurements are specified using the following LOINC codes:

  • Respiration: 9279-1
  • BloodPressure: 85354-9
  • BodyWeight: 29463-7
  • BodyHeight: 8302-2
  • BodyTemperature: 8310-5
  • Oxygenation, saturation, SpO2: 59408-5
  • HeartRate: 8867-4
  • PulseRate: 8889-8
  • BloodGlucose
    • fasting: 14770-2
    • general: 14743-9
    • post-meal: 14760-3

Retrieve all Observation resources that are a blood pressure observation: 

GET [base]/Observation?code=http://loinc.org|85354-9

Retrieve the most recent body height and the most recent body weight observation: 

GET [base]/Observation/$lastn?code=http://loinc.org|8302-2&code=http://loinc.org|29463-7
date date Obtained date/time. If the obtained element is a period, a date that falls in the period

Retrieve all Observation resources that are a blood pressure observation and have an effective date between 01-01-2010 and 31-12-2010: 

GET [base]/Observation?code=http://loinc.org|85354-9&date=ge2010-01-01&date=le2011-01-01

Retrieve at most four temperature observations that have an effective date greater than 01-06-2012: 

GET [base]/Observation/$lastn?max=4&code=http://loinc.org|8310-5&date=ge2012-06-01
3.3.1.2.1 Expected Actions

The XIS shall process the query to find and return the vital signs matching the provided query parameters.

3.3.2 XIS: response message

The XIS returns an HTTP Status code appropriate to the processing as well as a Bundle of matching vital signs Observation.

3.3.2.1 Trigger Events

The XIS completed processing of the retrieve vital signs request message.

3.3.2.2 Message Semantics

The body of the response message shall be a Bundle of type "searchset" containing all matching vital sign Observations as entries. If no Observations are found, a Bundle of type "searchset" shall be returned without any Observation as entries.

In the table below, the vital sign zibs and their respective profiles are listed. Zibs that MUST be supported are marked with (M). Other vital signs profiles, without a corresponding zib, are can be found in the HL7 FHIR specification.

Em.png

MedMij uses the FHIR Packaging mechanism. This conveniently bundles all profiles, terminology, example material and other conformance resources you need into a single archive, which can be downloaded or installed using the appropriate FHIR tooling. This version of the information standard uses the following packages:

Note: packages use Semantic Versioning. Other versions can be used at will as long as they have the same major.minor number or a minor number higher than the stated version.

Zib NL HCIM EN FHIR Resource FHIR Profile
Patiënt (M) Patient Patient http://fhir.nl/fhir/StructureDefinition/nl-core-patient
Zorgverlener (M) HealthProfessional Practitioner http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner
Ademhaling Respiration Observation http://nictiz.nl/fhir/StructureDefinition/zib-Respiration
Bloeddruk (M) BloodPressure * Observation http://nictiz.nl/fhir/StructureDefinition/zib-BloodPressure
LichaamsGewicht (M) BodyWeight* Observation http://nictiz.nl/fhir/StructureDefinition/zib-BodyWeight
LichaamsLengte BodyHeight* Observation http://nictiz.nl/fhir/StructureDefinition/zib-BodyHeight
Lichaamstemperatuur BodyTemperature* Observation http://nictiz.nl/fhir/StructureDefinition/zib-BodyTemperature
O2Saturatie oxygenation, saturation, SpO2* Observation http://nictiz.nl/fhir/StructureDefinition/zib-OxygenSaturation
Hartfrequentie (M) HeartRate* Observation http://nictiz.nl/fhir/StructureDefinition/zib-HeartRate
Polsfrequentie PulseRate* Observation http://nictiz.nl/fhir/StructureDefinition/zib-PulseRate
LaboratoriumUitslag (based on) (M) LaboratoryTestResult (based on) Observation http://nictiz.nl/fhir/StructureDefinition/vitalsign-bloodglucose

Em.png

The Vital Signs FHIR profiles contain "Must Support" flags for various elements. The "Must Support" flags are inherited from FHIR core, but no particular meaning has been specified for the interpretation of these flags. Therefore, the "Must Support" flags also have no particular meaning within this context and can be ignored.

3.3.2.3 Expected Actions

The PHR processes the results according to application-defined rules.

3.3.3 The $lastn operation

The following operation is needed for this use case.

The $lastn query meets the common need for searching for the most recent or last n=number of observations for a subject. For example, retrieving the last 5 temperatures for a patient to view trends or fetching the most recent laboratory results or vital signs. The link will provide more detailed information and examples regarding this operation.

The $lastn FHIR STU3 specification is vague regarding the sorting mechanism of $lastn. In FHIR R4 however, this has been clarified and can be read as follows: when using $lastn, the effective[x] element is used for sorting of Observations, sorted from most recent to the oldest.

Em.png

The $lastn operation applies differently to the blood glucose measurements, as it may return up to three Observation resources instead of just one. This is due to the fact that blood glucose measurements have three different categories (fasting, general and post-meal), resulting in three possible values for Observation.code. To query on blood glucose, the $lastn query on blood glucose Observations should include all these three values, but this will result in the latest Observation for each of these values.

