Canonical url | https://fake-acme.org/fhir/StructureDefinition/ACME-base-smoking-status |
Version | 1.0.0 |
Published by | Example, blamethem@fake-acme.org |
Status | active (since 2019-09-13) |
This Structure Definition defines the required elements and constraints on the Observation
resource that is derived from US Core Smoking Status Profile.
This is my profile:
ACME Base Smoking Status Profile (Observation) | I | US Core Smoking Status Observation Profile | There are no (further) constraints on this element Element idObservation US Core Smoking Status Observation Profile Alternate namesVital Signs, Measurement, Results, Tests, Obs DefinitionThe US Core Smoking Status Observation Profile is based upon the core FHIR Observation Resource and created to meet the 2015 Edition Common Clinical Data Set 'Smoking status' requirements. 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. US Core Smoking Status Observation Profile Constraints
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id | Σ | 0..1 | id | There are no (further) constraints on this element Element idObservation.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
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meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idObservation.meta Metadata about the resource DefinitionThe 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.
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idObservation.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. 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.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.language Language of the resource content DefinitionThe base language in which the resource is written. 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). A human language. Common Languages (extensible)Constraints
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text | I | 0..1 | Narrative | There are no (further) constraints on this element Element idObservation.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA 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. 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.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idObservation.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese 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. 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.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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identifier | Σ | 1..* | Identifier | Element idObservation.identifier Business Identifier for observation DefinitionA unique identifier assigned to this observation. Allows observations to be distinguished and referenced. Unordered, Open, by system(Value) Constraints
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acmeIdentifier | Σ | 1..1 | Identifier | There are no (further) constraints on this element Element idObservation.identifier:acmeIdentifier Business Identifier for observation DefinitionA unique identifier assigned to this observation. Allows observations to be distinguished and referenced.
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.identifier:acmeIdentifier.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.identifier:acmeIdentifier.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.identifier:acmeIdentifier.use usual | official | temp | secondary (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Identifies the purpose for this identifier, if known . IdentifierUse (required)Constraints
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type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.identifier:acmeIdentifier.type Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Allows users to make use of identifiers when the identifier system is not known. This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible)Constraints
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system | Σ | 0..1 | uriFixed Value | Element idObservation.identifier:acmeIdentifier.system The namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique. There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. see http://en.wikipedia.org/wiki/Uniform_resource_identifier
https://fake-acme.org/fhir/randomidentifier
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value | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.identifier:acmeIdentifier.value The value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system. If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.
General 123456 Mappings
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period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idObservation.identifier:acmeIdentifier.period Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
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assigner | Σ I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idObservation.identifier:acmeIdentifier.assigner Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
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basedOn | Σ I | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest) | There are no (further) constraints on this element Element idObservation.basedOn Fulfills plan, proposal or order Alternate namesFulfills DefinitionA plan, proposal or order that is fulfilled in whole or in part by this event. Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon. 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. Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest) Constraints
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status | S Σ | 1..1 | codeBinding | There are no (further) constraints on this element Element idObservation.status registered | preliminary | final | amended + DefinitionThe status of the result value. Need to track the status of individual results. Some results are finalized before the whole report is finalized. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Codes providing the status of an observation. ObservationStatus (required)Constraints
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category | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.category Classification of type of observation DefinitionA code that classifies the general type of observation being made. Used for filtering what observations are retrieved and displayed. 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. Codes for high level observation categories. Observation Category Codes (preferred)Constraints
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code | S Σ | 1..1 | CodeableConceptPattern | There are no (further) constraints on this element Element idObservation.code Smoking Status: LOINC 72166-2 = Tobacco smoking status NHIS Alternate namesName DefinitionSmoking Status: Limited to fixed LOINC value 72166-2 = Tobacco smoking status NHIS. Knowing what kind of observation is being made is essential to understanding the observation. 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. Codes identifying names of simple observations. LOINC Codes (example)Constraints
{ "coding": [ { "system": "http://loinc.org", "code": "72166-2" } ] }
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subject | S Σ I | 1..1 | Reference(US Core Patient Profile) | There are no (further) constraints on this element Element idObservation.subject Who and/or what this is about DefinitionThe 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. Observations have no value if you don't know who or what they're about. 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. Reference(US Core Patient Profile) Constraints
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context | I | 0..1 | Reference(Encounter | EpisodeOfCare) | There are no (further) constraints on this element Element idObservation.context Healthcare event during which this observation is made Alternate namesEncounter DefinitionThe healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made. For some observations it may be important to know the link between an observation and a particular encounter. 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). Reference(Encounter | EpisodeOfCare) Constraints
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effective[x] | Σ | 0..1 | There are no (further) constraints on this element Element idObservation.effective[x] Clinically relevant time/time-period for observation Alternate namesOccurrence DefinitionThe 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. Knowing when an observation was deemed true is important to its relevance as well as determining trends. At least a date should be present unless this observation is a historical report.
