Copy of 'RDC HDS STU3'

There are no (further) constraints on this element

Element id

Observation.implicitRules

Short description

A set of rules under which this content was created

Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

language

0..1

codeBinding

There are no (further) constraints on this element

Element id

Observation.language

Short description

Language of the resource content

Definition

The base language in which the resource is written.

Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Data type

Binding

A human language.

Common Languages (extensible)

Binding extensions

maxValueSet	All Languages

Conditions

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

Constraints

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

Mappings

rim: n/a

text

0..1

Narrative

There are no (further) constraints on this element

Element id

Observation.text

Short description

Text summary of the resource, for human interpretation

Alternate names

narrative, html, xhtml, display

Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

Data type

Narrative

Conditions

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

Constraints

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

Mappings

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

contained

0..*

Resource

There are no (further) constraints on this element

Element id

Observation.contained

Short description

Contained, inline Resources

Alternate names

inline resources, anonymous resources, contained resources

Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

Data type

Resource

Mappings

rim: Entity. Role, or Act
rim: N/A

extension

0..*

Element id

Observation.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

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

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

observationEventTiming

0..*

Element id

Observation.extension:observationEventTiming

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data type

http://roche.com/fhir/rdc/StructureDefinition/observation-event-timing

Extension URL

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

observationReference

0..*

Extension(Complex)

Element id

Observation.extension:observationReference

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data type

Extension(Complex)

Extension URL

http://roche.com/fhir/rdc/StructureDefinition/observation-reference

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

observationBgmRating

0..*

Element id

Observation.extension:observationBgmRating

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data type

http://roche.com/fhir/rdc/StructureDefinition/observation-bgmRating

Extension URL

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

medicationAdministrationTarget

0..*

Extension(Reference(medication-administration))

Element id

Observation.extension:medicationAdministrationTarget

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data type

Extension(Reference(medication-administration))

Extension URL

http://roche.com/fhir/rdc/StructureDefinition/medication-administration-target

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

medicationRequestTarget

0..*

Extension(Reference(medicationrequest))

Element id

Observation.extension:medicationRequestTarget

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data type

Extension(Reference(medicationrequest))

Extension URL

http://roche.com/fhir/rdc/StructureDefinition/medication-request-target

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

registeredTimeStamp

0..*

Extension(dateTime)

Element id

Observation.extension:registeredTimeStamp

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data type

Extension(dateTime)

Extension URL

http://roche.com/fhir/rdc/StructureDefinition/registered-timestamp

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

gdpr-controller

0..*

Element id

Observation.extension:gdpr-controller

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data type

http://roche.com/fhir/rdc/StructureDefinition/gdpr-controller

Extension URL

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

source

0..*

Element id

Observation.extension:source

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data type

http://roche.com/fhir/rdc/StructureDefinition/provenance-source

Extension URL

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

channel

0..*

Element id

Observation.extension:channel

Short description

Optional Extensions Element

Alternate names

extensions, user content

Definition

Optional Extension Element - found in all resources.

Comments

Data type

http://roche.com/fhir/rdc/StructureDefinition/provenance-channel

Extension URL

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

modifierExtension

?! C

0..*

There are no (further) constraints on this element

Element id

Observation.modifierExtension

Short description

Extensions that cannot be ignored

Alternate names

extensions, user content

Definition

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

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

identifier

0..1

There are no (further) constraints on this element

Element id

Observation.identifier

Short description

Business Identifier for observation

Definition

A unique identifier assigned to this observation.

Requirements

Allows observations to be distinguished and referenced.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd: Identifier
workflow: Event.identifier
v2: OBX.21 For OBX segments from systems without OBX-21 support a combination of ORC/OBR and OBX must be negotiated between trading partners to uniquely identify the OBX segment. Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4.
rim: id
w5: id

0..1

There are no (further) constraints on this element

Element id

Observation.identifier.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.identifier.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

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

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

Observation.identifier.use

Short description

usual | official | temp | secondary (If known)

Definition

The purpose of this identifier.

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Data type

Binding

Identifies the purpose for this identifier, if known .

IdentifierUse (required)

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

Observation.identifier.type

Short description

Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.

Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Data type

Identifier Type Codes (extensible)

Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
v2: CX.5
rim: Role.code or implied by context

system

0..1

uriBinding

Element id

Observation.identifier.system

Short description

The namespace for the identifier value

Definition

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

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Data type

Binding

identifiers (required)

Conditions

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

Constraints

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

Examples
General

http://www.acme.com/identifiers/patient

Mappings

rim: n/a
v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

0..1

There are no (further) constraints on this element

Element id

Observation.identifier.value

Short description

The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

Data type

Conditions

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

Constraints

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

Examples
General

Mappings

rim: n/a
v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

Σ C

0..1

There are no (further) constraints on this element

Element id

Observation.identifier.period

Short description

Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Comments

This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.

Data type

Conditions

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

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
per-1: If present, start SHALL have a lower value than end
start.empty() or end.empty() or (start <= end)

Mappings

rim: n/a
v2: DR
rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

Σ C

0..1

Reference(Organization)

There are no (further) constraints on this element

Element id

Observation.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Data type

Reference(Organization)

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

basedOn

Σ C

0..*

Reference(dm-careplan)

Element id

Observation.basedOn

Short description

Fulfills plan, proposal or order

Alternate names

Fulfills

Definition

A plan, proposal or order that is fulfilled in whole or in part by this event.

Requirements

Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

Comments

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.

Data type

Reference(dm-careplan)

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.basedOn
v2: ORC
rim: .outboundRelationship[typeCode=FLFS].target

0..1

There are no (further) constraints on this element

Element id

Observation.basedOn.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.basedOn.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

reference

Σ C

0..1

Element id

Observation.basedOn.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

A 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.

Comments

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.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A
ACSPIX2FHIR: CarePlan/${input.careplanId}

identifier

0..1

There are no (further) constraints on this element

Element id

Observation.basedOn.identifier

Short description

Logical reference, when literal reference is not known

Definition

An 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.

Comments

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.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd: Identifier
rim: .identifier

display

0..1

There are no (further) constraints on this element

Element id

Observation.basedOn.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

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.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

status

Σ ?!

1..1

codeBinding

Element id

Observation.status

Short description

registered | preliminary | final | amended +

Definition

The status of the result value.

Requirements

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

Comments

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

Data type

Binding

Codes providing the status of an observation.

ObservationStatus (required)

Conditions

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

Constraints

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

Mappings

rim: n/a
workflow: Event.status
sct-concept: < 445584004 |Report by finality status|
v2: OBX-11
rim: status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of "revise"
w5: status
ACSPIX2FHIR: final
GREENDOT: final

category

0..1

CodeableConceptBinding

Element id

Observation.category

Short description

Classification of type of observation

Definition

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

Requirements

Used for filtering what observations are retrieved and displayed.

Comments

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Data type

observation-category-type (required)

Binding

Codes for high level observation categories.

Conditions

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

Constraints

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

Mappings

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

0..1

There are no (further) constraints on this element

Element id

Observation.category.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.category.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

coding

0..*

There are no (further) constraints on this element

Element id

Observation.category.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

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.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim: CV
orim: fhir:Coding rdfs:subClassOf dt:CDCoding
v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

0..1

There are no (further) constraints on this element

Element id

Observation.category.coding.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.category.coding.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

system

0..1

Element id

Observation.category.coding.system

Short description

Identity of the terminology system

Definition

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

Requirements

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

Comments

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.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
ACSPIX2FHIR: http://roche.com/fhir/rdc/cs
GREENDOT: http://roche.com/fhir/rdc/cs

version

0..1

There are no (further) constraints on this element

Element id

Observation.category.coding.version

Short description

Version of the system - if relevant

Definition

The 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.

Comments

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.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

0..1

Element id

Observation.category.coding.code

Short description

Symbol in syntax defined by the system

Definition

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

Requirements

Need to refer to a particular code in the system.

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
ACSPIX2FHIR: ObservationCategoryCodes.code
GREENDOT: clinical-observation

display

0..1

Element id

Observation.category.coding.display

Short description

Representation defined by the system

Definition

A representation of the meaning of the code in the system, following the rules of the system.

Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
ACSPIX2FHIR: ObservationCategoryCodes.display
GREENDOT: Clinical Observation

userSelected

0..1

There are no (further) constraints on this element

Element id

Observation.category.coding.userSelected

Short description

If this coding was chosen directly by the user

Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Requirements

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.

Comments

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.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

text

0..1

There are no (further) constraints on this element

Element id

Observation.category.text

Short description

Plain text representation of the concept

Definition

A 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.

Requirements

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.

Comments

Very often the text is the same as a displayName of one of the codings.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

code

1..1

CodeableConceptBinding

Element id

Observation.code

Short description

Type of observation (code / type)

Alternate names

Name

Definition

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

Requirements

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

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Data type

Binding

Codes identifying names of simple observations.

