| MedMijCoreASAScore (Observation) | C | | Observation | Element idObservation Short descriptionASAScore Alternate namesVital Signs, Measurement, Results, Tests, ASAScore DefinitionClassification of physical condition according to the American Society of Anesthesiologists (ASA).
Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.
Observation Constraints- dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.empty() - dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() - dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() - dom-6: A resource should have narrative for robust management
text.`div`.exists() - dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
contained.meta.security.empty() - obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty() - obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
dataAbsentReason.empty() or value.empty()
Mappings- rim: Entity. Role, or Act
- workflow: Event
- sct-concept: < 363787002 |Observable entity|
- v2: OBX
- rim: Observation[classCode=OBS, moodCode=EVN]
- medmij-core-dataset-120-20260923: medmij-core-dataelement-1
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| id | Σ | 0..1 | id | There are no (further) constraints on this element Element idObservation.id Short descriptionLogical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
id ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idObservation.meta Short descriptionMetadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Meta ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| id | | 0..1 | string | There are no (further) constraints on this element Element idObservation.meta.id Short descriptionUnique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
string Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.meta.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension SlicingUnordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| versionId | Σ | 0..1 | id | There are no (further) constraints on this element Element idObservation.meta.versionId Short descriptionVersion specific identifier DefinitionThe version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
id ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| lastUpdated | Σ | 0..1 | instant | There are no (further) constraints on this element Element idObservation.meta.lastUpdated Short descriptionWhen the resource version last changed DefinitionWhen the resource last changed - e.g. when the version changed.
This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
instant ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| source | Σ | 0..1 | uri | There are no (further) constraints on this element Element idObservation.meta.source Short descriptionIdentifies where the resource comes from DefinitionA uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.
This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
uri ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| profile | Σ | 0..* | canonical(StructureDefinition) | There are no (further) constraints on this element Element idObservation.meta.profile Short descriptionProfiles this resource claims to conform to DefinitionCommentsIt is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
canonical(StructureDefinition) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| security | Σ | 0..* | CodingBinding | There are no (further) constraints on this element Element idObservation.meta.security Short descriptionSecurity Labels applied to this resource DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
Coding BindingSecurity Labels from the Healthcare Privacy and Security Classification System. All Security Labels (extensible) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
- rim: CV
- orim: fhir:Coding rdfs:subClassOf dt:CDCoding
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| tag | Σ | 0..* | Coding | Element idObservation.meta.tag Short descriptionTags applied to this resource DefinitionTags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
Coding SlicingUnordered, Open, by $this(Value) BindingCodes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". CommonTags (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
- rim: CV
- orim: fhir:Coding rdfs:subClassOf dt:CDCoding
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| careType | Σ | 0..* | CodingBinding | Element idObservation.meta.tag:careType Short descriptionCareType Alternate namesZorgtype DefinitionThe type of the healthcare provider responsible for the delivered care, or more specifically, the specialty of the department and/or health professional that delivered care. It enables patients and systems to interpret the origin and context of medical data.
The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
Coding BindingCodes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". AfdelingSpecialismeCodelijst (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
- rim: CV
- orim: fhir:Coding rdfs:subClassOf dt:CDCoding
- medmij-core-dataset-120-20260923: medmij-core-dataelement-123
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idObservation.implicitRules Short descriptionA set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
uri ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| language | | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.language Short descriptionLanguage of the resource content DefinitionThe base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
code BindingA human language. CommonLanguages (preferred) Binding extensionsConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| text | | 0..1 | Narrative | There are no (further) constraints on this element Element idObservation.text Short descriptionText summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Narrative ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- rim: N/A
- rim: Act.text?
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| contained | | 0..* | Resource | There are no (further) constraints on this element Element idObservation.contained Short descriptionContained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Resource Mappings- rim: Entity. Role, or Act
- rim: N/A
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension SlicingUnordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | ?! C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.modifierExtension Short descriptionExtensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer 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.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension SlicingUnordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| identifier | Σ | 0..* | Identifier | Element idObservation.identifier Short descriptionIdentificationNumber Alternate namesIdentificatienummer DefinitionGlobally unique number that identifies the instantiation of the CIM. The number is composed of an identification of the issuer organization and a unique number assigned by this organization.
