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

doco Documentation for this format
<status value="draft" /> <experimental value="false" /> <date value="2019-03-21T00:00:00-04:00" /> <publisher value="Canada Health Infoway" /> <contact> <telecom> <system value="url" /> <value value="http://infoway-inforoute.ca" /> </telecom> </contact> <description value="Constraints on the Observation resource to reflect source data mappings for the ACCESS Health project. Focus of this profile is on display of general lab information to citizen/patient viewers." /> <fhirVersion value="4.0.0" /> <mapping> <identity value="vendor-agnostic-v2" /> <uri value="http://unknown.org/Vendor Agnostic v2" /> <name value="Vendor Agnostic v2" /> </mapping> <mapping> <identity value="ontario--olis" /> <uri value="http://unknown.org/Ontario- OLIS" /> <name value="Ontario- OLIS" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <uri value="http://unknown.org/Prince Edward Island- Cerner Millennium" /> <name value="Prince Edward Island- Cerner Millennium" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <uri value="http://unknown.org/Nova Scotia- Meditech Magic" /> <name value="Nova Scotia- Meditech Magic" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <uri value="http://unknown.org/Nove Scotia- Cerner Millennium" /> <name value="Nove Scotia- Cerner Millennium" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <uri value="http://unknown.org/Nova Scotia- Meditech C/S" /> <name value="Nova Scotia- Meditech C/S" /> </mapping> <mapping> <identity value="workflow" /> <uri value="http://hl7.org/fhir/workflow" /> <name value="Workflow Pattern" /> </mapping> <mapping> <identity value="sct-concept" /> <uri value="http://snomed.info/conceptdomain" /> <name value="SNOMED CT Concept Domain Binding" /> </mapping> <mapping> <identity value="v2" /> <uri value="http://hl7.org/v2" /> <name value="HL7 v2 Mapping" /> </mapping> <mapping> <identity value="rim" /> <uri value="http://hl7.org/v3" /> <name value="RIM Mapping" /> </mapping> <mapping> <identity value="w5" /> <uri value="http://hl7.org/fhir/fivews" /> <name value="FiveWs Pattern Mapping" /> </mapping> <mapping> <identity value="sct-attr" /> <uri value="http://snomed.org/attributebinding" /> <name value="SNOMED CT Attribute Binding" /> </mapping> <kind value="resource" /> <abstract value="false" /> <type value="Observation" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Observation" /> <derivation value="constraint" /> <snapshot> <element id="Observation"> <path value="Observation" /> <short value="ACCESS Observation General Lab (Patient) Profile" /> <definition value="Expected requirements for the observation resource when reflecting general lab data based on existing source mappings." /> <comment value="Note for implementors: This profile focuses on general lab results. It excludes pathology, microbiology, serotology, etc for two reasons: 1) The density and content of information in the various lab types are dramatically different from each other, these differences drive different information and interaction requirements from patients, and 2) there is a large degree of variance in how general lab results are formatted (more structured) and how other types of labs like pathology are structured (largely text based). Additional analysis required for microbiology, serotology, and pathology lab result types to determine level of structured data available." /> <alias value="Vital Signs" /> <alias value="Measurement" /> <alias value="Results" /> <alias value="Tests" /> <min value="0" /> <max value="*" /> <base> <path value="Observation" /> <min value="0" /> <max value="*" /> </base> <constraint> <key value="dom-2" /> <severity value="error" /> <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" /> <expression value="contained.contained.empty()" /> <xpath value="not(parent::f:contained and f:contained)" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="dom-4" /> <severity value="error" /> <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" /> <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" /> <xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="dom-3" /> <severity value="error" /> <human value="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 value="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 value="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 value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice"> <valueBoolean value="true" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation"> <valueMarkdown value="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." /> </extension> <key value="dom-6" /> <severity value="warning" /> <human value="A resource should have narrative for robust management" /> <expression value="text.div.exists()" /> <xpath value="exists(f:text/h:div)" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="dom-5" /> <severity value="error" /> <human value="If a resource is contained in another resource, it SHALL NOT have a security label" /> <expression value="contained.meta.security.empty()" /> <xpath value="not(exists(f:contained/*/f:meta/f:security))" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="obs-7" /> <severity value="error" /> <human value="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="value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Observation" /> </constraint> <constraint> <key value="obs-6" /> <severity value="error" /> <human value="dataAbsentReason SHALL only be present if Observation.value[x] is not present" /> <expression value="dataAbsentReason.empty() or value.empty()" /> <xpath value="not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), 'value')])))" /> <source value="http://hl7.org/fhir/StructureDefinition/Observation" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="rim" /> <map value="Entity. Role, or Act" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="< 363787002 |Observable entity|" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX" /> </mapping> <mapping> <identity value="rim" /> <map value="Observation[classCode=OBS, moodCode=EVN]" /> </mapping> </element> <element id="Observation.id"> <path value="Observation.id" /> <short value="Logical id of this artifact" /> <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." /> <comment value="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 value="0" /> <max value="1" /> <base> <path value="Resource.id" /> <min value="0" /> <max value="1" /> </base> <type> <code value="id" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="Observation.meta"> <path value="Observation.meta" /> <short value="Metadata about the resource" /> <definition value="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 value="0" /> <max value="1" /> <base> <path value="Resource.meta" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Meta" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.implicitRules"> <path value="Observation.implicitRules" /> <short value="A set of rules under which this content was created" /> <definition value="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 value="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 value="0" /> <max value="1" /> <base> <path value="Resource.implicitRules" /> <min value="0" /> <max value="1" /> </base> <type> <code value="uri" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isModifier value="true" /> <isModifierReason value="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 value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="Observation.language"> <path value="Observation.language" /> <short value="Language of the resource content" /> <definition value="The base language in which the resource is written." /> <comment value="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 value="0" /> <max value="1" /> <base> <path value="Resource.language" /> <min value="0" /> <max value="1" /> </base> <type> <code value="code" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet"> <valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Language" /> </extension> <strength value="preferred" /> <description value="A human language." /> <valueSet value="http://hl7.org/fhir/ValueSet/languages" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="Observation.text"> <path value="Observation.text" /> <short value="Text summary of the resource, for human interpretation" /> <definition value="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 value="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 value="narrative" /> <alias value="html" /> <alias value="xhtml" /> <alias value="display" /> <min value="0" /> <max value="1" /> <base> <path value="DomainResource.text" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Narrative" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> <mapping> <identity value="rim" /> <map value="Act.text?" /> </mapping> </element> <element id="Observation.contained"> <path value="Observation.contained" /> <short value="Contained, inline Resources" /> <definition value="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 value="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 value="inline resources" /> <alias value="anonymous resources" /> <alias value="contained resources" /> <min value="0" /> <max value="*" /> <base> <path value="DomainResource.contained" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Resource" /> </type> <mapping> <identity value="rim" /> <map value="Entity. Role, or Act" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.extension"> <path value="Observation.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="DomainResource.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.modifierExtension"> <path value="Observation.modifierExtension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Extensions that cannot be ignored" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="DomainResource.