Code Mapping and Vendor Capabilities

What Ward emits on outbound writes, and what each vendor accepts. Confirm the vendor column against the target's current CapabilityStatement before promising a flow: supported write resources and code sets change per release and per customer.

Every outbound resource also carries a stable business identifier (system http://ward.health/fhir/sid/{kind}) so a replayed write is an idempotent no-op rather than a duplicate chart entry. The value is the Ward record UUID for rounds and assessments; for vitals it is {uuid}:{measurement} (e.g. …:blood_pressure, …:heart_rate), since one vitals row yields several observations. A reconciliation query must key on that qualified value for vitals.

Vital signs (US Core Observation)

Category vital-signs; values are UCUM-coded quantities.

Measurement	LOINC	UCUM unit
Heart rate	8867-4	/min
Blood pressure panel	85354-9	(components below)
— Systolic (component)	8480-6	mm[Hg]
— Diastolic (component)	8462-4	mm[Hg]
Respiratory rate	9279-1	/min
Oxygen saturation (pulse ox)	59408-5 + 2708-6	%
Body temperature	8310-5	[degF]
Pain severity	72514-3	{score}

Blood pressure files as one panel with systolic/diastolic components so it lands in the BP flowsheet row, not as two orphaned scalars. SpO2 carries both the pulse-oximetry method code (primary) and the generic saturation code, per US Core Pulse Oximetry.

Assessments (coded Observation)

Category survey. Known instruments use LOINC; an unrecognized type uses a ward CodeSystem so the code is honestly proprietary rather than a fabricated standard code. Severity is a coded interpretation; the human-readable interpretation is a note.

Assessment	LOINC
C-SSRS	89206-7
CIWA-Ar	75626-2
COWS	75625-4
PHQ-9 total score	44261-6
Morse Fall Scale	38208-5
Braden Scale	38227-5
(unrecognized)	http://ward.health/fhir/CodeSystem/assessment-type
Severity level	http://ward.health/fhir/CodeSystem/assessment-severity

1:1 rounds (DocumentReference)

A 1:1 safety round has no clean LOINC and files as a clinical-note DocumentReference (type LOINC 34746-8 Nurse Note, US Core category clinical-note) whose text always asserts the proximity result. The patient-status SNOMED codes below inform the note text.

Patient status	SNOMED CT
Sleeping	248218005
Awake and calm	271778009
Agitated	24199005
Distressed	224977004
Off unit	373066001
Other	74964007

The psych-status SNOMED set and the LOINC/UCUM assignments need clinical sign-off per facility before go-live. They are defaults, not a substitute for the facility's own flowsheet mapping.

Write strategy and idempotency

Ward writes idempotently keyed by the business identifier. Two strategies, selected per facility by write_strategy:

Strategy	Mechanism	Use when
conditional_update (default)	PUT {Type}?identifier={system}|{value}	The vendor supports conditional update on the resource
conditional_create	POST {Type} with If-None-Exist: identifier={system}|{value}	The vendor is create-only (rejects conditional PUT)

Confirming which one the target EMR accepts, per resource, against its CapabilityStatement (rest.resource.conditionalUpdate / conditionalCreate) is the first thing to validate in the vendor sandbox.

Per-vendor notes

Vendor	Reads	Writes	Notes
Epic	Patient, Encounter, Observation (R4)	Gated per customer	Often create-only; use conditional_create. SMART launch + read prove out on the public sandbox; writes are enabled per customer
Oracle Health (Cerner)	R4	Observation vital-signs, laboratory, imaging	Fixed LOINC list and a required performer. Vitals demo on the free sandbox; rounds/assessments go as DocumentReference/QuestionnaireResponse
MEDITECH Expanse	R4 read	Mostly interface-based	Confirm the supported write path; may be HL7 rather than FHIR write
Netsmart	Request-based access	Request-based	Start the CareConnect developer-access request early
HAPI / SMART Health IT	R4	Accepts writes	Vendor-neutral plumbing and Bundle/reference smoke tests, no vendor gates