ObservationCodes (required)

Conditions

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

Constraints

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

Mappings

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

0..1

There are no (further) constraints on this element

Element id

Observation.code.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.code.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

coding

0..*

There are no (further) constraints on this element

Element id

Observation.code.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim: CV
orim: fhir:Coding rdfs:subClassOf dt:CDCoding
v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

0..1

There are no (further) constraints on this element

Element id

Observation.code.coding.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.code.coding.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

system

1..1

Element id

Observation.code.coding.system

Short description

Identity of the terminology system

Definition

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

Requirements

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

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
ACSPIX2FHIR: ObservationCodes.system
GREENDOT: http://loinc.org

version

0..1

There are no (further) constraints on this element

Element id

Observation.code.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

Element id

Observation.code.coding.code

Short description

Symbol in syntax defined by the system

Definition

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

Requirements

Need to refer to a particular code in the system.

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
ACSPIX2FHIR: ObservationCodes.code
GREENDOT: 32016-8
GLUCI-CHEK: BG.Evt

display

1..1

Element id

Observation.code.coding.display

Short description

Representation defined by the system

Definition

A representation of the meaning of the code in the system, following the rules of the system.

Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
ACSPIX2FHIR: ObservationCodes.display
GREENDOT: Glucose [Mass/volume] in Capillary blood

userSelected

0..1

There are no (further) constraints on this element

Element id

Observation.code.coding.userSelected

Short description

If this coding was chosen directly by the user

Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Requirements

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.

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

text

0..1

There are no (further) constraints on this element

Element id

Observation.code.text

Short description

Plain text representation of the concept

Definition

A 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.

Requirements

Comments

Very often the text is the same as a displayName of one of the codings.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

subject

Σ C

1..1

Reference(http://roche.com/fhir/rdc/StructureDefinition/patient)

Element id

Observation.subject

Short description

Who and/or what this is about

Definition

The patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed. Comments: Indirect characteristics may be those of a specimen, fetus, donor, other observer (for example a relative or EMT), or any observation made about the subject.

Requirements

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

Comments

BG Observation -> subject element will be mapped to Patient.

Manual Entry Observation -> subject element will be mapped to Patient.

Data type

Reference(http://roche.com/fhir/rdc/StructureDefinition/patient)

Conditions

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

Constraints

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

Mappings

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

context

0..0

Reference(Encounter | EpisodeOfCare)

There are no (further) constraints on this element

Element id

Observation.context

Short description

Healthcare event during which this observation is made

Alternate names

Encounter

Definition

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

Requirements

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

Comments

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

Data type

Reference(Encounter | EpisodeOfCare)

Conditions

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

Constraints

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

Mappings

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

effective[x]

1..1

Element id

Observation.effective[x]

Short description

Clinically relevant time/time-period for observation

Alternate names

Occurrence

Definition

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

Requirements

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

Comments

At least a date should be present unless this observation is a historical report.

Conditions

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

Constraints

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

Mappings

rim: n/a
workflow: Event.occurrence[x]
v2: OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)
rim: effectiveTime
w5: when.done
ACSPIX2FHIR: ${BGDate}${Timestamp}:00+02:00
GLUCI-CHEK: BG.Dt
GLUCI-CHEK: BG.Tm

effectiveDateTime

dateTime

There are no (further) constraints on this element

Data type

dateTime

effectivePeriod

There are no (further) constraints on this element

Data type

issued

0..0

instant

There are no (further) constraints on this element

Element id

Observation.issued

Short description

Date/Time this was made available

Definition

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

Comments

Updated when the result is updated.

Data type

instant

Conditions

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

Constraints

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

Mappings

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

performer

Σ C

0..*

Reference(http://roche.com/fhir/rdc/StructureDefinition/patient | practitioner)

Element id

Observation.performer

Short description

Who is responsible for the observation

Definition

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

Requirements

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

Comments

performer element will be mapped to Patient.

Data type

Reference(http://roche.com/fhir/rdc/StructureDefinition/patient | practitioner)

Conditions

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

Constraints

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

Mappings

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

valueQuantity

Σ C

0..1

QuantityBinding

Element id

Observation.value[x]:valueQuantity

Short description

Actual result

Definition

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

Requirements

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

Comments

Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type).

If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples see the notes section below.