Allows observations to be distinguished and referenced.
Identifier ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
- rim: II - 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
- w5: FiveWs.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
- medmij-core-dataset-120-20260923: medmij-core-dataelement-115
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| basedOn | Σ C | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | There are no (further) constraints on this element Element idObservation.basedOn Short descriptionFulfills plan, proposal or order Alternate namesFulfills DefinitionA plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.
Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Event.basedOn
- v2: ORC
- rim: .inboundRelationship[typeCode=COMP].source[moodCode=EVN]
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| partOf | Σ C | 0..* | Reference(ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | MedicationStatement | Procedure) | There are no (further) constraints on this element Element idObservation.partOf Short descriptionPart of referenced event Alternate namesContainer DefinitionA larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.
To link an Observation to an Encounter use encounter. See the Notes below for guidance on referencing another Observation.
Reference(ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | MedicationStatement | Procedure) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Event.partOf
- v2: Varies by domain
- rim: .outboundRelationship[typeCode=FLFS].target
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| status | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idObservation.status Short descriptionregistered | preliminary | final | amended + DefinitionThe status of the result value.
Need to track the status of individual results. Some results are finalized before the whole report is finalized.
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
code BindingCodes providing the status of an observation. ObservationStatus (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- workflow: Event.status
- w5: FiveWs.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"
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| category | | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.category Short descriptionClassification of type of observation DefinitionA code that classifies the general type of observation being made.
Used for filtering what observations are retrieved and displayed.
In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.
CodeableConcept BindingCodes for high level observation categories. ObservationCategoryCodes (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- w5: FiveWs.class
- rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
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| code | Σ | 1..1 | CodeableConceptPattern | Element idObservation.code Short descriptionType of observation (code / type) Alternate namesName DefinitionDescribes what was observed. Sometimes this is called the observation "name".
Knowing what kind of observation is being made is essential to understanding the observation.
All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.
CodeableConcept BindingCodes identifying names of simple observations. LOINCCodes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Pattern{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "413347006"
}
]
}Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- workflow: Event.code
- w5: FiveWs.what[x]
- sct-concept: < 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|
- v2: OBX-3
- rim: code
- sct-attr: 116680003 |Is a|
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| subject | Σ C | 1..1 | Reference(Patient | NlcorePatient) | Element idObservation.subject Short descriptionPatient Alternate namesPatiënt DefinitionThe patient as subject of the information.
Observations have no value if you don't know who or what they're about.
One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.
Reference(Patient | NlcorePatient) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Event.subject
- w5: FiveWs.subject[x]
- v2: PID-3
- rim: participation[typeCode=RTGT]
- w5: FiveWs.subject
- medmij-core-dataset-120-20260923: medmij-core-dataelement-116
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| focus | Σ C | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idObservation.focus Short descriptionWhat the observation is about, when it is not about the subject of record DefinitionThe actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.
Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use specimen if a reference to a specimen is required. If a code is required instead of a resource use either bodysite for bodysites or the standard extension focusCode.
Reference(Resource) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- w5: FiveWs.subject[x]
- v2: OBX-3
- rim: participation[typeCode=SBJ]
- w5: FiveWs.subject
|
| encounter | Σ C | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element idObservation.encounter Short descriptionHealthcare event during which this observation is made Alternate namesContext DefinitionThe healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.
For some observations it may be important to know the link between an observation and a particular encounter.
This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).
Reference(Encounter) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Event.context
- w5: FiveWs.context
- v2: PV1
- rim: inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
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| effective[x] | Σ | 0..1 | | Element idObservation.effective[x] Short descriptionClinically relevant time/time-period for observation Alternate namesOccurrence DefinitionThe time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.
Knowing when an observation was deemed true is important to its relevance as well as determining trends.
At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.
Unordered, Open, by $this(Type) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- workflow: Event.occurrence[x]
- w5: FiveWs.done[x]
- v2: OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)
- rim: effectiveTime
|
| effectiveInstant | | | instant | There are no (further) constraints on this element Data typeinstant |
| effectivePeriod | | | Period | There are no (further) constraints on this element Data typePeriod |
| effectiveTiming | | | Timing | There are no (further) constraints on this element Data typeTiming |
| effectiveDateTime | Σ | 0..1 | dateTime | Element idObservation.effective[x]:effectiveDateTime Short descriptionEffectiveDateTime Alternate namesOccurrence, Tijdsindicatie, DatumTijd, ASAScoreDatumTijd DefinitionThe date and time at which the ASA score was determined.
