Core StructureDefinitions - STU3 | Example Lipid Profile

Example Lipid Profile (Observation)	I		Observation	Element id Observation Short description Triglyceride Result Alternate names Vital Signs, Measurement, Results, Tests Definition Group of elements for Triglyceride result. Comments Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as lab reports, etc. Data type Observation Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative `contained.text.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource `contained.where(('#'+id in %resource.descendants().reference).not()).empty()` obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present `value.empty() or code!=component.code` obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present `dataAbsentReason.empty() or value.empty()` Mappings rim: Entity. Role, or Act workflow: Event sct-concept: < 363787002 \|Observable entity\| v2: OBX rim: Observation[classCode=OBS, moodCode=EVN] w5: clinical.diagnostics
id	Σ	0..1	id	There are no (further) constraints on this element Element id Observation.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type id
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Observation.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. Data type Meta
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Observation.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Comments 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. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. Data type uri
language		0..1	codeBinding	There are no (further) constraints on this element Element id Observation.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. ?? (extensible)
text	I	0..1	Narrative	There are no (further) constraints on this element Element id Observation.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource, and may 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. Comments 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 in formation is added later. Data type Narrative Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Observation.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments 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. Data type Resource Mappings rim: N/A
extension		0..*	Extension	There are no (further) constraints on this element Element id Observation.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. In order 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. Comments 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. Data type Extension Mappings rim: N/A
modifierExtension	?!	0..*	Extension	There are no (further) constraints on this element Element id Observation.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order 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. Comments 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. Data type Extension Mappings rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Observation.identifier Short description Business Identifier for observation Definition A unique identifier assigned to this observation. Requirements Allows observations to be distinguished and referenced. Data type Identifier Mappings workflow: Event.identifier v2: 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. rim: id w5: id
basedOn	Σ	0..*	Reference(CarePlan \| DeviceRequest \| ImmunizationRecommendation \| MedicationRequest \| NutritionOrder \| ProcedureRequest \| ReferralRequest)	There are no (further) constraints on this element Element id Observation.basedOn Short description Fulfills plan, proposal or order Alternate names Fulfills Definition A plan, proposal or order that is fulfilled in whole or in part by this event. Requirements Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon. Data type Reference(CarePlan \| DeviceRequest \| ImmunizationRecommendation \| MedicationRequest \| NutritionOrder \| ProcedureRequest \| ReferralRequest) Mappings workflow: Event.basedOn v2: ORC rim: .outboundRelationship[typeCode=FLFS].target
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id Observation.status Short description registered \| preliminary \| final \| amended + Definition The status of the result value. Requirements Need to track the status of individual results. Some results are finalized before the whole report is finalized. Comments This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding Codes providing the status of an observation. ?? (required) Mappings workflow: Event.status sct-concept: < 445584004 \|Report by finality status\| v2: OBX-11 rim: status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of "revise" w5: status
category		0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id Observation.category Short description Classification of type of observation Definition A code that classifies the general type of observation being made. Requirements Used for filtering what observations are retrieved and displayed. Comments In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set. Data type CodeableConcept Binding Codes for high level observation categories. ?? (preferred) Mappings rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code w5: class
code	S Σ	1..1	CodeableConceptPattern	Element id Observation.code Short description Triglyceride Alternate names Name Definition Triglyceride. Requirements Knowing what kind of observation is being made is essential to understanding the observation. Data type CodeableConcept Binding Codes identifying names of simple observations. ?? (example) Pattern { "coding": [ { "system": "http://loinc.org", "code": "35217-9" } ] } Mappings workflow: Event.code sct-concept: < 363787002 \|Observable entity\| OR < 386053000 \|Evaluation procedure\| v2: OBX-3 rim: code sct-attr: 116680003 \|Is a\| w5: what
