<StructureDefinition xmlns="http://hl7.org/fhir">
  <meta>
    <lastUpdated value="2017-06-26T17:15:13.863-04:00" />
    <profile value="PhdBitsEnumerationObservation" />
  </meta>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="oo" />
  </extension>
  <url value="http://pchalliance.org/phdfhir/StructureDefinition/PhdBitsEnumerationObservation" />
  <name value="PhdBitsEnumerationObservation" />
  <status value="draft" />
  <date value="2017-06-02T14:29:52.39367-04:00" />
  <fhirVersion value="3.0.0" />
  <kind value="resource" />
  <abstract value="false" />
  <type value="Observation" />
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Observation" />
  <derivation value="constraint" />
  <differential>
    <element id="Observation">
      <path value="Observation" />
      <definition value="The PhdBitsEnumerationObservation reports PHD measurements that contain a Enum-Observed-Value-Simple-Bit-Str or Enum-Observed-Value-Basic-Bit-Str attribute." />
      <comment value="This type of measurement is used when the Personal Health Device reports a measurement as an IEEE 11073 10101 BITs value. This measurement is a complex representation where each bit means something. In many cases only certain bits are defined and it is generally true that the significant case is when the bit has been set. Given that measurement could result in up to 32 component entries (one for each bit) only set bits are required to be reported. Some specializations have used this measurement type when they should have used IEEE 10101 codes." />
    </element>
    <element id="Observation.meta.profile">
      <path value="Observation.meta.profile" />
      <min value="1" />
    </element>
    <element id="Observation.identifier">
      <path value="Observation.identifier" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="value" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.identifier:conditionalCreateIdentifier">
      <path value="Observation.identifier" />
      <sliceName value="conditionalCreateIdentifier" />
      <short value="Unique identifier of this measurment for a given patient and device" />
      <definition value="An identifier created from a combination of the measurement parameters like sensor time stamp, type code, enumeration BITs integer, patient and device identifiers, and selected elements of any facet component elements." />
      <comment value="This value is used in the conditional create to prevent data duplication. PHDs will often re-send already sent data for a variety of reasons. This element is required unless the metric measurement contains no time stamp or is a measurement containing a time stamp that is real time. By real time the time stamp reported by the PHD must be later than the current time reported by the PHD before any measurements are received. Temporarily stored data from IEEE 11073 20601 devices, which are required to delete the data after sending, can also be considered real time. Temporarily stored data from Bluetooth Low Energy Health devices may be resent so these cannot be considered as real time." />
      <requirements value="Allows observations to be distinguished in a selective enough manner to prevent resource duplication." />
      <max value="1" />
    </element>
    <element id="Observation.identifier:conditionalCreateIdentifier.value">
      <path value="Observation.identifier.value" />
      <min value="1" />
    </element>
    <element id="Observation.identifier:additionalIdentifiers">
      <path value="Observation.identifier" />
      <sliceName value="additionalIdentifiers" />
      <comment value="Use of additional identifiers is allowed by this profile" />
    </element>
    <element id="Observation.status">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint">
        <valueString value="default: final" />
      </extension>
      <path value="Observation.status" />
      <definition value="The status of the result value. Either 'final' or 'preliminary'" />
      <comment value="The value shall be set to 'final' unless a Measurement-Status attribute or Enum-Observed-Value attribute, representing a BITs value, status field indicates that the measurement is preliminary. In that case this field shall be set to 'preliminary'" />
    </element>
    <element id="Observation.code">
      <path value="Observation.code" />
      <comment value="For Enumeration BITs measurements, none will fall into the category of vital signs so a LOINC encoding is never necessary in this profile." />
    </element>
    <element id="Observation.code.coding">
      <path value="Observation.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.code.coding:11073Type">
      <path value="Observation.code.coding" />
      <sliceName value="11073Type" />
      <short value="The 11073-10101 code for the measurement" />
      <comment value="For 11073-20601 metric enumeration measurements, this code is obtained from one or more of the Type, Metric-Id, Enum-Observed-Value.metric, and Metric-Id-Partition attributes. The algorithm to get the 16-bit partition and 16-bit term code is as follows:&#xD;&#xA;&#xD;&#xA;1. The partition and term code are obtained from the Type attribute.&#xD;&#xA;2. If there is a Metric-Id attribute the term code comes from this attribute.&#xD;&#xA;3. If there is a Enum-Observed-Value attribute the term code comes from this attribute.&#xD;&#xA;4. If the term code is NOT from the Type attribute, and there is a Metric-Id-Partition attribute, the partition comes from this attribute.&#xD;&#xA;5. The 32-bit 11073-10101 code value is given by partition * 2 **16 + term code.&#xD;&#xA;&#xD;&#xA;It is this value that is placed in the code.coding.code element for this 11073Type slice" />