Knowing when an observation was deemed true is important to its relevance as well as determining trends.
At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.
dateTime ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- workflow: Event.occurrence[x]
- w5: FiveWs.done[x]
- v2: OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)
- rim: effectiveTime
- medmij-core-dataset-120-20260923: medmij-core-dataelement-119
|
| issued | Σ | 0..1 | instant | There are no (further) constraints on this element Element idObservation.issued Short descriptionDate/Time this version was made available DefinitionThe date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.
For Observations that don’t require review and verification, it may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.
instant ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- w5: FiveWs.recorded
- v2: OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)
- rim: participation[typeCode=AUT].time
|
| performer | Σ C | 0..* | Reference(CareTeam | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | NlcoreHealthProfessionalPractitionerRole) | Element idObservation.performer Short descriptionPerformer Alternate namesUitvoerder DefinitionThe health professional who determined the ASA score.
May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.
Each occurrence of the zib HealthProfessional is normally represented by two FHIR resources: a PractitionerRole resource (instance of nl-core-HealthProfessional-PractitionerRole) and a Practitioner resource (instance of nl-core-HealthProfessional-Practitioner). The Practitioner resource is referenced from the PractitionerRole instance. For this reason, sending systems should fill the reference to the PractitionerRole instance here, and not the Practitioner resource. Receiving systems can then retrieve the reference to the Practitioner resource from that PractitionerRole instance.
In rare circumstances, there is only a Practitioner instance, in which case it is that instance which will be referenced here. However, since this should be the exception, the nl-core-HealthProfessional-Practitioner profile is not explicitly mentioned as a target profile.
Reference(CareTeam | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | NlcoreHealthProfessionalPractitionerRole) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- workflow: Event.performer.actor
- w5: FiveWs.actor
- v2: OBX.15 / (Practitioner) OBX-16, PRT-5:PRT-4='RO' / (Device) OBX-18 , PRT-10:PRT-4='EQUIP' / (Organization) OBX-23, PRT-8:PRT-4='PO'
- rim: participation[typeCode=PRF]
- medmij-core-dataset-120-20260923: medmij-core-dataelement-4
- medmij-core-dataset-120-20260923: medmij-core-dataelement-117
|
| value[x] | Σ C | 1..1 | | Element idObservation.value[x] Short descriptionActual result DefinitionThe information determined as a result of making the observation, if the information has a simple value.
An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.
An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.
Unordered, Open, by $this(Type) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1, obs-7 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- sct-concept: < 441742003 |Evaluation finding|
- v2: OBX.2, OBX.5, OBX.6
- rim: value
- sct-attr: 363714003 |Interprets|
|
| valueBoolean | | | boolean | There are no (further) constraints on this element Data typeboolean |
| valueDateTime | | | dateTime | There are no (further) constraints on this element Data typedateTime |
| valueInteger | | | integer | There are no (further) constraints on this element Data typeinteger |
| valuePeriod | | | Period | There are no (further) constraints on this element Data typePeriod |
| valueQuantity | | | Quantity | There are no (further) constraints on this element Data typeQuantity |
| valueRange | | | Range | There are no (further) constraints on this element Data typeRange |
| valueRatio | | | Ratio | There are no (further) constraints on this element Data typeRatio |
| valueSampledData | | | SampledData | There are no (further) constraints on this element Data typeSampledData |
| valueString | | | string | There are no (further) constraints on this element Data typestring |
| valueTime | | | time | There are no (further) constraints on this element Data typetime |
| valueCodeableConcept | Σ C | 1..1 | CodeableConceptBinding | Element idObservation.value[x]:valueCodeableConcept Short descriptionASAScoreValue Alternate namesASAScoreWaarde DefinitionThe value of the ASA score.
An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.
An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.
