{ "resourceType": "StructureDefinition", "id": "access-observation-gen-pat", "text": { "status": "generated", "div": "
NameFlagsCard.TypeDescription & Constraints\"doco\"
\".\"\".\"ObservationACCESS Observation General Lab (Patient) Profile
\".\"\".\"\".\"identifierIdentifierBusiness Identifier for observation
\".\"\".\"\".\"partOfReference(Procedure)Part of referenced event
\".\"\".\"\".\"statusScoderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
\".\"\".\"\".\"categorySCodeableConceptClassification of type of observation
Slice: Unordered, Open by value:pattern
Binding: ObservationCategoryCodes (preferred)
\".\"\".\"\".\"\".\"laboratoryS1..1CodeableConceptRequired Pattern: {\"coding\":[{\"system\":\"http://terminology.hl7.org/CodeSystem/observation-category\",\"code\":\"laboratory\"}]}
\".\"\".\"\".\"codeSCodeableConceptType of observation (code / type)
Binding: http://ehealthontario.ca/fhir/ValueSet/lab/observation-codes (preferred)
\".\"\".\"\".\"subjectS1..1Reference(http://hl7.org/fhir/ca/core/StructureDefinition/profile-patient)Who and/or what the observation is about
\".\"\".\"\".\"effectiveDateTimeSdateTimeClinically relevant time/time-period for observation
\".\"\".\"\".\"issuedDate/Time this version was made available
\".\"\".\"\".\"performerReference(Practitioner | Organization)Who is responsible for the observation
Slice: Unordered, Open by value:profile
\".\"\".\"\".\"\".\"practitionerReference(http://hl7.org/fhir/ca/core/StructureDefinition/profile-practitioner)Practitioner responsible for the observation
\".\"\".\"\".\"\".\"organizationReference(http://hl7.org/fhir/ca/core/StructureDefinition/profile-organization)Organization responsible for the observation
\".\"\".\"\".\"value[x]SQuantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, PeriodActual result
\".\"\".\"\".\"dataAbsentReasonSCodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible)
\".\"\".\"\".\"interpretationSCodeableConceptCodes signifying whether result is high, low, normal, compared to reference range
Binding: ObservationInterpretationCodes (extensible)
\".\"\".\"\".\"noteAnnotationComments about the observation
\".\"\".\"\".\"specimenReference(Specimen)Specimen used for this observation
\".\"\".\"\".\"referenceRangeBackboneElementProvides guide for interpretation
\".\"\".\"\".\"\".\"appliesToCodeableConceptReference range population
Binding: v2 NATURE OF ABNORMAL TESTING (example)
\".\"\".\"\".\"\".\"textstringText based reference range in an observation
\".\"\".\"\".\"hasMemberReference(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.

\"doco\" Documentation for this format
" }, "url": "http://infoway-inforoute.ca/fhir/StructureDefinition/access-observation-gen-pat", "version": "0.1.0", "name": "AccessObservationGeneralLabPatient", "title": "ACCESS Observation General Lab (Patient) Profile", "status": "draft", "experimental": false, "date": "2019-03-21T04:00:00+00:00", "publisher": "Canada Health Infoway", "contact": [ { "telecom": [ { "system": "url", "value": "http://infoway-inforoute.ca" } ] } ], "description": "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": "4.0.0", "mapping": [ { "identity": "vendor-agnostic-v2", "uri": "http://unknown.org/Vendor Agnostic v2", "name": "Vendor Agnostic v2" }, { "identity": "ontario--olis", "uri": "http://unknown.org/Ontario- OLIS", "name": "Ontario- OLIS" }, { "identity": "prince-edward-island--cerner-millennium", "uri": "http://unknown.org/Prince Edward Island- Cerner Millennium", "name": "Prince Edward Island- Cerner Millennium" }, { "identity": "nova-scotia--meditech-magic", "uri": "http://unknown.org/Nova Scotia- Meditech Magic", "name": "Nova Scotia- Meditech Magic" }, { "identity": "nove-scotia--cerner-millennium", "uri": "http://unknown.org/Nove Scotia- Cerner Millennium", "name": "Nove Scotia- Cerner Millennium" }, { "identity": "nova-scotia--meditech-c/s", "uri": "http://unknown.org/Nova Scotia- Meditech C/S", "name": "Nova Scotia- Meditech C/S" }, { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "sct-concept", "uri": "http://snomed.info/conceptdomain", "name": "SNOMED CT Concept Domain Binding" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "sct-attr", "uri": "http://snomed.org/attributebinding", "name": "SNOMED CT Attribute Binding" } ], "kind": "resource", "abstract": false, "type": "Observation", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation", "derivation": "constraint", "snapshot": { "element": [ { "id": "Observation", "path": "Observation", "short": "ACCESS Observation General Lab (Patient) Profile", "definition": "Expected requirements for the observation resource when reflecting general lab data based on existing source mappings.", "comment": "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.", "alias": [ "Vital Signs", "Measurement", "Results", "Tests" ], "min": 0, "max": "*", "base": { "path": "Observation", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "xpath": "not(parent::f:contained and f:contained)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource", "expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()", "xpath": "not(exists(for $contained in f:contained return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.div.exists()", "xpath": "exists(f:text/h:div)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:security))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "obs-7", "severity": "error", "human": "If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present", "expression": "value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()", "xpath": "not(f:*[starts-with(local-name(.), 'value')] and (for $coding in f:code/f:coding return f:component/f:code/f:coding[f:code/@value=$coding/f:code/@value] [f:system/@value=$coding/f:system/@value]))", "source": "http://hl7.org/fhir/StructureDefinition/Observation" }, { "key": "obs-6", "severity": "error", "human": "dataAbsentReason SHALL only be present if Observation.value[x] is not present", "expression": "dataAbsentReason.empty() or value.empty()", "xpath": "not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), 'value')])))", "source": "http://hl7.org/fhir/StructureDefinition/Observation" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "workflow", "map": "Event" }, { "identity": "sct-concept", "map": "< 363787002 |Observable entity|" }, { "identity": "v2", "map": "OBX" }, { "identity": "rim", "map": "Observation[classCode=OBS, moodCode=EVN]" } ] }, { "id": "Observation.id", "path": "Observation.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "code": "id" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Observation.meta", "path": "Observation.meta", "short": "Metadata about the resource", "definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.implicitRules", "path": "Observation.implicitRules", "short": "A set of rules under which this content was created", "definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.", "comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Observation.language", "path": "Observation.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" } ], "strength": "preferred", "description": "A human language.", "valueSet": "http://hl7.org/fhir/ValueSet/languages" }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Observation.text", "path": "Observation.text", "short": "Text summary of the resource, for human interpretation", "definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.", "comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "rim", "map": "Act.text?" } ] }, { "id": "Observation.contained", "path": "Observation.contained", "short": "Contained, inline Resources", "definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.", "comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.extension", "path": "Observation.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.modifierExtension", "path": "Observation.modifierExtension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.identifier", "path": "Observation.identifier", "short": "Business Identifier for observation", "definition": "A unique identifier assigned to this observation.", "requirements": "Allows observations to be distinguished and referenced.", "min": 0, "max": "*", "base": { "path": "Observation.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "workflow", "map": "Event.identifier" }, { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "v2", "map": "OBX.21 For OBX segments from systems without OBX-21 support a combination of ORC/OBR and OBX must be negotiated between trading partners to uniquely identify the OBX segment. Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4." }, { "identity": "rim", "map": "id" }, { "identity": "vendor-agnostic-v2", "map": "OBX-21 (Observation Instance Identifier)\nOther suggested options if OBX-21 is not available: OBR-2 (Placer Order Number) + OBR-3(Filler Order Number) + OBX-3 (Observation Identifier)" }, { "identity": "ontario--olis", "map": "OBR-3.1" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBR-3.1 + OBR-4.1" }, { "identity": "nova-scotia--meditech-magic", "map": "OBR-3.1 + OBR-4.1" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBR-20 + OBR-4.1" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBR-3.1 + OBR-4.1" } ] }, { "id": "Observation.basedOn", "path": "Observation.basedOn", "short": "Fulfills plan, proposal or order", "definition": "A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.", "alias": [ "Fulfills" ], "min": 0, "max": "*", "base": { "path": "Observation.basedOn", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/CarePlan", "http://hl7.org/fhir/StructureDefinition/DeviceRequest", "http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation", "http://hl7.org/fhir/StructureDefinition/MedicationRequest", "http://hl7.org/fhir/StructureDefinition/NutritionOrder", "http://hl7.org/fhir/StructureDefinition/ServiceRequest" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.basedOn" }, { "identity": "v2", "map": "ORC" }, { "identity": "rim", "map": ".inboundRelationship[typeCode=COMP].source[moodCode=EVN]" } ] }, { "id": "Observation.partOf", "path": "Observation.partOf", "short": "Part of referenced event", "definition": "A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.", "comment": "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. \n\nData 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. \n\nThis is also a special concept for microbiology message (currently out of scope of this profile).", "alias": [ "Container" ], "min": 0, "max": "*", "base": { "path": "Observation.partOf", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Procedure" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.partOf" }, { "identity": "v2", "map": "Varies by domain" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=FLFS].target" }, { "identity": "vendor-agnostic-v2", "map": "OBR-26 + OBR-29" }, { "identity": "ontario--olis", "map": "OBR-26 + OBR-29" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBR-26 + OBR-29" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBR-26 + OBR-29" } ] }, { "id": "Observation.status", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint", "valueString": "default: final" } ], "path": "Observation.status", "short": "registered | preliminary | final | amended +", "definition": "The status of the result value.", "comment": "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).", "requirements": "Need to track the status of individual results. Some results are finalized before the whole report is finalized.", "min": 1, "max": "1", "base": { "path": "Observation.status", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ObservationStatus" } ], "strength": "required", "description": "Observation Status", "valueSet": "http://hl7.org/fhir/ValueSet/observation-status" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "FiveWs.status" }, { "identity": "sct-concept", "map": "< 445584004 |Report by finality status|" }, { "identity": "v2", "map": "OBX-11" }, { "identity": "rim", "map": "status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of \"revise\"" }, { "identity": "vendor-agnostic-v2", "map": "OBX-11 (Observation Result Status)" }, { "identity": "ontario--olis", "map": "OBX-11 (Codes supported: P, F, C, N, W, X, Z)" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-11 (Codes upported: P, F, C, D, R, S, D, U, I)" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-11 (Codes supported: P, F, D, A*)" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-11 (Codes supported: P, F, C)" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-11 (Codes supported: P, F, C, D, A*, FOUT*)" } ] }, { "id": "Observation.category", "path": "Observation.category", "slicing": { "discriminator": [ { "type": "value", "path": "pattern" } ], "rules": "open" }, "short": "Classification of type of observation", "definition": "A code that classifies the general type of observation being made.", "comment": "Laboratory should be the default code used in this general lab profile. Other profiles may support other codes. \n\nMapping/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.", "requirements": "Used for filtering what observations are retrieved and displayed.", "min": 1, "max": "*", "base": { "path": "Observation.category", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ObservationCategory" } ], "strength": "preferred", "description": "Observation Category Codes", "valueSet": "http://hl7.org/fhir/ValueSet/observation-category" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "FiveWs.class" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=\"COMP].target[classCode=\"LIST\", moodCode=\"EVN\"].code" } ] }, { "id": "Observation.category.id", "path": "Observation.category.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "_code": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-json-type", "valueString": "string" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-xml-type", "valueString": "xsd:string" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-rdf-type", "valueString": "xsd:string" } ] } } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Observation.category.extension", "path": "Observation.category.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.category.coding", "path": "Observation.category.coding", "short": "Code defined by a terminology system", "definition": "A reference to a code defined by a terminology system.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "Observation.category.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Observation.category.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "Observation.category.laboratory", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "Observation.category.laboratory", "short": "Concept - reference to a terminology or just text", "definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 1, "max": "1", "base": { "path": "Observation.category.laboratory", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory" } ] }, "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "Observation.code", "path": "Observation.code", "short": "Type of observation (code / type)", "definition": "Describes what was observed. Sometimes this is called the observation \"name\".", "comment": "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.", "requirements": "Knowing what kind of observation is being made is essential to understanding the observation.", "alias": [ "Name" ], "min": 1, "max": "1", "base": { "path": "Observation.code", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ObservationCode" } ], "strength": "preferred", "description": "OLIS Observation Codes", "valueSet": "http://ehealthontario.ca/fhir/ValueSet/lab/observation-codes" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "workflow", "map": "Event.code" }, { "identity": "w5", "map": "FiveWs.what[x]" }, { "identity": "sct-concept", "map": "< 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|" }, { "identity": "v2", "map": "OBX-3" }, { "identity": "rim", "map": "code" }, { "identity": "sct-attr", "map": "116680003 |Is a|" }, { "identity": "vendor-agnostic-v2", "map": "OBX-3.1 (Observation Identifier ID/Print Number)\nOther suggested options if OBX-3 is not available: OBR-4 (Universal Service Identifier)" }, { "identity": "ontario--olis", "map": "OBX-3.1" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-3.1 (Code set 72 with some ability to send LOINC if site selects \"send nomenclature identifier\")" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-3.1" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-3.1" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-3.1" } ] }, { "id": "Observation.subject", "path": "Observation.subject", "short": "Who and/or what the observation is about", "definition": "The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the `focus` element or the `code` itself specifies the actual focus of the observation.", "comment": "One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.", "requirements": "Observations