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.identifier"> <path value="Observation.identifier" /> <short value="Business Identifier for observation" /> <definition value="A unique identifier assigned to this observation." /> <requirements value="Allows observations to be distinguished and referenced." /> <min value="0" /> <max value="*" /> <base> <path value="Observation.identifier" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Identifier" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" /> </mapping> <mapping> <identity value="rim" /> <map value="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]" /> </mapping> <mapping> <identity value="servd" /> <map value="Identifier" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.identifier" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.identifier" /> </mapping> <mapping> <identity value="v2" /> <map value="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." /> </mapping> <mapping> <identity value="rim" /> <map value="id" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-21 (Observation Instance Identifier) Other suggested options if OBX-21 is not available: OBR-2 (Placer Order Number) + OBR-3(Filler Order Number) + OBX-3 (Observation Identifier)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-3.1" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-3.1 + OBR-4.1" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-3.1 + OBR-4.1" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-20 + OBR-4.1" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-3.1 + OBR-4.1" /> </mapping> </element> <element id="Observation.basedOn"> <path value="Observation.basedOn" /> <short value="Fulfills plan, proposal or order" /> <definition value="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 value="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 value="Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon." /> <alias value="Fulfills" /> <min value="0" /> <max value="*" /> <base> <path value="Observation.basedOn" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/CarePlan" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceRequest" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/NutritionOrder" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/ServiceRequest" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.basedOn" /> </mapping> <mapping> <identity value="v2" /> <map value="ORC" /> </mapping> <mapping> <identity value="rim" /> <map value=".inboundRelationship[typeCode=COMP].source[moodCode=EVN]" /> </mapping> </element> <element id="Observation.partOf"> <path value="Observation.partOf" /> <short value="Part of referenced event" /> <definition value="A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure." /> <comment value="SME Note: This is an important element to aid in the visualization of tests that are related. Tests that are related MUST be displayed together in the viewer to maintain clinical significance. Data Mapping Note: Some LIS have the capacity to have a very complex hierarchy of tests. Example A clinician ordered a panel ' Transplant panel' . This panel contains 3 group tests (OBR). Each of these 3 groups contains in turn multiples atomic tests (OBX). To maintain the link between all the groups, the LIS send a value in the OBR -26 (parent result) and OBR-29 ( parent number) . This is specially important when the multiples HL7 messages are sent for the results. This is also a special concept for microbiology message (currently out of scope of this profile)." /> <alias value="Container" /> <min value="0" /> <max value="*" /> <base> <path value="Observation.partOf" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Procedure" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.partOf" /> </mapping> <mapping> <identity value="v2" /> <map value="Varies by domain" /> </mapping> <mapping> <identity value="rim" /> <map value=".outboundRelationship[typeCode=FLFS].target" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-26 + OBR-29" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-26 + OBR-29" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-26 + OBR-29" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-26 + OBR-29" /> </mapping> </element> <element id="Observation.status"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint"> <valueString value="default: final" /> </extension> <path value="Observation.status" /> <short value="registered | preliminary | final | amended +" /> <definition value="The status of the result value." /> <comment value="Mapping Note: The LIS that were examined in Nova Scotia included some additional codes that were unique to the LIS (i.e. FOUT). See the notes in the mapping document discussing the need to map the HL7 v2 codes used by the LIS (shorthand often single-digit codes) to the codes used by the FHIR value set (usually full word code)." /> <requirements value="Need to track the status of individual results. Some results are finalized before the whole report is finalized." /> <min value="1" /> <max value="1" /> <base> <path value="Observation.status" /> <min value="1" /> <max value="1" /> </base> <type> <code value="code" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isModifierReason value="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 value="true" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ObservationStatus" /> </extension> <strength value="required" /> <description value="Observation Status" /> <valueSet value="http://hl7.org/fhir/ValueSet/observation-status" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.status" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.status" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="< 445584004 |Report by finality status|" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-11" /> </mapping> <mapping> <identity value="rim" /> <map value="status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of "revise"" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-11 (Observation Result Status)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-11 (Codes supported: P, F, C, N, W, X, Z)" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-11 (Codes upported: P, F, C, D, R, S, D, U, I)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-11 (Codes supported: P, F, D, A*)" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-11 (Codes supported: P, F, C)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-11 (Codes supported: P, F, C, D, A*, FOUT*)" /> </mapping> </element> <element id="Observation.category"> <path value="Observation.category" /> <slicing> <discriminator> <type value="value" /> <path value="pattern" /> </discriminator> <rules value="open" /> </slicing> <short value="Classification of type of observation" /> <definition value="A code that classifies the general type of observation being made." /> <comment value="Laboratory should be the default code used in this general lab profile. Other profiles may support other codes. Mapping/Implementor Note: There is no absolute semantic match in v2 that identifies the category of the ORU message, however the element was made must-support under the assumption that the category could be populated during the conversion process through a variety of means (primarily by source information in the message header- some Nova Scotia labs even send lab module). Unlike the US Core, laboratory was not set as a fixed value to avoid over-constraining the profile to the point of counteracting jurisdictional designs already in place (OLIS observationCategory value set supports both exam and laboratory codes). US Core Observation Results Profile requires the first use of category to default to 'laboratory' using the code system 'http://hl7.org/fhir/observation-category'. Additional codes can be used to provide more detail on the type of laboratory test." /> <requirements value="Used for filtering what observations are retrieved and displayed." /> <min value="1" /> <max value="*" /> <base> <path value="Observation.category" /> <min value="0" /> <max value="*" /> </base> <type> <code value="CodeableConcept" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ObservationCategory" /> </extension> <strength value="preferred" /> <description value="Observation Category Codes" /> <valueSet value="http://hl7.org/fhir/ValueSet/observation-category" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.class" /> </mapping> <mapping> <identity value="rim" /> <map value=".outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code" /> </mapping> </element> <element id="Observation.category.id"> <path value="Observation.category.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <code> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-json-type"> <valueString value="string" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-xml-type"> <valueString value="xsd:string" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-rdf-type"> <valueString value="xsd:string" /> </extension> </code> </type> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="Observation.category.extension"> <path value="Observation.category.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.category.coding"> <path value="Observation.category.coding" /> <short value="Code defined by a terminology system" /> <definition value="A reference to a code defined by a terminology system." /> <comment value="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 value="Allows for alternative encodings within a code system, and translations to other code systems." /> <min value="0" /> <max value="*" /> <base> <path value="CodeableConcept.coding" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Coding" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" /> </mapping> <mapping> <identity value="rim" /> <map value="CV" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:Coding rdfs:subClassOf dt:CDCoding" /> </mapping> <mapping> <identity value="v2" /> <map value="C*E.1-8, C*E.10-22" /> </mapping> <mapping> <identity value="rim" /> <map value="union(., ./translation)" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" /> </mapping> </element> <element id="Observation.category.text"> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable"> <valueBoolean value="true" /> </extension> <path value="Observation.category.text" /> <short value="Plain text representation of the concept" /> <definition value="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 value="Very often the text is the same as a displayName of one of the codings." /> <requirements value="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 value="0" /> <max value="1" /> <base> <path value="CodeableConcept.text" /> <min value="0" /> <max value="1" /> </base> <type> <code value="string" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="C*E.9. But note many systems use C*E.2 for this" /> </mapping> <mapping> <identity value="rim" /> <map value="./originalText[mediaType/code="text/plain"]/data" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" /> </mapping> </element> <element id="Observation.category.laboratory"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="normative" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version"> <valueCode value="4.0.0" /> </extension> <path value="Observation.category.laboratory" /> <short value="Concept - reference to a terminology or just text" /> <definition value="A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text." /> <comment value="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 value="1" /> <max value="1" /> <base> <path value="Observation.category.laboratory" /> <min value="1" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/observation-category" /> <code value="laboratory" /> </coding> </patternCodeableConcept> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="Observation.code"> <path value="Observation.code" /> <short value="Type of observation (code / type)" /> <definition value="Describes what was observed. Sometimes this is called the observation "name"." /> <comment value="Mapping Note: Every LIS has its own data dictionary. Some LIS dictionaries use nomenclature that has 1:1 mapping to LOINC codes (example: OLIS) others do not. Some LIS vendors (example: Cerner Millennium) may reuse a foundational data dictionary but LIS sites often opt to add additional codes as a supplement to the data dictionary which leads to inconsistency across sites. These codes can be numeric, alpha-numeric, text, or some