<status value="draft" /> <experimental value="false" /> <date value="2019-03-21T00:00:00-04:00" /> <publisher value="Canada Health Infoway" /> <contact> <telecom> <system value="url" /> <value value="http://infoway-inforoute.ca" /> </telecom> </contact> <description value="Constraints on the Observation resource to reflect source data mappings for the ACCESS Health project. Focus of this profile is on display of general lab information to citizen/patient viewers." /> <fhirVersion value="4.0.0" /> <mapping> <identity value="vendor-agnostic-v2" /> <uri value="http://unknown.org/Vendor Agnostic v2" /> <name value="Vendor Agnostic v2" /> </mapping> <mapping> <identity value="ontario--olis" /> <uri value="http://unknown.org/Ontario- OLIS" /> <name value="Ontario- OLIS" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <uri value="http://unknown.org/Prince Edward Island- Cerner Millennium" /> <name value="Prince Edward Island- Cerner Millennium" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <uri value="http://unknown.org/Nova Scotia- Meditech Magic" /> <name value="Nova Scotia- Meditech Magic" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <uri value="http://unknown.org/Nove Scotia- Cerner Millennium" /> <name value="Nove Scotia- Cerner Millennium" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <uri value="http://unknown.org/Nova Scotia- Meditech C/S" /> <name value="Nova Scotia- Meditech C/S" /> </mapping> <mapping> <identity value="workflow" /> <uri value="http://hl7.org/fhir/workflow" /> <name value="Workflow Pattern" /> </mapping> <mapping> <identity value="sct-concept" /> <uri value="http://snomed.info/conceptdomain" /> <name value="SNOMED CT Concept Domain Binding" /> </mapping> <mapping> <identity value="v2" /> <uri value="http://hl7.org/v2" /> <name value="HL7 v2 Mapping" /> </mapping> <mapping> <identity value="rim" /> <uri value="http://hl7.org/v3" /> <name value="RIM Mapping" /> </mapping> <mapping> <identity value="w5" /> <uri value="http://hl7.org/fhir/fivews" /> <name value="FiveWs Pattern Mapping" /> </mapping> <mapping> <identity value="sct-attr" /> <uri value="http://snomed.org/attributebinding" /> <name value="SNOMED CT Attribute Binding" /> </mapping> <kind value="resource" /> <abstract value="false" /> <type value="Observation" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Observation" /> <derivation value="constraint" /> <differential> <element id="Observation"> <path value="Observation" /> <short value="ACCESS Observation General Lab (Patient) Profile" /> <definition value="Expected requirements for the observation resource when reflecting general lab data based on existing source mappings." /> <comment value="Note for implementors: This profile focuses on general lab results. It excludes pathology, microbiology, serotology, etc for two reasons: 1) The density and content of information in the various lab types are dramatically different from each other, these differences drive different information and interaction requirements from patients, and 2) there is a large degree of variance in how general lab results are formatted (more structured) and how other types of labs like pathology are structured (largely text based). Additional analysis required for microbiology, serotology, and pathology lab result types to determine level of structured data available." /> <mustSupport value="false" /> <isModifier value="false" /> </element> <element id="Observation.identifier"> <path value="Observation.identifier" /> <short value="Business Identifier for observation" /> <type> <code value="Identifier" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-21 (Observation Instance Identifier) Other suggested options if OBX-21 is not available: OBR-2 (Placer Order Number) + OBR-3(Filler Order Number) + OBX-3 (Observation Identifier)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-3.1" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-3.1 + OBR-4.1" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-3.1 + OBR-4.1" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-20 + OBR-4.1" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-3.1 + OBR-4.1" /> </mapping> </element> <element id="Observation.partOf"> <path value="Observation.partOf" /> <short value="Part of referenced event" /> <comment value="SME Note: This is an important element to aid in the visualization of tests that are related. Tests that are related MUST be displayed together in the viewer to maintain clinical significance. Data Mapping Note: Some LIS have the capacity to have a very complex hierarchy of tests. Example A clinician ordered a panel ' Transplant panel' . This panel contains 3 group tests (OBR). Each of these 3 groups contains in turn multiples atomic tests (OBX). To maintain the link between all the groups, the LIS send a value in the OBR -26 (parent result) and OBR-29 ( parent number) . This is specially important when the multiples HL7 messages are sent for the results. This is also a special concept for microbiology message (currently out of scope of this profile)." /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Procedure" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-26 + OBR-29" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-26 + OBR-29" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-26 + OBR-29" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-26 + OBR-29" /> </mapping> </element> <element id="Observation.status"> <path value="Observation.status" /> <short value="registered | preliminary | final | amended +" /> <comment value="Mapping Note: The LIS that were examined in Nova Scotia included some additional codes that were unique to the LIS (i.e. FOUT). See the notes in the mapping document discussing the need to map the HL7 v2 codes used by the LIS (shorthand often single-digit codes) to the codes used by the FHIR value set (usually full word code)." /> <type> <code value="code" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="required" /> <description value="Observation Status" /> <valueSet value="http://hl7.org/fhir/ValueSet/observation-status" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-11 (Observation Result Status)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-11 (Codes supported: P, F, C, N, W, X, Z)" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-11 (Codes upported: P, F, C, D, R, S, D, U, I)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-11 (Codes supported: P, F, D, A*)" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-11 (Codes supported: P, F, C)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-11 (Codes supported: P, F, C, D, A*, FOUT*)" /> </mapping> </element> <element id="Observation.category"> <path value="Observation.category" /> <slicing> <discriminator> <type value="value" /> <path value="pattern" /> </discriminator> <rules value="open" /> </slicing> <short value="Classification of type of observation" /> <comment value="Laboratory should be the default code used in this general lab profile. Other profiles may support other codes. Mapping/Implementor Note: There is no absolute semantic match in v2 that identifies the category of the ORU message, however the element was made must-support under the assumption that the category could be populated during the conversion process through a variety of means (primarily by source information in the message header- some Nova Scotia labs even send lab module). Unlike the US Core, laboratory was not set as a fixed value to avoid over-constraining the profile to the point of counteracting jurisdictional designs already in place (OLIS observationCategory value set supports both exam and laboratory codes). US Core Observation Results Profile requires the first use of category to default to 'laboratory' using the code system 'http://hl7.org/fhir/observation-category'. Additional codes can be used to provide more detail on the type of laboratory test." /> <min value="1" /> <max value="*" /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="preferred" /> <description value="Observation Category Codes" /> <valueSet value="http://hl7.org/fhir/ValueSet/observation-category" /> </binding> </element> <element id="Observation.category.laboratory"> <path value="Observation.category.laboratory" /> <min value="1" /> <max value="1" /> <type> <code value="CodeableConcept" /> </type> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/observation-category" /> <code value="laboratory" /> </coding> </patternCodeableConcept> <mustSupport value="true" /> <isModifier value="false" /> </element> <element id="Observation.code"> <path value="Observation.code" /> <short value="Type of observation (code / type)" /> <comment value="Mapping Note: Every LIS has its own data dictionary. Some LIS dictionaries use nomenclature that has 1:1 mapping to LOINC codes (example: OLIS) others do not. Some LIS vendors (example: Cerner Millennium) may reuse a foundational data dictionary but LIS sites often opt to add additional codes as a supplement to the data dictionary which leads to inconsistency across sites. These codes can be numeric, alpha-numeric, text, or some combination (seen frequently in the test data from Nova Scotia). Occasionally codes may be retired by the vendor or LIS master file but the codes are kept for a period of time to ensure the transition accounts for tests that have not been completed." /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="preferred" /> <description value="OLIS Observation Codes" /> <valueSet value="http://ehealthontario.ca/fhir/ValueSet/lab/observation-codes" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-3.1 (Observation Identifier ID/Print Number) Other suggested options if OBX-3 is not available: OBR-4 (Universal Service Identifier)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-3.1" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-3.1 (Code set 72 with some ability to send LOINC if site selects "send nomenclature identifier")" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-3.1" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-3.1" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-3.1" /> </mapping> </element> <element id="Observation.subject"> <path value="Observation.subject" /> <short value="Who and/or what the observation is about" /> <min value="1" /> <max value="1" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/core/StructureDefinition/profile-patient" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="PID-3 (Patient Identifier List) Other suggested options if PID-3 is not available or the patient resource is tied to provincial identifiers: PID-2" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="PID-3" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="PID-3 (if v2.3.1 and above), PID-4 (if v2.3 or below)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="PID-3" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="PID-3" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="PID-3" /> </mapping> </element> <element id="Observation.effectiveDateTime"> <path value="Observation.effectiveDateTime" /> <short value="Clinically relevant time/time-period for observation" /> <comment value="SME/Mapping Note: This element refers to the date the specimen was collected which is usually found in OBR-7. In some lab test such as Timed test, multiples samples are collected at various time (same date). In this case, the date of specimen collection can be included in the OBX segment. However, this has been found to be an issue with many LIS since they do not provide the information in the messages. The patient/physician may refer to this date to distinguish from the other blood collection." /> <type> <code value="dateTime" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-14 (Date/Time of the Observation) Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-14 Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-14" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-14 Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-14 Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-14 Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> </element> <element id="Observation.issued"> <path value="Observation.issued" /> <short value="Date/Time this version was made available" /> <comment value="SME Note: This refers to the date the result was released aka result are made available. Mapping/Implementor Note: Pay special attention to situation with a group test (containing multiple atomic tests) .If the test result of only one atomic test is changed after the initial release, then the date in the OBX segment will