Phd Base Observation Profile
The Phd Base Observation profile contains the elements that are common to all Phd Observation profiles describing measurements. These element are:
- code: what the measurement is,
- subject: the patient this measurement refers to,
- effective[ x ]: the time stamp and perhaps duration of the measurement,
- device: the PHD taking the measurement,
- derivedFrom: references to any coincident time stamp and/or source handle reference, and
- components: contains any additional measurement descriptions (supplemental types, relative time stamps, and measurement status
The structure definition is given below:
Observation | I | Observation | Element idObservation Measurements and simple assertions Alternate namesVital Signs, Measurement, Results, Tests DefinitionMeasurements and simple assertions made about a patient, device or other subject. This variant on the Observation defines a base profile for the PHD Observation profiles. This profile is abstract and does not exist alone. Observation 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. id Constraints
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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. Meta Constraints
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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. uri Constraints
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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). code BindingA human language. ?? (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. Narrative Constraints
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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. Resource Mappings
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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. Extension Sliced: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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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identifier | Σ | 0..* | Identifier | Element idObservation.identifier Business Identifier for observation DefinitionA unique identifier assigned to this observation. Allows observations to be distinguished and referenced. For Phd Observations that require conditional creates the create selection criteria will be based upon the information placed in an identifier element. The information will uniquely represent the measurement content. How that information is generated is dependent upon the Phd Observation Profile. Identifier Constraints
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basedOn | Σ I | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/CarePlan | http://hl7.org/fhir/StructureDefinition/DeviceRequest | http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation | http://hl7.org/fhir/StructureDefinition/MedicationRequest | http://hl7.org/fhir/StructureDefinition/NutritionOrder | http://hl7.org/fhir/StructureDefinition/ProcedureRequest | http://hl7.org/fhir/StructureDefinition/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(http://hl7.org/fhir/StructureDefinition/CarePlan | http://hl7.org/fhir/StructureDefinition/DeviceRequest | http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation | http://hl7.org/fhir/StructureDefinition/MedicationRequest | http://hl7.org/fhir/StructureDefinition/NutritionOrder | http://hl7.org/fhir/StructureDefinition/ProcedureRequest | http://hl7.org/fhir/StructureDefinition/ReferralRequest) Constraints
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status | Σ ?! | 1..1 | codeBinding | Element idObservation.status registered | preliminary | final | amended + DefinitionThe status of the result value. Either 'final' or 'preliminary' Need to track the status of individual results. Some results are finalized before the whole report is finalized. The value shall be set to 'final' unless a Measurement-Status attribute or Nu-Observed-Value attribute status field indicates that the measurement is preliminary. In that case this field shall be set to 'preliminary' code BindingCodes providing the status of an observation. ?? (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. CodeableConcept BindingCodes for high level observation categories. ?? (preferred)Constraints
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code | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.code Type of observation (code / type) Alternate namesName DefinitionDescribes what was observed. Sometimes this is called the observation "name". 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. CodeableConcept BindingCodes identifying names of simple observations. ?? (example)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.code.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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coding | Σ | 1..* | Coding | Element idObservation.code.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Coding Sliced:Ordered, Open, by system(Value) Constraints
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11073Type | Σ | 1..1 | Coding | Element idObservation.code.coding:11073Type The 11073-10101 code for the measurement DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. For non-compound 11073-20601 metric numeric measurements, this code is obtained from one or more of the Type, Metric-Id, Nu-Observed-Value, and Metric-Id-Partition attributes. The algorithm to get the 16-bit partition and 16-bit term code is as follows: 1. The partition and term code are obtained from the Type attribute. 2. If there is a Metric-Id attribute the term code comes from this attribute. 3. If there is a Nu-Observed-Value attribute the term code comes from this attribute. 4. If the term code is NOT from the Type attribute, and there is a Metric-Id-Partition attribute, the partition comes from this attribute. 5. The 32-bit 11073-10101 code value is given by partition * 2 **16 + term code. It is this value that is placed in the code.coding.code element for this 11073Type slice. For compound numeric measurements, the code comes from the Type attribute. Coding Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.coding:11073Type.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.code.coding:11073Type.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | Element idObservation.code.coding:11073Type.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. 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 de-reference to some definition that establish the system clearly and unambiguously. uri Constraints
urn:iso:std:iso:11073:10101
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.coding:11073Type.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. string Constraints
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code | Σ | 1..1 | code | There are no (further) constraints on this element Element idObservation.code.coding:11073Type.code Symbol in syntax defined by the system DefinitionA 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). Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size code Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.coding:11073Type.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size string Constraints
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idObservation.code.coding:11073Type.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. boolean Constraints
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LoincCoding | Σ | 0..1 | Coding | Element idObservation.code.coding:LoincCoding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. If the measurement is one of the magic vital signs, the Magic LOINC code for that vital sign as specified by FHIR appears here. When it occurs It shall be second after the MDC code. Coding Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.coding:LoincCoding.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.code.coding:LoincCoding.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | Element idObservation.code.coding:LoincCoding.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. 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 de-reference to some definition that establish the system clearly and unambiguously. uri Constraints
http://loinc.org
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.coding:LoincCoding.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. string Constraints
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code | Σ | 1..1 | code | Element idObservation.code.coding:LoincCoding.code Symbol in syntax defined by the system DefinitionA 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). Need to refer to a particular code in the system. Required if the measurement is a vital sign code Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.coding:LoincCoding.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size string Constraints
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idObservation.code.coding:LoincCoding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. boolean Constraints
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings. string Constraints
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subject | Σ I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Group | http://hl7.org/fhir/StructureDefinition/Device | http://hl7.org/fhir/StructureDefinition/Location) | 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(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Group | http://hl7.org/fhir/StructureDefinition/Device | http://hl7.org/fhir/StructureDefinition/Location) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.subject.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.subject.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | Σ I | 1..1 | string | There are no (further) constraints on this element Element idObservation.subject.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. string Constraints