have no value if you don't know who or what they're about.", "min": 1, "max": "1", "base": { "path": "Observation.subject", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/ca/core/StructureDefinition/profile-patient" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.subject" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "v2", "map": "PID-3" }, { "identity": "rim", "map": "participation[typeCode=RTGT]" }, { "identity": "w5", "map": "FiveWs.subject" }, { "identity": "vendor-agnostic-v2", "map": "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" }, { "identity": "ontario--olis", "map": "PID-3" }, { "identity": "prince-edward-island--cerner-millennium", "map": "PID-3 (if v2.3.1 and above), PID-4 (if v2.3 or below)" }, { "identity": "nova-scotia--meditech-magic", "map": "PID-3" }, { "identity": "nove-scotia--cerner-millennium", "map": "PID-3" }, { "identity": "nova-scotia--meditech-c/s", "map": "PID-3" } ] }, { "id": "Observation.focus", "path": "Observation.focus", "short": "What the observation is about, when it is not about the subject of record", "definition": "The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.", "comment": "Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., \"Blood Glucose\") and does not need to be represented separately using this element. Use `specimen` if a reference to a specimen is required. If a code is required instead of a resource use either `bodysite` for bodysites or the standard extension [focusCode](extension-observation-focuscode.html).", "min": 0, "max": "*", "base": { "path": "Observation.focus", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "v2", "map": "OBX-3" }, { "identity": "rim", "map": "participation[typeCode=SBJ]" }, { "identity": "w5", "map": "FiveWs.subject" } ] }, { "id": "Observation.encounter", "path": "Observation.encounter", "short": "Healthcare event during which this observation is made", "definition": "The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.", "comment": "This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).", "requirements": "For some observations it may be important to know the link between an observation and a particular encounter.", "alias": [ "Context" ], "min": 0, "max": "1", "base": { "path": "Observation.encounter", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.context" }, { "identity": "w5", "map": "FiveWs.context" }, { "identity": "v2", "map": "PV1" }, { "identity": "rim", "map": "inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]" } ] }, { "id": "Observation.effective[x]", "path": "Observation.effective[x]", "slicing": { "discriminator": [ { "type": "type", "path": "$this" } ], "ordered": false, "rules": "open" }, "short": "Clinically relevant time/time-period for observation", "definition": "The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the \"physiologically relevant time\". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.", "comment": "At least a date should be present unless this observation is a historical report. For recording imprecise or \"fuzzy\" times (For example, a blood glucose measurement taken \"after breakfast\") use the [Timing](datatypes.html#timing) datatype which allow the measurement to be tied to regular life events.", "requirements": "Knowing when an observation was deemed true is important to its relevance as well as determining trends.", "alias": [ "Occurrence" ], "min": 0, "max": "1", "base": { "path": "Observation.effective[x]", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" }, { "code": "Period" }, { "code": "Timing" }, { "code": "instant" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.occurrence[x]" }, { "identity": "w5", "map": "FiveWs.done[x]" }, { "identity": "v2", "map": "OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)" }, { "identity": "rim", "map": "effectiveTime" } ] }, { "id": "Observation.effective[x]:effectiveDateTime", "path": "Observation.effective[x]", "sliceName": "effectiveDateTime", "short": "Clinically relevant time/time-period for observation", "definition": "The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the \"physiologically relevant time\". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.", "comment": "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. \n\nThe patient/physician may refer to this date to distinguish from the other blood collection.", "requirements": "Knowing when an observation was deemed true is important to its relevance as well as determining trends.", "alias": [ "Occurrence" ], "min": 0, "max": "1", "base": { "path": "Observation.effective[x]", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.occurrence[x]" }, { "identity": "w5", "map": "FiveWs.done[x]" }, { "identity": "v2", "map": "OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)" }, { "identity": "rim", "map": "effectiveTime" }, { "identity": "vendor-agnostic-v2", "map": "OBX-14 (Date/Time of the Observation) Other suggested options if OBX-14 is not available: OBR-7" }, { "identity": "ontario--olis", "map": "OBX-14 \n\nOther suggested options if OBX-14 is not available: OBR-7" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-14" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-14 \n\nOther suggested options if OBX-14 is not available: OBR-7" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-14 \n\nOther suggested options if OBX-14 is not available: OBR-7" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-14 \n\nOther suggested options if OBX-14 is not available: OBR-7" } ] }, { "id": "Observation.issued", "path": "Observation.issued", "short": "Date/Time this version was made available", "definition": "The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.", "comment": "SME Note: This refers to the date the result was released aka result are made available. \n\nMapping/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.", "min": 0, "max": "1", "base": { "path": "Observation.issued", "min": 0, "max": "1" }, "type": [ { "code": "instant" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.recorded" }, { "identity": "v2", "map": "OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)" }, { "identity": "rim", "map": "participation[typeCode=AUT].time" }, { "identity": "vendor-agnostic-v2", "map": "OBR-22 (Results Rpt/Status Chng - Date/Time +)\n\nOther suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" }, { "identity": "ontario--olis", "map": "OBR-7" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBR-22" }, { "identity": "nova-scotia--meditech-magic", "map": "OBR-22\n\nOther suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBR-22\n\nOther suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBR-7" } ] }, { "id": "Observation.performer", "path": "Observation.performer", "slicing": { "discriminator": [ { "type": "value", "path": "profile" } ], "rules": "open" }, "short": "Who is responsible for the observation", "definition": "Who was responsible for asserting the observed value as \"true\".", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.", "min": 0, "max": "*", "base": { "path": "Observation.performer", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.performer.actor" }, { "identity": "w5", "map": "FiveWs.actor" }, { "identity": "v2", "map": "OBX.15 / (Practitioner) OBX-16, PRT-5:PRT-4='RO' / (Device) OBX-18 , PRT-10:PRT-4='EQUIP' / (Organization) OBX-23, PRT-8:PRT-4='PO'" }, { "identity": "rim", "map": "participation[typeCode=PRF]" } ] }, { "id": "Observation.performer.id", "path": "Observation.performer.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "_code": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-json-type", "valueString": "string" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-xml-type", "valueString": "xsd:string" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-rdf-type", "valueString": "xsd:string" } ] } } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Observation.performer.extension", "path": "Observation.performer.