Observation (CA-Core)

ObservationCategoryCodes (preferred)

Binding

Codes for high level observation categories.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
w5: FiveWs.class
rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code

code

O Σ

1..1

Element id

Observation.code

Short description

Concept - reference to a terminology or just text

Alternate names

Name

Definition

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Requirements

Knowing what kind of observation is being made is essential to understanding the observation.

Comments

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.

Data type

Binding

Codes identifying names of simple observations.

LOINCCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
workflow: Event.code
w5: FiveWs.what[x]
sct-concept: < 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|
v2: OBX-3
rim: code
sct-attr: 116680003 |Is a|

Obligations

Code	Actor
MAY:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

subject

Σ C

0..1

Reference(LocationCACore | PatientCACore | Device | Group)

Element id

Observation.subject

Short description

Who and/or what the observation is about

Definition

The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the focus element or the code itself specifies the actual focus of the observation.

Requirements

Observations have no value if you don't know who or what they're about.

Comments

One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.

Data type

Reference(LocationCACore | PatientCACore | Device | Group)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.subject
w5: FiveWs.subject[x]
v2: PID-3
rim: participation[typeCode=RTGT]
w5: FiveWs.subject

focus

Σ C

0..*

Reference(Resource)

There are no (further) constraints on this element

Element id

Observation.focus

Short description

What the observation is about, when it is not about the subject of record

Definition

The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.

Comments

Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use specimen if a reference to a specimen is required. If a code is required instead of a resource use either bodysite for bodysites or the standard extension focusCode.

Data type

Reference(Resource)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.subject[x]
v2: OBX-3
rim: participation[typeCode=SBJ]
w5: FiveWs.subject

encounter

Σ C

0..1

Element id

Observation.encounter

Short description

Healthcare event during which this observation is made

Alternate names

Context

Definition

The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.

Requirements

For some observations it may be important to know the link between an observation and a particular encounter.

Comments

This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.context
w5: FiveWs.context
v2: PV1
rim: inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]

effective[x]

O Σ

0..1

Element id

Observation.effective[x]

Short description

Clinically relevant time/time-period for observation

Alternate names

Occurrence

Definition

The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.

Requirements

Knowing when an observation was deemed true is important to its relevance as well as determining trends.

Comments

At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
workflow: Event.occurrence[x]
w5: FiveWs.done[x]
v2: OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)
rim: effectiveTime

Obligations

Code	Actor
MAY:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

effectiveDateTime

There are no (further) constraints on this element

Data type

effectiveInstant

There are no (further) constraints on this element

Data type

effectivePeriod

There are no (further) constraints on this element

Data type

effectiveTiming

Timing

There are no (further) constraints on this element

Data type

Timing

issued

0..1

There are no (further) constraints on this element

Element id

Observation.issued

Short description

Date/Time this version was made available

Definition

The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.

Comments

For Observations that don’t require review and verification, it may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
w5: FiveWs.recorded
v2: OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)
rim: participation[typeCode=AUT].time

performer

Σ C

0..*

Element id

Observation.performer

Short description

Who is responsible for the observation

Definition

Who was responsible for asserting the observed value as "true".

Requirements

May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.performer.actor
w5: FiveWs.actor
v2: OBX.15 / (Practitioner) OBX-16, PRT-5:PRT-4='RO' / (Device) OBX-18 , PRT-10:PRT-4='EQUIP' / (Organization) OBX-23, PRT-8:PRT-4='PO'
rim: participation[typeCode=PRF]

value[x]

Σ C

0..1

There are no (further) constraints on this element

Element id

Observation.value[x]

Short description

Actual result

Definition

The information determined as a result of making the observation, if the information has a simple value.

Requirements

An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

Comments

An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1, obs-7

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
sct-concept: < 441742003 |Evaluation finding|
v2: OBX.2, OBX.5, OBX.6
rim: value
sct-attr: 363714003 |Interprets|

valueBoolean

There are no (further) constraints on this element

Data type

valueCodeableConcept

There are no (further) constraints on this element

Data type

valueDateTime

There are no (further) constraints on this element

Data type

valueInteger

There are no (further) constraints on this element

Data type

valuePeriod

There are no (further) constraints on this element

Data type

valueQuantity

There are no (further) constraints on this element

Data type

valueRange

There are no (further) constraints on this element

Data type

valueRatio

There are no (further) constraints on this element

Data type

valueSampledData

There are no (further) constraints on this element

Data type

valueString

There are no (further) constraints on this element

Data type

valueTime

There are no (further) constraints on this element

Data type

dataAbsentReason

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

Observation.dataAbsentReason

Short description

Why the result is missing

Definition

Provides a reason why the expected value in the element Observation.value[x] is missing.