      <max value="1" />
    </element>
    <element id="Observation.code.coding:11073Type.system">
      <path value="Observation.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.code.coding:11073Type.code">
      <path value="Observation.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.code.coding:alternativeCoding">
      <path value="Observation.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="A reference to a code describing the meaning of the primary 11073 code in an alternative terminology system." />
    </element>
    <element id="Observation.code.coding:alternativeCoding.system">
      <path value="Observation.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.code.coding:alternativeCoding.code">
      <path value="Observation.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.subject">
      <path value="Observation.subject" />
      <min value="1" />
    </element>
    <element id="Observation.subject.reference">
      <path value="Observation.subject.reference" />
      <min value="1" />
    </element>
    <element id="Observation.effective[x]">
      <path value="Observation.effective[x]" />
      <slicing>
        <discriminator>
          <type value="exists" />
          <path value="start" />
        </discriminator>
        <rules value="open" />
      </slicing>
      <definition value="The time or time-period the observed value is asserted as being true. It is a time period if a Measurement-Duration attribute is part of the metric measurement sent by the PHD. Otherwise it is the time stamp sent by the PHD or the time of reception by the PHG if the PHD sent no time stamp." />
      <min value="1" />
    </element>
    <element id="Observation.effective[x]:dateTimeEffective">
      <path value="Observation.effective[x]" />
      <sliceName value="dateTimeEffective" />
      <comment value="A date and time shall always be present." />
      <type>
        <code value="dateTime" />
      </type>
    </element>
    <element id="Observation.effective[x]:periodEffective">
      <path value="Observation.effective[x]" />
      <sliceName value="periodEffective" />
      <definition value="The time period when there is a Measurement-Duration attribute. The difference between the end and start fields is the value of the Measurement-Duration." />
      <type>
        <code value="Period" />
      </type>
    </element>
    <element id="Observation.effective[x]:periodEffective.start">
      <path value="Observation.effective[x].start" />
      <min value="1" />
    </element>
    <element id="Observation.effective[x]:periodEffective.end">
      <path value="Observation.effective[x].end" />
      <min value="1" />
    </element>
    <element id="Observation.value[x]">
      <path value="Observation.value[x]" />
      <comment value="The values are reported in Observation.component elements." />
      <max value="0" />
    </element>
    <element id="Observation.dataAbsentReason">
      <path value="Observation.dataAbsentReason" />
      <definition value="Provides a reason why there are Observation.component elements reporting the BITs values present. This would be due to an error condition indicated by the Measurement-Status attribute." />
      <comment value="The current values in the http://hl7.org/fhir/data-absent-reason system do not provide the same detailed set of options reported in the Measurement-Status. In those cases one uses the generic 'error' code if the error is 'fatal'. The measurementStatusComponent can be used to report more specific information." />
    </element>
    <element id="Observation.dataAbsentReason.coding.system">
      <path value="Observation.dataAbsentReason.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.dataAbsentReason.coding.code">
      <path value="Observation.dataAbsentReason.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.device">
      <path value="Observation.device" />
      <comment value="This field will reference the DeviceComponent when the updated fixes are in place. In the meantime it will reference the DeviceMetric" />
      <min value="1" />
    </element>
    <element id="Observation.device.reference">
      <path value="Observation.device.reference" />
      <short value="Reference to the device responsible for the measurement" />
      <definition value="Reference to the device-related resources that describe the sensor device taking the measurement and the gateway that handled it." />
      <comment value="This reference points to the DeviceComponent resource chain containing information about the sensor device  that took the measurement and gateway (if any) that handled it." />
      <min value="1" />
    </element>
    <element id="Observation.related">
      <path value="Observation.related" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="target.reference" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.related:coincidentTimeStampRelated">
      <path value="Observation.related" />
      <sliceName value="coincidentTimeStampRelated" />
      <short value="Pointer to the Coincident Time Stamp" />
      <definition value="A reference to the Coincident Time Stamp observation. The Coincident Time Stamp indicates how the time stamps from the PHD are corrected, if at all." />
      <comment value="This reference shall be present if the PHD reports a time stamp. The reference shall point to the Coincident Time Stamp observation. The Coincident Time Stamp Observation provides an audit of the time stamp. Whether or not the gateway corrected the time stamp can be determined from the elements in this Observation. If the timestamps were corrected, the elements of the Observation can be used to obtain the actual time stamps reported by the PHD.&#xD;&#xA;&#xD;&#xA;There is no reference to a Coincident Time Stamp Observation when the PHD does not report a time stamp." />