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.performer.reference", "path": "Observation.performer.reference", "short": "Literal reference, Relative, internal or absolute URL", "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.", "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "min": 0, "max": "1", "base": { "path": "Reference.reference", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1", "ref-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.performer.type", "path": "Observation.performer.type", "short": "Type the reference refers to (e.g. \"Patient\")", "definition": "The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. \"Patient\" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).", "comment": "This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.", "min": 0, "max": "1", "base": { "path": "Reference.type", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "FHIRResourceTypeExt" } ], "strength": "extensible", "description": "Aa resource (or, for logical models, the URI of the logical model).", "valueSet": "http://hl7.org/fhir/ValueSet/resource-types" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.performer.identifier", "path": "Observation.performer.identifier", "short": "Logical reference, when literal reference is not known", "definition": "An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.", "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).", "min": 0, "max": "1", "base": { "path": "Reference.identifier", "min": 0, "max": "1" }, "type": [ { "code": "Identifier" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "rim", "map": ".identifier" } ] }, { "id": "Observation.performer.display", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Observation.performer.display", "short": "Text alternative for the resource", "definition": "Plain text narrative that identifies the resource in addition to the resource reference.", "comment": "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "min": 0, "max": "1", "base": { "path": "Reference.display", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.performer.practitioner", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "Observation.performer.practitioner", "short": "Practitioner responsible for the observation", "definition": "A reference from one resource to another.", "comment": "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.", "min": 0, "max": "*", "base": { "path": "Observation.performer.practitioner" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/ca/core/StructureDefinition/profile-practitioner" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "vendor-agnostic-v2", "map": "OBR-32 (Principal Result Interpreter) or OBX-16 (Responsible Observer)" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBR-32" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-16 (not sent for all results)" } ] }, { "id": "Observation.performer.organization", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "normative" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version", "valueCode": "4.0.0" } ], "path": "Observation.performer.organization", "short": "Organization responsible for the observation", "definition": "A reference from one resource to another.", "comment": "SME Note: Most commonly, performing organization will be available (more frequently than performing practitioner).", "min": 0, "max": "*", "base": { "path": "Observation.performer.organization" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/ca/core/StructureDefinition/profile-organization" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "vendor-agnostic-v2", "map": "OBX-23 (when v2.5.1 or higher), OBX-15 (Producer's ID) if supported, otherwise Z segments" }, { "identity": "ontario--olis", "map": "ZBR-6" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-23" }, { "identity": "nova-scotia--meditech-magic", "map": "ZPS-2" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-15" } ] }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "short": "Actual result", "definition": "The information determined as a result of making the observation, if the information has a simple value.", "comment": "An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.", "min": 0, "max": "1", "base": { "path": "Observation.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "Quantity" }, { "code": "CodeableConcept" }, { "code": "string" }, { "code": "boolean" }, { "code": "integer" }, { "code": "Range" }, { "code": "Ratio" }, { "code": "SampledData" }, { "code": "time" }, { "code": "dateTime" }, { "code": "Period" } ], "condition": [ "ele-1", "obs-7" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "sct-concept", "map": "< 441742003 |Evaluation finding|" }, { "identity": "v2", "map": "OBX.2, OBX.5, OBX.6" }, { "identity": "rim", "map": "value" }, { "identity": "sct-attr", "map": "363714003 |Interprets|" }, { "identity": "vendor-agnostic-v2", "map": "OBX.2 (Value Type), OBX.5 (Observation Value), OBX.6 (Units)" }, { "identity": "ontario--olis", "map": "OBX.2, OBX.5, OBX.6" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX.2, OBX.5, OBX.6" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX.2, OBX.5, OBX.6" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX.2, OBX.5, OBX.6" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX.2, OBX.5, OBX.6" } ] }, { "id": "Observation.dataAbsentReason", "path": "Observation.dataAbsentReason", "short": "Why the result is missing", "definition": "Provides a reason why the expected value in the element Observation.value[x] is missing.", "comment": "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. \n\nKey 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.", "requirements": "For many results it is necessary to handle exceptional values in measurements.", "min": 0, "max": "1", "base": { "path": "Observation.dataAbsentReason", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1", "obs-6" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ObservationValueAbsentReason" } ], "strength": "extensible", "description": "Data Absent Reason", "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "value.nullFlavor" }, { "identity": "vendor-agnostic-v2", "map": "OBX-11* (Observation Result Status)" }, { "identity": "ontario--olis", "map": "OBX-11*" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-11*" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-11*" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-11*" } ] }, { "id": "Observation.interpretation", "path": "Observation.interpretation", "short": "Codes signifying whether result is high, low, normal, compared to reference range", "definition": "A categorical assessment of an observation value. For example, high, low, normal.", "comment": "Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.", "requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.", "alias": [ "Abnormal Flag" ], "min": 0, "max": "*", "base": { "path": "Observation.interpretation", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ObservationInterpretation" } ], "strength": "extensible", "description": "Observation Interpretation", "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "sct-concept", "map": "< 260245000 |Findings values|" }, { "identity": "v2", "map": "OBX-8" }, { "identity": "rim", "map": "interpretationCode" }, { "identity": "sct-attr", "map": "363713009 |Has interpretation|" }, { "identity": "vendor-agnostic-v2", "map": "OBX-8 (Interpretation Codes)" }, { "identity": "ontario--olis", "map": "OBX-8" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-8" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-8" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-8" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-8" } ] }, { "id": "Observation.note", "path": "Observation.note", "short": "Comments about the observation", "definition": "Comments about the observation or the results.", "comment": "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. \n\nImplementor 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.", "requirements": "Need to be able to provide free text additional information.", "min": 0, "max": "*", "base": { "path": "Observation.note", "min": 0, "max": "*" }, "type": [ { "code": "Annotation" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "Act" }, { "identity": "v2", "map": "NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)" }, { "identity": "rim", "map": "subjectOf.observationEvent[code=\"annotation\"].value" }, { "identity": "vendor-agnostic-v2", "map": "NTE-3 (Comment)" }, { "identity": "ontario--olis", "map": "NTE-3" }, { "identity": "prince-edward-island--cerner-millennium", "map": "NTE-3" }, { "identity": "nova-scotia--meditech-magic", "map": "NTE-3" }, { "identity": "nove-scotia--cerner-millennium", "map": "NTE-3" }, { "identity": "nova-scotia--meditech-c/s", "map": "NTE-3" } ] }, { "id": "Observation.bodySite", "path": "Observation.bodySite", "short": "Observed body part", "definition": "Indicates the site on the subject's body where the observation was made (i.e. the