be updated. Most LIS will also update the date in the OBR segment. Some LIS will update the date of all the atomic tests regardless if the result was changed or remains the same. This can be an issue if the displaying application/viewer has a trigger to warn the user of the change base of the issued date." /> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-22 (Results Rpt/Status Chng - Date/Time +) Other suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-22" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-22 Other suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-22 Other suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-7" /> </mapping> </element> <element id="Observation.performer"> <path value="Observation.performer" /> <slicing> <discriminator> <type value="value" /> <path value="profile" /> </discriminator> <rules value="open" /> </slicing> <short value="Who is responsible for the observation" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" /> </type> <mustSupport value="false" /> <isModifier value="false" /> </element> <element id="Observation.performer.practitioner"> <path value="Observation.performer.practitioner" /> <short value="Practitioner responsible for the observation" /> <comment value="SME Note: Very rare in general labs to have physicians that sign the lab result. Lab performing practitioner is usually internal information that gets stored by LIS for operational purposes, but not likely of value to patients or clinicians. In pathology (out of scope of this profile) there might be information that is used for f/u with the performing agent." /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/core/StructureDefinition/profile-practitioner" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-32 (Principal Result Interpreter) or OBX-16 (Responsible Observer)" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-32" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-16 (not sent for all results)" /> </mapping> </element> <element id="Observation.performer.organization"> <path value="Observation.performer.organization" /> <short value="Organization responsible for the observation" /> <comment value="SME Note: Most commonly, performing organization will be available (more frequently than performing practitioner)." /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/core/StructureDefinition/profile-organization" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-23 (when v2.5.1 or higher), OBX-15 (Producer's ID) if supported, otherwise Z segments" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="ZBR-6" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-23" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="ZPS-2" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-15" /> </mapping> </element> <element id="Observation.value[x]"> <path value="Observation.value[x]" /> <short value="Actual result" /> <type> <code value="Quantity" /> </type> <type> <code value="CodeableConcept" /> </type> <type> <code value="string" /> </type> <type> <code value="boolean" /> </type> <type> <code value="integer" /> </type> <type> <code value="Range" /> </type> <type> <code value="Ratio" /> </type> <type> <code value="SampledData" /> </type> <type> <code value="time" /> </type> <type> <code value="dateTime" /> </type> <type> <code value="Period" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX.2 (Value Type), OBX.5 (Observation Value), OBX.6 (Units)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> </element> <element id="Observation.dataAbsentReason"> <path value="Observation.dataAbsentReason" /> <short value="Why the result is missing" /> <comment value="Implementor Note: While this is an important FHIR element to support (provides meaning for patients) it has a weak semantic mapping to available HL7 v2 ORU fields (utilized by the Nova Scotia & PEI LIS analyzed). Considered must support for the CA Baseline and US Core profiles, however there is no structured v2 field/code set outside of observation result status (cancel code) that addresses data absent reason. Likely to be addressed in notes which present their own set of challenges in automatic extraction. Key area of consideration given the value that this element has in reducing confusion in patients expecting to see a result that do not receive one. Unless further intervention occurs on behalf of the labs or converter, dataAbsentReason would likely only be populated when the ObservationResultStatus = cancelled." /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="extensible" /> <description value="Data Absent Reason" /> <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-11* (Observation Result Status)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-11*" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-11*" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-11*" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-11*" /> </mapping> </element> <element id="Observation.interpretation"> <path value="Observation.interpretation" /> <short value="Codes signifying whether result is high, low, normal, compared to reference range" /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="extensible" /> <description value="Observation Interpretation" /> <valueSet value="http://hl7.org/fhir/ValueSet/observation-interpretation" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-8 (Interpretation Codes)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-8" /> </mapping> </element> <element id="Observation.note"> <path value="Observation.note" /> <short value="Comments about the observation" /> <comment value="SME Note: Notes are entered by the lab staff to justify, clarify, or aid the interpretation of the result. It can be a few words to paragraphs. Usually sent in an NTE type of segment. Implementor Note: One consideration that needs to be explored with LIS sites is whether there is any risk of exposing data that is inappropriate for the patient in this field. Another consideration if expecting lossless 2-way conversion, is that there are two places where notes can occur in HL7 v2 ORU messages: linked to the OBR (observation) and the OBX (result). Once the note is in FHIR, it will be difficult to identify whether or not it is tied to observation or result using existing structured data. If