Data type

Quantity

Binding

MetricUnits (required)

Conditions

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

Constraints

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

Mappings

rim: n/a
workflow: Event.notDone, Event.notDoneReason (maps to valeu[x] or dataAbsentReason)
sct-concept: < 441742003 |Evaluation finding|
v2: OBX.2, OBX.5, OBX.6
rim: value
sct-attr: 363714003 |Interprets|
ACSPIX2FHIR: delete obs.valueQuantity

0..1

There are no (further) constraints on this element

Element id

Observation.value[x]:valueQuantity.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.value[x]:valueQuantity.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

value

0..1

decimal

Element id

Observation.value[x]:valueQuantity.value

Short description

Numerical value (with implicit precision)

Definition

The value of the measured amount. The value includes an implicit precision in the presentation of the value.

Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

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).

Data type

decimal

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: SN.2 / CQ - N/A
rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
ACSPIX2FHIR: BG.Val
GREENDOT: com.roche.greendot.engine.finalValueDetected.getMeasurement().getValue()
GLUCI-CHEK: BG.Val

comparator

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

Observation.value[x]:valueQuantity.comparator

Short description

< | <= | >= | > - how to understand the value

Definition

How 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.

Requirements

Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

Comments

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.

Meaning when missing

If there is no comparator, then there is no modification of the value

Data type

Binding

How the Quantity should be understood and represented.

QuantityComparator (required)

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: SN.1 / CQ.1
rim: IVL properties

unit

0..1

Element id

Observation.value[x]:valueQuantity.unit

Short description

Unit representation

Definition

A human-readable form of the unit.

Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: (see OBX.6 etc.) / CQ.2
rim: PQ.unit
ACSPIX2FHIR: ${deviceBGUnit}
GREENDOT: type of metric

system

Σ C

0..1

Element id

Observation.value[x]:valueQuantity.system

Short description

System that defines coded unit form

Definition

The identification of the system that provides the coded form of the unit.

Requirements

Need to know the system that defines the coded form of the unit.

Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: (see OBX.6 etc.) / CQ.2
rim: CO.codeSystem, PQ.translation.codeSystem
ACSPIX2FHIR: http://unitsofmeasure.org
GREENDOT: http://unitsofmeasure.org

code

0..1

Element id

Observation.value[x]:valueQuantity.code

Short description

Coded form of the unit

Definition

A computer processable form of the unit in some unit representation system.

Requirements

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.

Comments

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.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: (see OBX.6 etc.) / CQ.2
rim: PQ.code, MO.currency, PQ.translation.code
ACSPIX2FHIR: ${deviceBGUnit}
GREENDOT: type of metric display

dataAbsentReason

0..1

CodeableConceptBinding

Element id

Observation.dataAbsentReason

Short description

Why the result is missing

Definition

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

Requirements

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

Comments

Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.

Data type

Binding

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

null-flavor (required)

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
workflow: Event.notDone, Event.notDoneReason (maps to valeu[x] or dataAbsentReason)
v2: N/A
rim: value.nullFlavor

0..1

There are no (further) constraints on this element

Element id

Observation.dataAbsentReason.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.dataAbsentReason.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

coding

0..*

There are no (further) constraints on this element

Element id

Observation.dataAbsentReason.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim: CV
orim: fhir:Coding rdfs:subClassOf dt:CDCoding
v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

0..1

There are no (further) constraints on this element

Element id

Observation.dataAbsentReason.coding.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.dataAbsentReason.coding.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

system

0..1

Element id

Observation.dataAbsentReason.coding.system

Short description

Identity of the terminology system

Definition

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

Requirements

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

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
ACSPIX2FHIR: input.Val="HI" then 'http://hl7.org/fhir/v3/nullFlavor' elseIf "LO" then 'http://hl7.org/fhir/v3/nullFlavor' elseIf "-" then 'http://hl7.org/fhir/data-absent-reason'
GREENDOT: input.Val="HI" then 'http://hl7.org/fhir/v3/nullFlavor' elseIf "LO" then 'http://hl7.org/fhir/v3/nullFlavor' elseIf "-" then 'http://hl7.org/fhir/data-absent-reason'

version

0..1

There are no (further) constraints on this element

Element id

Observation.dataAbsentReason.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

0..1

Element id

Observation.dataAbsentReason.coding.code

Short description

Symbol in syntax defined by the system

Definition

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

Requirements

Need to refer to a particular code in the system.

