{
  "description": null,
  "_filename": "NHSDigital-Observation.StructureDefinition.json",
  "package_name": "uk.nhsdigital.r4",
  "date": null,
  "derivation": "constraint",
  "publisher": null,
  "fhirVersion": "4.0.1",
  "name": "NHSDigitalObservation",
  "abstract": false,
  "type": "Observation",
  "experimental": null,
  "resourceType": "StructureDefinition",
  "title": null,
  "package_version": "2.9.0",
  "status": "draft",
  "id": "b6e3ffa1-3780-4f07-b10a-dabd22fb3452",
  "kind": "resource",
  "url": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Observation",
  "version": null,
  "differential": {
    "element": [ {
      "id": "Observation.extension",
      "min": 0,
      "path": "Observation.extension",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      }
    }, {
      "id": "Observation.extension:covid19Testing",
      "max": "1",
      "min": 0,
      "path": "Observation.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/Extension-COVID19-TestResult" ]
      } ],
      "sliceName": "covid19Testing",
      "mustSupport": true
    }, {
      "id": "Observation.identifier",
      "min": 1,
      "path": "Observation.identifier",
      "definition": "A unique identifier assigned to this observation.\r\n\r\nFor COVID-19 Test History this will be The identifier will be the specimen id.\r\n\r\n```json\r\n\r\n    \"identifier\":  [\r\n        {\r\n            \"system\": \"https://fhir.nhs.uk/Id/SpecimenId\",\r\n            \"value\": \"eb89a392-5b20-11eb-ae93-0242ac130002\"\r\n        }\r\n    ],\r\n```",
      "mustSupport": true
    }, {
      "id": "Observation.identifier.system",
      "min": 1,
      "path": "Observation.identifier.system"
    }, {
      "id": "Observation.identifier.value",
      "min": 1,
      "path": "Observation.identifier.value"
    }, {
      "id": "Observation.status",
      "path": "Observation.status",
      "definition": "The status of the result value.\r\n\r\nFor COVID-19 Test History the status of the observation will always be `final`\r\n\r\n```json\r\n\r\n    \"status\": \"final\",\r\n```",
      "mustSupport": true
    }, {
      "id": "Observation.category",
      "path": "Observation.category",
      "binding": {
        "strength": "required",
        "valueSet": "https://fhir.nhs.uk/ValueSet/NHSDigital-Observation-category"
      },
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "coding.system",
          "type": "value"
        } ]
      },
      "definition": "This is an optional element. If used the category will always be `laboratory`\r\n\r\n```json\r\n\r\n    \"category\":  [\r\n        {\r\n            \"coding\":  [\r\n                {\r\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/observation-category\",\r\n                    \"code\": \"laboratory\",\r\n                    \"display\": \"Laboratory\"\r\n                }\r\n            ],\r\n            \"text\": \"Laboratory\"\r\n        }\r\n    ],\r\n```\r\n\r\nFor COVID-19 Tests, the ValueSet **SHOULD** be used to indicate which test pillar the observation originated.\r\n\r\n```json\r\n\r\n     \"category\": [\r\n        {\r\n            \"coding\": [\r\n                {\r\n                    \"system\": \"https://fhir.nhs.uk/CodeSystem/covid-test-pillar\",\r\n                    \"code\": \"pillar-1\",\r\n                    \"display\": \"pillar 1\"\r\n                }\r\n            ]\r\n        }\r\n    ],\r\n```",
      "mustSupport": true
    }, {
      "id": "Observation.category.coding",
      "min": 1,
      "path": "Observation.category.coding"
    }, {
      "id": "Observation.category.coding.system",
      "min": 1,
      "path": "Observation.category.coding.system",
      "mustSupport": true
    }, {
      "id": "Observation.category.coding.code",
      "min": 1,
      "path": "Observation.category.coding.code",
      "mustSupport": true
    }, {
      "id": "Observation.category:COVID-TestPillar",
      "max": "1",
      "path": "Observation.category",
      "sliceName": "COVID-TestPillar"
    }, {
