VitalSigns

A comprehensive panel of vital signs measurements capturing cardiovascular, respiratory, and basic health indicators. Includes blood pressure, heart rate, respiratory rate, temperature, oxygen saturation, weight, height, and pain assessment.

Overview

VitalSigns captures a complete set of basic physiological measurements in a single observation panel. Rather than creating separate observations for each vital sign, this entity groups them together as they are typically collected during a clinical encounter. It includes all standard vitals (BP, HR, RR, temp, SpO2), anthropometrics (weight, height), and pain assessment, with calculated fields for BMI, mean arterial pressure, and oxygen saturation status.

Key Concepts

Core Vital Signs

Standard physiological measurements:

Vital Sign	Fields	Unit	Normal Range
Blood Pressure	`bloodPressureSystolic`, `bloodPressureDiastolic`	mmHg	90-120/60-80
Heart Rate	`heartRate`	beats/min	60-100
Respiratory Rate	`respiratoryRate`	breaths/min	12-20
Temperature	`temperature`	°C	36.1-37.2
Oxygen Saturation	`oxygenSaturation`	%	95-100

Anthropometric Measurements

Body measurements for clinical assessment:

Measurement	Field	Unit	Purpose
Weight	`weight`	kg	Dosing, fluid status
Height	`height`	cm	BMI calculation
BMI	`bmi` (calculated)	kg/m²	Body composition

Temperature Sites

The temperatureSite field affects interpretation:

Site	Typical Variance	Common Use
`oral`	Reference	Adult routine
`axillary`	-0.5°C	Non-invasive
`rectal`	+0.5°C	Pediatric, accurate
`tympanic`	Variable	Quick screening
`temporal`	Variable	Non-contact
`forehead`	Variable	Screening

Oxygen Supplementation

Context for SpO2 interpretation:

oxygenSupplemental - Is patient on O2?
oxygenFlowRate - L/min if on oxygen
Critical for assessing true respiratory status

Pain Assessment

The painScore field (0-10 scale):

0 = No pain
1-3 = Mild pain
4-6 = Moderate pain
7-10 = Severe pain

Observation Status

Lifecycle from recording to verification:

Status	Description
`registered`	Initially recorded
`preliminary`	Pending verification
`final`	Verified and complete
`amended`	Modified after final
`corrected`	Error corrected
`cancelled`	Voided
`entered-in-error`	Invalid

Use Cases

Routine Vital Signs

During standard assessment:

Record BP, HR, RR, temp, SpO2
Note temperature site
Document if on supplemental oxygen
Assess pain level
Measure weight if needed
Set status to final when verified

Triage Assessment

In emergency department:

Capture full vital signs panel
Flag critical values
Note oxygen requirements
Document pain score
Support acuity determination
Trigger alerts for abnormals

Inpatient Monitoring

During hospitalization:

Record vitals per protocol (q4h, q8h)
Link to encounter
Track trends over time
Flag deterioration
Support early warning scores
Document supplemental oxygen changes

Pediatric Assessment

For pediatric patients:

Use age-appropriate reference ranges
Prefer tympanic or temporal temp
Document weight accurately
Calculate BMI percentile
Note cooperation level

Critical Care

In intensive care:

Frequent vital sign documentation
Track oxygen requirements closely
Calculate MAP for perfusion
Document pain despite sedation
Support hemodynamic monitoring

Related Entities

Entity	Relationship	Description
Patient	References	Subject of vitals
Encounter	References	Visit context
Practitioner	References	Who performed measurement
ClinicalIdentifier	Contains	Business identifiers

Calculated Fields

Field	Type	Description
`bmi`	number	Body mass index: weight(kg) / height(m)²
`meanArterialPressure`	number	MAP: diastolic + (systolic - diastolic)/3
`pulseOxStatus`	string	Normal (≥95%), Low (90-94%), Critical (<90%)

