NHSDigital-Observation

Conformance url FHIR Module Maturity Level
https://fhir.nhs.uk/StructureDefinition/NHSDigital-Observation Diagnostics trial-use


Combined with
Command 'link' could not render: Resource was not found for 'canonical=https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation'


covid19TestingS0..1Extension(Complex)
system1..
value1..
statusS
systemS1..
codeS1..
systemFixed Value
systemFixed Value
codeS
system1..Fixed Value
value1..
effectiveDateTimedateTime
performerS CNHSDigitalReference(CareTeam | NHSDigitalOrganization | NHSDigitalPatient | NHSDigitalPractitionerRoleMinimal)
value[x]S
system1..
code1..
display1..
system1..
value1..
system1..
value1..
display1..

from
Command 'link' could not render: Resource was not found for 'canonical=https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation'
covid19TestingS0..1Extension(Complex)
system1..
value1..
statusS
systemS1..
codeS1..
systemFixed Value
systemFixed Value
codeS
system1..Fixed Value
value1..
effectiveDateTimedateTime
performerS CNHSDigitalReference(CareTeam | NHSDigitalOrganization | NHSDigitalPatient | NHSDigitalPractitionerRoleMinimal)
value[x]S
system1..
code1..
display1..
system1..
value1..
system1..
value1..
display1..

You dot not have a license to run FQL queries.

-
Command 'pagelink' could not render: Page not found.

Constraint Profiles

You dot not have a license to run FQL queries.

Definition

Measurements and simple assertions made about a patient, device or other subject.

Comment

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 laboratory reports, etc.

Constraints

extension:covid19Testing
Element Id Observation.extension:covid19Testing
Cardinality 0..1
Slice Name covid19Testing
type Extension(ExtensionCOVID19TestResult)

Definition

Optional Extension Element - found in all resources.

identifier
Element Id Observation.identifier
Cardinality 1..*
type Identifier

Definition

A unique identifier assigned to this observation.

For COVID-19 Test History this will be The identifier will be the specimen id.


    "identifier":  [
        {
            "system": "https://fhir.nhs.uk/Id/SpecimenId",
            "value": "eb89a392-5b20-11eb-ae93-0242ac130002"
        }
    ],

Requirements

Allows observations to be distinguished and referenced.

status
Element Id Observation.status
Cardinality 1..1
Terminology Binding ObservationStatus (Required)
Codes providing the status of an observation.
type code

Definition

The status of the result value.

For COVID-19 Test History the status of the observation will always be final


    "status": "final",

Requirements

Need to track the status of individual results. Some results are finalized before the whole report is finalized.

Comment

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

category
Element Id Observation.category
Cardinality 0..*
Terminology Binding ObservationCategory (Required)
Slicing OPEN discriminator - VALUE coding.system
type CodeableConcept

Definition

This is an optional element. If used the category will always be laboratory


    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                    "code": "laboratory",
                    "display": "Laboratory"
                }
            ],
            "text": "Laboratory"
        }
    ],

For COVID-19 Tests, the ValueSet SHOULD be used to indicate which test pillar the observation originated.


     "category": [
        {
            "coding": [
                {
                    "system": "https://fhir.nhs.uk/CodeSystem/covid-test-pillar",
                    "code": "pillar-1",
                    "display": "pillar 1"
                }
            ]
        }
    ],

Requirements

Used for filtering what observations are retrieved and displayed.

Comment

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.

category.coding.system
Element Id Observation.category.coding.system
Cardinality 1..1
type uri

Definition

The identification of the code system that defines the meaning of the symbol in the code.

Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comment

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

category.coding.code
Element Id Observation.category.coding.code
Cardinality 1..1
type code

Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Requirements

Need to refer to a particular code in the system.

category:COVID-TestPillar
Element Id Observation.category:COVID-TestPillar
Cardinality 0..1
Terminology Binding ObservationCategoryCodes (Preferred)
Codes for high level observation categories.
Slice Name COVID-TestPillar
type CodeableConcept

Definition

A code that classifies the general type of observation being made.

Requirements

Used for filtering what observations are retrieved and displayed.

Comment

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.

category:COVID-TestPillar.coding.system
Element Id Observation.category:COVID-TestPillar.coding.system
Cardinality 0..1
Fixed Value https://fhir.nhs.uk/CodeSystem/covid-test-pillar
type uri

Definition

The identification of the code system that defines the meaning of the symbol in the code.

Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comment

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

category:UKCoreCategory
Element Id Observation.category:UKCoreCategory
Cardinality 0..*
Terminology Binding ObservationCategoryCodes (Preferred)
Codes for high level observation categories.
Slice Name UKCoreCategory
type CodeableConcept

Definition

A code that classifies the general type of observation being made.

Requirements

Used for filtering what observations are retrieved and displayed.

Comment

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.

category:UKCoreCategory.coding.system
Element Id Observation.category:UKCoreCategory.coding.system
Cardinality 0..1
Fixed Value http://terminology.hl7.org/CodeSystem/observation-category
type uri

Definition

The identification of the code system that defines the meaning of the symbol in the code.

Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comment

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

code
Element Id Observation.code
Cardinality 1..1
Terminology Binding LOINCCodes (Example)
Codes identifying names of simple observations.
type CodeableConcept

Definition

Type of observation, for COVID-10 see Observation Definition for code values.