      "id": "Observation.category:COVID-TestPillar.coding.system",
      "path": "Observation.category.coding.system",
      "fixedUri": "https://fhir.nhs.uk/CodeSystem/covid-test-pillar"
    }, {
      "id": "Observation.category:UKCoreCategory",
      "path": "Observation.category",
      "sliceName": "UKCoreCategory"
    }, {
      "id": "Observation.category:UKCoreCategory.coding.system",
      "path": "Observation.category.coding.system",
      "fixedUri": "http://terminology.hl7.org/CodeSystem/observation-category"
    }, {
      "id": "Observation.code",
      "path": "Observation.code",
      "definition": "Type of observation, for COVID-10 see [Observation Definition](https://simplifier.net/guide/NHSDigital/Home/FHIRAssets/AllAssets/ObservationDefinition/ObservationDefinition.guide.md) for `code` values.\r\n\r\n```json\r\n    \"code\": {\r\n        \"coding\":  [\r\n            {\r\n                \"system\": \"http://snomed.info/sct\",\r\n                \"code\": \"871555000\",\r\n                \"display\": \"Detection of ribonucleic acid of Severe acute respiratory syndrome coronavirus 2\"\r\n            }\r\n        ]\r\n    },\r\n```",
      "mustSupport": true
    }, {
      "id": "Observation.subject",
      "min": 1,
      "path": "Observation.subject",
      "type": [ {
        "code": "Reference",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Group", "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Device", "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Location", "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Patient-Minimal" ]
      } ],
      "constraint": [ {
        "key": "patient-reference",
        "human": "subject - An identifier reference or resource reference must be provided",
        "severity": "warning",
        "expression": "(reference.exists() or (identifier.exists()))"
      }, {
        "key": "patient-nhs",
        "human": "Length of the supplied NHS Number is wrong.",
        "severity": "error",
        "expression": "identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').exists().not() or (identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').exists()  and identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').value.matches('^([0-9]{10})$'))"
      } ],
      "definition": "The NHS Number will be an identifier reference which can be used with PDS FHIR API to return Patient demographics. If a local Patient is available, a reference to this will be present (e.g. \"Patient/123\")\r\n\r\n```json\r\n\r\n    \"subject\": {\r\n        \"reference\": \"Patient/123\",\r\n        \"identifier\":  [\r\n            {\r\n                \"system\": \"https://fhir.nhs.uk/Id/nhs-number\",\r\n                \"value\": \"987123456\"\r\n            }\r\n        ]\r\n    },\r\n```",
      "mustSupport": true
    }, {
      "id": "Observation.subject.identifier.system",
      "min": 1,
      "path": "Observation.subject.identifier.system",
      "fixedUri": "https://fhir.nhs.uk/Id/nhs-number"
    }, {
      "id": "Observation.subject.identifier.value",
      "min": 1,
      "path": "Observation.subject.identifier.value"
    }, {
      "id": "Observation.effective[x]",
      "min": 1,
      "path": "Observation.effective[x]",
      "type": [ {
        "code": "dateTime"
      } ],
      "definition": "The date and time the result was asserted.\r\n\r\n```json\r\n\r\n    \"effectiveDateTime\": \"2020-09-23T13:00:08.476+00:00\"\r\n```",
      "mustSupport": true
    }, {
      "id": "Observation.performer",
      "path": "Observation.performer",
      "type": [ {
        "code": "Reference",
        "profile": [ "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Reference" ],
        "aggregation": [ "referenced" ],
        "targetProfile": [ "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Organization", "https://fhir.hl7.org.uk/StructureDefinition/UKCore-CareTeam", "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Patient", "https://fhir.nhs.uk/StructureDefinition/NHSDigital-PractitionerRole-Minimal" ]
      } ],
      "constraint": [ {
