| LzNursingReport (Observation) | C | | nl-core-observation | Element idObservation Short descriptionNursingReport Alternate namesVital Signs, Measurement, Results, Tests, Dagrapportage DefinitionA report documenting a patient contact in a long-term healthcare nursing setting. The report can be recorded by different types of health professionals and is not necessarily written by a nurse.
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 lab reports, etc.
nl-core-observation Constraints- dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.empty() - dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative
contained.text.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
contained.where(('#'+id in %resource.descendants().reference).not()).empty() - obs-7: If code is the same as a component code then the value element associated with the code SHALL NOT be present
value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).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]
- w5: clinical.diagnostics
- lz-dataset-100-rc3-20260811: lz-dataelement-1
|
| id | Ī£ | 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() | (children().count() > id.count())
Mappings |
| meta | Ī£ | 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 may 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() | (children().count() > id.count())
Mappings |
| implicitRules | Ī£ ?! | 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.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.
This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
uri 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() | (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. Common Languages (extensible) 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() | (children().count() > id.count())
Mappings |
| text | C | 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 may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.
Narrative ConditionsThe 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?
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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.
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. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension 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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| reportTitle | C | 0..1 | Extension(string) | Element idObservation.extension:reportTitle Short descriptionOptional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources.
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(string) Extension URLhttp://medmij.nl/fhir/StructureDefinition/ext-NursingReport.ReportTitle 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() | (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. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension 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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| identifier | Ī£ | 0..* | Identifier | There are no (further) constraints on this element Element idObservation.identifier Short descriptionBusiness Identifier for observation DefinitionA unique identifier assigned to this observation.
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() | (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
- hcim-basicelements-v1.0-2017EN: NL-CM:0.0.6
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| basedOn | Ī£ C | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest) | 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.
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 | ProcedureRequest | ReferralRequest) 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() | (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: .outboundRelationship[typeCode=FLFS].target
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| status | Ī£ ?! | 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() | (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
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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 ownerās 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. Observation Category Codes (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() | (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
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| code | Ī£ | 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.
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
CodeableConcept BindingCodes identifying names of simple observations. LOINC Codes (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() | (children().count() > id.count())
Pattern{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "11591000146107"
}
]
}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
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| subject | Ī£ C | 1..1 | Reference(nl-core-patient) | Element idObservation.subject Short descriptionWho and/or what this is about DefinitionThe patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed. Comments: Indirect characteristics may be those of a specimen, fetus, donor, other observer (for example a relative or EMT), or any observation made about the subject.
Observations have no value if you don't know who or what they're about.
One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.
If the target of the observation is different than the subject, the general extension observation-focal-subject. may be used. However, the distinction between the patient's own value for an observation versus that of the fetus, or the donor or blood product unit, etc., are often specified in the observation code.
Reference(nl-core-patient) 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() | (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
- v2: PID-3
- rim: participation[typeCode=SBJ]
- w5: who.focus
- hcim-basicelements-v1.0-2017EN: NL-CM:0.0.11
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| context | C | 0..1 | Reference(nl-core-episodeofcare | gp-Encounter | Zib Encounter) | There are no (further) constraints on this element Element idObservation.context Short descriptionHealthcare event during which this observation is made Alternate namesEncounter DefinitionThe healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.
For some observations it may be important to know the link between an observation and a particular encounter.
This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter or episode but still be tied to the context of the encounter or episode (e.g. pre-admission lab tests).
Reference(nl-core-episodeofcare | gp-Encounter | Zib 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() | (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
- v2: PV1
- rim: inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
- w5: context
|
| effective[x] | Ī£ | 1..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.
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() | (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
- hcim-basicelements-v1.0-2017EN: NL-CM:0.0.14
|
| effectivePeriod | | | Period | There are no (further) constraints on this element Data typePeriod |
| effectiveDateTime | Ī£ | 1..1 | dateTime | Element idObservation.effective[x]:effectiveDateTime Short descriptionReportDateTime Alternate namesOccurrence, RapportageDatumTijd DefinitionThe date/time on which the nursing report is registered.
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.
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() | (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
- hcim-basicelements-v1.0-2017EN: NL-CM:0.0.14
- lz-dataset-100-rc3-20260811: lz-dataelement-3
|
| issued | Ī£ | 0..1 | instant | There are no (further) constraints on this element Element idObservation.issued Short descriptionDate/Time this was made available DefinitionThe date and time this observation was made available to providers, typically after the results have been reviewed and verified.
Updated when the result is updated.
instant 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() | (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 | Ī£ C | 1..1 | Reference(nl-core-organization | nl-core-practitioner) | Element idObservation.performer Short descriptionPerformer Alternate namesUitvoerder DefinitionThe health professional or organization who registered the nursing report.
May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(nl-core-organization | nl-core-practitioner) 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() | (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
- 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
- hcim-basicelements-v1.0-2017EN: NL-CM:0.0.7
- lz-dataset-100-rc3-20260811: lz-dataelement-4
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idObservation.performer.id Short descriptionxml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Note that FHIR strings may not exceed 1MB in size
string 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() | (children().count() > id.count())
Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.performer.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. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension 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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| practitionerRole | C | 0..1 | Extension(Reference(nl-core-practitionerrole)) | There are no (further) constraints on this element Element idObservation.performer.extension:practitionerRole Short descriptionOptional Extensions Element Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources.
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(Reference(nl-core-practitionerrole)) Extension URLhttp://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference 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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| reference | Ī£ C | 0..1 | string | There are no (further) constraints on this element Element idObservation.performer.reference Short descriptionLiteral reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
string ConditionsThe 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 |
| identifier | Ī£ | 0..1 | Identifier | There are no (further) constraints on this element Element idObservation.performer.identifier Short descriptionLogical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.