CodeableConcept BindingASAScore (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1, obs-7 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- sct-concept: < 441742003 |Evaluation finding|
- v2: OBX.2, OBX.5, OBX.6
- rim: value
- sct-attr: 363714003 |Interprets|
- medmij-core-dataset-120-20260923: medmij-core-dataelement-3
|
| dataAbsentReason | C | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.dataAbsentReason Short descriptionWhy the result is missing DefinitionProvides a reason why the expected value in the element Observation.value[x] is missing.
For many results it is necessary to handle exceptional values in measurements.
Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory".
The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.
CodeableConcept BindingCodes specifying why the result (`Observation.value[x]`) is missing. DataAbsentReason (extensible) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1, obs-6 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2: N/A
- rim: value.nullFlavor
|
| interpretation | | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.interpretation Short descriptionHigh, low, normal, etc. Alternate namesAbnormal Flag DefinitionA categorical assessment of an observation value. For example, high, low, normal.
For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.
CodeableConcept BindingCodes identifying interpretations of observations. ObservationInterpretationCodes (extensible) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- sct-concept: < 260245000 |Findings values|
- v2: OBX-8
- rim: interpretationCode
- sct-attr: 363713009 |Has interpretation|
|
| note | | 0..* | Annotation | There are no (further) constraints on this element Element idObservation.note Short descriptionComments about the observation DefinitionComments about the observation or the results.
Need to be able to provide free text additional information.
May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.
Annotation ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: N/A
- rim: Act
- v2: NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)
- rim: subjectOf.observationEvent[code="annotation"].value
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idObservation.note.id Short descriptionUnique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
string Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.note.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension SlicingUnordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| author[x] | Σ | 0..1 | | There are no (further) constraints on this element Element idObservation.note.author[x] Short descriptionIndividual responsible for the annotation DefinitionThe individual responsible for making the annotation.
Organization is used when there's no need for specific attribution as to who made the comment.
The cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: N/A
- rim: Act.participant[typeCode=AUT].role
|
| authorReference | | | Reference(Organization | Patient | Practitioner | RelatedPerson) | There are no (further) constraints on this element Data typeReference(Organization | Patient | Practitioner | RelatedPerson) |
| authorString | | | string | There are no (further) constraints on this element Data typestring |
| time | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element idObservation.note.time Short descriptionWhen the annotation was made DefinitionIndicates when this particular annotation was made.
dateTime ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: N/A
- rim: Act.effectiveTime
|
| text | Σ | 1..1 | markdown | Element idObservation.note.text Short descriptionComment Alternate namesToelichting DefinitionComment on the ASA score, including comments on for example the circumstances and/or disruptive factors that may influence the result.
Systems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/
markdown ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: N/A
- rim: Act.text
- medmij-core-dataset-120-20260923: medmij-core-dataelement-5
|
| bodySite | | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.bodySite Short descriptionObserved body part DefinitionIndicates the site on the subject's body where the observation was made (i.e. the target site).
Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component.
If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite.
CodeableConcept BindingCodes describing anatomical locations. May include laterality. SNOMEDCTBodyStructures (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- sct-concept: < 123037004 |Body structure|
- v2: OBX-20
- rim: targetSiteCode
- sct-attr: 718497002 |Inherent location|
|
| method | | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.method Short descriptionHow it was done DefinitionIndicates the mechanism used to perform the observation.
In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.
Only used if not implicit in code for Observation.code.
CodeableConcept BindingMethods for simple observations. ObservationMethods (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2: OBX-17
- rim: methodCode
|
| specimen | C | 0..1 | Reference(Specimen) | There are no (further) constraints on this element Element idObservation.specimen Short descriptionSpecimen used for this observation DefinitionThe specimen that was used when this observation was made.
Should only be used if not implicit in code found in 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).
Reference(Specimen) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- sct-concept: < 123038009 |Specimen|
- v2: SPM segment
- rim: participation[typeCode=SPC].specimen
- sct-attr: 704319004 |Inherent in|
|
| device | C | 0..1 | Reference(Device | DeviceMetric) | There are no (further) constraints on this element Element idObservation.device Short description(Measurement) Device DefinitionThe device used to generate the observation data.
Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.
