Usage Note: For now, this is out of scope. This could be a lab result that is tied to a procedure, however it is very uncommon to have this linkage within the EMR. eg specimen, observation after the fact is NOT a part of; surgery observations.

MA: C3 says yes it is available; Can access it via Task.ID or Problem.ID or Allergy.ID etc. BUT, if done at task level, other non-relavent observations could be captured along with that. (ex: height for diabeties). ie: data is being captured but it could very likely be 'noisy'.

Usage Note: The sending systems will always send text and where possible will also send a codified value. These are not always available. Local codes shoudl be converted to LOINC where possible.

EMR API: LOINC (example) http://hl7.org/fhir/ValueSet/observation-codes >1000 codes MA: loinc (most common), ICD-9, snomed,type code, atc class, workload, and no codes as well PSS: MS: PCLOCD, ICD-10

All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

Usage Note: In some cases the lab observation can be linked to the encoutner in the EMR. Example: Prenatal urinalysis results are often linked to an encounter.
Usage Note DW: Use of this element may vary by implementation/clent agreements Usage Note: This is not in scope for OLIS

This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

Usage Note: If the name of the performer (eg Lifelabs or Dr. Smith) is known this should be sent.

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.

Usage Note: A value of "temp-unknown" may be used for pending results in the EMR (status=registered). This could occur with a panel that has returned some final results with others that are showing as outstanding

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.

Usage Note: Annotations added by the clinician. Notes from the lab are conveyed as separate observations

May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.

Usage Note: If present in the lab result this will be passed on as is.

Only used if not implicit in code for Observation.code.

Usage Note: This will be present if received from the lab and if stored in the EMR

This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.

Discussion required: May be some linking in MedAccess.
Usage Note: This is not supported by OLIS

For a discussion on the ways Observations can be assembled in groups together see Notes below.

Example from MA: <OBX.3> <CE.1>6690-2</CE.1> <CE.2>WBC</CE.2> <CE.3/> <CE.4/> <CE.5/> <CE.6/> </OBX.3> All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

MA: Display range, lower range, upper range. What is the display range? Do we share this? If YES we need an extension. Definitiion: the range that you want to set as a ideal/base reference

Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.