      <requirements value="This Observation allows one to re-create the original time stamp generated by the PHD should it have been modified by the PHG." />
    </element>
    <element id="Observation.related:coincidentTimeStampRelated.target.reference">
      <path value="Observation.related.target.reference" />
      <min value="1" />
    </element>
    <element id="Observation.related:SourceHandleReferenceRelated">
      <path value="Observation.related" />
      <sliceName value="SourceHandleReferenceRelated" />
      <comment value="A measurement may have one or more source handle references which point to measurements that this measurement is related to in some way. When one of these attributes are present in the measurement, these values point to other measurements. In this case these measurements will be previously generated Observation resources which are then referenced here. Note that the previously received measurement must be received in the same connection as the current measurement. The application does not need to keep record of all measurements from the given device!" />
      <requirements value="Points to a measurement that this measurement is related to or dependent upon, for example a BMI which is calculated from a weight and height measurement or a heart rate taken during a running session." />
    </element>
    <element id="Observation.related:SourceHandleReferenceRelated.target.reference">
      <path value="Observation.related.target.reference" />
      <min value="1" />
    </element>
    <element id="Observation.related:additionalRelated">
      <path value="Observation.related" />
      <sliceName value="additionalRelated" />
      <comment value="Additional references are allowed but out of scope of this profile" />
    </element>
    <element id="Observation.component">
      <path value="Observation.component" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code.coding.code" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.component:bitsComponent">
      <path value="Observation.component" />
      <sliceName value="bitsComponent" />
      <short value="BITs setting entry components" />
      <definition value="Each bitsComponent contains one of the bits settings as code from the BITs measurement. These entries are NOT present if a Measurement-Status attribute indicates an error." />
      <comment value="A BITs measurement is a measurement where each BIT means something, such as a device status where many status situations may be reported." />
      <requirements value="Handles a measurement that may be represented by several different settings." />
    </element>
    <element id="Observation.component:bitsComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:bitsComponent.code.coding:ASN1Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="ASN1Type" />
      <short value="The ANS1 BITs code for the measurement" />
      <comment value="For BITs measurements, this code is an alpha-numeric string created from the code reported in the Observation.code.coding:11073Type.code followed by a dot (.) followed by the MDER bit being reported. For example, the CGM Device status measurement code is 8418060. If the value reported in the BITs field is 0001 1000 0000 0000 the MDER bits set are bits 3 and 4. Note that MDER bit 0 is the HIGH order bit. Bit 3 means 'sensor malfunction' and bit 4 means 'device specific alert'. THis measurement would require two component elements and one would be 8418060.3 and the other would be 8418060.4. Note these are alphas-numeric strings and not decimal numbers. If one took the code 8418060.3 and looked it up in the ASN1 Bits vocabulary one would find it meant 'sensor malfunctioned'." />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:bitsComponent.code.coding:ASN1Type.system">
      <path value="Observation.component.code.coding.system" />
      <comment value="This value is a placeholder until the correct reference URL is registered." />
      <min value="1" />
      <fixedUri value="http://hl7.org/fhir/IEEE.ASN1" />
    </element>
    <element id="Observation.component:bitsComponent.code.coding:ASN1Type.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:bitsComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="A reference to a code describing the meaning of the primary ASN1 BITs code in an alternative terminology system." />
    </element>
    <element id="Observation.component:bitsComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:bitsComponent.code:alternativeCoding.coding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:bitsComponentComponent.value[x]:valueCodeableConcept">
      <path value="Observation.component.valueCodeableConcept" />
      <sliceName value="valueCodeableConcept" />
      <definition value="The information determined as a result of making the observation, if the information is a code." />
      <comment value="If the application wishes to report an unsupported setting, this element is absent and the dataAbsentReason is used to report the condition." />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="Observation.component:bitsComponentComponent.value[x]:valueCodeableConcept.coding">
      <path value="Observation.component.valueCodeableConcept.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
    </element>
    <element id="Observation.component:bitsComponentComponent.value[x]:valueCodeableConcept.coding:v2BinaryValue">
      <path value="Observation.component.valueCodeableConcept.coding" />
      <sliceName value="v2BinaryValue" />