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idObservation.subject.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Identifier Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.subject.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. string Constraints
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context | I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Encounter | http://hl7.org/fhir/StructureDefinition/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(http://hl7.org/fhir/StructureDefinition/Encounter | http://hl7.org/fhir/StructureDefinition/EpisodeOfCare) Constraints
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effectivePeriod | Σ | 1..1 | Period | Element idObservation.effective[x].effective[x]:effectivePeriod Clinically relevant time/time-period for observation Alternate namesOccurrence DefinitionThe time period when there is a Measure-Active-Period attribute. The difference between the end and start fields is the value of the Measure-Active-Period. 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. Period Sliced:Unordered, Open, by start(Exists) Constraints
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(All Slices) | There are no (further) constraints on this element | |||
id | 0..1 | string | There are no (further) constraints on this element Element idObservation.effective[x]:effectivePeriod.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.effective[x]:effectivePeriod.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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start | Σ I | 1..1 | dateTime | There are no (further) constraints on this element Element idObservation.effective[x].effective[x]:effectivePeriod.start Starting time with inclusive boundary DefinitionThe start of the period. The boundary is inclusive. If the low element is missing, the meaning is that the low boundary is not known. dateTime Constraints
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end | Σ I | 1..1 | dateTime | Element idObservation.effective[x].effective[x]:effectivePeriod.end End time with inclusive boundary, if not ongoing DefinitionThe end of the period. It will be the value of the Measure-Active-Period plus the start time. The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03. If the end of the period is missing, it means that the period is ongoing dateTime Constraints
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dateTimeEffective | Σ | 0..1 | dateTime | Element idObservation.effective[x]:dateTimeEffective 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. A date and time shall always be present. dateTime Constraints
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issued | Σ | 0..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. instant Constraints
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performer | Σ I | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/Organization | http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/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(http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/Organization | http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/RelatedPerson) Constraints
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value[x] | Σ I | 0..1 | There are no (further) constraints on this element Element idObservation.value[x] Actual 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. 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.
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valueQuantity | Quantity | There are no (further) constraints on this element Data type Quantity | ||
valueCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type CodeableConcept | ||
valueString | string | There are no (further) constraints on this element Data type string | ||
valueBoolean | boolean | There are no (further) constraints on this element Data type boolean | ||
valueRange | Range | There are no (further) constraints on this element Data type Range | ||
valueRatio | Ratio | There are no (further) constraints on this element Data type Ratio | ||
valueSampledData | SampledData | There are no (further) constraints on this element Data type SampledData | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type Attachment | ||
valueTime | time | There are no (further) constraints on this element Data type time | ||
valueDateTime | dateTime | There are no (further) constraints on this element Data type dateTime | ||
valuePeriod | Period | There are no (further) constraints on this element Data type Period | ||
dataAbsentReason | I | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element 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. CodeableConcept BindingCodes specifying why the result (Observation.value[x]) is missing. ?? (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. CodeableConcept BindingCodes identifying interpretations of observations. ?? (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 string Constraints
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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. CodeableConcept BindingCodes describing anatomical locations. May include laterality. ?? (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. CodeableConcept BindingMethods for simple observations. ?? (example)Constraints
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specimen | I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/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 Reference(http://hl7.org/fhir/StructureDefinition/Specimen) Constraints
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device | I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Device | http://hl7.org/fhir/StructureDefinition/DeviceMetric) | Element idObservation.device (Measurement) Device DefinitionThe device used to generate the observation data. This field will reference the DeviceComponent when the updated fixes are in place. In the meantime it will reference the DeviceMetric Reference(http://hl7.org/fhir/StructureDefinition/Device | http://hl7.org/fhir/StructureDefinition/DeviceMetric) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.device.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.device.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | Σ I | 1..1 | string | Element idObservation.device.reference Reference to the device responsible for the measurement DefinitionReference to the device-related resources that describe the sensor device taking the measurement and the gateway that handled it. This element will point to a DeviceComponent resource following the Phd Parent DeviceComponent Profile. This reference points to the DeviceComponent resource containing information about the sensor device that took the measurement and gateway (if any) that handled it. string Constraints
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idObservation.device.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Identifier Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.device.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. string 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. BackboneElement Constraints
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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 string Constraints
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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. Extension Sliced: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. Extension Constraints
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low | I | 0..1 | http://hl7.org/fhir/StructureDefinition/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. http://hl7.org/fhir/StructureDefinition/SimpleQuantity Constraints
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high | I | 0..1 | http://hl7.org/fhir/StructureDefinition/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. http://hl7.org/fhir/StructureDefinition/SimpleQuantity Constraints
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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. CodeableConcept BindingCode for the meaning of a reference range. ?? (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. CodeableConcept BindingCodes identifying the population the reference range applies to. ?? (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. Range Constraints
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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 string Constraints
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related | Σ | 0..* | BackboneElement | 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. BackboneElement Sliced:Ordered, Open, by target.reference(Value) Constraints
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(All Slices) | There are no (further) constraints on this element | |||
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 string Constraints
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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. Extension Sliced: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. Extension Constraints