When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference
Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
Identifier 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() | (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 | Ī£ | 0..1 | string | There are no (further) constraints on this element Element idObservation.performer.display Short descriptionText alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
string 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() | (children().count() > id.count())
Mappings |
| value[x] | Ī£ 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 may not if it is in error, or if it represents a group of observations.
Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type).
If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples see the notes section below.
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() | (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|
|
| valueAttachment | | | Attachment | There are no (further) constraints on this element Data typeAttachment |
| 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 |
| 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 |
| valueTime | | | time | There are no (further) constraints on this element Data typetime |
| valueString | Ī£ C | 1..1 | string | Element idObservation.value[x]:valueString Short descriptionReportContent Alternate namesRapportageInhoud DefinitionThe content of the nursing report.
An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations.
Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type).
If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples see the notes section below.
string 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() | (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|
- lz-dataset-100-rc3-20260811: lz-dataelement-19
|
| 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. Observation Value Absent Reason (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() | (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
|
| interpretation | | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.interpretation Short descriptionHigh, low, normal, etc. Alternate namesAbnormal Flag DefinitionThe assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.
For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
CodeableConcept BindingCodes identifying interpretations of observations. Observation Interpretation Codes (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() | (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|
|
| 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 body-site-instance.
CodeableConcept BindingCodes describing anatomical locations. May include laterality. SNOMED CT Body Structures (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() | (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. Observation Methods (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() | (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() | (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.
An extension should be used if further typing of the device is needed. Devices used to support obtaining an observation can be represented using either an extension or through the Observation.related element.
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() | (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.
Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.
Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this may not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
BackboneElement 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() | (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 descriptionxml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Note that FHIR strings may not exceed 1MB in size
string 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() | (children().count() > id.count())
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. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension 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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | Ī£ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.referenceRange.modifierExtension Short descriptionExtensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension 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() | (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() | (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() | (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. Observation Reference Range Meaning Codes (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() | (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.
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. Observation Reference Range Applies To Codes (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() | (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() | (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 | 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 may 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() | (children().count() > id.count())
Mappings- rim: n/a
- v2: OBX-7
- rim: value:ST
|
| related | Ī£ | 0..* | BackboneElement | There are no (further) constraints on this element Element idObservation.related Short descriptionResource related to this observation DefinitionA reference to another resource (usually another Observation) whose relationship is defined by the relationship type code.
Normally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and a set of related observations or sometimes a QuestionnaireResponse from which the measure is derived.
For a discussion on the ways Observations can assembled in groups together see Notes below.
BackboneElement 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() | (children().count() > id.count())
Mappings- rim: n/a
- v2: Relationships established by OBX-4 usage
- rim: outBoundRelationship
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idObservation.related.id Short descriptionxml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Note that FHIR strings may not exceed 1MB in size
string 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() | (children().count() > id.count())
Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.related.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. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension 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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | Ī£ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.related.modifierExtension Short descriptionExtensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension 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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| type | | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.related.type Short descriptionhas-member | derived-from | sequel-to | replaces | qualified-by | interfered-by DefinitionA code specifying the kind of relationship that exists with the target resource.
A relationship type SHOULD be provided.
The "derived-from" type is the only logical choice when referencing the QuestionnaireAnswer resource.
code BindingCodes specifying how two observations are related. ObservationRelationshipType (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() | (children().count() > id.count())
Mappings- rim: n/a
- v2: N/A
- rim: .typeCode
|
| target | C | 1..1 | Reference(Observation | QuestionnaireResponse | Sequence) | There are no (further) constraints on this element Element idObservation.related.target Short descriptionResource that is related to this one DefinitionCommentsReferences 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(Observation | QuestionnaireResponse | Sequence) 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() | (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)
- rim: .targetObservation
|
| component | Ī£ | 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() | (children().count() > id.count())
Mappings- rim: n/a
- v2: containment by OBX-4?
- rim: outBoundRelationship[typeCode=COMP]
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idObservation.component.id Short descriptionxml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Note that FHIR strings may not exceed 1MB in size
string 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() | (children().count() > id.count())
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. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension 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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | Ī£ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component.modifierExtension Short descriptionExtensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension 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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| code | Ī£ | 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.
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
CodeableConcept BindingCodes identifying names of simple observations. LOINC Codes (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() | (children().count() > id.count())
Mappings- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- sct-concept: < 363787002 |Observable entity| OR
< 386053000 |Evaluation procedure|
- v2: OBX-3
- rim: code
- w5: what
|
| value[x] | Ī£ | 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 may not if it is in error, or if it represents a group of observations.
Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For boolean values use valueCodeableConcept and select codes from http://hl7.org/fhir/ValueSet/v2-0136 (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).
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
- sct-concept: 363714003 |Interprets| < 441742003 |Evaluation finding|
- v2: OBX.2, OBX.5, OBX.6
- rim: value
- sct-attr: 363714003 |Interprets|
|
| valueAttachment | | | Attachment | There are no (further) constraints on this element Data typeAttachment |
| valueCodeableConcept | | | CodeableConcept | There are no (further) constraints on this element Data typeCodeableConcept |
| valueDateTime | | | dateTime | There are no (further) constraints on this element Data typedateTime |
| 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.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. Observation Value Absent Reason (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() | (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..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component.interpretation Short descriptionHigh, low, normal, etc. Alternate namesAbnormal Flag DefinitionThe assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag.
For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element.
CodeableConcept BindingCodes identifying interpretations of observations. Observation Interpretation Codes (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() | (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 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.
- v2: OBX.7
- rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
|