target site).", "comment": "Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. \n\nIf the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension[ bodySite](extension-bodysite.html).", "min": 0, "max": "1", "base": { "path": "Observation.bodySite", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BodySite" } ], "strength": "example", "description": "Codes describing anatomical locations. May include laterality.", "valueSet": "http://hl7.org/fhir/ValueSet/body-site" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "sct-concept", "map": "< 123037004 |Body structure|" }, { "identity": "v2", "map": "OBX-20" }, { "identity": "rim", "map": "targetSiteCode" }, { "identity": "sct-attr", "map": "718497002 |Inherent location|" } ] }, { "id": "Observation.method", "path": "Observation.method", "short": "How it was done", "definition": "Indicates the mechanism used to perform the observation.", "comment": "Only used if not implicit in code for Observation.code.", "requirements": "In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.", "min": 0, "max": "1", "base": { "path": "Observation.method", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ObservationMethod" } ], "strength": "example", "description": "Methods for simple observations.", "valueSet": "http://hl7.org/fhir/ValueSet/observation-methods" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "v2", "map": "OBX-17" }, { "identity": "rim", "map": "methodCode" } ] }, { "id": "Observation.specimen", "path": "Observation.specimen", "short": "Specimen used for this observation", "definition": "The specimen that was used when this observation was made.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Observation.specimen", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Specimen" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "sct-concept", "map": "< 123038009 |Specimen|" }, { "identity": "v2", "map": "SPM segment" }, { "identity": "rim", "map": "participation[typeCode=SPC].specimen" }, { "identity": "sct-attr", "map": "704319004 |Inherent in|" }, { "identity": "vendor-agnostic-v2", "map": "OBR-3.1 (Filler Order Number ID) , SPM-2 (Specimen ID) can be used in interfaces that are HL7 v2.5.1 and higher" }, { "identity": "ontario--olis", "map": "OBR-3.1" }, { "identity": "prince-edward-island--cerner-millennium", "map": "SPM-2" }, { "identity": "nova-scotia--meditech-magic", "map": "OBR-3.1" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBR-20 (Filler Field 1+..Unformatted Millennium accension number)" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBR-3.1" } ] }, { "id": "Observation.device", "path": "Observation.device", "short": "(Measurement) Device", "definition": "The device used to generate the observation data.", "comment": "Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.", "min": 0, "max": "1", "base": { "path": "Observation.device", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Device", "http://hl7.org/fhir/StructureDefinition/DeviceMetric" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "sct-concept", "map": "< 49062001 |Device|" }, { "identity": "v2", "map": "OBX-17 / PRT -10" }, { "identity": "rim", "map": "participation[typeCode=DEV]" }, { "identity": "sct-attr", "map": "424226004 |Using device|" } ] }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "short": "Provides guide for interpretation", "definition": "Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an \"OR\". In other words, to represent two distinct target populations, two `referenceRange` elements would be used.", "comment": "Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.", "requirements": "Knowing what values are considered \"normal\" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.", "min": 0, "max": "*", "base": { "path": "Observation.referenceRange", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "obs-3", "severity": "error", "human": "Must have at least a low or a high or text", "expression": "low.exists() or high.exists() or text.exists()", "xpath": "(exists(f:low) or exists(f:high)or exists(f:text))", "source": "http://hl7.org/fhir/StructureDefinition/Observation" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "OBX.7" }, { "identity": "rim", "map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]" }, { "identity": "vendor-agnostic-v2", "map": "OBX-7 (Reference Range)" }, { "identity": "ontario--olis", "map": "OBX-7" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-7" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-7" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-7" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-7" } ] }, { "id": "Observation.referenceRange.id", "path": "Observation.referenceRange.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "_code": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-json-type", "valueString": "string" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-xml-type", "valueString": "xsd:string" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-rdf-type", "valueString": "xsd:string" } ] } } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Observation.referenceRange.extension", "path": "Observation.referenceRange.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.referenceRange.modifierExtension", "path": "Observation.referenceRange.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.referenceRange.low", "path": "Observation.referenceRange.low", "short": "Low Range, if relevant", "definition": "The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).", "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "min": 0, "max": "1", "base": { "path": "Observation.referenceRange.low", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "condition": [ "ele-1", "obs-3" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "sqty-1", "severity": "error", "human": "The comparator is not used on a SimpleQuantity", "expression": "comparator.empty()", "xpath": "not(exists(f:comparator))", "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "v2", "map": "OBX-7" }, { "identity": "rim", "map": "value:IVL_PQ.low" } ] }, { "id": "Observation.referenceRange.high", "path": "Observation.referenceRange.high", "short": "High Range, if relevant", "definition": "The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).", "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "min": 0, "max": "1", "base": { "path": "Observation.referenceRange.high", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "condition": [ "ele-1", "obs-3" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "sqty-1", "severity": "error", "human": "The comparator is not used on a SimpleQuantity", "expression": "comparator.empty()", "xpath": "not(exists(f:comparator))", "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "v2", "map": "OBX-7" }, { "identity": "rim", "map": "value:IVL_PQ.high" } ] }, { "id": "Observation.referenceRange.type", "path": "Observation.referenceRange.type", "short": "Reference range qualifier", "definition": "Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.", "comment": "This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.", "requirements": "Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.", "min": 0, "max": "1", "base": { "path": "Observation.referenceRange.