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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. code BindingCodes specifying how two observations are related. ?? (required)Constraints
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target | I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Observation | http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse | http://hl7.org/fhir/StructureDefinition/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(http://hl7.org/fhir/StructureDefinition/Observation | http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse | http://hl7.org/fhir/StructureDefinition/Sequence) Constraints
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coincidentTimeStampRelated | Σ | 0..* | BackboneElement | Element idObservation.related:coincidentTimeStampRelated Pointer to the Coincident Time Stamp DefinitionA reference to the Coincident Time Stamp observation. The Coincident Time Stamp indicates how the time stamps from the PHD are corrected, if at all. This Observation allows one to re-create the original time stamp generated by the PHD should it have been modified by the PHG. This reference shall be present if the PHD reports a time stamp. The reference shall point to the Coincident Time Stamp observation. The Coincident Time Stamp Observation provides an audit of the time stamp. Whether or not the gateway corrected the time stamp can be determined from the elements in this Observation. If the timestamps were corrected, the elements of the Observation can be used to obtain the actual time stamps reported by the PHD. There is no reference to a Coincident Time Stamp Observation when the PHD does not report a time stamp. BackboneElement Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.related:coincidentTimeStampRelated.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.related:coincidentTimeStampRelated.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. Extension Sliced: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:coincidentTimeStampRelated.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. Extension Constraints
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type | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.related:coincidentTimeStampRelated.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. code BindingCodes specifying how two observations are related. ?? (required)Constraints
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target | I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Observation | http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse | http://hl7.org/fhir/StructureDefinition/Sequence) | There are no (further) constraints on this element Element idObservation.related:coincidentTimeStampRelated.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(http://hl7.org/fhir/StructureDefinition/Observation | http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse | http://hl7.org/fhir/StructureDefinition/Sequence) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.related:coincidentTimeStampRelated.target.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.related:coincidentTimeStampRelated.target.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | Σ I | 1..1 | string | There are no (further) constraints on this element Element idObservation.related:coincidentTimeStampRelated.target.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. string Constraints
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idObservation.related:coincidentTimeStampRelated.target.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Identifier Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.related:coincidentTimeStampRelated.target.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. string Constraints
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SourceHandleReferenceRelated | Σ | 0..* | BackboneElement | Element idObservation.related:SourceHandleReferenceRelated Resource related to this observation DefinitionA reference to another resource (usually another Observation) whose relationship is defined by the relationship type code. Points to a measurement that this measurement is related to or dependent upon, for example a BMI which is calculated from a weight and height measurement or a heart rate taken during a running session. A measurement may have one or more source handle references which point to measurements that this measurement is related to in some way. When one of these attributes are present in the measurement, these values point to other measurements. In this case these measurements will be previously generated Observation resources which are then referenced here. Note that the previously received measurement must be received in the same connection as the current measurement. The application does not need to keep record of all measurements from the given device! BackboneElement Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.related:SourceHandleReferenceRelated.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.related:SourceHandleReferenceRelated.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. Extension Sliced: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:SourceHandleReferenceRelated.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. Extension Constraints
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type | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.related:SourceHandleReferenceRelated.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. code BindingCodes specifying how two observations are related. ?? (required)Constraints
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target | I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Observation | http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse | http://hl7.org/fhir/StructureDefinition/Sequence) | There are no (further) constraints on this element Element idObservation.related:SourceHandleReferenceRelated.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(http://hl7.org/fhir/StructureDefinition/Observation | http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse | http://hl7.org/fhir/StructureDefinition/Sequence) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.related:SourceHandleReferenceRelated.target.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.related:SourceHandleReferenceRelated.target.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | Σ I | 1..1 | string | There are no (further) constraints on this element Element idObservation.related:SourceHandleReferenceRelated.target.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. string Constraints
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idObservation.related:SourceHandleReferenceRelated.target.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Identifier Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.related:SourceHandleReferenceRelated.target.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. string Constraints
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component | Σ | 0..* | BackboneElement | 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. BackboneElement Sliced:Unordered, Open, by code.coding.code(Value) Constraints
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(All Slices) | There are no (further) constraints on this element | |||
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 string Constraints
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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. Extension Sliced: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. Extension Constraints
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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. CodeableConcept BindingCodes identifying names of simple observations. ?? (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 Quantity | ||
valueCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type CodeableConcept | ||
valueString | string | There are no (further) constraints on this element Data type string | ||
valueRange | Range | There are no (further) constraints on this element Data type Range | ||
valueRatio | Ratio | There are no (further) constraints on this element Data type Ratio | ||
valueSampledData | SampledData | There are no (further) constraints on this element Data type SampledData | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type Attachment | ||
valueTime | time | There are no (further) constraints on this element Data type time | ||
valueDateTime | dateTime | There are no (further) constraints on this element Data type dateTime | ||
valuePeriod | Period | There are no (further) constraints on this element Data type Period | ||