      <min value="1" />
    </element>
    <element id="Observation.component:bitsComponentComponent.value[x]:valueCodeableConcept.coding:v2BinaryValue.system">
      <path value="Observation.component.valueCodeableConcept.coding.system" />
      <min value="1" />
      <fixedUri value="http://hl7.org/fhir/v2/0136" />
    </element>
    <element id="Observation.component:bitsComponentComponent.value[x]:valueCodeableConcept.coding:v2BinaryValue.code">
      <path value="Observation.component.valueCodeableConcept.coding.code" />
      <definition value="If the bit is set this code is 'y' and 'n' if the bit is cleared. Only set bits are required to be reported. If the bit is unsupported, a dataAbsentReason is used." />
      <min value="1" />
    </element>
    <element id="Observation.component:bitsComponentComponent.value[x]:valueCodeableConcept.coding:alternativeCoding">
      <path value="Observation.component.valueCodeableConcept.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="The given binary setting value expressed in an alternative coding system" />
    </element>
    <element id="Observation.component:bitsComponentComponent.value[x]:valueCodeableConcept.coding:alternativeCoding.system">
      <path value="Observation.component.valueCodeableConcept.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:bitsComponentComponent.value[x]:valueCodeableConcept.coding:alternativeCoding.code">
      <path value="Observation.component.valueCodeableConcept.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:bitsComponentComponent.dataAbsentReason">
      <path value="Observation.dataAbsentReason" />
      <definition value="Provides a reason why there are Observation.component elements reporting the BITs values present. This would be due to an error condition indicated by the Measurement-Status attribute." />
      <comment value="This element is only used if the application wishes to report that the state of the bit is unsupported." />
    </element>
    <element id="Observation.component:bitsComponentComponent.dataAbsentReason.coding.system">
      <path value="Observation.dataAbsentReason.coding.system" />
      <min value="1" />
      <fixedUri value="http://hl7.org/fhir/data-absent-reason" />
    </element>
    <element id="Observation.component:bitsComponentComponent.dataAbsentReason.coding.code">
      <path value="Observation.dataAbsentReason.coding.code" />
      <min value="1" />
      <fixedCode value="unsupported" />
    </element>
    <element id="Observation.component:supplementalTypesComponent">
      <path value="Observation.component" />
      <sliceName value="supplementalTypesComponent" />
      <definition value="For each paritition:term code pair contained in the Supplemental-Types attribute, a separate supplementalTypesComponent element is generated. The component is not generated if the attribute is absent or empty. The component shall be generated otherwise." />
      <comment value="A PHD may send a Supplemental-Types attribute as part of the measurement. This attribute consists of a set of MDC nomenclature codes as partition:term code pairs. Each pair is a code describing something additional about the measurement, such as MDC_MODALITY_SPOT in the pulse oximeter which indicates that the provided meausrement is a stable average. An MDC_MODALITY_FAST would indicate that a short averaging is used and the result reported regardless of stability." />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="68193 is the 32-bit nomenclature code indicating a 'Supplemental-Types' value" />
      <min value="1" />
      <fixedCode value="68193" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="It is recommended to display at least the reference identifier for the Supplemental-Types which is MDC_ATTR_SUPPLEMENTAL_TYPES" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="The Supplemental-Types concept expressed in an alternative coding system" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept">
      <path value="Observation.component.valueCodeableConcept" />
      <sliceName value="valueCodeableConcept" />
      <definition value="The information determined as a result of making the observation, if the information is a code." />
      <min value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding">
      <path value="Observation.component.valueCodeableConcept.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value">
      <path value="Observation.component.valueCodeableConcept.coding" />
      <sliceName value="11073Value" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value.system">
      <path value="Observation.component.valueCodeableConcept.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:11073Value.code">
      <path value="Observation.component.valueCodeableConcept.coding.code" />
      <definition value="For the given Supplemental-Types entry the code here is given by: partition * 2**16 + term code" />
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:alternativeCoding">
      <path value="Observation.component.valueCodeableConcept.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="The given Supplemental-Types entry value expressed in an alternative coding system" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:alternativeCoding.system">
      <path value="Observation.component.valueCodeableConcept.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.value[x]:valueCodeableConcept.coding:alternativeCoding.code">
      <path value="Observation.component.valueCodeableConcept.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:supplementalTypesComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:relativeTimeComponent">