4 Use case: Send Vital Signs

4.1 Introduction

The send vital signs transaction is used by the PHR to send vital signs to the XIS.

4.2 Actors

Transaction group Transaction Actor Role
Send Vital Signs(PUSH) Send vital signs request Patient (using a PHR) Sends vital signs to the XIS
Send vital signs response Healthcare professional (using a XIS) Receives vital signs from the PHR

4.3 Invocations

4.3.1 PHR: request message

The send vital sings request message uses the HTTP POST method on the target XIS's base.

4.3.1.1 Trigger Events

This message is invoked when the PHR needs to send one or more vital signs observations to the XIS.

4.3.1.2 Message Semantics

Because sending vital signs will most likely consist of multiple Observations, a batch operation is used. This allows for creating a set of resources in a single interaction and makes it possible to include referenced secondary resources if needed.

A batch interaction is performed by an HTTP POST command as shown: 

POST [base]

The body of the post submission is a Bundle with Bundle.type=batch. Each entry carries request details (Bundle.entry.request) that provides the HTTP details of the action in order to inform the system processing the batch or what to do for the entry. (Note: .request is optional, but SHALL be present, even for the resources which aren't Observations. See the overarching principles for more information.)

Em.png

Sending systems are expected to use an internal reference to the Patient resource included in the request Bundle if they cannot refer to the subject in any other way (see the overarching principles). This contradicts the FHIR specification, which states that internal references cannot be used for batch operations. This is a known issue which will be addressed in the future versions of this information standard. See MM-1620 for more information.

Identification:

Sending systems are strongly encouraged to assign a stable identifier to the .identifier element when sending vital signs, this helps receiving systems with detecting duplicates and re-identification of Observation resources. For more information on dealing with identifiers, see the general MedMij FHIR IG.

Links:

The vital signs data send to the XIS SHALL conform to the matching vital sign profile. The table below lists profiles that represent zibs that can be used for vital sign information exchange. If no matching vital sign zib profile is present, vital sign profiles listed in the FHIR specification can be used. Other vital sign concepts are currently out of scope for this use case.

Em.png

MedMij uses the FHIR Packaging mechanism. This conveniently bundles all profiles, terminology, example material and other conformance resources you need into a single archive, which can be downloaded or installed using the appropriate FHIR tooling. This version of the information standard uses the following packages:

Note: packages use Semantic Versioning. Other versions can be used at will as long as they have the same major.minor number or a minor number higher than the stated version.

Zib NL HCIM EN FHIR Resource FHIR Profile
Patiënt (M) Patient Patient http://fhir.nl/fhir/StructureDefinition/nl-core-patient
Zorgverlener (M) HealthProfessional Practitioner http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner
Ademhaling Respiration Observation http://nictiz.nl/fhir/StructureDefinition/zib-Respiration
Bloeddruk (M) BloodPressure* Observation http://nictiz.nl/fhir/StructureDefinition/zib-BloodPressure
LichaamsGewicht (M) BodyWeight* Observation http://nictiz.nl/fhir/StructureDefinition/zib-BodyWeight
LichaamsLengte BodyHeight* Observation http://nictiz.nl/fhir/StructureDefinition/zib-BodyHeight
Lichaamstemperatuur BodyTemperature* Observation http://nictiz.nl/fhir/StructureDefinition/zib-BodyTemperature
O2Saturatie oxygenation, saturation, SpO2* Observation http://nictiz.nl/fhir/StructureDefinition/zib-OxygenSaturation
Hartfrequentie (M) HeartRate* Observation http://nictiz.nl/fhir/StructureDefinition/zib-HeartRate
Polsfrequentie PulseRate* Observation http://nictiz.nl/fhir/StructureDefinition/zib-PulseRate
LaboratoriumUitslag (based on) (M) LaboratoryTestResult (based on) Observation http://nictiz.nl/fhir/StructureDefinition/vitalsign-bloodglucose
4.3.1.2.1 Expected Actions

On receipt of the submission, the XIS shall validate the resources and respond with an appropriate HTTP code.

4.3.2 XIS: response message

The XIS returns an HTTP Status code appropriate to the processing outcome and returns a Bundle, of type batch-response, that contains one entry for each entry in the request, in the same order, with the outcome of processing the entry.

4.3.2.1 Trigger Events

The XIS completed processing of the send vital signs request message.

4.3.2.2 Message Semantics

The XIS SHALL return a Bundle with type set to batch-response that contains one entry for each entry in the request, in the same order, with the outcome of processing the entry.

A client may use the returned Bundle to track the outcomes of processing the entry, and the identities assigned to the resources by the server. Each entry element SHALL contain a response element which details the outcome of processing the entry - the HTTP status code, and the location and ETag header values, which are used for identifying and versioning the resources. In addition, a resource may be included in the entry, as specified by the Prefer header.

Read more: create batch

4.3.2.3 Expected Actions

The PHR processes the results according to application-defined rules.

4.3.2.4 Handling Errors

The server may be unable to accept a Bundle due to errors or because of business rules (e.g. because of an unsupported code value in an Observation resource). Refer to the Handling Errors section in the MedMij FHIR IG for more information.

5 Release notes

Release notes can be found on the functional design page.

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