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effectiveDateTime | dateTime | There are no (further) constraints on this element Data type | ||
effectivePeriod | Period | There are no (further) constraints on this element Data type | ||
issued | S Σ | 1..1 | instant | There are no (further) constraints on this element Element idObservation.issued Date/Time this was made available DefinitionThe date and time this observation was made available to providers, typically after the results have been reviewed and verified. Updated when the result is updated.
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performer | Σ I | 0..* | Reference(Practitioner | Organization | Patient | RelatedPerson) | There are no (further) constraints on this element Element idObservation.performer Who is responsible for the observation DefinitionWho was responsible for asserting the observed value as "true". May give a degree of confidence in the observation and also indicates where follow-up questions should be directed. 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. Reference(Practitioner | Organization | Patient | RelatedPerson) Constraints
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valueCodeableConcept | S Σ I | 1..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.valueCodeableConcept:valueCodeableConcept Coded Responses from Smoking Status Value Set DefinitionThe information determined as a result of making the observation, if the information has a simple value. An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations. 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. This value set indicates the current smoking status of a patient Smoking Status (extensible)Constraints
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dataAbsentReason | I | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.dataAbsentReason Why the result is missing DefinitionProvides a reason why the expected value in the element Observation.value[x] is missing. For many results it is necessary to handle exceptional values in measurements. 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. Codes specifying why the result (Observation.value[x]) is missing. Observation Value Absent Reason (extensible)Constraints
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interpretation | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.interpretation High, low, normal, etc. Alternate namesAbnormal Flag DefinitionThe 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. For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result. 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. Codes identifying interpretations of observations. Observation Interpretation Codes (extensible)Constraints
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comment | 0..1 | string | There are no (further) constraints on this element Element idObservation.comment Comments about result DefinitionMay include statements about significant, unexpected or unreliable values, or information about the source of the value where this may be relevant to the interpretation of the result. Need to be able to provide free text additional information. Note that FHIR strings may not exceed 1MB in size
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bodySite | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.bodySite Observed body part DefinitionIndicates the site on the subject's body where the observation was made (i.e. the target site). 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. Codes describing anatomical locations. May include laterality. SNOMED CT Body Structures (example)Constraints
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method | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.method How it was done DefinitionIndicates the mechanism used to perform the observation. In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results. Only used if not implicit in code for Observation.code. Methods for simple observations. Observation Methods (example)Constraints
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specimen | I | 0..1 | Reference(Specimen) | There are no (further) constraints on this element Element idObservation.specimen Specimen used for this observation DefinitionThe specimen that was used when this observation was made. Should only be used if not implicit in code found in
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device | I | 0..1 | Reference(Device | DeviceMetric) | There are no (further) constraints on this element Element idObservation.device (Measurement) Device DefinitionThe device used to generate the observation data. 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. Reference(Device | DeviceMetric) Constraints
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referenceRange | I | 0..* | BackboneElement | There are no (further) constraints on this element Element idObservation.referenceRange Provides guide for interpretation DefinitionGuidance on how to interpret the value by comparison to a normal or recommended range. 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. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.referenceRange.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.referenceRange.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.referenceRange.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay 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. 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.
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low | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idObservation.referenceRange.low Low Range, if relevant DefinitionThe 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). 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.