dataAbsentReason | I | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element 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. CodeableConcept BindingCodes specifying why the result (Observation.value[x]) is missing. ?? (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. CodeableConcept BindingCodes identifying interpretations of observations. ?? (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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supplementalTypesComponent | Σ | 0..* | BackboneElement | Element idObservation.component:supplementalTypesComponent Component results DefinitionFor each paritition:term code pair contained in the Supplemental-Types attribute, a separate supplementalTypesComponent element is generated. The component is not generated if the attribute is absent or empty. The component shall be generated otherwise. 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. A PHD may send a Supplemental-Types attribute as part of the measurement. This attribute consists of a set of MDC nomenclature codes as partition:term code pairs. Each pair is a code describing something additional about the measurement, such as MDC_MODALITY_SPOT in the pulse oximeter which indicates that the provided meausrement is a stable average. An MDC_MODALITY_FAST would indicate that a short averaging is used and the result reported regardless of stability. BackboneElement Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.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. Extension Sliced: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:supplementalTypesComponent.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. Extension Constraints
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code | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.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. CodeableConcept BindingCodes identifying names of simple observations. ?? (example)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.code.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.code.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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coding | Σ | 1..* | Coding | Element idObservation.component:supplementalTypesComponent.code.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Coding Sliced:Ordered, Open, by system(Value) Constraints
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11073Type | Σ | 1..1 | Coding | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.code.coding:11073Type Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Coding Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.code.coding:11073Type.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.code.coding:11073Type.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | Element idObservation.component:supplementalTypesComponent.code.coding:11073Type.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. 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 de-reference to some definition that establish the system clearly and unambiguously. uri Constraints
urn:iso:std:iso:11073:10101
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.code.coding:11073Type.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. string Constraints
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code | Σ | 1..1 | codeFixed Value | Element idObservation.component:supplementalTypesComponent.code.coding:11073Type.code Symbol in syntax defined by the system Definition68193 is the 32-bit nomenclature code indicating a 'Supplemental-Types' value Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size code Constraints
68193
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display | Σ | 0..1 | string | Element idObservation.component:supplementalTypesComponent.code.coding:11073Type.display Representation defined by the system DefinitionIt is recommended to display at least the reference identifier for the Supplemental-Types which is MDC_ATTR_SUPPLEMENTAL_TYPES Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size string Constraints
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.code.coding:11073Type.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. boolean Constraints
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.code.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings. string Constraints
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valueCodeableConcept | Σ | 1..1 | CodeableConcept | Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept Actual component result DefinitionThe information determined as a result of making the observation, if the information is a code. 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). CodeableConcept Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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coding | Σ | 1..* | Coding | Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Coding Sliced:Ordered, Open, by system(Value) Constraints
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11073Value | Σ | 1..1 | Coding | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Coding Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. 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 de-reference to some definition that establish the system clearly and unambiguously. uri Constraints
urn:iso:std:iso:11073:10101
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. string Constraints
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code | Σ | 1..1 | code | Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value.code Symbol in syntax defined by the system DefinitionFor the given Supplemental-Types entry the code here is given by: partition * 2**16 + term code Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size code Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size string Constraints
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. boolean Constraints
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings. string Constraints
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dataAbsentReason | I | 0..0 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.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. CodeableConcept BindingCodes specifying why the result (Observation.value[x]) is missing. ?? (extensible)Constraints
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interpretation | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.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. CodeableConcept BindingCodes identifying interpretations of observations. ?? (extensible)Constraints
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referenceRange | 0..* | see (referenceRange) | There are no (further) constraints on this element Element idObservation.component:supplementalTypesComponent.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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relativeTimeComponent | Σ | 0..1 | BackboneElement | Element idObservation.component:relativeTimeComponent Component results DefinitionThis component shall be present if the measurement contains a Relative-Time-Stamp. 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. Relative time stamps are converted to wall clock time by the PHG through the Coincident Time Stamp Observation. The original relative time value shall be provided here in order to recover the data sent by the sensor device. The Relative-Time-Stamp is a 32-bit unsigned integer in units of 1/8th ms. BackboneElement Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.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. Extension Sliced: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:relativeTimeComponent.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. Extension Constraints
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code | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.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. CodeableConcept BindingCodes identifying names of simple observations. ?? (example)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.code.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.code.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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coding | Σ | 1..* | Coding | Element idObservation.component:relativeTimesComponent.code.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Coding Sliced:Ordered, Open, by code(Value) Constraints
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11073Type | Σ | 1..1 | Coding | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.code.coding:11073Type Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Coding Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.code.coding:11073Type.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.code.coding:11073Type.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | Element idObservation.component:relativeTimeComponent.code.coding:11073Type.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. 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 de-reference to some definition that establish the system clearly and unambiguously. uri Constraints
urn:iso:std:iso:11073:10101
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.code.coding:11073Type.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. string Constraints
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code | Σ | 1..1 | codeFixed Value | Element idObservation.component:relativeTimeComponent.code.coding:11073Type.code Symbol in syntax defined by the system DefinitionThe MDC code of the Relative-Time-Stamp attribute Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size code Constraints
67985
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display | Σ | 0..1 | string | Element idObservation.component:relativeTimeComponent.code.coding:11073Type.display Representation defined by the system DefinitionThe reference identifier should be included in the description. For a Relative-Time-Stamp the ref id is MDC_ATTR_TIME_STAMP_REL Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size string Constraints
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.code.coding:11073Type.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. boolean Constraints
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.code.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings. string Constraints
