{
  "resourceType": "StructureDefinition",
  "id": "sd-mii-icu-monitoring-und-vitaldaten",
  "url": "https://gematik.de/fhir/isik/StructureDefinition/sd-mii-icu-monitoring-und-vitaldaten",
  "version": "6.0.0-rc",
  "name": "SD_MII_ICU_Monitoring_Und_Vitaldaten",
  "title": "SD MII ICU Monitoring und Vitaldaten",
  "status": "active",
  "experimental": false,
  "date": "2026-04-02",
  "publisher": "gematik GmbH",
  "description": "Dieses Profil dient als Abstraktionsprofil für verschiedene spezialisierte Beobachtungen in der Akutmedizin zur Abbildung von Monitoring- und Vitaldaten.",
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "Observation",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Observation",
        "path": "Observation",
        "constraint": [
          {
            "key": "vs-de-2",
            "human": "If there is no component or hasMember element then either a value[x] or a data absent reason must be present",
            "source": "https://gematik.de/fhir/isik/StructureDefinition/sd-mii-icu-monitoring-und-vitaldaten",
            "severity": "error",
            "expression": "(component.empty() and hasMember.empty()) implies (dataAbsentReason.exists() or value.exists())"
          }
        ]
      },
      {
        "id": "Observation.id",
        "path": "Observation.id",
        "short": "serverseitige, interne ID des Datensatzes",
        "comment": "**bedingtes Pflichtfeld/bedingtes MS:** Alle von einem Server bereitgestellten Ressourcen MÜSSEN über eine `id` verfügen.\n  Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über eine `id`verfügen. ",
        "mustSupport": true
      },
      {
        "id": "Observation.meta.versionId",
        "path": "Observation.meta.versionId",
        "short": "Eindeutiger Name der serverseitigen Version des Datensatzes",
        "comment": "Alle von einem Server bereitgestellten Ressourcen SOLLEN über eine `versionID` verfügen.\n  Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über eine `versionID`verfügen. "
      },
      {
        "id": "Observation.meta.lastUpdated",
        "path": "Observation.meta.lastUpdated",
        "short": "Zeitpunkt der letzten Änderung",
        "comment": "Alle von einem Server bereitgestellten Ressourcen SOLLEN über ein `lastUpdate` verfügen.\n  Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über ein `lastUpdate`verfügen. "
      },
      {
        "id": "Observation.implicitRules",
        "path": "Observation.implicitRules",
        "short": "Verweis auf die Regeln, nach denen die Ressource erstellt wurde",
        "comment": "Begründung Constraint: In ISiK existiert kein Use-Case für dieses Element. Da es sich um ein Modifying Element handelt, wird es daher ausgeschlossen.\n  Darüber hinaus werden die Regeln als URI vorgehalten. Dies führt dazu, dass sich hinter der URI eine beliebige Menge an Regeln befinden kann; wodurch  nicht sichergestellt werden kann, dass alle Clients die Regeln korrekt interpretieren können.",
        "max": "0"
      },
      {
        "id": "Observation.identifier",
        "path": "Observation.identifier",
        "mustSupport": true
      },
      {
        "id": "Observation.basedOn",
        "path": "Observation.basedOn",
        "short": "maximal Kardinalität bei Übernahme aus MII-Kerndatensatz-ICU entfernt",
        "mustSupport": true
      },
      {
        "id": "Observation.partOf",
        "path": "Observation.partOf",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Procedure"
            ]
          }
        ]
      },
      {
        "id": "Observation.status",
        "path": "Observation.status",
        "comment": "Motivation MS: Observation.status ist bereits durch die Kardinalität der Basisklasse Observation erzwungen. Dieses Feld dient der Präzisierung des Status der Untersuchung",
        "mustSupport": true
      },
      {
        "id": "Observation.category",
        "path": "Observation.category",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "$this"
            }
          ],
          "ordered": false,
          "rules": "open"
        },
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.category:vs-cat",
        "path": "Observation.category",
        "sliceName": "vs-cat",
        "min": 1,
        "max": "1",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "vital-signs",
              "system": "http://terminology.hl7.org/CodeSystem/observation-category"
            }
          ]
        },
        "mustSupport": true
      },
      {
        "id": "Observation.category:vs-cat.coding",
        "path": "Observation.category.coding",
        "mustSupport": true
      },
      {
        "id": "Observation.category:vs-cat.coding.system",
        "path": "Observation.category.coding.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.category:vs-cat.coding.code",
        "path": "Observation.category.coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.code",
        "path": "Observation.code",
        "constraint": [
          {
            "key": "code-coding-icu",
            "human": "Es muss mindestens ein snomed oder loinc code vorhanden sein",
            "source": "https://gematik.de/fhir/isik/StructureDefinition/sd-mii-icu-monitoring-und-vitaldaten",
            "severity": "error",
            "expression": "coding.exists() implies coding.where(system = 'http://snomed.info/sct').exists() or coding.where(system = 'http://loinc.org').exists()"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.code.coding",
        "path": "Observation.code.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "$this"
            }
          ],
          "rules": "open"
        },
        "min": 1