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high | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idObservation.referenceRange.high High Range, if relevant DefinitionThe 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). 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.
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type | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.referenceRange.type Reference range qualifier DefinitionCodes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range. Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc, - for proper interpretation. This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed. Code for the meaning of a reference range. Observation Reference Range Meaning Codes (extensible)Constraints
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appliesTo | 0..* | CodeableConcept | There are no (further) constraints on this element Element idObservation.referenceRange.appliesTo Reference range population DefinitionCodes 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. Need to be able to identify the target population for proper interpretation. This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed. Codes identifying the population the reference range applies to. Observation Reference Range Applies To Codes (example)Constraints
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age | I | 0..1 | Range | There are no (further) constraints on this element Element idObservation.referenceRange.age Applicable age range, if relevant DefinitionThe 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. Some analytes vary greatly over age. 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.
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text | 0..1 | string | There are no (further) constraints on this element Element idObservation.referenceRange.text Text based reference range in an observation DefinitionText 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'. Note that FHIR strings may not exceed 1MB in size
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related | Σ | 0..* | BackboneElement | There are no (further) constraints on this element Element idObservation.related Resource related to this observation DefinitionA reference to another resource (usually another Observation) whose relationship is defined by the relationship type code. 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. For a discussion on the ways Observations can assembled in groups together see Notes below.
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.related.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.related.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.related.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay 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. 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.
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type | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.related.type has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by DefinitionA code specifying the kind of relationship that exists with the target resource. A relationship type SHOULD be provided. The "derived-from" type is the only logical choice when referencing the QuestionnaireAnswer resource. Codes specifying how two observations are related. ObservationRelationshipType (required)Constraints
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target | I | 1..1 | Reference(Observation | QuestionnaireResponse | Sequence) | There are no (further) constraints on this element Element idObservation.related.target Resource that is related to this one DefinitionA reference to the observation or QuestionnaireResponse resource that is related to this observation. 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. Reference(Observation | QuestionnaireResponse | Sequence) Constraints
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component | Σ | 0..* | BackboneElement | There are no (further) constraints on this element Element idObservation.component Component results DefinitionSome 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. 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. For a discussion on the ways Observations can be assembled in groups together see Notes below.
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay 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. 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.
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code | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.component.code Type of component observation (code / type) DefinitionDescribes what was observed. Sometimes this is called the observation "code". Knowing what kind of observation is being made is essential to understanding the observation. 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. Codes identifying names of simple observations. LOINC Codes (example)Constraints
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value[x] | Σ | 0..1 | There are no (further) constraints on this element Element idObservation.component.value[x] Actual component result DefinitionThe information determined as a result of making the observation, if the information has a simple value. An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations. 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).
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valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueRange | Range | There are no (further) constraints on this element Data type | ||
valueRatio | Ratio | There are no (further) constraints on this element Data type | ||
valueSampledData | SampledData | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueTime | time | There are no (further) constraints on this element Data type | ||
valueDateTime | dateTime | There are no (further) constraints on this element Data type | ||
valuePeriod | Period | There are no (further) constraints on this element Data type | ||
dataAbsentReason | I | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component.dataAbsentReason Why the component result is missing DefinitionProvides a reason why the expected value in the element Observation.value[x] is missing. For many results it is necessary to handle exceptional values in measurements. "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. Codes specifying why the result (Observation.value[x]) is missing. Observation Value Absent Reason (extensible)Constraints
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interpretation | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component.interpretation High, low, normal, etc. Alternate namesAbnormal Flag DefinitionThe 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. For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result. The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element. Codes identifying interpretations of observations. Observation Interpretation Codes (extensible)Constraints
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referenceRange | 0..* | see (referenceRange) | There are no (further) constraints on this element Element idObservation.component.referenceRange Provides guide for interpretation of component result DefinitionGuidance on how to interpret the value by comparison to a normal or recommended range. 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. 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.