Reference(Device | DeviceMetric) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- sct-concept: < 49062001 |Device|
- v2: OBX-17 / PRT -10
- rim: participation[typeCode=DEV]
- sct-attr: 424226004 |Using device|
|
| referenceRange | C | 0..* | BackboneElement | There are no (further) constraints on this element Element idObservation.referenceRange Short descriptionProvides guide for interpretation DefinitionGuidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two referenceRange elements would be used.
Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.
Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
BackboneElement ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - obs-3: Must have at least a low or a high or text
low.exists() or high.exists() or text.exists()
Mappings- rim: n/a
- v2: OBX.7
- rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idObservation.referenceRange.id Short descriptionUnique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
string Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.referenceRange.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension SlicingUnordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.referenceRange.modifierExtension Short descriptionExtensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| low | C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idObservation.referenceRange.low Short descriptionLow Range, if relevant DefinitionThe value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
SimpleQuantity ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1, obs-3 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists() - sqty-1: The comparator is not used on a SimpleQuantity
comparator.empty()
Mappings- rim: n/a
- v2: SN (see also Range) or CQ
- rim: PQ, IVL<PQ>, MO, CO, depending on the values
- v2: OBX-7
- rim: value:IVL_PQ.low
|
| high | C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idObservation.referenceRange.high Short descriptionHigh Range, if relevant DefinitionThe value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
SimpleQuantity ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1, obs-3 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - qty-3: If a code for the unit is present, the system SHALL also be present
code.empty() or system.exists() - sqty-1: The comparator is not used on a SimpleQuantity
comparator.empty()
Mappings- rim: n/a
- v2: SN (see also Range) or CQ
- rim: PQ, IVL<PQ>, MO, CO, depending on the values
- v2: OBX-7
- rim: value:IVL_PQ.high
|
| type | | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.referenceRange.type Short descriptionReference range qualifier DefinitionCodes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.
Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.
This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.
CodeableConcept BindingCode for the meaning of a reference range. ObservationReferenceRangeMeaningCodes (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- sct-concept: < 260245000 |Findings values| OR
< 365860008 |General clinical state finding|
OR
< 250171008 |Clinical history or observation findings| OR
< 415229000 |Racial group| OR
< 365400002 |Finding of puberty stage| OR
< 443938003 |Procedure carried out on subject|
- v2: OBX-10
- rim: interpretationCode
|
| appliesTo | | 0..* | CodeableConcept | There are no (further) constraints on this element Element idObservation.referenceRange.appliesTo Short descriptionReference range population DefinitionCodes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple appliesTo are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.
Need to be able to identify the target population for proper interpretation.
This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.
CodeableConcept BindingCodes identifying the population the reference range applies to. ObservationReferenceRangeAppliesToCodes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- sct-concept: < 260245000 |Findings values| OR
< 365860008 |General clinical state finding|
OR
< 250171008 |Clinical history or observation findings| OR
< 415229000 |Racial group| OR
< 365400002 |Finding of puberty stage| OR
< 443938003 |Procedure carried out on subject|
- v2: OBX-10
- rim: interpretationCode
|
| age | C | 0..1 | Range | There are no (further) constraints on this element Element idObservation.referenceRange.age Short descriptionApplicable age range, if relevant DefinitionThe age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.
Some analytes vary greatly over age.
The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.
Range ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - rng-2: If present, low SHALL have a lower value than high
low.empty() or high.empty() or (low <= high)
Mappings- rim: n/a
- v2: NR and also possibly SN (but see also quantity)
- rim: IVL<QTY[not(type="TS")]> [lowClosed="true" and highClosed="true"]or URG<QTY[not(type="TS")]>
- rim: outboundRelationship[typeCode=PRCN].targetObservationCriterion[code="age"].value
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| text | | 0..1 | string | There are no (further) constraints on this element Element idObservation.referenceRange.text Short descriptionText based reference range in an observation DefinitionText based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals".
Note that FHIR strings SHALL NOT exceed 1MB in size
string ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: OBX-7
- rim: value:ST
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| hasMember | Σ C | 0..* | Reference(MolecularSequence | Observation | QuestionnaireResponse) | There are no (further) constraints on this element Element idObservation.hasMember Short descriptionRelated resource that belongs to the Observation group DefinitionThis observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.
When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.