combination (seen frequently in the test data from Nova Scotia). Occasionally codes may be retired by the vendor or LIS master file but the codes are kept for a period of time to ensure the transition accounts for tests that have not been completed." /> <requirements value="Knowing what kind of observation is being made is essential to understanding the observation." /> <alias value="Name" /> <min value="1" /> <max value="1" /> <base> <path value="Observation.code" /> <min value="1" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="true" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ObservationCode" /> </extension> <strength value="preferred" /> <description value="OLIS Observation Codes" /> <valueSet value="http://ehealthontario.ca/fhir/ValueSet/lab/observation-codes" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.code" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.what[x]" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="< 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-3" /> </mapping> <mapping> <identity value="rim" /> <map value="code" /> </mapping> <mapping> <identity value="sct-attr" /> <map value="116680003 |Is a|" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-3.1 (Observation Identifier ID/Print Number) Other suggested options if OBX-3 is not available: OBR-4 (Universal Service Identifier)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-3.1" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-3.1 (Code set 72 with some ability to send LOINC if site selects "send nomenclature identifier")" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-3.1" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-3.1" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-3.1" /> </mapping> </element> <element id="Observation.subject"> <path value="Observation.subject" /> <short value="Who and/or what the observation is about" /> <definition value="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 value="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 value="Observations have no value if you don't know who or what they're about." /> <min value="1" /> <max value="1" /> <base> <path value="Observation.subject" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/core/StructureDefinition/profile-patient" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.subject" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.subject[x]" /> </mapping> <mapping> <identity value="v2" /> <map value="PID-3" /> </mapping> <mapping> <identity value="rim" /> <map value="participation[typeCode=RTGT]" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.subject" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="PID-3 (Patient Identifier List) Other suggested options if PID-3 is not available or the patient resource is tied to provincial identifiers: PID-2" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="PID-3" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="PID-3 (if v2.3.1 and above), PID-4 (if v2.3 or below)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="PID-3" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="PID-3" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="PID-3" /> </mapping> </element> <element id="Observation.focus"> <path value="Observation.focus" /> <short value="What the observation is about, when it is not about the subject of record" /> <definition value="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 value="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 value="0" /> <max value="*" /> <base> <path value="Observation.focus" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.subject[x]" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-3" /> </mapping> <mapping> <identity value="rim" /> <map value="participation[typeCode=SBJ]" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.subject" /> </mapping> </element> <element id="Observation.encounter"> <path value="Observation.encounter" /> <short value="Healthcare event during which this observation is made" /> <definition value="The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made." /> <comment value="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 value="For some observations it may be important to know the link between an observation and a particular encounter." /> <alias value="Context" /> <min value="0" /> <max value="1" /> <base> <path value="Observation.encounter" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.context" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.context" /> </mapping> <mapping> <identity value="v2" /> <map value="PV1" /> </mapping> <mapping> <identity value="rim" /> <map value="inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]" /> </mapping> </element> <element id="Observation.effective[x]"> <path value="Observation.effective[x]" /> <slicing> <discriminator> <type value="type" /> <path value="$this" /> </discriminator> <ordered value="false" /> <rules value="open" /> </slicing> <short value="Clinically relevant time/time-period for observation" /> <definition value="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 value="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 value="Knowing when an observation was deemed true is important to its relevance as well as determining trends." /> <alias value="Occurrence" /> <min value="0" /> <max value="1" /> <base> <path value="Observation.effective[x]" /> <min value="0" /> <max value="1" /> </base> <type> <code value="dateTime" /> </type> <type> <code value="Period" /> </type> <type> <code value="Timing" /> </type> <type> <code value="instant" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.occurrence[x]" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.done[x]" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)" /> </mapping> <mapping> <identity value="rim" /> <map value="effectiveTime" /> </mapping> </element> <element id="Observation.effective[x]:effectiveDateTime"> <path value="Observation.effective[x]" /> <sliceName value="effectiveDateTime" /> <short value="Clinically relevant time/time-period for observation" /> <definition value="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 value="SME/Mapping Note: This element refers to the date the specimen was collected which is usually found in OBR-7. In some lab test such as Timed test, multiples samples are collected at various time (same date). In this case, the date of specimen collection can be included in the OBX segment. However, this has been found to be an issue with many LIS since they do not provide the information in the messages. The patient/physician may refer to this date to distinguish from the other blood collection." /> <requirements value="Knowing when an observation was deemed true is important to its relevance as well as determining trends." /> <alias value="Occurrence" /> <min value="0" /> <max value="1" /> <base> <path value="Observation.effective[x]" /> <min value="0" /> <max value="1" /> </base> <type> <code value="dateTime" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.occurrence[x]" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.done[x]" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)" /> </mapping> <mapping> <identity value="rim" /> <map value="effectiveTime" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-14 (Date/Time of the Observation) Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-14 Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-14" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-14 Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-14 Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-14 Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> </element> <element id="Observation.issued"> <path value="Observation.issued" /> <short value="Date/Time this version was made available" /> <definition value="The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified." /> <comment value="SME Note: This refers to the date the result was released aka result are made available. Mapping/Implementor Note: Pay special attention to situation with a group test (containing multiple atomic tests) .If the test result of only one atomic test is changed after the initial release, then the date in the OBX segment will be updated. Most LIS will also update the date in the OBR segment. Some LIS will update the date of all the atomic tests regardless if the result was changed or remains the same. This can be an issue if the displaying application/viewer has a trigger to warn the user of the change base of the issued date." /> <min value="0" /> <max value="1" /> <base> <path value="Observation.issued" /> <min value="0" /> <max value="1" /> </base> <type> <code value="instant" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.recorded" /> </mapping> <mapping> <identity value="v2" /> <map value="OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)" /> </mapping> <mapping> <identity value="rim" /> <map value="participation[typeCode=AUT].time" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-22 (Results Rpt/Status Chng - Date/Time +) Other suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-22" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-22 Other suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-22 Other suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-7" /> </mapping> </element> <element id="Observation.performer"> <path value="Observation.performer" /> <slicing> <discriminator> <type value="value" /> <path value="profile" /> </discriminator> <rules value="open" /> </slicing> <short value="Who is responsible for the observation" /> <definition value="Who was responsible for asserting the observed value as "true"." /> <comment value="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 value="May give a degree of confidence in the observation and also indicates where follow-up questions should be directed." /> <min value="0" /> <max value="*" /> <base> <path value="Observation.performer" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.performer.actor" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.actor" /> </mapping> <mapping> <identity value="v2" /> <map value="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'" /> </mapping> <mapping> <identity value="rim" /> <map value="participation[typeCode=PRF]" /> </mapping> </element> <element id="Observation.performer.id"> <path value="Observation.performer.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <code> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-json-type"> <valueString value="string" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-xml-type"> <valueString value="xsd:string" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-rdf-type"> <valueString value="xsd:string" /> </extension> </code> </type> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="Observation.performer.extension"> <path value="Observation.performer.