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Based on the US Core Smoking Status:
US Core Smoking Status Observation Profile (Observation) | I | Observation | Element idObservation US Core Smoking Status Observation Profile Alternate namesVital Signs, Measurement, Results, Tests, Obs DefinitionThe US Core Smoking Status Observation Profile is based upon the core FHIR Observation Resource and created to meet the 2015 Edition Common Clinical Data Set 'Smoking status' requirements. 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.
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id | Σ | 0..1 | id | There are no (further) constraints on this element Element idObservation.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
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meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idObservation.meta Metadata about the resource DefinitionThe 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.
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idObservation.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. 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.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.language Language of the resource content DefinitionThe base language in which the resource is written. 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). A human language. Common Languages (extensible)Constraints
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text | I | 0..1 | Narrative | There are no (further) constraints on this element Element idObservation.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA 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. 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.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idObservation.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese 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. 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.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idObservation.identifier Business Identifier for observation DefinitionA unique identifier assigned to this observation. Allows observations to be distinguished and referenced.
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basedOn | Σ I | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest) | There are no (further) constraints on this element Element idObservation.basedOn Fulfills plan, proposal or order Alternate namesFulfills DefinitionA plan, proposal or order that is fulfilled in whole or in part by this event. Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon. 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. Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest) Constraints
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status | S Σ | 1..1 | codeBinding | Element idObservation.status registered | preliminary | final | amended + DefinitionThe status of the result value. Need to track the status of individual results. Some results are finalized before the whole report is finalized. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Codes providing the status of an observation. ObservationStatus (required)Constraints
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category | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.category Classification of type of observation DefinitionA code that classifies the general type of observation being made. Used for filtering what observations are retrieved and displayed. 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. Codes for high level observation categories. Observation Category Codes (preferred)Constraints
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code | S Σ | 1..1 | CodeableConceptPattern | Element idObservation.code Smoking Status: LOINC 72166-2 = Tobacco smoking status NHIS Alternate namesName DefinitionSmoking Status: Limited to fixed LOINC value 72166-2 = Tobacco smoking status NHIS. Knowing what kind of observation is being made is essential to understanding the observation. 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. Codes identifying names of simple observations. LOINC Codes (example)Constraints
{ "coding": [ { "system": "http://loinc.org", "code": "72166-2" } ] }
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subject | S Σ I | 1..1 | Reference(US Core Patient Profile) | Element idObservation.subject Who and/or what this is about DefinitionThe 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. Observations have no value if you don't know who or what they're about. 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. Reference(US Core Patient Profile) Constraints
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context | I | 0..1 | Reference(Encounter | EpisodeOfCare) | There are no (further) constraints on this element Element idObservation.context Healthcare event during which this observation is made Alternate namesEncounter DefinitionThe healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made. For some observations it may be important to know the link between an observation and a particular encounter. 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). Reference(Encounter | EpisodeOfCare) Constraints
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effective[x] | Σ | 0..1 | There are no (further) constraints on this element Element idObservation.effective[x] Clinically relevant time/time-period for observation Alternate namesOccurrence DefinitionThe 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. Knowing when an observation was deemed true is important to its relevance as well as determining trends. At least a date should be present unless this observation is a historical report.
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effectiveDateTime | dateTime | There are no (further) constraints on this element Data type | ||
effectivePeriod | Period | There are no (further) constraints on this element Data type | ||
issued | S Σ | 1..1 | instant | Element idObservation.issued Date/Time this was made available DefinitionThe date and time this observation was made available to providers, typically after the results have been reviewed and verified. Updated when the result is updated.