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
ACSPIX2FHIR: input.Val="HI" then 'PINF' elseIf "LO" then 'NINF' elseIf "-" then 'unknown'
GREENDOT: input.Val="HI" then 'PINF' elseIf "LO" then 'NINF' elseIf "-" then 'unknown'
GLUCI-CHEK: BG.Val

display

0..1

Element id

Observation.dataAbsentReason.coding.display

Short description

Representation defined by the system

Definition

A representation of the meaning of the code in the system, following the rules of the system.

Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
ACSPIX2FHIR: input.Val="HI" then 'positive infinity' elseIf "LO" then 'negative infinity' elseIf "-" then 'Unknown'
GREENDOT: input.Val="HI" then 'positive infinity' elseIf "LO" then 'negative infinity' elseIf "-" then 'Unknown'

userSelected

0..1

There are no (further) constraints on this element

Element id

Observation.dataAbsentReason.coding.userSelected

Short description

If this coding was chosen directly by the user

Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Requirements

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.

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

text

0..1

Element id

Observation.dataAbsentReason.text

Short description

Plain text representation of the concept

Definition

A 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.

Requirements

Comments

Very often the text is the same as a displayName of one of the codings.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
ACSPIX2FHIR: 'Above sensor range' : 'Below sensor range'
GREENDOT: 'Above sensor range' : 'Below sensor range'

interpretation

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

Observation.interpretation

Short description

High, low, normal, etc.

Alternate names

Abnormal Flag

Definition

The assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.

Requirements

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

Comments

Data type

Observation Interpretation Codes (extensible)

Binding

Codes identifying interpretations of observations.

Conditions

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

Constraints

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

Mappings

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

0..1

There are no (further) constraints on this element

Element id

Observation.interpretation.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.interpretation.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

coding

0..*

There are no (further) constraints on this element

Element id

Observation.interpretation.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
rim: CV
orim: fhir:Coding rdfs:subClassOf dt:CDCoding
v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

0..1

There are no (further) constraints on this element

Element id

Observation.interpretation.coding.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.interpretation.coding.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

system

0..1

Element id

Observation.interpretation.coding.system

Short description

Identity of the terminology system

Definition

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

Requirements

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

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
ACSPIX2FHIR: http://hl7.org/fhir/v2/0078

version

0..1

There are no (further) constraints on this element

Element id

Observation.interpretation.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

0..1

Element id

Observation.interpretation.coding.code

Short description

Symbol in syntax defined by the system

Definition

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

Requirements

Need to refer to a particular code in the system.

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
ACSPIX2FHIR: 'L' or 'H'

display

0..1

There are no (further) constraints on this element

Element id

Observation.interpretation.coding.display

Short description

Representation defined by the system

Definition

A representation of the meaning of the code in the system, following the rules of the system.

Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element id

Observation.interpretation.coding.userSelected

Short description

If this coding was chosen directly by the user

Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Requirements

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.

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

text

0..1

There are no (further) constraints on this element

Element id

Observation.interpretation.text

Short description

Plain text representation of the concept

Definition

A 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.

Requirements

Comments

Very often the text is the same as a displayName of one of the codings.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

comment

0..1

There are no (further) constraints on this element

Element id

Observation.comment

Short description

Comments about result

Definition

May 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.

Requirements

Need to be able to provide free text additional information.

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

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

bodySite

0..1

CodeableConceptBinding

Element id

Observation.bodySite

Short description

Observed body part

Definition

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

Comments

Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension body-site-instance.

Data type

Binding

Codes describing anatomical locations. May include laterality.

body-site (required)

Conditions

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

Constraints

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

Mappings

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

method

0..0

There are no (further) constraints on this element

Element id

Observation.method

Short description

How it was done

Definition

Indicates the mechanism used to perform the observation.

Requirements

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

Comments

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

Data type

Binding

Methods for simple observations.

Observation Methods (example)

Conditions

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

Constraints

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

Mappings

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

specimen

0..0

Reference(Specimen)

There are no (further) constraints on this element

Element id

Observation.specimen

Short description

Specimen used for this observation

Definition

The specimen that was used when this observation was made.

Comments

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

Data type

Reference(Specimen)

Conditions

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

Constraints

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

Mappings

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

device

0..1

Reference(dm-devicemetric | phg-device)

Element id

Observation.device

Short description

(Measurement) Device

Definition

The device used to generate the observation data.