subject	Σ	0..1	Reference(Patient \| Group \| Device \| Location)	There are no (further) constraints on this element Element id Observation.subject Short description Who and/or what this is about Definition The patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed. Comments: Indirect characteristics may be those of a specimen, fetus, donor, other observer (for example a relative or EMT), or any observation made about the subject. Requirements Observations have no value if you don't know who or what they're about. Comments 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. If the target of the observation is different than the subject, the general extension observation-focal-subject. may be used. However, the distinction between the patient's own value for an observation versus that of the fetus, or the donor or blood product unit, etc., are often specified in the observation code. Data type Reference(Patient \| Group \| Device \| Location) Mappings workflow: Event.subject v2: PID-3 rim: participation[typeCode=SBJ] w5: who.focus
context		0..1	Reference(Encounter \| EpisodeOfCare)	There are no (further) constraints on this element Element id Observation.context Short description Healthcare event during which this observation is made Alternate names Encounter Definition The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made. Requirements For some observations it may be important to know the link between an observation and a particular encounter. Comments 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 or episode but still be tied to the context of the encounter or episode (e.g. pre-admission lab tests). Data type Reference(Encounter \| EpisodeOfCare) Mappings workflow: Event.context v2: PV1 rim: inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN] w5: context
effective[x]	Σ	0..1		There are no (further) constraints on this element Element id Observation.effective[x] Short description Clinically relevant time/time-period for observation Alternate names Occurrence Definition The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself. Requirements Knowing when an observation was deemed true is important to its relevance as well as determining trends. Comments At least a date should be present unless this observation is a historical report. Mappings workflow: Event.occurrence[x] v2: OBX-14, and/or OBX-19 after v2.4 (depends on who observation made) rim: effectiveTime w5: when.done
effectiveDateTime			dateTime	There are no (further) constraints on this element Data type dateTime
effectivePeriod			Period	There are no (further) constraints on this element Data type Period
issued	Σ	0..1	instant	There are no (further) constraints on this element Element id Observation.issued Short description Date/Time this was made available Definition The date and time this observation was made available to providers, typically after the results have been reviewed and verified. Comments Updated when the result is updated. Data type instant Mappings v2: OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made) rim: participation[typeCode=AUT].time w5: when.recorded
performer	Σ	0..*	Reference(Practitioner \| Organization \| Patient \| RelatedPerson)	There are no (further) constraints on this element Element id Observation.performer Short description Who is responsible for the observation Definition Who was responsible for asserting the observed value as "true". Requirements May give a degree of confidence in the observation and also indicates where follow-up questions should be directed. Data type Reference(Practitioner \| Organization \| Patient \| RelatedPerson) Mappings workflow: Event.performer v2: 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' rim: participation[typeCode=PRF] w5: who.actor
valueQuantity	S Σ I	0..1	Quantity	Element id Observation.valueQuantity Short description Triglyceride value Definition Triglyceride value. If a result is not available, use the comments field. Requirements An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations. Comments Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type). If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples see the notes section below. Data type Quantity Mappings workflow: Event.notDone, Event.notDoneReason (maps to valeu[x] or dataAbsentReason) sct-concept: < 441742003 \|Evaluation finding\| v2: OBX.2, OBX.5, OBX.6 rim: value sct-attr: 363714003 \|Interprets\|
dataAbsentReason	I	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Observation.dataAbsentReason Short description Why the result is missing Definition Provides a reason why the expected value in the element Observation.value[x] is missing. Requirements For many results it is necessary to handle exceptional values in measurements. Comments 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 "specimen unsatisfactory". 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. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values. Data type CodeableConcept Binding Codes specifying why the result (Observation.value[x]) is missing. ?? (extensible) Mappings workflow: Event.notDone, Event.notDoneReason (maps to valeu[x] or dataAbsentReason) v2: N/A rim: value.nullFlavor
interpretation	S	0..1	CodeableConceptBinding	Element id Observation.interpretation Short description + \| ++ \| +++ \| - \| -- \| --- Alternate names Abnormal Flag Definition \| ++ \| +++ \| - \| -- \| ---. Requirements For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result. Data type CodeableConcept Binding Codes identifying interpretations of observations. ?? (extensible) Mappings sct-concept: < 260245000 \|Findings values\| v2: OBX-8 rim: interpretationCode sct-attr: 363713009 \|Has interpretation\|
comment	S	0..1	string	Element id Observation.comment Short description Comments about result Definition Comments about result. Requirements Need to be able to provide free text additional information. Data type string Mappings workflow: Event.note v2: NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX) rim: subjectOf.observationEvent[code="annotation"].value
bodySite		0..1	CodeableConcept	There are no (further) constraints on this element Element id Observation.bodySite Short description Observed body part Definition Indicates the site on the subject's body where the observation was made (i.e. the target site). Comments 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 body-site-instance. Data type CodeableConcept Binding Codes describing anatomical locations. May include laterality. ?? (example) Mappings sct-concept: < 123037004 \|Body structure\| v2: OBX-20 rim: targetSiteCode sct-attr: 718497002 \|Inherent location\|