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performer | Σ I | 0..* | Reference(Practitioner | Organization | Patient | RelatedPerson) | There are no (further) constraints on this element Element idObservation.performer Who is responsible for the observation DefinitionWho was responsible for asserting the observed value as "true". May give a degree of confidence in the observation and also indicates where follow-up questions should be directed. 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. Reference(Practitioner | Organization | Patient | RelatedPerson) Constraints
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valueCodeableConcept | S Σ I | 1..1 | CodeableConceptBinding | Element idObservation.valueCodeableConcept Coded Responses from Smoking Status Value Set DefinitionThe information determined as a result of making the observation, if the information has a simple value. An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations. 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. This value set indicates the current smoking status of a patient Smoking Status (extensible)Constraints
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dataAbsentReason | I | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.dataAbsentReason Why the result is missing DefinitionProvides a reason why the expected value in the element Observation.value[x] is missing. For many results it is necessary to handle exceptional values in measurements. 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. Codes specifying why the result (Observation.value[x]) is missing. Observation Value Absent Reason (extensible)Constraints
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interpretation | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.interpretation High, low, normal, etc. Alternate namesAbnormal Flag DefinitionThe 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. For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result. 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. Codes identifying interpretations of observations. Observation Interpretation Codes (extensible)Constraints
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comment | 0..1 | string | There are no (further) constraints on this element Element idObservation.comment Comments about result DefinitionMay include statements about significant, unexpected or unreliable values, or information about the source of the value where this may be relevant to the interpretation of the result. Need to be able to provide free text additional information. Note that FHIR strings may not exceed 1MB in size
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bodySite | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.bodySite Observed body part DefinitionIndicates the site on the subject's body where the observation was made (i.e. the target site). 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. Codes describing anatomical locations. May include laterality. SNOMED CT Body Structures (example)Constraints
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method | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.method How it was done DefinitionIndicates the mechanism used to perform the observation. In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results. Only used if not implicit in code for Observation.code. Methods for simple observations. Observation Methods (example)Constraints
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specimen | I | 0..1 | Reference(Specimen) | There are no (further) constraints on this element Element idObservation.specimen Specimen used for this observation DefinitionThe specimen that was used when this observation was made. Should only be used if not implicit in code found in
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device | I | 0..1 | Reference(Device | DeviceMetric) | There are no (further) constraints on this element Element idObservation.device (Measurement) Device DefinitionThe device used to generate the observation data. 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. Reference(Device | DeviceMetric) Constraints
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referenceRange | I | 0..* | BackboneElement | There are no (further) constraints on this element Element idObservation.referenceRange Provides guide for interpretation DefinitionGuidance on how to interpret the value by comparison to a normal or recommended range. 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. 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.
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.referenceRange.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.referenceRange.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.referenceRange.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay 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. 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.
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low | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idObservation.referenceRange.low Low Range, if relevant DefinitionThe 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). 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.
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high | I | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idObservation.referenceRange.high High Range, if relevant DefinitionThe 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). 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.
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type | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.referenceRange.type Reference range qualifier DefinitionCodes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range. Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc, - for proper interpretation. This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed. Code for the meaning of a reference range. Observation Reference Range Meaning Codes (extensible)Constraints
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appliesTo | 0..* | CodeableConcept | There are no (further) constraints on this element Element idObservation.referenceRange.appliesTo Reference range population DefinitionCodes 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. Need to be able to identify the target population for proper interpretation. This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed. Codes identifying the population the reference range applies to. Observation Reference Range Applies To Codes (example)Constraints
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age | I | 0..1 | Range | There are no (further) constraints on this element Element idObservation.referenceRange.age Applicable age range, if relevant DefinitionThe 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. Some analytes vary greatly over age. 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.
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text | 0..1 | string | There are no (further) constraints on this element Element idObservation.referenceRange.text Text based reference range in an observation DefinitionText 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'. Note that FHIR strings may not exceed 1MB in size
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related | Σ | 0..* | BackboneElement | There are no (further) constraints on this element Element idObservation.related Resource related to this observation DefinitionA reference to another resource (usually another Observation) whose relationship is defined by the relationship type code. 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. For a discussion on the ways Observations can assembled in groups together see Notes below.
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.related.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.related.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.related.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay 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. 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.
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type | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.related.type has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by DefinitionA code specifying the kind of relationship that exists with the target resource. A relationship type SHOULD be provided. The "derived-from" type is the only logical choice when referencing the QuestionnaireAnswer resource. Codes specifying how two observations are related. ObservationRelationshipType (required)Constraints
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target | I | 1..1 | Reference(Observation | QuestionnaireResponse | Sequence) | There are no (further) constraints on this element Element idObservation.related.target Resource that is related to this one DefinitionA reference to the observation or QuestionnaireResponse resource that is related to this observation. 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. Reference(Observation | QuestionnaireResponse | Sequence) Constraints
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component | Σ | 0..* | BackboneElement | There are no (further) constraints on this element Element idObservation.component Component results DefinitionSome 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. 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. For a discussion on the ways Observations can be assembled in groups together see Notes below.