Comments

BG Observation -> device element will be mapped to DeviceMetric

Manual Entry Observation -> device element will be mapped to DeviceMetric

Data type

Reference(dm-devicemetric | phg-device)

Conditions

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

Constraints

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

Mappings

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

referenceRange

0..1

There are no (further) constraints on this element

Element id

Observation.referenceRange

Short description

Provides guide for interpretation

Definition

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

Requirements

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

Comments

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

Data type

Conditions

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

Constraints

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

Mappings

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

0..1

There are no (further) constraints on this element

Element id

Observation.referenceRange.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.referenceRange.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

Observation.referenceRange.modifierExtension

Short description

Extensions that cannot be ignored

Alternate names

extensions, user content, modifiers

Definition

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

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

low

0..1

There are no (further) constraints on this element

Element id

Observation.referenceRange.low

Short description

Low Range, if relevant

Definition

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

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data type

Conditions

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

Constraints

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

Mappings

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

high

0..1

There are no (further) constraints on this element

Element id

Observation.referenceRange.high

Short description

High Range, if relevant

Definition

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

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Data type

Conditions

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

Constraints

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

Mappings

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

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

Observation.referenceRange.type

Short description

Reference range qualifier

Definition

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

Requirements

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

Comments

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

Data type

Observation Reference Range Meaning Codes (extensible)

Binding

Code for the meaning of a reference range.

Conditions

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

Constraints

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

Mappings

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

appliesTo

0..*

There are no (further) constraints on this element

Element id

Observation.referenceRange.appliesTo

Short description

Reference range population

Definition

Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race.

Requirements

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

Comments

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

Data type

Observation Reference Range Applies To Codes (example)

Binding

Codes identifying the population the reference range applies to.

Conditions

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

Constraints

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

Mappings

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

age

0..1

Range

There are no (further) constraints on this element

Element id

Observation.referenceRange.age

Short description

Applicable age range, if relevant

Definition

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

Requirements

Some analytes vary greatly over age.

Comments

The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.

Data type

Range

Conditions

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

Constraints

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

Mappings

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

text

0..1

There are no (further) constraints on this element

Element id

Observation.referenceRange.text

Short description

Text based reference range in an observation

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

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

0..*

There are no (further) constraints on this element

Element id

Observation.related

Short description

Resource related to this observation

Definition

A reference to another resource (usually another Observation) whose relationship is defined by the relationship type code.

Requirements

Normally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and a set of related observations or sometimes a QuestionnaireResponse from which the measure is derived.

Comments

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

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: Relationships established by OBX-4 usage
rim: outBoundRelationship

0..1

There are no (further) constraints on this element

Element id

Observation.related.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.related.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

Observation.related.modifierExtension

Short description

Extensions that cannot be ignored

Alternate names

extensions, user content, modifiers

Definition

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

type

1..1

codeBinding

Element id

Observation.related.type

Short description

Definition

A code specifying the kind of relationship that exists with the target resource.

Requirements

A relationship type SHOULD be provided.

Comments

The "derived-from" type is the only logical choice when referencing the QuestionnaireAnswer resource.

Data type

ObservationRelationshipType (required)

Binding

Codes specifying how two observations are related.

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: N/A
rim: .typeCode
ACSPIX2FHIR: has-member

target

1..1

Reference(bg-observation | health-event-observation | observation | EWM-observation)

Element id

Observation.related.target

Short description

Resource that is related to this one

Definition

A reference to the observation or QuestionnaireResponse resource that is related to this observation.

Comments

Data type

Reference(bg-observation | health-event-observation | observation | EWM-observation)

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
rim: .targetObservation

0..1

There are no (further) constraints on this element

Element id

Observation.related.target.id

Short description

xml:id (or equivalent in JSON)

Definition

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

Comments

Note that FHIR strings may not exceed 1MB in size

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

Observation.related.target.extension

Short description

Additional Content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

reference

Σ C

0..1

Element id

Observation.related.target.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A
ACSPIX2FHIR: Observation/${relatedObservationId}
GLUCI-CHEK: BG.Evt
GLUCI-CHEK: BG.Ctrl
GLUCI-CHEK: BG.Evt
GLUCI-CHEK: BG.Evt
GLUCI-CHEK: BG.Evt
GLUCI-CHEK: BG.Evt
GLUCI-CHEK: BG.Evt

identifier

0..1

There are no (further) constraints on this element

Element id

Observation.related.target.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd: Identifier
rim: .identifier

display

0..1

There are no (further) constraints on this element

Element id

Observation.related.target.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

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.

Data type

Conditions

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

Constraints

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

Mappings

rim: n/a
rim: N/A

component

0..0

There are no (further) constraints on this element

Element id

Observation.component

Short description

Component results

Definition

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

Requirements

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

Comments

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

Data type