<status value="draft" /> <experimental value="false" /> <date value="2023-12-06T00:00:00-08:00" /> <description value="This profile represents the constraints applied to the Observation resource by the pan-Canadian Patient Summary project, which specifies a radiology observation for a patient summary based on the FHIR standard R4. This observation may represent the conclusions of a diagnostic procedure such a Chest X-ray (XR), or it may group the set of results produced by that single or multi-modality procedure. In the latter case, the main observation (this one) carries the overall conclusion of the study and/or a global interpretation by the observer of the study as value of this observation; and may references the atomic results of the study as "child observations". It also allows providing details about the related study using the partOf element referring to an ImagingStudy resource." /> <copyright value="Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy)." /> <fhirVersion value="4.0.1" /> <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" /> <comment value="Preliminary analysis has identified that radiology result information may have limited support in current systems intending to produce a diagnostic results section in their initial patient summaries, further feedback and investigation is required with participating jurisdictions to confirm the support of any of the radiology observation elements - until then, initial constraints put forth in the IPS-UV specification have been maintained with minimal relaxation." /> <constraint> <key value="psca-rad-1" /> <severity value="error" /> <human value="component and hasMember are mutually exclusive" /> <expression value="hasMember.empty() or component.empty()" /> <source value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-radiology-ca-ps" /> </constraint> </element> <element id="Observation.partOf"> <path value="Observation.partOf" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/imagingstudy-ca-ps" /> </type> </element> <element id="Observation.status"> <path value="Observation.status" /> <label value="Observation 'complete' status codes" /> <binding> <strength value="required" /> <valueSet value="http://hl7.org/fhir/uv/ips/ValueSet/results-status-uv-ips" /> </binding> </element> <element id="Observation.category"> <path value="Observation.category" /> <slicing> <discriminator> <type value="pattern" /> <path value="$this" /> </discriminator> <rules value="open" /> </slicing> <definition value="A code that classifies the general type of observation being made. In this profile, fixed to "imaging"." /> <min value="1" /> <type> <code value="CodeableConcept" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" /> </type> </element> <element id="Observation.category:radiology"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:display" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Observation.category" /> <sliceName value="radiology" /> <min value="1" /> <max value="1" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/observation-category" /> <code value="imaging" /> </coding> </patternCodeableConcept> <mustSupport value="true" /> </element> <element id="Observation.code"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:display" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Observation.code" /> <label value="Diagnostic Procedure Code" /> <definition value="Describes what was observed. Sometimes this is called the observation "name". In this profile this may correspond to the procedure code (e.g. Chest X-Ray)." /> <comment value="Work is underway to define the pan-Canadian terminology that will be preferred and/or socialized for this element" /> <mustSupport value="true" /> <binding> <extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding"> <extension url="purpose"> <valueCode value="candidate" /> </extension> <extension url="valueSet"> <valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-observations-uv-ips" /> </extension> <extension url="documentation"> <valueMarkdown value="LOINC Radiology Observation codes utilized in IPS. This additional binding is surfaced to socialize the value sets that are proposed for international exchange in IPS. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." /> </extension> </extension> <strength value="example" /> <description value="Work is underway to define the pan-Canadian terminology that will be preferred and/or socialized for this element. A stub value set pointing to pCLOCD code system is put forth in the meantime to encourage implementers to utilize the Canadian localization of LOINC" /> <valueSet value="http://fhir.infoway-inforoute.ca/io/psca/ValueSet/pCLOCD" /> </binding> </element> <element id="Observation.subject"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:able-to-populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Observation.subject" /> <definition value="The patient, or group of patients, location, or device whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed. Comments: Indirect characteristics may be those of a specimen, fetus, donor, other observer (for example a relative or EMT), or any observation made about the subject. In this profile, subject is constrained to the patient." /> <type> <code value="Reference" /> <targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" /> </type> <mustSupport value="true" /> </element> <element id="Observation.subject.reference"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:display" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Observation.subject.reference" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="Observation.effective[x]"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:display" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Observation.effective[x]" /> <min value="1" /> <type> <code value="dateTime" /> </type> <type> <code value="Period" /> </type> <constraint> <key value="psca-rad-2" /> <severity value="error" /> <human value="Datetime must be at least to day" /> <expression value="$this.ofType(dateTime).empty() or ($this as dateTime).toString().length() >= 8" /> <xpath value="not(boolean(effectiveDateTime)) or f:matches(effectiveDateTime,/\d{4}-[01]\d-[0-3]\dT[0-2]\d:[0-5]\d([+-][0-2]\d:[0-5]\d|Z)/)" /> <source value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-radiology-ca-ps" /> </constraint> <mustSupport value="true" /> </element> <element id="Observation.performer"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:display" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Observation.performer" /> <comment value="IPS considers this a Must Support element with a minimum cardinality of 1. While all jurisdictions supporting pathology in patient summary have indicated they can populate performer, some jurisdictions indicated this may be populated with provincial health authority information that may not be clinically meaningful. This constraint may be evaluated in IPS and PS-CA in the next release as updates are made to the underlying data models that underpin the FHIR profiles." /> <min value="1" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitioner-lab-ca-ps" /> <targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/practitionerrole-lab-ca-ps" /> <targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/organization-lab-ca-ps" /> <targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/CareTeam" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" /> </type> <mustSupport