    "code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "871555000",
                "display": "Detection of ribonucleic acid of Severe acute respiratory syndrome coronavirus 2"
            }
        ]
    },

Requirements

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

Comment

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

code.coding:snomedCT
Element Id Observation.code.coding:snomedCT
Cardinality 0..*
Terminology Binding UKCoreObservationType (Extensible)
A code from the SNOMED Clinical Terminology UK coding system describing a type of observation
Slice Name snomedCT
type Coding

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comment

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

code.coding:snomedCT.system
Element Id Observation.code.coding:snomedCT.system
Cardinality 1..1
Fixed Value http://snomed.info/sct
type uri

Definition

The identification of the code system that defines the meaning of the symbol in the code.

Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comment

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

code.coding:loinc
Element Id Observation.code.coding:loinc
Cardinality 0..*
Slice Name loinc
type Coding

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comment

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

code.coding:loinc.system
Element Id Observation.code.coding:loinc.system
Cardinality 1..1
Fixed Value http://loinc.org
type uri

Definition

The identification of the code system that defines the meaning of the symbol in the code.

Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comment

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

subject
Element Id Observation.subject
Cardinality 1..1
type Reference(Group Device UKCoreLocation NHSDigitalPatientMinimal)

Definition

The NHS Number will be an identifier reference which can be used with PDS FHIR API to return Patient demographics. If a local Patient is available, a reference to this will be present (e.g. "Patient/123")


    "subject": {
        "reference": "Patient/123",
        "identifier":  [
            {
                "system": "https://fhir.nhs.uk/Id/nhs-number",
                "value": "987123456"
            }
        ]
    },

Requirements

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

Comment

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

Constraints

  • patient-reference (WARNING) subject - An identifier reference or resource reference must be provided
  • patient-nhs (ERROR) Supplied NHS Number is outside the English and Welsh NHS Number range or length of the number is wrong.

subject.identifier.system
Element Id Observation.subject.identifier.system
Cardinality 1..1
Fixed Value https://fhir.nhs.uk/Id/nhs-number
type uri

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

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.

Comment

Identifier.system is always case sensitive.

effective[x]
Element Id Observation.effective[x]
Cardinality 1..1
type dateTime

Definition

The date and time the result was asserted.


    "effectiveDateTime": "2020-09-23T13:00:08.476+00:00"

Requirements

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

Comment

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

performer
Element Id Observation.performer
Cardinality 0..*
type Reference(NHSDigitalOrganization CareTeam NHSDigitalPatient NHSDigitalPractitionerRoleMinimalNHSDigitalReference)

Definition

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


"performer": [
  {
    "type": "Organization",
    "identifier": {
      "type": {
        "coding": [
          {
            "system": "https://fhir.nhs.uk/CodeSystem/organisation-role",
            "code": "173",
            "display": "PATHOLOGY LAB"
          }
        ]
      },
      "value": "LFD004"
    }
  },
  {
    "type": "Organization",
    "identifier": {
      "type": {
        "coding": [
          {
            "system": "https://fhir.nhs.uk/Id/OrgType",
            "code": "TestCentreId",
            "display": "Testing Centre"
          }
        ]
      },
      "value": "WKE03"
    }
  }
]

Requirements

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

Comment

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Constraints

  • performer (ERROR) An identifier reference or resource reference must be provided

value[x]
Element Id Observation.value[x]
Cardinality 0..1
type QuantityCodeableConceptstringbooleanintegerRangeRatioSampledDatatimedateTimePeriod

Definition

COVID-19 valueCodeableConcept

The COVID 19 test result. This is a SNOMED CT from the valueSet associated with the code, see Observation Definition


    "valueCodeableConcept": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "1240581000000104",
                "display": "SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) detection result positive"
            }
        ],
        "text": "SARS-CoV-2-ORGY"
    },

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.

Comment

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

bodySite.coding:snomedCT
Element Id Observation.bodySite.coding:snomedCT
Cardinality 0..1
Terminology Binding UKCoreBodySite (Extensible)
A code from the SNOMED Clinical Terminology UK with the expression (<<442083009		 anatomical or acquired body structure )
Slice Name snomedCT
type Coding

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comment

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

bodySite.coding:snomedCT.system
Element Id Observation.bodySite.coding:snomedCT.system
Cardinality 1..1
Fixed Value http://snomed.info/sct
type uri

Definition

The identification of the code system that defines the meaning of the symbol in the code.

Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comment

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

method
Element Id Observation.method
Cardinality 0..1
Terminology Binding ObservationMethods (Extensible)
type CodeableConcept

Definition

The name of the test that was performed, this is a SNOMED CT concept.


    "method": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "1240461000000109",
                "display": "Measurement of SARS-CoV-2 antibody (procedure)"
            }
        ]
    },

Requirements

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

Comment

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

specimen
Element Id Observation.specimen
Cardinality 0..1
type Reference(Specimen)

Definition

For COVID-19 Test History. The identifier of the specimen used for the test.


    "specimen": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/SpecimenId",
            "value": "eb89a392-5b20-11eb-ae93-0242ac130002"
        }
    },

Comment

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).

device
Element Id Observation.device
Cardinality 0..1
type Reference(Device DeviceMetric)

Definition

Details of the COVID-19 test kit used.


    "device": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/Covid19-TestKit",
            "value": "LFT"
        },
        "display": "Lateral Flow Test"
    }

Comment

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

component.code.coding:snomedCT
Element Id Observation.component.code.coding:snomedCT
Cardinality 0..*
Terminology Binding UKCoreObservationType (Extensible)
A code from the SNOMED Clinical Terminology UK coding system describing a type of observation
Slice Name snomedCT
type Coding

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comment

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

component.code.coding:snomedCT.system
Element Id Observation.component.code.coding:snomedCT.system
Cardinality 1..1
Fixed Value http://snomed.info/sct
type uri

Definition

The identification of the code system that defines the meaning of the symbol in the code.

Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comment

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.