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ObservationRangeMeaning" } ], "strength": "preferred", "description": "Code for the meaning of a reference range.", "valueSet": "http://hl7.org/fhir/ValueSet/referencerange-meaning" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "sct-concept", "map": "< 260245000 |Findings values| OR \r< 365860008 |General clinical state finding| \rOR \r< 250171008 |Clinical history or observation findings| OR \r< 415229000 |Racial group| OR \r< 365400002 |Finding of puberty stage| OR\r< 443938003 |Procedure carried out on subject|" }, { "identity": "v2", "map": "OBX-10" }, { "identity": "rim", "map": "interpretationCode" } ] }, { "id": "Observation.referenceRange.appliesTo", "path": "Observation.referenceRange.appliesTo", "short": "Reference range population", "definition": "Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple `appliesTo` are interpreted as an \"AND\" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.", "comment": "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) . \n\nSME 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.", "requirements": "Need to be able to identify the target population for proper interpretation.", "min": 0, "max": "*", "base": { "path": "Observation.referenceRange.appliesTo", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ObservationRangeType" } ], "strength": "example", "description": "v2 Nature of abnormal test", "valueSet": "http://terminology.hl7.org/ValueSet/v2-0080" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "sct-concept", "map": "< 260245000 |Findings values| OR \r< 365860008 |General clinical state finding| \rOR \r< 250171008 |Clinical history or observation findings| OR \r< 415229000 |Racial group| OR \r< 365400002 |Finding of puberty stage| OR\r< 443938003 |Procedure carried out on subject|" }, { "identity": "v2", "map": "OBX-10" }, { "identity": "rim", "map": "interpretationCode" }, { "identity": "vendor-agnostic-v2", "map": "OBX-10 (Nature of Abnormal Test)" }, { "identity": "ontario--olis", "map": "OBX-10" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-10" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-10" } ] }, { "id": "Observation.referenceRange.age", "path": "Observation.referenceRange.age", "short": "Applicable age range, if relevant", "definition": "The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.", "comment": "The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.", "requirements": "Some analytes vary greatly over age.", "min": 0, "max": "1", "base": { "path": "Observation.referenceRange.age", "min": 0, "max": "1" }, "type": [ { "code": "Range" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "rng-2", "severity": "error", "human": "If present, low SHALL have a lower value than high", "expression": "low.empty() or high.empty() or (low <= high)", "xpath": "not(exists(f:low/f:value/@value)) or not(exists(f:high/f:value/@value)) or (number(f:low/f:value/@value) <= number(f:high/f:value/@value))", "source": "http://hl7.org/fhir/StructureDefinition/Range" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "NR and also possibly SN (but see also quantity)" }, { "identity": "rim", "map": "IVL [lowClosed=\"true\" and highClosed=\"true\"]or URG" }, { "identity": "rim", "map": "outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=\"age\"].value" } ] }, { "id": "Observation.referenceRange.text", "path": "Observation.referenceRange.text", "short": "Text based reference range in an observation", "definition": "Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of \"Negative\" or a list or table of \"normals\".", "comment": "Note that FHIR strings SHALL NOT exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Observation.referenceRange.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "OBX-7" }, { "identity": "rim", "map": "value:ST" }, { "identity": "vendor-agnostic-v2", "map": "OBX-7 (Reference Range)" }, { "identity": "ontario--olis", "map": "OBX-7" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-7" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-7" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-7" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-7" } ] }, { "id": "Observation.hasMember", "path": "Observation.hasMember", "short": "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.", "definition": "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": "Mapping Note: Consistent semantic equivalent mapping difficult to determine at existing LIS sites.", "min": 0, "max": "*", "base": { "path": "Observation.hasMember", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://infoway-inforoute.ca/fhir/StructureDefinition/access-observation-gen-pat" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "v2", "map": "Relationships established by OBX-4 usage" }, { "identity": "rim", "map": "outBoundRelationship" }, { "identity": "vendor-agnostic-v2", "map": "Relationships established by OBX-4 usage" } ] }, { "id": "Observation.derivedFrom", "path": "Observation.derivedFrom", "short": "Related measurements the observation is made from", "definition": "The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.", "comment": "All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see [Notes](observation.html#obsgrouping) below.", "min": 0, "max": "*", "base": { "path": "Observation.derivedFrom", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/DocumentReference", "http://hl7.org/fhir/StructureDefinition/ImagingStudy", "http://hl7.org/fhir/StructureDefinition/Media", "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse", "http://hl7.org/fhir/StructureDefinition/Observation", "http://hl7.org/fhir/StructureDefinition/MolecularSequence" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "v2", "map": "Relationships established by OBX-4 usage" }, { "identity": "rim", "map": ".targetObservation" } ] }, { "id": "Observation.component", "path": "Observation.component", "short": "Component results", "definition": "Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.", "comment": "For a discussion on the ways Observations can be assembled in groups together see [Notes](observation.html#notes) below.", "requirements": "Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.", "min": 0, "max": "*", "base": { "path": "Observation.component", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "containment by OBX-4?" }, { "identity": "rim", "map": "outBoundRelationship[typeCode=COMP]" } ] }, { "id": "Observation.component.id", "path": "Observation.component.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "_code": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-json-type", "valueString": "string" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-xml-type", "valueString": "xsd:string" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-rdf-type", "valueString": "xsd:string" } ] } } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Observation.component.extension", "path": "Observation.component.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.component.modifierExtension", "path": "Observation.component.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Observation.component.code", "path": "Observation.component.code", "short": "Type of component observation (code / type)", "definition": "Describes what was observed. Sometimes this is called the observation \"code\".", "comment": "*All* code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.", "requirements": "Knowing what kind of observation is being made is essential to understanding the observation.", "min": 1, "max": "1", "base": { "path": "Observation.component.code", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ObservationCode" } ], "strength": "example", "description": "Codes identifying names of simple observations.", "valueSet": "http://hl7.org/fhir/ValueSet/observation-codes" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "FiveWs.what[x]" }, { "identity": "sct-concept", "map": "< 363787002 |Observable entity| OR \r< 386053000 |Evaluation procedure|" }, { "identity": "v2", "map": "OBX-3" }, { "identity": "rim", "map": "code" } ] }, { "id": "Observation.component.value[x]", "path": "Observation.component.value[x]", "short": "Actual component result", "definition": "The information determined as a result of making the observation, if the information has a simple value.", "comment": "Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.", "requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.", "min": 0, "max": "1", "base": { "path": "Observation.component.