method		0..1	CodeableConcept	There are no (further) constraints on this element Element id Observation.method Short description How it was done Definition Indicates the mechanism used to perform the observation. Requirements In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results. Comments Only used if not implicit in code for Observation.code. Data type CodeableConcept Binding Methods for simple observations. ?? (example) Mappings v2: OBX-17 rim: methodCode
specimen		0..1	Reference(Specimen)	There are no (further) constraints on this element Element id Observation.specimen Short description Specimen used for this observation Definition The specimen that was used when this observation was made. Comments Should only be used if not implicit in code found in `Observation.code`. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report). Data type Reference(Specimen) Mappings sct-concept: < 123038009 \|Specimen\| v2: SPM segment rim: participation[typeCode=SPC].specimen sct-attr: 704319004 \|Inherent in\|
device		0..1	Reference(Device \| DeviceMetric)	There are no (further) constraints on this element Element id Observation.device Short description (Measurement) Device Definition The device used to generate the observation data. Comments An extension should be used if further typing of the device is needed. Devices used to support obtaining an observation can be represented using either an extension or through the Observation.related element. Data type Reference(Device \| DeviceMetric) Mappings sct-concept: < 49062001 \|Device\| v2: OBX-17 / PRT -10 rim: participation[typeCode=DEV] sct-attr: 424226004 \|Using device\|
referenceRange	S I	1..1	BackboneElement	There are no (further) constraints on this element Element id Observation.referenceRange Short description Provides guide for interpretation Definition Guidance on how to interpret the value by comparison to a normal or recommended range. Requirements Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts. Comments 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 may 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. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `children().count() > id.count()` obs-3: Must have at least a low or a high or text `low.exists() or high.exists() or text.exists()` Mappings v2: OBX.7 rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
id		0..1	string	There are no (further) constraints on this element Element id Observation.referenceRange.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension		0..*	Extension	There are no (further) constraints on this element Element id Observation.referenceRange.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order 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. Comments 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. Data type Extension Mappings rim: n/a
modifierExtension	Σ ?!	0..*	Extension	There are no (further) constraints on this element Element id Observation.referenceRange.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order 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. Comments 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. Data type Extension Mappings rim: N/A
low	I	0..0	http://hl7.org/fhir/StructureDefinition/SimpleQuantity	There are no (further) constraints on this element Element id Observation.referenceRange.low Short description Low Range, if relevant Definition The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3). Data type http://hl7.org/fhir/StructureDefinition/SimpleQuantity Mappings v2: OBX-7 rim: value:IVL_PQ.low
high	I	1..1	http://hl7.org/fhir/StructureDefinition/SimpleQuantity	Element id Observation.referenceRange.high Short description High Range, if relevant Definition The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3). Requirements <2.0 mmol/L. Comments Per Australian NHF Recommendations. Data type http://hl7.org/fhir/StructureDefinition/SimpleQuantity Mappings v2: OBX-7 rim: value:IVL_PQ.high
type		0..0	CodeableConceptBinding	There are no (further) constraints on this element Element id Observation.referenceRange.type Short description Reference range qualifier Definition Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range. Requirements Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc, - for proper interpretation. Comments This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed. Data type CodeableConcept Binding Code for the meaning of a reference range. ?? (extensible) Mappings sct-concept: < 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\| v2: OBX-10 rim: interpretationCode
appliesTo		0..0	CodeableConcept	There are no (further) constraints on this element Element id Observation.referenceRange.appliesTo Short description Reference range population Definition Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Requirements Need to be able to identify the target population for proper interpretation. Comments This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed. Data type CodeableConcept Binding Codes identifying the population the reference range applies to. ?? (example) Mappings sct-concept: < 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\| v2: OBX-10 rim: interpretationCode
age		0..0	Range	There are no (further) constraints on this element Element id Observation.referenceRange.age Short description Applicable age range, if relevant Definition The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so. Requirements Some analytes vary greatly over age. Data type Range Mappings rim: outboundRelationship[typeCode=PRCN].targetObservationCriterion[code="age"].value
text		0..1	string	There are no (further) constraints on this element Element id Observation.referenceRange.text Short description Text based reference range in an observation Definition Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of 'normals'. Data type string Mappings v2: OBX-7 rim: value:ST