value="true" /> </element> <element id="Observation.value[x]"> <path value="Observation.value[x]" /> <slicing> <discriminator> <type value="type" /> <path value="$this" /> </discriminator> <ordered value="false" /> <rules value="open" /> </slicing> </element> <element id="Observation.value[x]:valueString"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:able-to-populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Observation.value[x]" /> <sliceName value="valueString" /> <label value="Overall Conclusion" /> <min value="0" /> <max value="1" /> <type> <code value="string" /> </type> <mustSupport value="true" /> </element> <element id="Observation.bodySite"> <path value="Observation.bodySite" /> <label value="body site" /> <type> <code value="CodeableConcept" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" /> </type> </element> <element id="Observation.device"> <path value="Observation.device" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/uv/ips/StructureDefinition/Device-observer-uv-ips" /> </type> </element> <element id="Observation.hasMember"> <path value="Observation.hasMember" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-results-radiology-ca-ps" /> </type> </element> <element id="Observation.component"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:able-to-populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Observation.component" /> <slicing> <discriminator> <type value="type" /> <path value="value" /> </discriminator> <description value="Slicing based on value[x] type." /> <rules value="closed" /> </slicing> <requirements value="Required if not(exists(Observation.valueString))" /> <mustSupport value="true" /> </element> <element id="Observation.component:observationText"> <path value="Observation.component" /> <sliceName value="observationText" /> <short value="Observation Text" /> <min value="0" /> <max value="*" /> </element> <element id="Observation.component:observationText.code"> <path value="Observation.component.code" /> <type> <code value="CodeableConcept" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" /> </type> <binding> <strength value="extensible" /> <valueSet value="http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-txtobs-uv-ips" /> </binding> </element> <element id="Observation.component:observationText.value[x]"> <path value="Observation.component.value[x]" /> <min value="1" /> <type> <code value="string" /> </type> </element> <element id="Observation.component:observationCode"> <path value="Observation.component" /> <sliceName value="observationCode" /> <short value="Observation Code" /> <min value="0" /> <max value="*" /> </element> <element id="Observation.component:observationCode.code"> <path value="Observation.component.code" /> <type> <code value="CodeableConcept" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" /> </type> <binding> <strength value="extensible" /> <valueSet value="http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-observations-uv-ips" /> </binding> </element> <element id="Observation.component:observationCode.value[x]"> <path value="Observation.component.value[x]" /> <min value="1" /> <type> <code value="CodeableConcept" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" /> </type> </element> <element id="Observation.component:numericQuantityMeasurement"> <path value="Observation.component" /> <sliceName value="numericQuantityMeasurement" /> <short value="Observation Measurement, including linear, area and volume quantity measurements" /> <min value="0" /> <max value="*" /> </element> <element id="Observation.component:numericQuantityMeasurement.code"> <path value="Observation.component.code" /> <type> <code value="CodeableConcept" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" /> </type> <binding> <strength value="extensible" /> <description value="Codes identifying numeric measurements" /> <valueSet value="http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-numobs-uv-ips" /> </binding> </element> <element id="Observation.component:numericQuantityMeasurement.value[x]"> <path value="Observation.component.value[x]" /> <min value="1" /> <type> <code value="Quantity" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/Quantity-ca-ps" /> </type> </element> <element id="Observation.component:numericRangeMeasurement"> <path value="Observation.component" /> <sliceName value="numericRangeMeasurement" /> <short value="Observation Measurement, including linear, area and volume range measurements" /> <min value="0" /> <max value="*" /> </element> <element id="Observation.component:numericRangeMeasurement.code"> <path value="Observation.component.code" /> <type> <code value="CodeableConcept" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" /> </type> <binding> <strength value="extensible" /> <description value="Codes identifying numeric measurements" /> <valueSet value="http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-numobs-uv-ips" /> </binding> </element> <element id="Observation.component:numericRangeMeasurement.value[x]"> <path value="Observation.component.value[x]" /> <min value="1" /> <type> <code value="Range" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/Range-ca-ps" /> </type> </element> <element id="Observation.component:numericRatioMeasurement"> <path value="Observation.component" /> <sliceName value="numericRatioMeasurement" /> <short value="Observation Measurement, including linear, area and volume ratio measurements" /> <min value="0" /> <max value="*" /> </element> <element id="Observation.component:numericRatioMeasurement.code"> <path value="Observation.component.code" /> <type> <code value="CodeableConcept" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" /> </type> <binding> <strength value="extensible" /> <description value="Codes identifying numeric measurements" /> <valueSet value="http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-numobs-uv-ips" /> </binding> </element> <element id="Observation.component:numericRatioMeasurement.value[x]"> <path value="Observation.component.value[x]" /> <min value="1" /> <type> <code value="Ratio" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/Ratio-ca-ps" /> </type> </element> <element id="Observation.component:numericSampledDataMeasurement"> <path value="Observation.component" /> <sliceName value="numericSampledDataMeasurement" /> <short value="Observation Measurement, including linear, area and volume sampled data measurements" /> <min value="0" /> <max value="*" /> </element> <element id="Observation.component:numericSampledDataMeasurement.code"> <path value="Observation.component.code" /> <type> <code value="CodeableConcept" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" /> </type> <binding> <strength value="extensible" /> <description value="Codes identifying numeric measurements" /> <valueSet value="http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-numobs-uv-ips" /> </binding> </element> <element id="Observation.component:numericSampledDataMeasurement.value[x]"> <path value="Observation.component.value[x]" /> <min value="1" /> <type> <code value="SampledData" /> </type> </element> </differential> </StructureDefinition>