lossless 2-way for notes is deemed critical, one method of approach would be extensions, but discussions with LIS & end-users recommended to determine feasibility." /> <type> <code value="Annotation" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="NTE-3 (Comment)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="NTE-3" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="NTE-3" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="NTE-3" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="NTE-3" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="NTE-3" /> </mapping> </element> <element id="Observation.specimen"> <path value="Observation.specimen" /> <short value="Specimen used for this observation" /> <comment value="Mapping Note: Cerner Millennium NS specifications do not support specimen number, the synonymous accession number is used. Accession number is an unique number given to a tube of blood, urine container. In that sense, specimen number and accession are the same." /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Specimen" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-3.1 (Filler Order Number ID) , SPM-2 (Specimen ID) can be used in interfaces that are HL7 v2.5.1 and higher" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-3.1" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="SPM-2" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-3.1" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-20 (Filler Field 1+..Unformatted Millennium accension number)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-3.1" /> </mapping> </element> <element id="Observation.referenceRange"> <path value="Observation.referenceRange" /> <short value="Provides guide for interpretation" /> <type> <code value="BackboneElement" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-7 (Reference Range)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-7" /> </mapping> </element> <element id="Observation.referenceRange.appliesTo"> <path value="Observation.referenceRange.appliesTo" /> <short value="Reference range population" /> <comment value="Mapping Note: One thing implementors should keep in mind is that the HL7 v2 ORU field allows for multiple values to be supplied (example: age based population, sex based population). When more than one value is present they are separated by ^ in the message (ex: A^S) . SME Note: This element allows for distinction of abnormal testing (age, race, sex, species, strain) but is not typically displayed in existing clinician lab viewers today." /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <binding> <strength value="example" /> <description value="v2 Nature of abnormal test" /> <valueSet value="http://terminology.hl7.org/ValueSet/v2-0080" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-10 (Nature of Abnormal Test)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-10" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-10" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-10" /> </mapping> </element> <element id="Observation.referenceRange.text"> <path value="Observation.referenceRange.text" /> <short value="Text based reference range in an observation" /> <type> <code value="string" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-7 (Reference Range)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-7" /> </mapping> </element> <element id="Observation.hasMember"> <path value="Observation.hasMember" /> <short value="Related resource that belongs to the Observation group. This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group." /> <comment value="Mapping Note: Consistent semantic equivalent mapping difficult to determine at existing LIS sites." /> <type> <code value="Reference" /> <targetProfile value="http://infoway-inforoute.ca/fhir/StructureDefinition/access-observation-gen-pat" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="Relationships established by OBX-4 usage" /> </mapping> </element> </differential> </StructureDefinition>

Name	Flags	Card.	Type	Description & Constraints
Observation				ACCESS Observation General Lab (Patient) Profile
identifier			Identifier	Business Identifier for observation
partOf			Reference(Procedure)	Part of referenced event
status	S		code	registered \| preliminary \| final \| amended + Binding: ObservationStatus (required)
category	S		CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:pattern Binding: ObservationCategoryCodes ( preferred )
laboratory	S	1..1	CodeableConcept	Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/observation-category","code":"laboratory"}]}
code	S		CodeableConcept	Type of observation (code / type) Binding: http://ehealthontario.ca/fhir/ValueSet/lab/observation-codes (preferred)
subject	S	1..1	Reference(http://hl7.org/fhir/ca/core/StructureDefinition/profile-patient)	Who and/or what the observation is about
effectiveDateTime	S		dateTime	Clinically relevant time/time-period for observation
issued				Date/Time this version was made available
performer			Reference ( Practitioner \| Organization )	Who is responsible for the observation Slice: Unordered, Open by value:profile
practitioner			Reference(http://hl7.org/fhir/ca/core/StructureDefinition/profile-practitioner)	Practitioner responsible for the observation
organization			Reference(http://hl7.org/fhir/ca/core/StructureDefinition/profile-organization)	Organization responsible for the observation
value[x]	S		Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual result
dataAbsentReason	S		CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible)
interpretation	S		CodeableConcept	Codes signifying whether result is high, low, normal, compared to reference range Binding: ObservationInterpretationCodes (extensible)
note			Annotation	Comments about the observation
specimen			Reference(Specimen)	Specimen used for this observation
referenceRange			BackboneElement	Provides guide for interpretation
appliesTo			CodeableConcept	Reference range population Binding: v2 NATURE OF ABNORMAL TESTING (example)
text			string	Text based reference range in an observation
hasMember			Reference(http://infoway-inforoute.ca/fhir/StructureDefinition/access-observation-gen-pat)	Related resource that belongs to the Observation group. This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.
Documentation for this format