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "Quantity" }, { "code": "CodeableConcept" }, { "code": "string" }, { "code": "boolean" }, { "code": "integer" }, { "code": "Range" }, { "code": "Ratio" }, { "code": "SampledData" }, { "code": "time" }, { "code": "dateTime" }, { "code": "Period" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "sct-concept", "map": "363714003 |Interprets| < 441742003 |Evaluation finding|" }, { "identity": "v2", "map": "OBX.2, OBX.5, OBX.6" }, { "identity": "rim", "map": "value" }, { "identity": "sct-attr", "map": "363714003 |Interprets|" } ] }, { "id": "Observation.component.dataAbsentReason", "path": "Observation.component.dataAbsentReason", "short": "Why the component result is missing", "definition": "Provides a reason why the expected value in the element Observation.component.value[x] is missing.", "comment": "\"Null\" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be \"detected\", \"not detected\", \"inconclusive\", or \"test not done\". \n\nThe alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code \"error\" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.", "requirements": "For many results it is necessary to handle exceptional values in measurements.", "min": 0, "max": "1", "base": { "path": "Observation.component.dataAbsentReason", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1", "obs-6" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ObservationValueAbsentReason" } ], "strength": "extensible", "description": "Codes specifying why the result (`Observation.value[x]`) is missing.", "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "value.nullFlavor" } ] }, { "id": "Observation.component.interpretation", "path": "Observation.component.interpretation", "short": "High, low, normal, etc.", "definition": "A categorical assessment of an observation value. For example, high, low, normal.", "comment": "Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.", "requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.", "alias": [ "Abnormal Flag" ], "min": 0, "max": "*", "base": { "path": "Observation.component.interpretation", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ObservationInterpretation" } ], "strength": "extensible", "description": "Codes identifying interpretations of observations.", "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "sct-concept", "map": "< 260245000 |Findings values|" }, { "identity": "v2", "map": "OBX-8" }, { "identity": "rim", "map": "interpretationCode" }, { "identity": "sct-attr", "map": "363713009 |Has interpretation|" } ] }, { "id": "Observation.component.referenceRange", "path": "Observation.component.referenceRange", "short": "Provides guide for interpretation of component result", "definition": "Guidance on how to interpret the value by comparison to a normal or recommended range.", "comment": "Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.", "requirements": "Knowing what values are considered \"normal\" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.", "min": 0, "max": "*", "base": { "path": "Observation.component.referenceRange", "min": 0, "max": "*" }, "contentReference": "#Observation.referenceRange", "mapping": [ { "identity": "v2", "map": "OBX.7" }, { "identity": "rim", "map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]" } ] } ] }, "differential": { "element": [ { "id": "Observation", "path": "Observation", "short": "ACCESS Observation General Lab (Patient) Profile", "definition": "Expected requirements for the observation resource when reflecting general lab data based on existing source mappings.", "comment": "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": false, "isModifier": false }, { "id": "Observation.identifier", "path": "Observation.identifier", "short": "Business Identifier for observation", "type": [ { "code": "Identifier" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBX-21 (Observation Instance Identifier)\nOther suggested options if OBX-21 is not available: OBR-2 (Placer Order Number) + OBR-3(Filler Order Number) + OBX-3 (Observation Identifier)" }, { "identity": "ontario--olis", "map": "OBR-3.1" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBR-3.1 + OBR-4.1" }, { "identity": "nova-scotia--meditech-magic", "map": "OBR-3.1 + OBR-4.1" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBR-20 + OBR-4.1" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBR-3.1 + OBR-4.1" } ] }, { "id": "Observation.partOf", "path": "Observation.partOf", "short": "Part of referenced event", "comment": "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. \n\nData 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. \n\nThis is also a special concept for microbiology message (currently out of scope of this profile).", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Procedure" ] } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBR-26 + OBR-29" }, { "identity": "ontario--olis", "map": "OBR-26 + OBR-29" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBR-26 + OBR-29" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBR-26 + OBR-29" } ] }, { "id": "Observation.status", "path": "Observation.status", "short": "registered | preliminary | final | amended +", "comment": "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": "code" } ], "mustSupport": true, "isModifier": false, "binding": { "strength": "required", "description": "Observation Status", "valueSet": "http://hl7.org/fhir/ValueSet/observation-status" }, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBX-11 (Observation Result Status)" }, { "identity": "ontario--olis", "map": "OBX-11 (Codes supported: P, F, C, N, W, X, Z)" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-11 (Codes upported: P, F, C, D, R, S, D, U, I)" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-11 (Codes supported: P, F, D, A*)" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-11 (Codes supported: P, F, C)" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-11 (Codes supported: P, F, C, D, A*, FOUT*)" } ] }, { "id": "Observation.category", "path": "Observation.category", "slicing": { "discriminator": [ { "type": "value", "path": "pattern" } ], "rules": "open" }, "short": "Classification of type of observation", "comment": "Laboratory should be the default code used in this general lab profile. Other profiles may support other codes. \n\nMapping/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": 1, "max": "*", "type": [ { "code": "CodeableConcept" } ], "mustSupport": true, "isModifier": false, "binding": { "strength": "preferred", "description": "Observation Category Codes", "valueSet": "http://hl7.org/fhir/ValueSet/observation-category" } }, { "id": "Observation.category.laboratory", "path": "Observation.category.laboratory", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "laboratory" } ] }, "mustSupport": true, "isModifier": false }, { "id": "Observation.code", "path": "Observation.code", "short": "Type of observation (code / type)", "comment": "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": "CodeableConcept" } ], "mustSupport": true, "isModifier": false, "binding": { "strength": "preferred", "description": "OLIS Observation Codes", "valueSet": "http://ehealthontario.ca/fhir/ValueSet/lab/observation-codes" }, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBX-3.1 (Observation Identifier ID/Print Number)\nOther suggested options if OBX-3 is not available: OBR-4 (Universal Service Identifier)" }, { "identity": "ontario--olis", "map": "OBX-3.1" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-3.1 (Code set 72 with some ability to send LOINC if site selects \"send nomenclature identifier\")" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-3.1" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-3.1" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-3.1" } ] }, { "id": "Observation.subject", "path": "Observation.subject", "short": "Who and/or what the observation is about", "min": 1, "max": "1", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/ca/core/StructureDefinition/profile-patient" ] } ], "mustSupport": true, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "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" }, { "identity": "ontario--olis", "map": "PID-3" }, { "identity": "prince-edward-island--cerner-millennium", "map": "PID-3 (if v2.3.1 and above), PID-4 (if v2.3 or below)" }, { "identity": "nova-scotia--meditech-magic", "map": "PID-3" }, { "identity": "nove-scotia--cerner-millennium", "map": "PID-3" }, { "identity": "nova-scotia--meditech-c/s", "map": "PID-3" } ] }, { "id": "Observation.effectiveDateTime", "path": "Observation.effectiveDateTime", "short": "Clinically relevant time/time-period for observation", "comment": "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. \n\nThe patient/physician may refer to this date to distinguish from the other blood collection.", "type": [ { "code": "dateTime" } ], "mustSupport": true, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBX-14 (Date/Time of the Observation) Other suggested options if OBX-14 is not available: OBR-7" }, { "identity": "ontario--olis", "map": "OBX-14 \n\nOther suggested options if OBX-14 is not available: OBR-7" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-14" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-14 \n\nOther suggested options if OBX-14 is not available: OBR-7" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-14 \n\nOther suggested options if OBX-14 is not available: OBR-7" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-14 \n\nOther suggested options if OBX-14 is not available: OBR-7" } ] }, { "id": "Observation.issued", "path": "Observation.issued", "short": "Date/Time