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valueQuantity | Σ | 1..1 | Quantity | Element idObservation.component:relativeTimeComponent.value[x]:valueQuantity 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). Quantity Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.value[x]:valueQuantity.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.value[x]:valueQuantity.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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value | Σ | 1..1 | decimal | Element idObservation.component:relativeTimeComponent.value[x]:valueQuantity.value Numerical value (with implicit precision) DefinitionThe value of the relative time attribute which is in units of 1/8th milliseconds scaled to microseconds. Precision is handled implicitly in almost all cases of measurement. The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). decimal Constraints
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comparator | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.value[x]:valueQuantity.comparator < | <= | >= | > - how to understand the value DefinitionHow the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value. If there is no comparator, then there is no modification of the value code BindingHow the Quantity should be understood and represented. ?? (required)Constraints
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unit | Σ | 1..1 | string | Element idObservation.component:relativeTimeComponent.value[x]:valueQuantity.unit Unit representation DefinitionA human-readable form of the unit which in this case is recommended to be the UCUM code for microseconds (us) There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Note that FHIR strings may not exceed 1MB in size string Constraints
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system | Σ I | 1..1 | uriFixed Value | Element idObservation.component:relativeTimeComponent.value[x]:valueQuantity.system System that defines coded unit form DefinitionThe unit code shall use the MDC system Need to know the system that defines the coded form of the unit. see http://en.wikipedia.org/wiki/Uniform_resource_identifier uri Constraints
urn:iso:std:iso:11073:10101
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code | Σ | 1..1 | codeFixed Value | Element idObservation.component:relativeTimeComponent.value[x]:valueQuantity.code Coded form of the unit DefinitionThe MDC code for microseconds is 264339 Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. code Constraints
264339
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dataAbsentReason | I | 0..0 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.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. CodeableConcept BindingCodes specifying why the result (Observation.value[x]) is missing. ?? (extensible)Constraints
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interpretation | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.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. CodeableConcept BindingCodes identifying interpretations of observations. ?? (extensible)Constraints
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referenceRange | 0..* | see (referenceRange) | There are no (further) constraints on this element Element idObservation.component:relativeTimeComponent.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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hiresRelativeTimeComponent | Σ | 0..1 | BackboneElement | Element idObservation.component:hiresRelativeTimeComponent Component results DefinitionThis component shall be present if the measurement contains Hi-Res-Relative-Time-Stamp. 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. Hi Res Relative time stamps are converted to wall clock time by the PHG through the Coincident Time Stamp Observation. The original relative time value shall be provided here in order to recover the data sent by the sensor device. The Hi-Res-Relative-Time-Stamp is a 64-bit unsigned interger in units of microseconds. BackboneElement Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.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. Extension Sliced: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:hiresRelativeTimeComponent.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. Extension Constraints
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code | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.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. CodeableConcept BindingCodes identifying names of simple observations. ?? (example)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.code.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.code.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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coding | Σ | 1..* | Coding | Element idObservation.component:hiresRelativeTimeComponent.code.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Coding Sliced:Ordered, Open, by code(Value) Constraints
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11073Type | Σ | 1..1 | Coding | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.code.coding:11073Type Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Coding Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.code.coding:11073Type.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.code.coding:11073Type.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | Element idObservation.component:hiresRelativeTimeComponent.code.coding:11073Type.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. 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 de-reference to some definition that establish the system clearly and unambiguously. uri Constraints
urn:iso:std:iso:11073:10101
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.code.coding:11073Type.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. string Constraints
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code | Σ | 1..1 | codeFixed Value | Element idObservation.component:hiresRelativeTimeComponent.code.coding:11073Type.code Symbol in syntax defined by the system DefinitionThe MDC code for the Hi-Res-Relative-Time-Stamp attribute Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size code Constraints
68073
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display | Σ | 0..1 | string | Element idObservation.component:hiresRelativeTime.code.coding:11073Type.display Representation defined by the system DefinitionThe reference identifier should be included in the description. For a Hi-Res-Relative-Time-Stamp the ref id is MDC_ATTR_TIME_STAMP_REL_HI_RES Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size string Constraints
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.code.coding:11073Type.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. boolean Constraints
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.code.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings. string Constraints
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valueQuantity | Σ | 1..1 | Quantity | Element idObservation.component:hiresRelativeTimeComponent.value[x]:valueQuantity 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). Quantity Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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value | Σ | 1..1 | decimal | Element idObservation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.value Numerical value DefinitionThe value of the hi res relative time attribute (already in microseconds). Precision is handled implicitly in almost all cases of measurement. The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). decimal Constraints
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comparator | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.comparator < | <= | >= | > - how to understand the value DefinitionHow the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value. If there is no comparator, then there is no modification of the value code BindingHow the Quantity should be understood and represented. ?? (required)Constraints
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unit | Σ | 1..1 | string | Element idObservation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.unit Unit representation DefinitionA human-readable form of the unit which in this case is recommended to be the UCUM code for microseconds (us) There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Note that FHIR strings may not exceed 1MB in size string Constraints
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system | Σ I | 1..1 | uriFixed Value | Element idObservation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.system System that defines coded unit form DefinitionThe unit code shall use the MDC system Need to know the system that defines the coded form of the unit. see http://en.wikipedia.org/wiki/Uniform_resource_identifier uri Constraints
urn:iso:std:iso:11073:10101
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code | Σ | 1..1 | codeFixed Value | Element idObservation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.code Coded form of the unit DefinitionThe MDC code for microseconds is 264339 Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. code Constraints
264339
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dataAbsentReason | I | 0..0 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.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. CodeableConcept BindingCodes specifying why the result (Observation.value[x]) is missing. ?? (extensible)Constraints