Requirements

For many results it is necessary to handle exceptional values in measurements.

Comments

Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory".

The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.

Data type

Binding

Codes specifying why the result (`Observation.value[x]`) is missing.

DataAbsentReason (extensible)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1, obs-6

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
v2: N/A
rim: value.nullFlavor

interpretation

0..*

CodeableConceptBinding

There are no (further) constraints on this element

Element id

Observation.interpretation

Short description

High, low, normal, etc.

Alternate names

Abnormal Flag

Definition

A categorical assessment of an observation value. For example, high, low, normal.

Requirements

For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

Comments

Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

Data type

ObservationInterpretationCodes (extensible)

Binding

Codes identifying interpretations of observations.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
sct-concept: < 260245000 |Findings values|
v2: OBX-8
rim: interpretationCode
sct-attr: 363713009 |Has interpretation|

note

0..*

Annotation

There are no (further) constraints on this element

Element id

Observation.note

Short description

Comments about the observation

Definition

Comments about the observation or the results.

Requirements

Need to be able to provide free text additional information.

Comments

May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.

Data type

Annotation

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: N/A
rim: Act
v2: NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)
rim: subjectOf.observationEvent[code="annotation"].value

0..1

There are no (further) constraints on this element

Element id

Observation.note.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.note.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

author[x]

0..1

Element id

Observation.note.author[x]

Short description

Individual responsible for the annotation

Definition

The individual responsible for making the annotation.

Comments

Organization is used when there's no need for specific attribution as to who made the comment.

Slicing

Unordered, Open, by $this(Type)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: N/A
rim: Act.participant[typeCode=AUT].role

authorString

There are no (further) constraints on this element

Data type

authorReference

0..1

Reference(OrganizationCACore | PatientCACore | PractitionerCACore | RelatedPerson)

Element id

Observation.note.author[x]:authorReference

Short description

Individual responsible for the annotation

Definition

The individual responsible for making the annotation.

Comments

Organization is used when there's no need for specific attribution as to who made the comment.

Data type

Reference(OrganizationCACore | PatientCACore | PractitionerCACore | RelatedPerson)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: N/A
rim: Act.participant[typeCode=AUT].role

time

0..1

There are no (further) constraints on this element

Element id

Observation.note.time

Short description

When the annotation was made

Definition

Indicates when this particular annotation was made.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: N/A
rim: Act.effectiveTime

text

1..1

markdown

There are no (further) constraints on this element

Element id

Observation.note.text

Short description

The annotation - text content (as markdown)

Definition

The text of the annotation in markdown format.

Comments

Systems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/

Data type

markdown

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: N/A
rim: Act.text

bodySite

0..1

There are no (further) constraints on this element

Element id

Observation.bodySite

Short description

Observed body part

Definition

Indicates the site on the subject's body where the observation was made (i.e. the target site).

Comments

Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component.

If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite.

Data type

SNOMEDCTBodyStructures (example)

Binding

Codes describing anatomical locations. May include laterality.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
sct-concept: < 123037004 |Body structure|
v2: OBX-20
rim: targetSiteCode
sct-attr: 718497002 |Inherent location|

method

0..1

There are no (further) constraints on this element

Element id

Observation.method

Short description

How it was done

Definition

Indicates the mechanism used to perform the observation.

Requirements

In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.

Comments

Only used if not implicit in code for Observation.code.

Data type

Binding

Methods for simple observations.

ObservationMethods (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
v2: OBX-17
rim: methodCode

specimen

0..1

Reference(Specimen)

There are no (further) constraints on this element

Element id

Observation.specimen

Short description

Specimen used for this observation

Definition

The specimen that was used when this observation was made.

Comments

Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).