Reference(MolecularSequence | Observation | QuestionnaireResponse) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2: Relationships established by OBX-4 usage
- rim: outBoundRelationship
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| derivedFrom | Σ C | 0..* | Reference(DocumentReference | ImagingStudy | Media | MolecularSequence | Observation | QuestionnaireResponse) | There are no (further) constraints on this element Element idObservation.derivedFrom Short descriptionRelated measurements the observation is made from DefinitionThe target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.
All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see Notes below.
Reference(DocumentReference | ImagingStudy | Media | MolecularSequence | Observation | QuestionnaireResponse) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))
Mappings- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2: Relationships established by OBX-4 usage
- rim: .targetObservation
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| component | Σ | 0..* | BackboneElement | There are no (further) constraints on this element Element idObservation.component Short descriptionComponent results DefinitionSome observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.
Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.
For a discussion on the ways Observations can be assembled in groups together see Notes below.
BackboneElement ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: containment by OBX-4?
- rim: outBoundRelationship[typeCode=COMP]
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| id | | 0..1 | string | There are no (further) constraints on this element Element idObservation.component.id Short descriptionUnique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
string Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension SlicingUnordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component.modifierExtension Short descriptionExtensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| code | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.component.code Short descriptionType of component observation (code / type) DefinitionDescribes what was observed. Sometimes this is called the observation "code".
Knowing what kind of observation is being made is essential to understanding the observation.
All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.
CodeableConcept BindingCodes identifying names of simple observations. LOINCCodes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- w5: FiveWs.what[x]
- sct-concept: < 363787002 |Observable entity| OR
< 386053000 |Evaluation procedure|
- v2: OBX-3
- rim: code
|
| value[x] | Σ | 0..1 | | There are no (further) constraints on this element Element idObservation.component.value[x] Short descriptionActual component result DefinitionThe information determined as a result of making the observation, if the information has a simple value.
An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.
Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.
The cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- sct-concept: 363714003 |Interprets| < 441742003 |Evaluation finding|
- v2: OBX.2, OBX.5, OBX.6
- rim: value
- sct-attr: 363714003 |Interprets|
|
| valueBoolean | | | boolean | There are no (further) constraints on this element Data typeboolean |
| valueCodeableConcept | | | CodeableConcept | There are no (further) constraints on this element Data typeCodeableConcept |
| valueDateTime | | | dateTime | There are no (further) constraints on this element Data typedateTime |
| valueInteger | | | integer | There are no (further) constraints on this element Data typeinteger |
| valuePeriod | | | Period | There are no (further) constraints on this element Data typePeriod |
| valueQuantity | | | Quantity | There are no (further) constraints on this element Data typeQuantity |
| valueRange | | | Range | There are no (further) constraints on this element Data typeRange |
| valueRatio | | | Ratio | There are no (further) constraints on this element Data typeRatio |
| valueSampledData | | | SampledData | There are no (further) constraints on this element Data typeSampledData |
| valueString | | | string | There are no (further) constraints on this element Data typestring |
| valueTime | | | time | There are no (further) constraints on this element Data typetime |
| dataAbsentReason | C | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component.dataAbsentReason Short descriptionWhy the component result is missing DefinitionProvides a reason why the expected value in the element Observation.component.value[x] is missing.
For many results it is necessary to handle exceptional values in measurements.
"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".
The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.
CodeableConcept BindingCodes specifying why the result (`Observation.value[x]`) is missing. DataAbsentReason (extensible) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1, obs-6 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2: N/A
- rim: value.nullFlavor
|
| interpretation | | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component.interpretation Short descriptionHigh, low, normal, etc. Alternate namesAbnormal Flag DefinitionA categorical assessment of an observation value. For example, high, low, normal.
For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.
CodeableConcept BindingCodes identifying interpretations of observations. ObservationInterpretationCodes (extensible) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- sct-concept: < 260245000 |Findings values|
- v2: OBX-8
- rim: interpretationCode
- sct-attr: 363713009 |Has interpretation|
|
| referenceRange | | 0..* | see (referenceRange) | There are no (further) constraints on this element Element idObservation.component.referenceRange Short descriptionProvides guide for interpretation of component result DefinitionGuidance on how to interpret the value by comparison to a normal or recommended range.
Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.
Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
- v2: OBX.7
- rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
|