Enums

status

Value	Description
`registered`	Vital signs recorded but not yet verified
`preliminary`	Initial values available, pending verification
`final`	Vital signs verified and complete
`amended`	Values modified after finalization
`corrected`	Values corrected due to error
`cancelled`	Vital signs recording cancelled
`entered-in-error`	Recording created in error

temperatureSite

Value	Description
`oral`	Temperature measured in the mouth
`axillary`	Temperature measured in the armpit
`rectal`	Temperature measured rectally (most accurate)
`tympanic`	Temperature measured in the ear canal
`temporal`	Temperature measured at temporal artery
`forehead`	Temperature measured on the forehead

pulseOxStatus

Value	Description
`Normal`	Oxygen saturation 95% or higher
`Low`	Oxygen saturation between 90-94%, concerning
`Critical`	Oxygen saturation below 90%, requires immediate attention

22 properties

Schema

Properties

Property	Type	Mode	Description	Required
identifier	ClinicalIdentifier[]	stored	Unique business identifiers assigned to this vital signs observation panel by healthcare systems for tracking and reference across multiple platforms Example: `[{"@type":"ClinicalIdentifier","value":"VS-2024-123456","clinicalSystem":"custom"}]`	Optional
status	string	stored	Current state of the observation in its lifecycle from initial recording through final verification or correction Values: `registered, preliminary, final, amended, corrected, cancelled, entered-in-error` Example: `"final"`	Required
patient	Patient	stored	Reference to the patient whose vital signs were measured	Required
encounter	Encounter	stored	Reference to the healthcare encounter during which these vital signs were recorded - provides clinical context for the measurements	Optional
effectiveDateTime	DateTime	stored	Date and time when the vital signs were measured - represents the clinically relevant moment of observation Example: `"2024-11-30T09:15:00Z"`	Required
performer	Practitioner	stored	Reference to the healthcare provider or clinical staff member who performed the vital signs measurements	Optional
bloodPressureSystolic	number	stored	Systolic blood pressure measurement in millimeters of mercury (mmHg) - represents maximum arterial pressure during heart contraction Example: `120`	Optional
bloodPressureDiastolic	number	stored	Diastolic blood pressure measurement in millimeters of mercury (mmHg) - represents minimum arterial pressure during heart relaxation Example: `80`	Optional
heartRate	number	stored	Heart rate measurement in beats per minute (bpm) - indicates cardiac rhythm and cardiovascular function Example: `72`	Optional
respiratoryRate	number	stored	Respiratory rate measurement in breaths per minute - indicates breathing frequency and respiratory function Example: `16`	Optional
temperature	number	stored	Body temperature measurement in degrees Celsius - core indicator of metabolic state and potential infection or inflammation Example: `37`	Optional
temperatureSite	string	stored	Anatomical location where temperature was measured - affects interpretation due to site-specific temperature variations Values: `oral, axillary, rectal, tympanic, temporal, forehead` Example: `"oral"`	Optional
oxygenSaturation	number	stored	Peripheral oxygen saturation (SpO2) measurement as percentage - indicates how well oxygen is being carried to extremities via hemoglobin Example: `98`	Optional
oxygenSupplemental	boolean	stored	Whether the patient was receiving supplemental oxygen at the time of SpO2 measurement - critical context for interpreting oxygen saturation values	Optional
oxygenFlowRate	number	stored	Supplemental oxygen flow rate in liters per minute (L/min) - recorded when patient is on oxygen therapy Example: `2`	Optional
weight	number	stored	Body weight measurement in kilograms (kg) - essential for medication dosing, fluid management, and nutritional assessment Example: `70.5`	Optional
height	number	stored	Body height measurement in centimeters (cm) - used for calculating body mass index and determining normal ranges for other measurements Example: `175`	Optional
painScore	number	stored	Patient-reported pain intensity on a 0-10 numeric scale where 0 indicates no pain and 10 represents the worst pain imaginable Example: `2`	Optional
notes	string	stored	Clinical observations, contextual information, or special circumstances related to the vital signs measurements - captures qualitative findings that supplement quantitative data Example: `"Patient appeared comfortable and cooperative during measurement"`	Optional
bmi	number	calculated	Body mass index calculated from weight (kg) divided by height squared (m²) - standard measure of body composition used to assess healthy weight ranges	Optional
meanArterialPressure	number	calculated	Mean arterial pressure (MAP) calculated from systolic and diastolic pressures using the formula: diastolic + (systolic - diastolic)/3 - represents average arterial pressure during a single cardiac cycle	Optional
pulseOxStatus	string	calculated	Clinical interpretation of oxygen saturation level - categorized as Normal (≥95%), Low (90-94%), or Critical (<90%) to support rapid clinical assessment Values: `Normal, Low, Critical`	Optional