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.performer.reference"> <path value="Observation.performer.reference" /> <short value="Literal reference, Relative, internal or absolute URL" /> <definition value="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 value="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 value="0" /> <max value="1" /> <base> <path value="Reference.reference" /> <min value="0" /> <max value="1" /> </base> <type> <code value="string" /> </type> <condition value="ele-1" /> <condition value="ref-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.performer.type"> <path value="Observation.performer.type" /> <short value="Type the reference refers to (e.g. "Patient")" /> <definition value="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. The 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 value="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 value="0" /> <max value="1" /> <base> <path value="Reference.type" /> <min value="0" /> <max value="1" /> </base> <type> <code value="uri" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="FHIRResourceTypeExt" /> </extension> <strength value="extensible" /> <description value="Aa resource (or, for logical models, the URI of the logical model)." /> <valueSet value="http://hl7.org/fhir/ValueSet/resource-types" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.performer.identifier"> <path value="Observation.performer.identifier" /> <short value="Logical reference, when literal reference is not known" /> <definition value="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 value="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. When 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 Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference 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 value="0" /> <max value="1" /> <base> <path value="Reference.identifier" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Identifier" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" /> </mapping> <mapping> <identity value="rim" /> <map value="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]" /> </mapping> <mapping> <identity value="servd" /> <map value="Identifier" /> </mapping> <mapping> <identity value="rim" /> <map value=".identifier" /> </mapping> </element> <element id="Observation.performer.display"> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable"> <valueBoolean value="true" /> </extension> <path value="Observation.performer.display" /> <short value="Text alternative for the resource" /> <definition value="Plain text narrative that identifies the resource in addition to the resource reference." /> <comment value="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 value="0" /> <max value="1" /> <base> <path value="Reference.display" /> <min value="0" /> <max value="1" /> </base> <type> <code value="string" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.performer.practitioner"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="normative" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version"> <valueCode value="4.0.0" /> </extension> <path value="Observation.performer.practitioner" /> <short value="Practitioner responsible for the observation" /> <definition value="A reference from one resource to another." /> <comment value="SME Note: Very rare in general labs to have physicians that sign the lab result. Lab performing practitioner is usually internal information that gets stored by LIS for operational purposes, but not likely of value to patients or clinicians. In pathology (out of scope of this profile) there might be information that is used for f/u with the performing agent." /> <min value="0" /> <max value="*" /> <base> <path value="Observation.performer.practitioner" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/core/StructureDefinition/profile-practitioner" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-32 (Principal Result Interpreter) or OBX-16 (Responsible Observer)" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-32" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-16 (not sent for all results)" /> </mapping> </element> <element id="Observation.performer.organization"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"> <valueCode value="normative" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version"> <valueCode value="4.0.0" /> </extension> <path value="Observation.performer.organization" /> <short value="Organization responsible for the observation" /> <definition value="A reference from one resource to another." /> <comment value="SME Note: Most commonly, performing organization will be available (more frequently than performing practitioner)." /> <min value="0" /> <max value="*" /> <base> <path value="Observation.performer.organization" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/core/StructureDefinition/profile-organization" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-23 (when v2.5.1 or higher), OBX-15 (Producer's ID) if supported, otherwise Z segments" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="ZBR-6" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-23" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="ZPS-2" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-15" /> </mapping> </element> <element id="Observation.value[x]"> <path value="Observation.value[x]" /> <short value="Actual result" /> <definition value="The information determined as a result of making the observation, if the information has a simple value." /> <comment value="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 value="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 value="0" /> <max value="1" /> <base> <path value="Observation.value[x]" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Quantity" /> </type> <type> <code value="CodeableConcept" /> </type> <type> <code value="string" /> </type> <type> <code value="boolean" /> </type> <type> <code value="integer" /> </type> <type> <code value="Range" /> </type> <type> <code value="Ratio" /> </type> <type> <code value="SampledData" /> </type> <type> <code value="time" /> </type> <type> <code value="dateTime" /> </type> <type> <code value="Period" /> </type> <condition value="ele-1" /> <condition value="obs-7" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="< 441742003 |Evaluation finding|" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="rim" /> <map value="value" /> </mapping> <mapping> <identity value="sct-attr" /> <map value="363714003 |Interprets|" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX.2 (Value Type), OBX.5 (Observation Value), OBX.6 (Units)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> </element> <element id="Observation.dataAbsentReason"> <path value="Observation.dataAbsentReason" /> <short value="Why the result is missing" /> <definition value="Provides a reason why the expected value in the element Observation.value[x] is missing." /> <comment value="Implementor Note: While this is an important FHIR element to support (provides meaning for patients) it has a weak semantic mapping to available HL7 v2 ORU fields (utilized by the Nova Scotia & PEI LIS analyzed). Considered must support for the CA Baseline and US Core profiles, however there is no structured v2 field/code set outside of observation result status (cancel code) that addresses data absent reason. Likely to be addressed in notes which present their own set of challenges in automatic extraction. Key area of consideration given the value that this element has in reducing confusion in patients expecting to see a result that do not receive one. Unless further intervention occurs on behalf of the labs or converter, dataAbsentReason would likely only be populated when the ObservationResultStatus = cancelled." /> <requirements value="For many results it is necessary to handle exceptional values in measurements." /> <min value="0" /> <max value="1" /> <base> <path value="Observation.dataAbsentReason" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <condition value="ele-1" /> <condition value="obs-6" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ObservationValueAbsentReason" /> </extension> <strength value="extensible" /> <description value="Data Absent Reason" /> <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="v2" /> <map value="N/A" /> </mapping> <mapping> <identity value="rim" /> <map value="value.nullFlavor" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-11* (Observation Result Status)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-11*" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-11*" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-11*" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-11*" /> </mapping> </element> <element id="Observation.interpretation"> <path value="Observation.interpretation" /> <short value="Codes signifying whether result is high, low, normal, compared to reference range" /> <definition value="A categorical assessment of an observation value. For example, high, low, normal." /> <comment value="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 value="For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result." /> <alias value="Abnormal Flag" /> <min value="0" /> <max value="*" /> <base> <path value="Observation.interpretation" /> <min value="0" /> <max value="*" /> </base> <type> <code value="CodeableConcept" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ObservationInterpretation" /> </extension> <strength value="extensible" /> <description value="Observation Interpretation" /> <valueSet value="http://hl7.org/fhir/ValueSet/observation-interpretation" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="< 260245000 |Findings values|" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="rim" /> <map value="interpretationCode" /> </mapping> <mapping> <identity value="sct-attr" /> <map value="363713009 |Has interpretation|" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-8 (Interpretation Codes)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-8" /> </mapping> </element> <element id="Observation.note"> <path value="Observation.note" /> <short value="Comments about the observation" /> <definition value="Comments about the observation or the results." /> <comment value="SME Note: Notes are entered by the lab staff to justify, clarify, or aid the interpretation of the result. It can be a few words to paragraphs. Usually sent in an NTE type of segment. Implementor Note: One consideration that needs to be explored with LIS sites is whether there is any risk of exposing data that is inappropriate for the patient in this field. Another consideration if expecting lossless 2-way conversion, is that there are two places where notes can occur in HL7 v2 ORU messages: linked to the OBR (observation) and the OBX (result). Once the note is in FHIR, it will be difficult to identify whether or not it is tied to observation or result using existing structured data. If lossless 2-way for notes is deemed critical, one method of approach would be extensions, but discussions with LIS & end-users recommended to determine feasibility." /> <requirements value="Need to be able to provide free text additional information." /> <min value="0" /> <max value="*" /> <base> <path value="Observation.note" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Annotation" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="N/A" /> </mapping> <mapping> <identity value="rim" /> <map