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay 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. 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.
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code | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.component.code Type of component observation (code / type) DefinitionDescribes what was observed. Sometimes this is called the observation "code". Knowing what kind of observation is being made is essential to understanding the observation. 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. Codes identifying names of simple observations. LOINC Codes (example)Constraints
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value[x] | Σ | 0..1 | There are no (further) constraints on this element Element idObservation.component.value[x] Actual component result DefinitionThe information determined as a result of making the observation, if the information has a simple value. An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations. 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).
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valueQuantity | Quantity | There are no (further) constraints on this element Data type | ||
valueCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||
valueString | string | There are no (further) constraints on this element Data type | ||
valueRange | Range | There are no (further) constraints on this element Data type | ||
valueRatio | Ratio | There are no (further) constraints on this element Data type | ||
valueSampledData | SampledData | There are no (further) constraints on this element Data type | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type | ||
valueTime | time | There are no (further) constraints on this element Data type | ||
valueDateTime | dateTime | There are no (further) constraints on this element Data type | ||
valuePeriod | Period | There are no (further) constraints on this element Data type | ||
dataAbsentReason | I | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component.dataAbsentReason Why the component result is missing DefinitionProvides a reason why the expected value in the element Observation.value[x] is missing. For many results it is necessary to handle exceptional values in measurements. "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. Codes specifying why the result (Observation.value[x]) is missing. Observation Value Absent Reason (extensible)Constraints
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interpretation | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component.interpretation High, low, normal, etc. Alternate namesAbnormal Flag DefinitionThe 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. For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result. The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element. Codes identifying interpretations of observations. Observation Interpretation Codes (extensible)Constraints
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referenceRange | 0..* | see (referenceRange) | There are no (further) constraints on this element Element idObservation.component.referenceRange Provides guide for interpretation of component result DefinitionGuidance on how to interpret the value by comparison to a normal or recommended range. 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. 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.
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{ "resourceType": "Observation", "id": "some-day-smoker", "meta": { "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus" ] }, "identifier": [ { "system": "https://fake-acme.org/fhir/randomidentifier", "value": "28a7886b-4e45-4087-8351-ee3f59dbe3d0" } ], "status": "final", "category": [ { "coding": [ { "system": "http://hl7.org/fhir/observation-category", "code": "social-history", "display": "Social History" } ], "text": "Social History" } ], "code": { "coding": [ { "system": "http://loinc.org", "code": "72166-2", "display": "Tobacco smoking status NHIS" } ], "text": "Tobacco smoking status NHIS" }, "subject": { "reference": "Patient/example", "display": "Amy Shaw" }, "issued": "2016-03-18T05:27:04Z", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "428041000124106" } ], "text": "Current some day smoker" } }
<Observation xmlns="http://hl7.org/fhir"> <id value="some-day-smoker" /> <meta> <profile value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus" /> </meta> <identifier> <system value="https://fake-acme.org/fhir/randomidentifier" /> <value value="28a7886b-4e45-4087-8351-ee3f59dbe3d0" /> </identifier> <status value="final" /> <category> <coding> <system value="http://hl7.org/fhir/observation-category" /> <code value="social-history" /> <display value="Social History" /> </coding> <text value="Social History" /> </category> <code> <coding> <system value="http://loinc.org" /> <code value="72166-2" /> <display value="Tobacco smoking status NHIS" /> </coding> <text value="Tobacco smoking status NHIS" /> </code> <subject> <reference value="Patient/example" /> <display value="Amy Shaw" /> </subject> <issued value="2016-03-18T05:27:04Z" /> <valueCodeableConcept> <coding> <system value="http://snomed.info/sct" /> <code value="428041000124106" /> </coding> <text value="Current some day smoker" /> </valueCodeableConcept> </Observation>
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