      },
      {
        "id": "Observation.code.coding:sct",
        "path": "Observation.code.coding",
        "sliceName": "sct",
        "min": 0,
        "max": "*",
        "patternCoding": {
          "system": "http://snomed.info/sct"
        },
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://gematik.de/fhir/isik/ValueSet/vs-mii-icu-code-monitoring-und-vitaldaten-snomed"
        }
      },
      {
        "id": "Observation.code.coding:sct.system",
        "path": "Observation.code.coding.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.code.coding:sct.code",
        "path": "Observation.code.coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.code.coding:loinc",
        "path": "Observation.code.coding",
        "sliceName": "loinc",
        "min": 0,
        "max": "*",
        "patternCoding": {
          "system": "http://loinc.org"
        },
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://gematik.de/fhir/isik/ValueSet/vs-mii-icu-code-monitoring-und-vitaldaten-loinc"
        }
      },
      {
        "id": "Observation.code.coding:loinc.system",
        "path": "Observation.code.coding.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.code.coding:loinc.code",
        "path": "Observation.code.coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.code.coding:IEEE-11073",
        "path": "Observation.code.coding",
        "sliceName": "IEEE-11073",
        "min": 0,
        "max": "*",
        "patternCoding": {
          "system": "urn:iso:std:iso:11073:10101"
        },
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://gematik.de/fhir/isik/ValueSet/vs-mii-icu-code-monitoring-und-vitaldaten-iso11073"
        }
      },
      {
        "id": "Observation.code.coding:IEEE-11073.system",
        "path": "Observation.code.coding.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.code.coding:IEEE-11073.code",
        "path": "Observation.code.coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.subject",
        "path": "Observation.subject",
        "min": 1,
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Patient"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.encounter",
        "path": "Observation.encounter",
        "mustSupport": true
      },
      {
        "id": "Observation.effective[x]",
        "path": "Observation.effective[x]",
        "min": 1,
        "type": [
          {
            "code": "dateTime"
          },
          {
            "code": "Period"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.performer",
        "path": "Observation.performer",
        "comment": "Motivation MS: Dieses Feld stellt eine präzisierende Angaben zum Zweck der Qualitätsbewertung bereit",
        "mustSupport": true
      },
      {
        "id": "Observation.value[x]",
        "path": "Observation.value[x]",
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.value[x].value",
        "path": "Observation.value[x].value",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.value[x].unit",
        "path": "Observation.value[x].unit",
        "mustSupport": true
      },
      {
        "id": "Observation.value[x].system",
        "path": "Observation.value[x].system",
        "min": 1,
        "patternUri": "http://unitsofmeasure.org",
        "mustSupport": true
      },
      {
        "id": "Observation.value[x].code",
        "path": "Observation.value[x].code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Observation.dataAbsentReason",
        "path": "Observation.dataAbsentReason",
        "constraint": [
          {
            "key": "mii-icu-1",
            "human": "If there is no Observation.value, a dataAbsentReason must be given.",
            "source": "https://gematik.de/fhir/isik/StructureDefinition/sd-mii-icu-monitoring-und-vitaldaten",
            "severity": "error",
            "expression": "value.exists().not() implies dataAbsentReason.exists()"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.interpretation",
        "path": "Observation.interpretation",
        "mustSupport": true
      },
      {
        "id": "Observation.bodySite",
        "path": "Observation.bodySite",
        "mustSupport": true,
        "binding": {
          "strength": "extensible",
          "valueSet": "https://gematik.de/fhir/isik/ValueSet/vs-mii-icu-bodysite-observation-monitoring-und-vitaldaten"
        }
      },
      {
        "id": "Observation.method",
        "path": "Observation.method",
        "comment": "Motivation MS: Dieses Feld stellt eine präzisierende Angaben zum Zweck der Qualitätsbewertung bereit",
        "mustSupport": true
      },
      {
        "id": "Observation.device",
        "path": "Observation.device",
        "mustSupport": true
      },
      {
        "id": "Observation.referenceRange",
        "path": "Observation.referenceRange",
        "mustSupport": true
      },
      {
        "id": "Observation.component",
        "path": "Observation.component",
        "mustSupport": true
      },
      {
        "id": "Observation.component.code",
        "path": "Observation.component.code",
        "mustSupport": true
      },
      {
        "id": "Observation.component.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Observation.component.dataAbsentReason",
        "path": "Observation.component.dataAbsentReason",
        "mustSupport": true
      },
      {
        "id": "Observation.component.interpretation",
        "path": "Observation.component.interpretation",
        "mustSupport": true
      },
      {
        "id": "Observation.component.referenceRange",
        "path": "Observation.component.referenceRange",
        "mustSupport": true
      }
    ]
  }
}