value="Act" /> </mapping> <mapping> <identity value="v2" /> <map value="NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)" /> </mapping> <mapping> <identity value="rim" /> <map value="subjectOf.observationEvent[code="annotation"].value" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="NTE-3 (Comment)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="NTE-3" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="NTE-3" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="NTE-3" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="NTE-3" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="NTE-3" /> </mapping> </element> <element id="Observation.bodySite"> <path value="Observation.bodySite" /> <short value="Observed body part" /> <definition value="Indicates the site on the subject's body where the observation was made (i.e. the target site)." /> <comment value="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. If 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 value="0" /> <max value="1" /> <base> <path value="Observation.bodySite" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="BodySite" /> </extension> <strength value="example" /> <description value="Codes describing anatomical locations. May include laterality." /> <valueSet value="http://hl7.org/fhir/ValueSet/body-site" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="< 123037004 |Body structure|" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-20" /> </mapping> <mapping> <identity value="rim" /> <map value="targetSiteCode" /> </mapping> <mapping> <identity value="sct-attr" /> <map value="718497002 |Inherent location|" /> </mapping> </element> <element id="Observation.method"> <path value="Observation.method" /> <short value="How it was done" /> <definition value="Indicates the mechanism used to perform the observation." /> <comment value="Only used if not implicit in code for Observation.code." /> <requirements value="In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results." /> <min value="0" /> <max value="1" /> <base> <path value="Observation.method" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ObservationMethod" /> </extension> <strength value="example" /> <description value="Methods for simple observations." /> <valueSet value="http://hl7.org/fhir/ValueSet/observation-methods" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-17" /> </mapping> <mapping> <identity value="rim" /> <map value="methodCode" /> </mapping> </element> <element id="Observation.specimen"> <path value="Observation.specimen" /> <short value="Specimen used for this observation" /> <definition value="The specimen that was used when this observation was made." /> <comment value="Mapping Note: Cerner Millennium NS specifications do not support specimen number, the synonymous accession number is used. Accession number is an unique number given to a tube of blood, urine container. In that sense, specimen number and accession are the same." /> <min value="0" /> <max value="1" /> <base> <path value="Observation.specimen" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Specimen" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="< 123038009 |Specimen|" /> </mapping> <mapping> <identity value="v2" /> <map value="SPM segment" /> </mapping> <mapping> <identity value="rim" /> <map value="participation[typeCode=SPC].specimen" /> </mapping> <mapping> <identity value="sct-attr" /> <map value="704319004 |Inherent in|" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-3.1 (Filler Order Number ID) , SPM-2 (Specimen ID) can be used in interfaces that are HL7 v2.5.1 and higher" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-3.1" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="SPM-2" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-3.1" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-20 (Filler Field 1+..Unformatted Millennium accension number)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-3.1" /> </mapping> </element> <element id="Observation.device"> <path value="Observation.device" /> <short value="(Measurement) Device" /> <definition value="The device used to generate the observation data." /> <comment value="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 value="0" /> <max value="1" /> <base> <path value="Observation.device" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceMetric" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="< 49062001 |Device|" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-17 / PRT -10" /> </mapping> <mapping> <identity value="rim" /> <map value="participation[typeCode=DEV]" /> </mapping> <mapping> <identity value="sct-attr" /> <map value="424226004 |Using device|" /> </mapping> </element> <element id="Observation.referenceRange"> <path value="Observation.referenceRange" /> <short value="Provides guide for interpretation" /> <definition value="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 value="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 value="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 value="0" /> <max value="*" /> <base> <path value="Observation.referenceRange" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="obs-3" /> <severity value="error" /> <human value="Must have at least a low or a high or text" /> <expression value="low.exists() or high.exists() or text.exists()" /> <xpath value="(exists(f:low) or exists(f:high)or exists(f:text))" /> <source value="http://hl7.org/fhir/StructureDefinition/Observation" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX.7" /> </mapping> <mapping> <identity value="rim" /> <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-7 (Reference Range)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-7" /> </mapping> </element> <element id="Observation.referenceRange.id"> <path value="Observation.referenceRange.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <code> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-json-type"> <valueString value="string" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-xml-type"> <valueString value="xsd:string" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-rdf-type"> <valueString value="xsd:string" /> </extension> </code> </type> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="Observation.referenceRange.extension"> <path value="Observation.referenceRange.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.referenceRange.modifierExtension"> <path value="Observation.referenceRange.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.referenceRange.low"> <path value="Observation.referenceRange.low" /> <short value="Low Range, if relevant" /> <definition value="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 value="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 value="0" /> <max value="1" /> <base> <path value="Observation.referenceRange.low" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Quantity" /> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" /> </type> <condition value="ele-1" /> <condition value="obs-3" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="qty-3" /> <severity value="error" /> <human value="If a code for the unit is present, the system SHALL also be present" /> <expression value="code.empty() or system.exists()" /> <xpath value="not(exists(f:code)) or exists(f:system)" /> <source value="http://hl7.org/fhir/StructureDefinition/Quantity" /> </constraint> <constraint> <key value="sqty-1" /> <severity value="error" /> <human value="The comparator is not used on a SimpleQuantity" /> <expression value="comparator.empty()" /> <xpath value="not(exists(f:comparator))" /> <source value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" /> </constraint> <isModifier value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="SN (see also Range) or CQ" /> </mapping> <mapping> <identity value="rim" /> <map value="PQ, IVL<PQ>, MO, CO, depending on the values" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="rim" /> <map value="value:IVL_PQ.low" /> </mapping> </element> <element id="Observation.referenceRange.high"> <path value="Observation.referenceRange.high" /> <short value="High Range, if relevant" /> <definition value="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 value="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 value="0" /> <max value="1" /> <base> <path value="Observation.referenceRange.high" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Quantity" /> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" /> </type> <condition value="ele-1" /> <condition value="obs-3" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="qty-3" /> <severity value="error" /> <human value="If a code for the unit is present, the system SHALL also be present" /> <expression value="code.empty() or system.exists()" /> <xpath value="not(exists(f:code)) or exists(f:system)" /> <source value="http://hl7.org/fhir/StructureDefinition/Quantity" /> </constraint> <constraint> <key value="sqty-1" /> <severity value="error" /> <human value="The comparator is not used on a SimpleQuantity" /> <expression value="comparator.empty()" /> <xpath value="not(exists(f:comparator))" /> <source value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" /> </constraint> <isModifier value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="SN (see also Range) or CQ" /> </mapping> <mapping> <identity value="rim" /> <map value="PQ, IVL<PQ>, MO, CO, depending on the values" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="rim" /> <map value="value:IVL_PQ.high" /> </mapping> </element> <element id="Observation.referenceRange.type"> <path value="Observation.referenceRange.type" /> <short value="Reference range qualifier" /> <definition value="Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range." /> <comment value="This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed." /> <requirements value="Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation." /> <min value="0" /> <max value="1" /> <base> <path value="Observation.referenceRange.type" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ObservationRangeMeaning" /> </extension> <strength value="preferred" /> <description value="Code for the meaning of a reference range." /> <valueSet value="http://hl7.org/fhir/ValueSet/referencerange-meaning" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="< 260245000 |Findings values| OR < 365860008 |General clinical state finding| OR < 250171008 |Clinical history or observation findings| OR < 415229000 |Racial group| OR < 365400002 |Finding of puberty stage| OR < 443938003 |Procedure carried out on subject|" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-10" /> </mapping> <mapping> <identity value="rim" /> <map value="interpretationCode" /> </mapping> </element> <element id="Observation.referenceRange.appliesTo"> <path value="Observation.referenceRange.appliesTo" /> <short value="Reference range population" /> <definition value="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 value="Mapping Note: One thing implementors should keep in mind is that the HL7 v2 ORU field allows for multiple values to be supplied (example: age based population, sex based population). When more than one value is present