Data type

Reference(Specimen)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
sct-concept: < 123038009 |Specimen|
v2: SPM segment
rim: participation[typeCode=SPC].specimen
sct-attr: 704319004 |Inherent in|

device

0..1

Reference(Device | DeviceMetric)

There are no (further) constraints on this element

Element id

Observation.device

Short description

(Measurement) Device

Definition

The device used to generate the observation data.

Comments

Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.

Data type

Reference(Device | DeviceMetric)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
sct-concept: < 49062001 |Device|
v2: OBX-17 / PRT -10
rim: participation[typeCode=DEV]
sct-attr: 424226004 |Using device|

referenceRange

0..*

There are no (further) constraints on this element

Element id

Observation.referenceRange

Short description

Provides guide for interpretation

Definition

Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two referenceRange elements would be used.

Requirements

Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

Comments

Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
obs-3: Must have at least a low or a high or text
low.exists() or high.exists() or text.exists()

Mappings

rim: n/a
v2: OBX.7
rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]

0..1

There are no (further) constraints on this element

Element id

Observation.referenceRange.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.referenceRange.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

Observation.referenceRange.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

low

0..1

There are no (further) constraints on this element

Element id

Observation.referenceRange.low

Short description

Low Range, if relevant

Definition

The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).

Comments

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.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1, obs-3

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1: The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim: n/a
v2: SN (see also Range) or CQ
rim: PQ, IVL<PQ>, MO, CO, depending on the values
v2: OBX-7
rim: value:IVL_PQ.low

high

0..1

There are no (further) constraints on this element

Element id

Observation.referenceRange.high

Short description

High Range, if relevant

Definition

The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).

Comments

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.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1, obs-3

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists()
sqty-1: The comparator is not used on a SimpleQuantity
comparator.empty()

Mappings

rim: n/a
v2: SN (see also Range) or CQ
rim: PQ, IVL<PQ>, MO, CO, depending on the values
v2: OBX-7
rim: value:IVL_PQ.high

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

Observation.referenceRange.type

Short description

Reference range qualifier

Definition

Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.

Requirements

Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.

Comments

This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.

Data type

ObservationReferenceRangeMeaningCodes (preferred)

Binding

Code for the meaning of a reference range.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
sct-concept: < 260245000 |Findings values| OR < 365860008 |General clinical state finding| OR < 250171008 |Clinical history or observation findings| OR < 415229000 |Racial group| OR < 365400002 |Finding of puberty stage| OR < 443938003 |Procedure carried out on subject|
v2: OBX-10
rim: interpretationCode

appliesTo

0..*

There are no (further) constraints on this element

Element id

Observation.referenceRange.appliesTo

Short description

Reference range population

Definition

Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple appliesTo are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.

Requirements

Need to be able to identify the target population for proper interpretation.

Comments

This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.

Data type

ObservationReferenceRangeAppliesToCodes (example)

Binding

Codes identifying the population the reference range applies to.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
sct-concept: < 260245000 |Findings values| OR < 365860008 |General clinical state finding| OR < 250171008 |Clinical history or observation findings| OR < 415229000 |Racial group| OR < 365400002 |Finding of puberty stage| OR < 443938003 |Procedure carried out on subject|
v2: OBX-10
rim: interpretationCode

age

0..1

There are no (further) constraints on this element

Element id

Observation.referenceRange.age

Short description

Applicable age range, if relevant

Definition

The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.

Requirements

Some analytes vary greatly over age.

Comments

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.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
rng-2: If present, low SHALL have a lower value than high
low.empty() or high.empty() or (low <= high)

Mappings

rim: n/a
v2: NR and also possibly SN (but see also quantity)
rim: IVL<QTY[not(type="TS")]> [lowClosed="true" and highClosed="true"]or URG<QTY[not(type="TS")]>
rim: outboundRelationship[typeCode=PRCN].targetObservationCriterion[code="age"].value

text

0..1

There are no (further) constraints on this element

Element id

Observation.referenceRange.text

Short description

Text based reference range in an observation

Definition

Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals".

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: OBX-7
rim: value:ST

hasMember

Σ C

0..*

Reference(MolecularSequence | Observation | QuestionnaireResponse)

There are no (further) constraints on this element

Element id

Observation.hasMember

Short description

Related resource that belongs to the Observation group

Definition

This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.

Comments

When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.