Examples

Example 1

{
  "@type": "VitalSigns",
  "identifier": [
    {
      "@type": "ClinicalIdentifier",
      "value": "VS-2024-001234",
      "clinicalSystem": "custom"
    }
  ],
  "status": "final",
  "patient": {
    "@type": "Patient",
    "givenName": "John",
    "familyName": "Smith",
    "birthDate": "1975-05-15"
  },
  "encounter": {
    "@type": "Encounter",
    "identifier": [
      {
        "@type": "ClinicalIdentifier",
        "value": "ENC-2024-001234"
      }
    ]
  },
  "effectiveDateTime": "2024-11-30T09:15:00Z",
  "performer": {
    "@type": "Practitioner",
    "givenName": "Emily",
    "familyName": "Davis"
  },
  "bloodPressureSystolic": 120,
  "bloodPressureDiastolic": 80,
  "heartRate": 72,
  "respiratoryRate": 16,
  "temperature": 37,
  "temperatureSite": "oral",
  "oxygenSaturation": 98,
  "oxygenSupplemental": false,
  "weight": 75,
  "height": 175,
  "painScore": 0,
  "notes": "Routine annual physical examination - all vital signs within normal limits",
  "_comment": "bmi: 24.5, meanArterialPressure: 93.3, pulseOxStatus: Normal"
}

Example 2

{
  "@type": "VitalSigns",
  "identifier": [
    {
      "@type": "ClinicalIdentifier",
      "value": "VS-2024-567890",
      "clinicalSystem": "custom"
    }
  ],
  "status": "final",
  "patient": {
    "@type": "Patient",
    "givenName": "Emma",
    "familyName": "Thompson",
    "birthDate": "2018-03-22"
  },
  "encounter": {
    "@type": "Encounter",
    "identifier": [
      {
        "@type": "ClinicalIdentifier",
        "value": "ENC-2024-567890"
      }
    ]
  },
  "effectiveDateTime": "2024-11-30T10:30:00Z",
  "performer": {
    "@type": "Practitioner",
    "givenName": "Sarah",
    "familyName": "Johnson"
  },
  "bloodPressureSystolic": 95,
  "bloodPressureDiastolic": 60,
  "heartRate": 95,
  "respiratoryRate": 22,
  "temperature": 37.8,
  "temperatureSite": "tympanic",
  "oxygenSaturation": 99,
  "oxygenSupplemental": false,
  "weight": 22,
  "height": 115,
  "painScore": 3,
  "notes": "Pediatric well-child visit - mild fever, vitals appropriate for age, child cooperative",
  "_comment": "bmi: 16.6, meanArterialPressure: 71.7, pulseOxStatus: Normal"
}

Example 3

{
  "@type": "VitalSigns",
  "identifier": [
    {
      "@type": "ClinicalIdentifier",
      "value": "VS-2024-987654",
      "clinicalSystem": "custom"
    }
  ],
  "status": "final",
  "patient": {
    "@type": "Patient",
    "givenName": "Robert",
    "familyName": "Williams",
    "birthDate": "1942-03-10"
  },
  "encounter": {
    "@type": "Encounter",
    "identifier": [
      {
        "@type": "ClinicalIdentifier",
        "value": "ER-2024-987654"
      }
    ]
  },
  "effectiveDateTime": "2024-11-30T14:45:00Z",
  "performer": {
    "@type": "Practitioner",
    "givenName": "Michael",
    "familyName": "Chen"
  },
  "bloodPressureSystolic": 145,
  "bloodPressureDiastolic": 92,
  "heartRate": 105,
  "respiratoryRate": 24,
  "temperature": 38.5,
  "temperatureSite": "oral",
  "oxygenSaturation": 89,
  "oxygenSupplemental": true,
  "oxygenFlowRate": 4,
  "weight": 82,
  "height": 170,
  "painScore": 7,
  "notes": "Critical care admission - respiratory distress with supplemental oxygen, elevated temperature, tachycardia, patient anxious and diaphoretic",
  "_comment": "bmi: 28.4, meanArterialPressure: 109.7, pulseOxStatus: Critical"
}