they are separated by ^ in the message (ex: A^S) . SME Note: This element allows for distinction of abnormal testing (age, race, sex, species, strain) but is not typically displayed in existing clinician lab viewers today." /> <requirements value="Need to be able to identify the target population for proper interpretation." /> <min value="0" /> <max value="*" /> <base> <path value="Observation.referenceRange.appliesTo" /> <min value="0" /> <max value="*" /> </base> <type> <code value="CodeableConcept" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ObservationRangeType" /> </extension> <strength value="example" /> <description value="v2 Nature of abnormal test" /> <valueSet value="http://terminology.hl7.org/ValueSet/v2-0080" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="< 260245000 |Findings values| OR < 365860008 |General clinical state finding| OR < 250171008 |Clinical history or observation findings| OR < 415229000 |Racial group| OR < 365400002 |Finding of puberty stage| OR < 443938003 |Procedure carried out on subject|" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-10" /> </mapping> <mapping> <identity value="rim" /> <map value="interpretationCode" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-10 (Nature of Abnormal Test)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-10" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-10" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-10" /> </mapping> </element> <element id="Observation.referenceRange.age"> <path value="Observation.referenceRange.age" /> <short value="Applicable age range, if relevant" /> <definition value="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 value="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 value="Some analytes vary greatly over age." /> <min value="0" /> <max value="1" /> <base> <path value="Observation.referenceRange.age" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Range" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="rng-2" /> <severity value="error" /> <human value="If present, low SHALL have a lower value than high" /> <expression value="low.empty() or high.empty() or (low <= high)" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Range" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="NR and also possibly SN (but see also quantity)" /> </mapping> <mapping> <identity value="rim" /> <map value="IVL<QTY[not(type="TS")]> [lowClosed="true" and highClosed="true"]or URG<QTY[not(type="TS")]>" /> </mapping> <mapping> <identity value="rim" /> <map value="outboundRelationship[typeCode=PRCN].targetObservationCriterion[code="age"].value" /> </mapping> </element> <element id="Observation.referenceRange.text"> <path value="Observation.referenceRange.text" /> <short value="Text based reference range in an observation" /> <definition value="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 value="Note that FHIR strings SHALL NOT exceed 1MB in size" /> <min value="0" /> <max value="1" /> <base> <path value="Observation.referenceRange.text" /> <min value="0" /> <max value="1" /> </base> <type> <code value="string" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="rim" /> <map value="value:ST" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-7 (Reference Range)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-7" /> </mapping> </element> <element id="Observation.hasMember"> <path value="Observation.hasMember" /> <short value="Related resource that belongs to the Observation group. This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group." /> <definition value="This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group." /> <comment value="Mapping Note: Consistent semantic equivalent mapping difficult to determine at existing LIS sites." /> <min value="0" /> <max value="*" /> <base> <path value="Observation.hasMember" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Reference" /> <targetProfile value="http://infoway-inforoute.ca/fhir/StructureDefinition/access-observation-gen-pat" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="v2" /> <map value="Relationships established by OBX-4 usage" /> </mapping> <mapping> <identity value="rim" /> <map value="outBoundRelationship" /> </mapping> <mapping> <identity value="vendor-agnostic-v2" /> <map value="Relationships established by OBX-4 usage" /> </mapping> </element> <element id="Observation.derivedFrom"> <path value="Observation.derivedFrom" /> <short value="Related measurements the observation is made from" /> <definition value="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 value="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 value="0" /> <max value="*" /> <base> <path value="Observation.derivedFrom" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/ImagingStudy" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Media" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/MolecularSequence" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" /> <xpath value="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 value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="v2" /> <map value="Relationships established by OBX-4 usage" /> </mapping> <mapping> <identity value="rim" /> <map value=".targetObservation" /> </mapping> </element> <element id="Observation.component"> <path value="Observation.component" /> <short value="Component results" /> <definition value="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 value="For a discussion on the ways Observations can be assembled in groups together see [Notes](observation.html#notes) below." /> <requirements value="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 value="0" /> <max value="*" /> <base> <path value="Observation.component" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="containment by OBX-4?" /> </mapping> <mapping> <identity value="rim" /> <map value="outBoundRelationship[typeCode=COMP]" /> </mapping> </element> <element id="Observation.component.id"> <path value="Observation.component.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <code> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-json-type"> <valueString value="string" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-xml-type"> <valueString value="xsd:string" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-rdf-type"> <valueString value="xsd:string" /> </extension> </code> </type> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="Observation.component.extension"> <path value="Observation.component.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.component.modifierExtension"> <path value="Observation.component.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="Observation.component.code"> <path value="Observation.component.code" /> <short value="Type of component observation (code / type)" /> <definition value="Describes what was observed. Sometimes this is called the observation "code"." /> <comment value="*All* code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation." /> <requirements value="Knowing what kind of observation is being made is essential to understanding the observation." /> <min value="1" /> <max value="1" /> <base> <path value="Observation.component.code" /> <min value="1" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ObservationCode" /> </extension> <strength value="example" /> <description value="Codes identifying names of simple observations." /> <valueSet value="http://hl7.org/fhir/ValueSet/observation-codes" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.what[x]" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="< 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-3" /> </mapping> <mapping> <identity value="rim" /> <map value="code" /> </mapping> </element> <element id="Observation.component.value[x]"> <path value="Observation.component.value[x]" /> <short value="Actual component result" /> <definition value="The information determined as a result of making the observation, if the information has a simple value." /> <comment value="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 value="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 value="0" /> <max value="1" /> <base> <path value="Observation.component.value[x]" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Quantity" /> </type> <type> <code value="CodeableConcept" /> </type> <type> <code value="string" /> </type> <type> <code value="boolean" /> </type> <type> <code value="integer" /> </type> <type> <code value="Range" /> </type> <type> <code value="Ratio" /> </type> <type> <code value="SampledData" /> </type> <type> <code value="time" /> </type> <type> <code value="dateTime" /> </type> <type> <code value="Period" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="363714003 |Interprets| < 441742003 |Evaluation finding|" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="rim" /> <map value="value" /> </mapping> <mapping> <identity value="sct-attr" /> <map value="363714003 |Interprets|" /> </mapping> </element> <element id="Observation.component.dataAbsentReason"> <path value="Observation.component.dataAbsentReason" /> <short value="Why the component result is missing" /> <definition value="Provides a reason why the expected value in the element Observation.component.value[x] is missing." /> <comment value=""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". The 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 value="For many results it is necessary to handle exceptional values in measurements." /> <min value="0" /> <max value="1" /> <base> <path value="Observation.component.dataAbsentReason" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <condition value="ele-1" /> <condition value="obs-6" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ObservationValueAbsentReason" /> </extension> <strength value="extensible" /> <description value="Codes specifying why the result (`Observation.value[x]`) is missing." /> <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="v2" /> <map value="N/A" /> </mapping> <mapping> <identity value="rim" /> <map value="value.nullFlavor" /> </mapping> </element> <element id="Observation.component.interpretation"> <path value="Observation.component.interpretation" /> <short value="High, low, normal, etc." /> <definition value="A categorical assessment of an observation value. For example, high, low, normal." /> <comment value="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 value="For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result." /> <alias value="Abnormal Flag" /> <min value="0" /> <max value="*" /> <base> <path value="Observation.component.interpretation" /> <min value="0" /> <max value="*" /> </base> <type> <code value="CodeableConcept" /> </type> <condition value="ele-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <xpath value="@value|f:*|h:div" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ObservationInterpretation" /> </extension> <strength value="extensible" /> <description value="Codes identifying interpretations of observations." /> <valueSet value="http://hl7.org/fhir/ValueSet/observation-interpretation" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="sct-concept" /> <map value="< 260245000 |Findings