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interpretation | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.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. CodeableConcept BindingCodes identifying interpretations of observations. ?? (extensible)Constraints
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referenceRange | 0..* | see (referenceRange) | There are no (further) constraints on this element Element idObservation.component:hiresRelativeTimeComponent.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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measurementStatusComponent | Σ | 0..* | BackboneElement | Element idObservation.component:measurementStatusComponent Component results DefinitionThis component gives one of the settings reported in the Measurement-Status attribute that are not reported in the Observation.dataAbsentReason or Observation.status element. The settings that ARE reported in the dataAbsentReason and status elements are 'invalid', 'questionable', 'not-available', and 'early-indication'. It is optional to report any of the other settings UNLESS MDER-BITs 14 or 15 are set. It is optional to report any defined cleared setting; these are all events. This component indicates a Measurement-Status setting. When MDER-BITs 14 and 15 are set, these are special uses cases by the Pulse Oximeter and Continuous Glucose specialization. MDER-BIT 14 indicates that a threshold set up in other attributes has been crossed. MDER-BIT 15 indicates that the alert mechanism has been turned off. There will be one measurementStatusComponent entry for every setting reported. BackboneElement Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.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. Extension Sliced: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:measurementStatusComponent.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. Extension Constraints
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code | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.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. CodeableConcept BindingCodes identifying names of simple observations. ?? (example)Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.code.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.code.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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coding | Σ | 1..1 | Coding | Element idObservation.component:measurementStatusComponent.code.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. Normally alternative coding systems are allowed but in this case the value is intimately tied to the code. The code represents the feature indicated by a bit settin in the attribute value. which is either cleared (0) or set (1). Thus the value for this entry is itself a binary 'Y' or 'N' code from http://hl7.org/fhir/v2/0136 Coding Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.code.coding.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.code.coding.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | Element idObservation.component:measurementStatusComponent.code.coding.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. 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 de-reference to some definition that establish the system clearly and unambiguously. uri Constraints
http://hl7.org/fhir/IEEE.ASN1
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.code.coding.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. string Constraints
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code | Σ | 1..1 | code | Element idObservation.component:measurementStatusComponent.code.coding.code Symbol in syntax defined by the system DefinitionThis code, which is an alpha-numeric string, is generated by the attribute MDC code, which is 133447 for the Measurement-Status, followed by a dot (.) followed by the MDER-bit that was set. Need to refer to a particular code in the system. Note that this code is an alpha-numeric string and not a decimal number. Think of it like a very-limited OID. MDER-BITs 14 and 15 shall be reported if set. code Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.code.coding.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size string Constraints
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.code.coding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. boolean Constraints
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.code.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings. string Constraints
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valueCodeableConcept | Σ | 1..1 | CodeableConcept | Element idObservation.component:measurementStatusComponent.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). CodeableConcept Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.value[x].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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.value[x].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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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coding | Σ | 1..1 | Coding | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.value[x]:valueCodeableConcept.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. 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. Coding Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.value[x].coding.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 string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.value[x].coding.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. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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system | Σ | 1..1 | uriFixed Value | Element idObservation.component:measurementStatusComponent.value[x]:valueCodeableConcept.coding.system Identity of the terminology system DefinitionThis coding system contains only two entries, 'Y' (yes) and 'N' (no) Need to be unambiguous about the source of the definition of the symbol. 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 de-reference to some definition that establish the system clearly and unambiguously. uri Constraints
http://hl7.org/fhir/v2/0136
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version | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.value[x].coding.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. string Constraints
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code | Σ | 1..1 | code | Element idObservation.component:measurementStatusComponent.value[x]:valueCodeableConcept.coding.code Symbol in syntax defined by the system DefinitionIf the MDER-Bit is set, the code value is 'Y' otherwise it is 'N' Need to refer to a particular code in the system. Recall that when the value is 'Y' the alarm or alert is turned off code Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.value[x].coding.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size string Constraints
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userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.value[x].coding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. boolean Constraints
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.value[x].text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings. string Constraints
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dataAbsentReason | I | 0..0 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.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. CodeableConcept BindingCodes specifying why the result (Observation.value[x]) is missing. ?? (extensible)Constraints
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interpretation | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.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. CodeableConcept BindingCodes identifying interpretations of observations. ?? (extensible)Constraints
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referenceRange | 0..* | see (referenceRange) | There are no (further) constraints on this element Element idObservation.component:measurementStatusComponent.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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PHD Profile Identifier
The PHD Profile Identifier is used to prevent data duplication. It serves as the selection criteria in the conditional create. All measurements that have a timestamp earlier than the current time of connection are required to use the conditional create upload when converted to FHIR. If the uploader knows that the received measurement is a new measurement or the measurement is received with no time stamp, then the identifier is not needed.
Ideally the uploader will implement a duplication detection mechanism and filter out any measurements that have already been uploaded. One possible mechanism is to record the latest time stamp of any measurement received during a connection. Then for a given device and patient and upload destination, on a subsequent connection filter out any measurements with a time stamp earlier than the recorded latest time stamp of the previous connection. The latest time stamp is then updated given the information received during the current connection. The filter not only saves the server from handling the conditional update transaction but saves bandwidth and upload costs.