Data type

Reference(MolecularSequence | Observation | QuestionnaireResponse)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: Relationships established by OBX-4 usage
rim: outBoundRelationship

derivedFrom

Σ C

0..*

There are no (further) constraints on this element

Element id

Observation.derivedFrom

Short description

Related measurements the observation is made from

Definition

The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.

Comments

All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see Notes below.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: Relationships established by OBX-4 usage
rim: .targetObservation

component

0..*

There are no (further) constraints on this element

Element id

Observation.component

Short description

Component results

Definition

Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.

Requirements

Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

Comments

For a discussion on the ways Observations can be assembled in groups together see Notes below.

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: containment by OBX-4?
rim: outBoundRelationship[typeCode=COMP]

0..1

There are no (further) constraints on this element

Element id

Observation.component.id

Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.component.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

Observation.component.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Requirements

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

code

1..1

There are no (further) constraints on this element

Element id

Observation.component.code

Short description

Type of component observation (code / type)

Definition

Describes what was observed. Sometimes this is called the observation "code".

Requirements

Knowing what kind of observation is being made is essential to understanding the observation.

Comments

All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

Data type

Binding

Codes identifying names of simple observations.

LOINCCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
w5: FiveWs.what[x]
sct-concept: < 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|
v2: OBX-3
rim: code

value[x]

0..1

There are no (further) constraints on this element

Element id

Observation.component.value[x]

Short description

Actual component result

Definition

The information determined as a result of making the observation, if the information has a simple value.

Requirements

An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

Comments

Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
sct-concept: 363714003 |Interprets| < 441742003 |Evaluation finding|
v2: OBX.2, OBX.5, OBX.6
rim: value
sct-attr: 363714003 |Interprets|

valueBoolean

There are no (further) constraints on this element

Data type

valueCodeableConcept

There are no (further) constraints on this element

Data type

valueDateTime

There are no (further) constraints on this element

Data type

valueInteger

There are no (further) constraints on this element

Data type

valuePeriod

There are no (further) constraints on this element

Data type

valueQuantity

There are no (further) constraints on this element

Data type

valueRange

There are no (further) constraints on this element

Data type

valueRatio

There are no (further) constraints on this element

Data type

valueSampledData

There are no (further) constraints on this element

Data type

valueString

There are no (further) constraints on this element

Data type

valueTime

There are no (further) constraints on this element

Data type

dataAbsentReason

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

Observation.component.dataAbsentReason

Short description

Why the component result is missing

Definition

Provides a reason why the expected value in the element Observation.component.value[x] is missing.

Requirements

For many results it is necessary to handle exceptional values in measurements.

Comments

"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".

Data type

Binding

Codes specifying why the result (`Observation.value[x]`) is missing.

DataAbsentReason (extensible)

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1, obs-6

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
v2: N/A
rim: value.nullFlavor

interpretation

0..*

CodeableConceptBinding

There are no (further) constraints on this element

Element id

Observation.component.interpretation

Short description

High, low, normal, etc.

Alternate names

Abnormal Flag

Definition

A categorical assessment of an observation value. For example, high, low, normal.

Requirements

For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

Comments

Data type

ObservationInterpretationCodes (extensible)

Binding

Codes identifying interpretations of observations.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
sct-concept: < 260245000 |Findings values|
v2: OBX-8
rim: interpretationCode
sct-attr: 363713009 |Has interpretation|

referenceRange

0..*

see (referenceRange)

There are no (further) constraints on this element

Element id

Observation.component.referenceRange

Short description

Provides guide for interpretation of component result

Definition

Guidance on how to interpret the value by comparison to a normal or recommended range.

Requirements

Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

Comments

Mappings

v2: OBX.7
rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]

ObservationCACore (Observation)

Observation

code

There are no (further) constraints on this element

Element id

Observation.code

Data type

Obligations

Code	Actor
MAY:populate-if-known	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/producer
SHALL:no-error	http://fhir.infoway-inforoute.ca/ca-core/ActorDefinition/consumer

subject

Reference(LocationCACore | PatientCACore | Device | Group)

There are no (further) constraints on this element

Element id

Observation.subject

Data type

Reference(LocationCACore | PatientCACore | Device | Group)

encounter

There are no (further) constraints on this element

Element id

Observation.encounter

Data type