values|" /> </mapping> <mapping> <identity value="v2" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="rim" /> <map value="interpretationCode" /> </mapping> <mapping> <identity value="sct-attr" /> <map value="363713009 |Has interpretation|" /> </mapping> </element> <element id="Observation.component.referenceRange"> <path value="Observation.component.referenceRange" /> <short value="Provides guide for interpretation of component result" /> <definition value="Guidance on how to interpret the value by comparison to a normal or recommended range." /> <comment value="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 value="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 value="0" /> <max value="*" /> <base> <path value="Observation.component.referenceRange" /> <min value="0" /> <max value="*" /> </base> <contentReference value="#Observation.referenceRange" /> <mapping> <identity value="v2" /> <map value="OBX.7" /> </mapping> <mapping> <identity value="rim" /> <map value="outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]" /> </mapping> </element> </snapshot> <differential> <element id="Observation"> <path value="Observation" /> <short value="ACCESS Observation General Lab (Patient) Profile" /> <definition value="Expected requirements for the observation resource when reflecting general lab data based on existing source mappings." /> <comment value="Note for implementors: This profile focuses on general lab results. It excludes pathology, microbiology, serotology, etc for two reasons: 1) The density and content of information in the various lab types are dramatically different from each other, these differences drive different information and interaction requirements from patients, and 2) there is a large degree of variance in how general lab results are formatted (more structured) and how other types of labs like pathology are structured (largely text based). Additional analysis required for microbiology, serotology, and pathology lab result types to determine level of structured data available." /> <mustSupport value="false" /> <isModifier value="false" /> </element> <element id="Observation.identifier"> <path value="Observation.identifier" /> <short value="Business Identifier for observation" /> <type> <code value="Identifier" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-21 (Observation Instance Identifier) Other suggested options if OBX-21 is not available: OBR-2 (Placer Order Number) + OBR-3(Filler Order Number) + OBX-3 (Observation Identifier)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-3.1" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-3.1 + OBR-4.1" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-3.1 + OBR-4.1" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-20 + OBR-4.1" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-3.1 + OBR-4.1" /> </mapping> </element> <element id="Observation.partOf"> <path value="Observation.partOf" /> <short value="Part of referenced event" /> <comment value="SME Note: This is an important element to aid in the visualization of tests that are related. Tests that are related MUST be displayed together in the viewer to maintain clinical significance. Data Mapping Note: Some LIS have the capacity to have a very complex hierarchy of tests. Example A clinician ordered a panel ' Transplant panel' . This panel contains 3 group tests (OBR). Each of these 3 groups contains in turn multiples atomic tests (OBX). To maintain the link between all the groups, the LIS send a value in the OBR -26 (parent result) and OBR-29 ( parent number) . This is specially important when the multiples HL7 messages are sent for the results. This is also a special concept for microbiology message (currently out of scope of this profile)." /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Procedure" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-26 + OBR-29" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-26 + OBR-29" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-26 + OBR-29" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-26 + OBR-29" /> </mapping> </element> <element id="Observation.status"> <path value="Observation.status" /> <short value="registered | preliminary | final | amended +" /> <comment value="Mapping Note: The LIS that were examined in Nova Scotia included some additional codes that were unique to the LIS (i.e. FOUT). See the notes in the mapping document discussing the need to map the HL7 v2 codes used by the LIS (shorthand often single-digit codes) to the codes used by the FHIR value set (usually full word code)." /> <type> <code value="code" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="required" /> <description value="Observation Status" /> <valueSet value="http://hl7.org/fhir/ValueSet/observation-status" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-11 (Observation Result Status)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-11 (Codes supported: P, F, C, N, W, X, Z)" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-11 (Codes upported: P, F, C, D, R, S, D, U, I)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-11 (Codes supported: P, F, D, A*)" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-11 (Codes supported: P, F, C)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-11 (Codes supported: P, F, C, D, A*, FOUT*)" /> </mapping> </element> <element id="Observation.category"> <path value="Observation.category" /> <slicing> <discriminator> <type value="value" /> <path value="pattern" /> </discriminator> <rules value="open" /> </slicing> <short value="Classification of type of observation" /> <comment value="Laboratory should be the default code used in this general lab profile. Other profiles may support other codes. Mapping/Implementor Note: There is no absolute semantic match in v2 that identifies the category of the ORU message, however the element was made must-support under the assumption that the category could be populated during the conversion process through a variety of means (primarily by source information in the message header- some Nova Scotia labs even send lab module). Unlike the US Core, laboratory was not set as a fixed value to avoid over-constraining the profile to the point of counteracting jurisdictional designs already in place (OLIS observationCategory value set supports both exam and laboratory codes). US Core Observation Results Profile requires the first use of category to default to 'laboratory' using the code system 'http://hl7.org/fhir/observation-category'. Additional codes can be used to provide more detail on the type of laboratory test." /> <min value="1" /> <max value="*" /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="preferred" /> <description value="Observation Category Codes" /> <valueSet value="http://hl7.org/fhir/ValueSet/observation-category" /> </binding> </element> <element id="Observation.category.laboratory"> <path value="Observation.category.laboratory" /> <min value="1" /> <max value="1" /> <type> <code value="CodeableConcept" /> </type> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/observation-category" /> <code value="laboratory" /> </coding> </patternCodeableConcept> <mustSupport value="true" /> <isModifier value="false" /> </element> <element id="Observation.code"> <path value="Observation.code" /> <short value="Type of observation (code / type)" /> <comment value="Mapping Note: Every LIS has its own data dictionary. Some LIS dictionaries use nomenclature that has 1:1 mapping to LOINC codes (example: OLIS) others do not. Some LIS vendors (example: Cerner Millennium) may reuse a foundational data dictionary but LIS sites often opt to add additional codes as a supplement to the data dictionary which leads to inconsistency across sites. These codes can be numeric, alpha-numeric, text, or some combination (seen frequently in the test data from Nova Scotia). Occasionally codes may be retired by the vendor or LIS master file but the codes are kept for a period of time to ensure the transition accounts for tests that have not been completed." /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="preferred" /> <description value="OLIS Observation Codes" /> <valueSet value="http://ehealthontario.ca/fhir/ValueSet/lab/observation-codes" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-3.1 (Observation Identifier ID/Print Number) Other suggested options if OBX-3 is not available: OBR-4 (Universal Service Identifier)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-3.1" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-3.1 (Code set 72 with some ability to send LOINC if site selects "send nomenclature identifier")" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-3.1" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-3.1" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-3.1" /> </mapping> </element> <element id="Observation.subject"> <path value="Observation.subject" /> <short value="Who and/or what the observation is about" /> <min value="1" /> <max value="1" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/core/StructureDefinition/profile-patient" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="PID-3 (Patient Identifier List) Other suggested options if PID-3 is not available or the patient resource is tied to provincial identifiers: PID-2" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="PID-3" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="PID-3 (if v2.3.1 and above), PID-4 (if v2.3 or below)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="PID-3" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="PID-3" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="PID-3" /> </mapping> </element> <element id="Observation.effectiveDateTime"> <path value="Observation.effectiveDateTime" /> <short value="Clinically relevant time/time-period for observation" /> <comment value="SME/Mapping Note: This element refers to the date the specimen was collected which is usually found in OBR-7. In some lab test such as Timed test, multiples samples are collected at various time (same date). In this case, the date of specimen collection can be included in the OBX segment. However, this has been found to be an issue with many LIS since they do not provide the information in the messages. The patient/physician may refer to this date to distinguish from the other blood collection." /> <type> <code value="dateTime" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-14 (Date/Time of the Observation) Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-14 Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-14" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-14 Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-14 Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-14 Other suggested options if OBX-14 is not available: OBR-7" /> </mapping> </element> <element id="Observation.issued"> <path value="Observation.issued" /> <short value="Date/Time this version was made available" /> <comment value="SME Note: This refers to the date the result was released aka result are made available. Mapping/Implementor Note: Pay special attention to situation with a group test (containing multiple