this version was made available", "comment": "SME Note: This refers to the date the result was released aka result are made available. \n\nMapping/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": false, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBR-22 (Results Rpt/Status Chng - Date/Time +)\n\nOther suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" }, { "identity": "ontario--olis", "map": "OBR-7" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBR-22" }, { "identity": "nova-scotia--meditech-magic", "map": "OBR-22\n\nOther suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBR-22\n\nOther suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBR-7" } ] }, { "id": "Observation.performer", "path": "Observation.performer", "slicing": { "discriminator": [ { "type": "value", "path": "profile" } ], "rules": "open" }, "short": "Who is responsible for the observation", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "mustSupport": false, "isModifier": false }, { "id": "Observation.performer.practitioner", "path": "Observation.performer.practitioner", "short": "Practitioner responsible for the observation", "comment": "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": "Reference", "targetProfile": [ "http://hl7.org/fhir/ca/core/StructureDefinition/profile-practitioner" ] } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBR-32 (Principal Result Interpreter) or OBX-16 (Responsible Observer)" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBR-32" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-16 (not sent for all results)" } ] }, { "id": "Observation.performer.organization", "path": "Observation.performer.organization", "short": "Organization responsible for the observation", "comment": "SME Note: Most commonly, performing organization will be available (more frequently than performing practitioner).", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/ca/core/StructureDefinition/profile-organization" ] } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBX-23 (when v2.5.1 or higher), OBX-15 (Producer's ID) if supported, otherwise Z segments" }, { "identity": "ontario--olis", "map": "ZBR-6" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-23" }, { "identity": "nova-scotia--meditech-magic", "map": "ZPS-2" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-15" } ] }, { "id": "Observation.value[x]", "path": "Observation.value[x]", "short": "Actual result", "type": [ { "code": "Quantity" }, { "code": "CodeableConcept" }, { "code": "string" }, { "code": "boolean" }, { "code": "integer" }, { "code": "Range" }, { "code": "Ratio" }, { "code": "SampledData" }, { "code": "time" }, { "code": "dateTime" }, { "code": "Period" } ], "mustSupport": true, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBX.2 (Value Type), OBX.5 (Observation Value), OBX.6 (Units)" }, { "identity": "ontario--olis", "map": "OBX.2, OBX.5, OBX.6" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX.2, OBX.5, OBX.6" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX.2, OBX.5, OBX.6" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX.2, OBX.5, OBX.6" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX.2, OBX.5, OBX.6" } ] }, { "id": "Observation.dataAbsentReason", "path": "Observation.dataAbsentReason", "short": "Why the result is missing", "comment": "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. \n\nKey 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": "CodeableConcept" } ], "mustSupport": true, "isModifier": false, "binding": { "strength": "extensible", "description": "Data Absent Reason", "valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason" }, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBX-11* (Observation Result Status)" }, { "identity": "ontario--olis", "map": "OBX-11*" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-11*" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-11*" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-11*" } ] }, { "id": "Observation.interpretation", "path": "Observation.interpretation", "short": "Codes signifying whether result is high, low, normal, compared to reference range", "type": [ { "code": "CodeableConcept" } ], "mustSupport": true, "isModifier": false, "binding": { "strength": "extensible", "description": "Observation Interpretation", "valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation" }, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBX-8 (Interpretation Codes)" }, { "identity": "ontario--olis", "map": "OBX-8" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-8" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-8" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-8" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-8" } ] }, { "id": "Observation.note", "path": "Observation.note", "short": "Comments about the observation", "comment": "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. \n\nImplementor 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": "Annotation" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "NTE-3 (Comment)" }, { "identity": "ontario--olis", "map": "NTE-3" }, { "identity": "prince-edward-island--cerner-millennium", "map": "NTE-3" }, { "identity": "nova-scotia--meditech-magic", "map": "NTE-3" }, { "identity": "nove-scotia--cerner-millennium", "map": "NTE-3" }, { "identity": "nova-scotia--meditech-c/s", "map": "NTE-3" } ] }, { "id": "Observation.specimen", "path": "Observation.specimen", "short": "Specimen used for this observation", "comment": "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": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Specimen" ] } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBR-3.1 (Filler Order Number ID) , SPM-2 (Specimen ID) can be used in interfaces that are HL7 v2.5.1 and higher" }, { "identity": "ontario--olis", "map": "OBR-3.1" }, { "identity": "prince-edward-island--cerner-millennium", "map": "SPM-2" }, { "identity": "nova-scotia--meditech-magic", "map": "OBR-3.1" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBR-20 (Filler Field 1+..Unformatted Millennium accension number)" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBR-3.1" } ] }, { "id": "Observation.referenceRange", "path": "Observation.referenceRange", "short": "Provides guide for interpretation", "type": [ { "code": "BackboneElement" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBX-7 (Reference Range)" }, { "identity": "ontario--olis", "map": "OBX-7" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-7" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-7" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-7" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-7" } ] }, { "id": "Observation.referenceRange.appliesTo", "path": "Observation.referenceRange.appliesTo", "short": "Reference range population", "comment": "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) . \n\nSME 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": "CodeableConcept" } ], "mustSupport": false, "isModifier": false, "binding": { "strength": "example", "description": "v2 Nature of abnormal test", "valueSet": "http://terminology.hl7.org/ValueSet/v2-0080" }, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBX-10 (Nature of Abnormal Test)" }, { "identity": "ontario--olis", "map": "OBX-10" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-10" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-10" } ] }, { "id": "Observation.referenceRange.text", "path": "Observation.referenceRange.text", "short": "Text based reference range in an observation", "type": [ { "code": "string" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "OBX-7 (Reference Range)" }, { "identity": "ontario--olis", "map": "OBX-7" }, { "identity": "prince-edward-island--cerner-millennium", "map": "OBX-7" }, { "identity": "nova-scotia--meditech-magic", "map": "OBX-7" }, { "identity": "nove-scotia--cerner-millennium", "map": "OBX-7" }, { "identity": "nova-scotia--meditech-c/s", "map": "OBX-7" } ] }, { "id": "Observation.hasMember", "path": "Observation.hasMember", "short": "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": "Mapping Note: Consistent semantic equivalent mapping difficult to determine at existing LIS sites.", "type": [ { "code": "Reference", "targetProfile": [ "http://infoway-inforoute.ca/fhir/StructureDefinition/access-observation-gen-pat" ] } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "vendor-agnostic-v2", "map": "Relationships established by OBX-4 usage" } ] } ] } }