      <path value="Observation.component" />
      <sliceName value="relativeTimeComponent" />
      <definition value="This component shall be present if the measurement contains a Relative-Time-Stamp." />
      <comment value="Relative time stamps are converted to wall clock time by the PHG through the Coincident Time Stamp Observation. The original relative time value shall be provided here in order to recover the data sent by the sensor device.&#xD;&#xA;The Relative-Time-Stamp is a 32-bit unsigned integer in units of 1/8th ms." />
      <max value="1" />
    </element>
    <element id="Observation.component:relativeTimesComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="The MDC code of the Relative-Time-Stamp attribute" />
      <min value="1" />
      <fixedCode value="67985" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="The reference identifier should be included in the description. For a Relative-Time-Stamp the ref id is MDC_ATTR_TIME_STAMP_REL" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.value[x]:valueQuantity">
      <path value="Observation.component.valueQuantity" />
      <sliceName value="valueQuantity" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Quantity" />
      </type>
    </element>
    <element id="Observation.component:relativeTimeComponent.value[x]:valueQuantity.value">
      <path value="Observation.component.valueQuantity.value" />
      <definition value="The value of the relative time attribute which is in units of 1/8th milliseconds scaled to microseconds." />
      <min value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.value[x]:valueQuantity.unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.valueQuantity.unit" />
      <definition value="A human-readable form of the unit in this case the UCUM code for microseconds (us)" />
      <min value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.value[x]:valueQuantity.system">
      <path value="Observation.component.valueQuantity.system" />
      <definition value="The unit code shall use the MDC system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:relativeTimeComponent.value[x]:valueQuantity.code">
      <path value="Observation.component.valueQuantity.code" />
      <definition value="The MDC code for microseconds is 264339" />
      <min value="1" />
    </element>
    <element id="Observation.component:relativeTimeComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent">
      <path value="Observation.component" />
      <sliceName value="hiresRelativeTimeComponent" />
      <definition value="This component shall be present if the measurement contains Hi-Res-Relative-Time-Stamp." />
      <comment value="Hi Res Relative time stamps are converted to wall clock time by the PHG through the Coincident Time Stamp Observation. The original relative time value shall be provided here in order to recover the data sent by the sensor device.&#xD;&#xA;The Hi-Res-Relative-Time-Stamp is a 64-bit unsigned interger in units of microseconds." />
      <max value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="The MDC code for the Hi-Res-Relative-Time-Stamp attribute" />
      <min value="1" />
      <fixedCode value="68073" />
    </element>
    <element id="Observation.component:hiresRelativeTime.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="The reference identifier should be included in the description. For a Hi-Res-Relative-Time-Stamp the ref id is MDC_ATTR_TIME_STAMP_REL_HI_RES" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.value[x]:valueQuantity">
      <path value="Observation.component.valueQuantity" />
      <sliceName value="valueQuantity" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Quantity" />
      </type>
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.value">
      <path value="Observation.component.valueQuantity.value" />
      <definition value="The value of the hi res relative time attribute (already in microseconds)." />
      <min value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.unit">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.valueQuantity.unit" />
      <definition value="A human-readable form of the unit in this case the UCUM code for microseconds (us)" />
      <min value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.system">
      <path value="Observation.component.valueQuantity.system" />
      <definition value="The unit code shall use the MDC system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.value[x]:valueQuantity.code">
      <path value="Observation.component.valueQuantity.code" />
      <definition value="The MDC code for microseconds is 264339" />
      <min value="1" />
    </element>
    <element id="Observation.component:hiresRelativeTimeComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:labelStringComponent">
      <path value="Observation.component" />
      <sliceName value="labelStringComponent" />
      <definition value="This component reports the value in Label-String attribute. Reporting the Label-String attribute information is optional." />
      <comment value="This attribute consists of a human readable string giving a further description of the measurement type" />
      <max value="1" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="code" />
        </discriminator>
        <ordered value="true" />
        <rules value="open" />
      </slicing>
      <min value="1" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:11073Type">
      <path value="Observation.component.code.coding" />
      <sliceName value="11073Type" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:11073Type.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="urn:iso:std:iso:11073:10101" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:11073Type.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="The MDC code for the Label-String attribute" />