atomic tests) .If the test result of only one atomic test is changed after the initial release, then the date in the OBX segment will be updated. Most LIS will also update the date in the OBR segment. Some LIS will update the date of all the atomic tests regardless if the result was changed or remains the same. This can be an issue if the displaying application/viewer has a trigger to warn the user of the change base of the issued date." /> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-22 (Results Rpt/Status Chng - Date/Time +) Other suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-22" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-22 Other suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-22 Other suggested options if OBR-22 is not available: OBR-7 or OBX-19 (if LIS is HL7 v2.4 or higher)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-7" /> </mapping> </element> <element id="Observation.performer"> <path value="Observation.performer" /> <slicing> <discriminator> <type value="value" /> <path value="profile" /> </discriminator> <rules value="open" /> </slicing> <short value="Who is responsible for the observation" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" /> </type> <mustSupport value="false" /> <isModifier value="false" /> </element> <element id="Observation.performer.practitioner"> <path value="Observation.performer.practitioner" /> <short value="Practitioner responsible for the observation" /> <comment value="SME Note: Very rare in general labs to have physicians that sign the lab result. Lab performing practitioner is usually internal information that gets stored by LIS for operational purposes, but not likely of value to patients or clinicians. In pathology (out of scope of this profile) there might be information that is used for f/u with the performing agent." /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/core/StructureDefinition/profile-practitioner" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-32 (Principal Result Interpreter) or OBX-16 (Responsible Observer)" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBR-32" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-16 (not sent for all results)" /> </mapping> </element> <element id="Observation.performer.organization"> <path value="Observation.performer.organization" /> <short value="Organization responsible for the observation" /> <comment value="SME Note: Most commonly, performing organization will be available (more frequently than performing practitioner)." /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/core/StructureDefinition/profile-organization" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-23 (when v2.5.1 or higher), OBX-15 (Producer's ID) if supported, otherwise Z segments" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="ZBR-6" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-23" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="ZPS-2" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-15" /> </mapping> </element> <element id="Observation.value[x]"> <path value="Observation.value[x]" /> <short value="Actual result" /> <type> <code value="Quantity" /> </type> <type> <code value="CodeableConcept" /> </type> <type> <code value="string" /> </type> <type> <code value="boolean" /> </type> <type> <code value="integer" /> </type> <type> <code value="Range" /> </type> <type> <code value="Ratio" /> </type> <type> <code value="SampledData" /> </type> <type> <code value="time" /> </type> <type> <code value="dateTime" /> </type> <type> <code value="Period" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX.2 (Value Type), OBX.5 (Observation Value), OBX.6 (Units)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX.2, OBX.5, OBX.6" /> </mapping> </element> <element id="Observation.dataAbsentReason"> <path value="Observation.dataAbsentReason" /> <short value="Why the result is missing" /> <comment value="Implementor Note: While this is an important FHIR element to support (provides meaning for patients) it has a weak semantic mapping to available HL7 v2 ORU fields (utilized by the Nova Scotia & PEI LIS analyzed). Considered must support for the CA Baseline and US Core profiles, however there is no structured v2 field/code set outside of observation result status (cancel code) that addresses data absent reason. Likely to be addressed in notes which present their own set of challenges in automatic extraction. Key area of consideration given the value that this element has in reducing confusion in patients expecting to see a result that do not receive one. Unless further intervention occurs on behalf of the labs or converter, dataAbsentReason would likely only be populated when the ObservationResultStatus = cancelled." /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="extensible" /> <description value="Data Absent Reason" /> <valueSet value="http://hl7.org/fhir/ValueSet/data-absent-reason" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-11* (Observation Result Status)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-11*" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-11*" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-11*" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-11*" /> </mapping> </element> <element id="Observation.interpretation"> <path value="Observation.interpretation" /> <short value="Codes signifying whether result is high, low, normal, compared to reference range" /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="true" /> <isModifier value="false" /> <binding> <strength value="extensible" /> <description value="Observation Interpretation" /> <valueSet value="http://hl7.org/fhir/ValueSet/observation-interpretation" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-8 (Interpretation Codes)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-8" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-8" /> </mapping> </element> <element id="Observation.note"> <path value="Observation.note" /> <short value="Comments about the observation" /> <comment value="SME Note: Notes are entered by the lab staff to justify, clarify, or aid the interpretation of the result. It can be a few words to paragraphs. Usually sent in an NTE type of segment. Implementor Note: One consideration that needs to be explored with LIS sites is whether there is any risk of exposing data that is inappropriate for the patient in this field. Another consideration if expecting lossless 2-way conversion, is that there are two places where notes can occur in HL7 v2 ORU messages: linked to the OBR (observation) and the OBX (result). Once the note is in FHIR, it will be difficult to identify whether or not it is tied to observation or result using existing structured data. If lossless 2-way for notes is deemed critical, one method of approach would be extensions, but discussions with LIS & end-users recommended to determine feasibility." /> <type> <code value="Annotation" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="NTE-3 (Comment)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="NTE-3" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="NTE-3" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="NTE-3" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="NTE-3" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="NTE-3" /> </mapping> </element> <element id="Observation.specimen"> <path value="Observation.specimen" /> <short value="Specimen used for this observation" /> <comment value="Mapping Note: Cerner Millennium NS specifications do not support specimen number, the synonymous accession number is used. Accession number is an unique number given to a tube of blood, urine container. In that sense, specimen number and accession are the same." /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Specimen" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBR-3.1 (Filler Order Number ID) , SPM-2 (Specimen ID) can be used in interfaces that are HL7 v2.5.1 and higher" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBR-3.1" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="SPM-2" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBR-3.1" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBR-20 (Filler Field 1+..Unformatted Millennium accension number)" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBR-3.1" /> </mapping> </element> <element id="Observation.referenceRange"> <path value="Observation.referenceRange" /> <short value="Provides guide for interpretation" /> <type> <code value="BackboneElement" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-7 (Reference Range)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-7" /> </mapping> </element> <element id="Observation.referenceRange.appliesTo"> <path value="Observation.referenceRange.appliesTo" /> <short value="Reference range population" /> <comment value="Mapping Note: One thing implementors should keep in mind is that the HL7 v2 ORU field allows for multiple values to be supplied (example: age based population, sex based population). When more than one value is present they are separated by ^ in the message (ex: A^S) . SME Note: This element allows for distinction of abnormal testing (age, race, sex, species, strain) but is not typically displayed in existing clinician lab viewers today." /> <type> <code value="CodeableConcept" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <binding> <strength value="example" /> <description value="v2 Nature of abnormal test" /> <valueSet value="http://terminology.hl7.org/ValueSet/v2-0080" /> </binding> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-10 (Nature of Abnormal Test)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-10" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-10" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-10" /> </mapping> </element> <element id="Observation.referenceRange.text"> <path value="Observation.referenceRange.text" /> <short value="Text based reference range in an observation" /> <type> <code value="string" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="OBX-7 (Reference Range)" /> </mapping> <mapping> <identity value="ontario--olis" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="prince-edward-island--cerner-millennium" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-magic" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nove-scotia--cerner-millennium" /> <map value="OBX-7" /> </mapping> <mapping> <identity value="nova-scotia--meditech-c/s" /> <map value="OBX-7" /> </mapping> </element> <element id="Observation.hasMember"> <path value="Observation.hasMember" /> <short value="Related resource that belongs to the Observation group. This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group." /> <comment value="Mapping Note: Consistent semantic equivalent mapping difficult to determine at existing LIS sites." /> <type> <code value="Reference" /> <targetProfile value="http://infoway-inforoute.ca/fhir/StructureDefinition/access-observation-gen-pat" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="vendor-agnostic-v2" /> <map value="Relationships established by OBX-4 usage" /> </mapping> </element> </differential> </StructureDefinition>