The identifier is a combined string of elements that contain sufficient information to uniquely identify the measurement for a given patient and device. The identifier is thus a combination of the device identifier, patient identifier, PHD timestamp of the measurement, measurement type code, measurement value, and the list of Supplemental-Types codes if any. Each entry is separated by a dash (-). It is important to use the time stamp of the PHD and not the potentially modified time stamp placed in the Observation.effective[x] element. Two PHGs may have slightly different times which would allow a duplicate measurement to appear different.
All Continua compliant PHGs must implement this identifier in the same manner. Compliance assures that even if the patient uploads the same measurement to the same server from a different PHG, a duplicate of the measurement will not be generated on the server. Some Bluetooth Low Energy PHDs do not provide a means of deleting stored data and will upload all the old data with each new addition up to the point of the device storage.
The consumer of this Observation resource should ignore the identifier element used for the PHD Profiles.
Generation of the PHD Profile Identifier is PHD Profile specific and is outlined in the respective profiles.
Obtaining the Type of Measurement
One obtains the 11073 20601 measurement type for the code element in the same manner for all metric measurments. See the section Obtaining the Observation.code for the details of this mapping.
Subject
The subject element points to the PhdPatient resource using the logical id of the Patient resource, for example 'Patient/123546'
Time Stamp: effective[x]
PHDs report time stamps in one of four methods and may not report time stamps at all. The time clock types are summarized below:
Time Stamp Type | Description | PHD requirement | PHG conversion |
---|---|---|---|
Absolute Time | Local Wall clock time without time zone information | PHD must provide its current absolute time | PHG maps UTC plus offset and may correct it as described in the section Coincident Time Stamp |
Base-Offset Time | Time as UTC plus time added in minutes to get the local time | PHD must provide its current base-offset time | PHG maps UTC plus offset and may correct it as described in the section Coincident Time Stamp |
Relative time | The number of ticks in units of 1/8th millisecond | PHD must provide its current relative time | PHD obtains the current relative time at its current time and maps all measurement times to UTC plus offset based upon the difference given by the current relative time |
Hi-Resolution Relative time | The number of ticks in units of microseconds | PHD must provide its current hi-res time | PHD obtains the current hi-res relative time at its current time and maps all measurement times to UTC plus offset based upon the difference given by the current relative time |
No time stamp | PHG uses time of reception as UTC plus offset |
The PHG maps the 'converted' time stamp to either an Observation.effectiveDateTime element or an Observation.effectivePeriod element. The second situation occurs when the metric measurement includes a Measurement-Active-Period (duration) attribute. Then the time stamp attribute gives the start of the period and the end of the period is obtained by adding the Measurement-Active-Period value to it. If no time stamp is provided, the PHG, using the time of reception of the measurement as its time stamp must then do the reverse; the time of reception is the end time and the start time is given by subtracting the Measurement-Active-Period value from it.
Device
The Observation.device element is a reference to the Device resource representing the PHD that took the measurement.
derivedFrom: Coincident time stamp and Source Handle reference
This element references Observation resources that are in some manner related to this Observation resource. In the PHD use case, this situation occurs whenever the metric measurement reported by the PHD has a time stamp and/or the measurement contains a source handle reference attribute.
Time Stamp case
When the metric measurement contains a time stamp, there will be a Coincident Time Stamp Observation defining the details of how the Observtion.effective[x] element is generated.
Source-Handle-Reference case
A Source-Handle-Reference attribute points to a previously reported measurement that is important to this measurement. By previously it is meant that the measurement is reported prior to the current measurement but in the same connection. If multiple such measurements have been received, the correct one is that which is most recently received. As an example, the cardiovascular specialization defines a session measurement defining some type of exercise period, such as a run. All measurements taken during that run have a source handle reference attribute pointing to the session measurement. Since Source-Handle-Reference attributes use IEEE 11073 Object handle values and not Logical resource ids to point to measurements, the PHG will need to keep track of the Observation resources created during a connection to identify the correct Observation resource, and thus logical id, the Source-Handle-Reference attribute points to. The latest version of the IEEE 11073 20601 standard also supports a Source-Handle-Reference-List containing a list of handles so there can be more than one entry generated due to these attributes. The references are placed in a derivedFrom element.
Components
Component elements are used whenever the metric measurement contains additional information attributes that further describe the measurement. There are four such attributes that can be reported by all three types of metric measurements; the Supplemental-Types, Relative-Time, Hi-Res-Relative-Time, and Measurement-Status.