      <min value="1" />
      <fixedCode value="133415" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:11073Type.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Observation.component.code.coding.display" />
      <definition value="The reference identifier for the attribute should be included. The Label-String attribute ref id is MDC_ATTR_LABEL_STRING" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:alternativeCoding">
      <path value="Observation.component.code.coding" />
      <sliceName value="alternativeCoding" />
      <definition value="These elements allow the expression of the label string in alternative coding systems." />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:alternativeCoding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Observation.component:labelStringComponent.code.coding:alternativeCoding.code">
      <path value="Observation.component.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Observation.component:labelStringComponent.value[x]:valueString">
      <path value="Observation.component.valueString" />
      <sliceName value="valueString" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="string" />
      </type>
    </element>
    <element id="Observation.component:labelStringComponent.value[x]:valueString.value">
      <path value="Observation.component.valueString.value" />
      <definition value="This is the value of the label string attribute." />
      <min value="1" />
    </element>
    <element id="Observation.component:labelStringComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
    <element id="Observation.component:measurementStatusComponent">
      <path value="Observation.component" />
      <sliceName value="measurementStatusComponent" />
      <definition value="This component gives one of the settings reported in the Measurement-Status attribute that are not reported in the Observation.dataAbsentReason  or Observation.status element. The settings that ARE reported in the dataAbsentReason and status elements are 'invalid', 'questionable', 'not-available',  and 'early-indication'. It is optional to report any of the other settings UNLESS MDER-BITs 14 or 15 are set. It is optional to report any defined cleared setting." />
      <comment value="When MDER-BITs 14 and 15 are set, these are special uses cases by the Pulse Oximeter and Continuous Glucose specialization. MDER-BIT 14 indicates that a threshold set up in other attributes has been crossed. MDER-BIT 15 indicates that the alert mechanism has been turned off.  There will be one measurementStatusComponent entry for every setting reported." />
      <requirements value="This component indicates a Measurement-Status setting." />
    </element>
    <element id="Observation.component:measurementStatusComponent.code.coding">
      <path value="Observation.component.code.coding" />
      <comment value="Normally alternative coding systems are allowed but in this case the value is intimately tied to the code. The code represents the feature indicated by a bit settin in the attribute value. which is either cleared (0) or set (1). Thus the value for this entry is itself a binary 'y' or 'n' code from http://hl7.org/fhir/v2/0136" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:measurementStatusComponent.code.coding.system">
      <path value="Observation.component.code.coding.system" />
      <min value="1" />
      <fixedUri value="http://hl7.org/fhir/IEEE.ASN1" />
    </element>
    <element id="Observation.component:measurementStatusComponent.code.coding.code">
      <path value="Observation.component.code.coding.code" />
      <definition value="This code, which is an alpha-numeric string, is generated by the attribute MDC code, which is 133447 for the Measurement-Status, followed by a dot (.) followed by the MDER-bit that was set." />
      <comment value="Note that this code is an alpha-numeric string and not a decimal number. Think of it like a very-limited OID. MDER-BITs 14 and 15 shall be reported if set." />
      <min value="1" />
    </element>
    <element id="Observation.component:measurementStatusComponent.value[x]:valueCodeableConcept">
      <path value="Observation.component.valueCodeableConcept" />
      <min value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
    </element>
    <element id="Observation.component:measurementStatusComponent.value[x]:valueCodeableConcept.coding">
      <path value="Observation.component.valueCodeableConcept.coding" />
      <min value="1" />
      <max value="1" />
    </element>
    <element id="Observation.component:measurementStatusComponent.value[x]:valueCodeableConcept.coding.system">
      <path value="Observation.component.valueCodeableConcept.coding.system" />
      <definition value="This coding system contains only two entries, 'y' (yes) and 'n' (no)" />
      <min value="1" />
      <fixedUri value="http://hl7.org/fhir/v2/0136" />
    </element>
    <element id="Observation.component:measurementStatusComponent.value[x]:valueCodeableConcept.coding.code">
      <path value="Observation.component.valueCodeableConcept.coding.code" />
      <definition value="If the MDER-Bit is set, the code value is 'y' otherwise it is 'n'" />
      <comment value="Recall that when the value is 'y' the alarm or alert is turned off" />
      <min value="1" />
    </element>
    <element id="Observation.component:measurementStatusComponent.dataAbsentReason">
      <path value="Observation.component.dataAbsentReason" />
      <max value="0" />
    </element>
  </differential>
</StructureDefinition>