related	Σ	0..0	BackboneElement	There are no (further) constraints on this element Element id Observation.related Short description Resource related to this observation Definition A reference to another resource (usually another Observation) whose relationship is defined by the relationship type code. Requirements Normally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and a set of related observations or sometimes a QuestionnaireResponse from which the measure is derived. Comments For a discussion on the ways Observations can assembled in groups together see Notes below. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `children().count() > id.count()` Mappings v2: Relationships established by OBX-4 usage rim: outBoundRelationship
component	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element id Observation.component Short description Component results Definition Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations. Requirements Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation. Comments For a discussion on the ways Observations can be assembled in groups together see Notes below. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `children().count() > id.count()` Mappings v2: containment by OBX-4? rim: outBoundRelationship[typeCode=COMP]
id		0..1	string	There are no (further) constraints on this element Element id Observation.component.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension		0..*	Extension	There are no (further) constraints on this element Element id Observation.component.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order 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. Comments 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. Data type Extension Mappings rim: n/a
modifierExtension	Σ ?!	0..*	Extension	There are no (further) constraints on this element Element id Observation.component.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order 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. Comments 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. Data type Extension Mappings rim: N/A
code	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element id Observation.component.code Short description Type of component observation (code / type) Definition Describes what was observed. Sometimes this is called the observation "code". Requirements Knowing what kind of observation is being made is essential to understanding the observation. Data type CodeableConcept Binding Codes identifying names of simple observations. ?? (example) Mappings sct-concept: < 363787002 \|Observable entity\| OR < 386053000 \|Evaluation procedure\| v2: OBX-3 rim: code w5: what
value[x]	Σ	0..1		There are no (further) constraints on this element Element id Observation.component.value[x] Short description Actual component result Definition The information determined as a result of making the observation, if the information has a simple value. Requirements An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations. Comments Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is 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 boolean values use valueCodeableConcept and select codes from http://hl7.org/fhir/ValueSet/v2-0136 (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type). Mappings sct-concept: 363714003 \|Interprets\| < 441742003 \|Evaluation finding\| v2: OBX.2, OBX.5, OBX.6 rim: value sct-attr: 363714003 \|Interprets\|
valueQuantity			Quantity	There are no (further) constraints on this element Data type Quantity
valueCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
valueString			string	There are no (further) constraints on this element Data type string
valueRange			Range	There are no (further) constraints on this element Data type Range
valueRatio			Ratio	There are no (further) constraints on this element Data type Ratio
valueSampledData			SampledData	There are no (further) constraints on this element Data type SampledData
valueAttachment			Attachment	There are no (further) constraints on this element Data type Attachment
valueTime			time	There are no (further) constraints on this element Data type time
valueDateTime			dateTime	There are no (further) constraints on this element Data type dateTime
valuePeriod			Period	There are no (further) constraints on this element Data type Period
dataAbsentReason	I	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Observation.component.dataAbsentReason Short description Why the component result is missing Definition Provides a reason why the expected value in the element Observation.value[x] is missing. Requirements For many results it is necessary to handle exceptional values in measurements. Comments "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. Data type CodeableConcept Binding Codes specifying why the result (Observation.value[x]) is missing. ?? (extensible) Mappings v2: N/A rim: value.nullFlavor
interpretation		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Observation.component.interpretation Short description High, low, normal, etc. Alternate names Abnormal Flag Definition The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag. Requirements For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result. Comments The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element. Data type CodeableConcept Binding Codes identifying interpretations of observations. ?? (extensible) Mappings sct-concept: < 260245000 \|Findings values\| v2: OBX-8 rim: interpretationCode sct-attr: 363713009 \|Has interpretation\|
referenceRange		0..*	see (referenceRange)	There are no (further) constraints on this element Element id Observation.component.referenceRange Short description Provides guide for interpretation of component result Definition Guidance on how to interpret the value by comparison to a normal or recommended range. Requirements Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts. Comments 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 may 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. Mappings v2: OBX.7 rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]

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Last updated on 7/10/2017, 2:40:09 PM

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