Supplemental Types
The Supplemental Types attribute contains a list of one or more partition-term code pairs. These define MDC codes that describe some property of the measurement. There will be one component element for each entry pair in the list. For example, the code MDC_MODALITY_SPOT used in the pulse oximeter specialization indicates that the measurement reported is a stable average. In contrast there is MDC_MODALITY_FAST and MDC_MODALITY_SLOW. The component elements are as populated as follows:
Observation.component element | entry | Additional Information |
---|---|---|
code.coding.code | 68193 | This is the MDC code for the Supplemental Types attribute |
code.coding.system | urn:iso:std:iso:11073:10101 | Indicates the MDC coding system |
code.coding.display | optional but | Should contain the reference id MDC_ATTR_SUPPLEMENTAL_TYPES along with any other additional text |
valueCodeableConcept.coding.system | urn:iso:std:iso:11073:10101 | Indicates the MDC coding system |
valueCodeableConcept.coding.code | the 32-bit MDC code | (partition) * 216 + term code |
valueCodeableConcept.coding.display | optional but | Should contain the reference id for the reported code along with any other additional text |
Relative Time Stamp
The Relative-Time-Stamp attribute contains the time stamp of the measurement in units of ticks where each tick is 1/8th of a millisecond. When mapped to FHIR, it is converted to microseconds (multiplied by 125). This attribute is reported to audit the derivation of the Observation.effective[x] time stamp value. The component element is mapped as follows:
Observation.component element | entry | Additional Information |
---|---|---|
code.coding.code | 67985 | This is the MDC code for the Relative-Time-Stamp attribute |
code.coding.system | urn:iso:std:iso:11073:10101 | Indicates the MDC coding system |
code.coding.display | optional but | Should contain the reference id MDC_ATTR_TIME_STAMP_REL along with any other additional text |
valueQuantity.value | the value | This is relative time value scaled to microseconds |
valueQuantity.unit | optional | |
valueQuantity.system | http://unitsofmeasure.org | Indicates the UCUM coding system |
valueQuantity.code | shall be the code 'us' for microseconds |
High Resolution Relative Time Stamp
The Hi-Res-Relative-Time-Stamp attribute contains the time stamp of the measurement in units of ticks where each tick is a microsecond. This attribute is reported as a means to audit the derivation of the Observation.effective[x] time stamp value. The component element is mapped as follows:
Observation.component element | entry | Additional Information |
---|---|---|
code.coding.code | 68073 | This is the MDC code for the Relative-Time-Stamp attribute |
code.coding.system | urn:iso:std:iso:11073:10101 | Indicates the MDC coding system |
code.coding.display | optional but | Should contain the reference id MDC_ATTR_TIME_STAMP_REL_HI_RES along with any other additional text |
valueQuantity.value | the value | This is relative time value scaled to microseconds |
valueQuantity.unit | optional | |
valueQuantity.system | http://unitsofmeasure.org | Indicates the UCUM coding system |
valueQuantity.code | shall be the code 'us' for microseconds |
Measurement Status
The Measurement Status attribute is an ASN.1 16-BITs measurement used to report errors or other special conditions. It defines 11 events. Being events, only set bits are reported. The attribute reports one or more of the following conditions in the indicated Mder bit position:
- invalid(0),
- questionable(1),
- not-available(2),
- calibration-ongoing(3),
- test-data(4),
- demo-data(5),
- validated-data(8)
- early-indication(9)
- msmt-ongoing(10),
- msmt-value-exceed-boundaries(14),
- msmt-state-ann-inhibited(15)
Though it is possible to have multiple bits simultaneously set, some combinations of set bits do not make sense and should not occur.
To report these cases in FHIR requires the use of three different elements. The interpretation codes are taken from the measurement status value set defined in the Point of Care implementation guide. The mapping is shown in the following table:
status Mder bit | ASN1 name | Observation element | |
---|---|---|---|
0 | invalid | dataAbsentReason.coding.code="error" http://hl7.org/fhir/ValueSet/data-absent-reason |
|
1 | questionable | interpretation.coding.system="http://hl7.org/fhir/uv/pocd/CodeSystem/measurement-status" interpretation.coding.code="questionable" |
|
2 | not-available | dataAbsentReason.coding.code="not-performed" dataAbsentReason.coding.system="http://hl7.org/fhir/ValueSet/data-absent-reason |
|
3 | calibration-ongoing | interpretation.coding.system="http://hl7.org/fhir/uv/pocd/CodeSystem/measurement-status" interpretation.coding.code="calibration-ongoing" |
|
4 | test-data | meta.security.coding.code="HTEST" meta.security.coding.system="http://hl7.org/fhir/ValueSet/security-labels" |
|
5 | demo-data | meta.security.coding.code="HTEST" meta.security.coding.system="http://hl7.org/fhir/ValueSet/security-labels" |
|
8 | validated-data | interpretation.coding.system="http://hl7.org/fhir/uv/pocd/CodeSystem/measurement-status" interpretation.coding.code="validated-data" |
|
9 | early-indication | interpretation.coding.system="http://hl7.org/fhir/uv/pocd/CodeSystem/measurement-status" interpretation.coding.code="early-indication" |
|
10 | msmt-ongoing | dataAbsentReason.coding.code="temp-unknown" dataAbsentReason.coding.system="http://hl7.org/fhir/ValueSet/data-absent-reason" |
|
14 | msmt-value-exceed-boundaries | interpretation.coding.system="http://hl7.org/fhir/uv/pocd/CodeSystem/measurement-status" interpretation.coding.code="in-alarm" |
|
15 | msmt-state-ann-inhibited | interpretation.coding.system="http://hl7.org/fhir/uv/pocd/CodeSystem/measurement-status" interpretation.coding.code="alarm-inhibited" |
Note that a status field is reported in the Nu-Observed-Value and Enum-Observed-Value attributes. When these attributes are sent, the status field in the attribute replaces the Measurement-Status attribute should the PHD have sent both (which would seem unlikely).
The status field is also reported in the Compound-Nu-Observed-Value. In this case the status field applies only to the Observation.component. An overall Measurement-Status attribute may also be present. The Observation.component has its own dataAbsentReason and interpretation element. However it does not have a meta element. On the other hand it does not make sense to have one sub-value of a compound report test data while another does not. A compound measurement in 20601 is a single measurement taken as a whole. However it is possible that a sub-value fails in the measurement process thus an error can occur on one sub-value while the others succeed.