        "key": "performer",
        "human": "An identifier reference or resource reference must be provided",
        "severity": "error",
        "expression": "(reference.exists() or identifier.exists())"
      } ],
      "definition": "Who was responsible for asserting the observed value as \"true\". \r\n\r\n```json\r\n\r\n\"performer\": [\r\n  {\r\n    \"type\": \"Organization\",\r\n    \"identifier\": {\r\n      \"type\": {\r\n        \"coding\": [\r\n          {\r\n            \"system\": \"https://fhir.nhs.uk/CodeSystem/organisation-role\",\r\n            \"code\": \"173\",\r\n            \"display\": \"PATHOLOGY LAB\"\r\n          }\r\n        ]\r\n      },\r\n      \"value\": \"LFD004\"\r\n    }\r\n  },\r\n  {\r\n    \"type\": \"Organization\",\r\n    \"identifier\": {\r\n      \"type\": {\r\n        \"coding\": [\r\n          {\r\n            \"system\": \"https://fhir.nhs.uk/Id/OrgType\",\r\n            \"code\": \"TestCentreId\",\r\n            \"display\": \"Testing Centre\"\r\n          }\r\n        ]\r\n      },\r\n      \"value\": \"WKE03\"\r\n    }\r\n  }\r\n]\r\n\r\n```",
      "mustSupport": true
    }, {
      "id": "Observation.value[x]",
      "path": "Observation.value[x]",
      "definition": "### COVID-19 valueCodeableConcept \r\n\r\nThe COVID 19 test result. This is a SNOMED CT from the valueSet associated with the `code`, see [Observation Definition](https://simplifier.net/guide/NHSDigital/Home/FHIRAssets/AllAssets/ObservationDefinition/ObservationDefinition.guide.md)\r\n\r\n```json \r\n\r\n    \"valueCodeableConcept\": {\r\n        \"coding\":  [\r\n            {\r\n                \"system\": \"http://snomed.info/sct\",\r\n                \"code\": \"1240581000000104\",\r\n                \"display\": \"SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) detection result positive\"\r\n            }\r\n        ],\r\n        \"text\": \"SARS-CoV-2-ORGY\"\r\n    },\r\n```",
      "mustSupport": true
    }, {
      "id": "Observation.method",
      "path": "Observation.method",
      "definition": "The name of the test that was performed, this is a SNOMED CT concept.\r\n\r\n```json\r\n\r\n    \"method\": {\r\n        \"coding\":  [\r\n            {\r\n                \"system\": \"http://snomed.info/sct\",\r\n                \"code\": \"1240461000000109\",\r\n                \"display\": \"Measurement of SARS-CoV-2 antibody (procedure)\"\r\n            }\r\n        ]\r\n    },\r\n```",
      "mustSupport": true
    }, {
      "id": "Observation.method.coding.system",
      "min": 1,
      "path": "Observation.method.coding.system"
    }, {
      "id": "Observation.method.coding.code",
      "min": 1,
      "path": "Observation.method.coding.code"
    }, {
      "id": "Observation.method.coding.display",
      "min": 1,
      "path": "Observation.method.coding.display"
    }, {
      "id": "Observation.specimen",
      "path": "Observation.specimen",
      "definition": "For COVID-19 Test History. The identifier of the specimen used for the test.\r\n \r\n```json\r\n\r\n    \"specimen\": {\r\n        \"identifier\": {\r\n            \"system\": \"https://fhir.nhs.uk/Id/SpecimenId\",\r\n            \"value\": \"eb89a392-5b20-11eb-ae93-0242ac130002\"\r\n        }\r\n    },\r\n```",
      "mustSupport": true
    }, {
      "id": "Observation.specimen.identifier.system",
      "min": 1,
      "path": "Observation.specimen.identifier.system"
    }, {
      "id": "Observation.specimen.identifier.value",
      "min": 1,
      "path": "Observation.specimen.identifier.value"
    }, {
      "id": "Observation.device",
      "path": "Observation.device",
      "definition": "Details of the [COVID-19 test kit](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/Id/Covid19-TestKit) used.  \r\n\r\n```json\r\n\r\n    \"device\": {\r\n        \"identifier\": {\r\n            \"system\": \"https://fhir.nhs.uk/Id/Covid19-TestKit\",\r\n            \"value\": \"LFT\"\r\n        },\r\n        \"display\": \"Lateral Flow Test\"\r\n    }\r\n```",
      "mustSupport": true
    }, {
      "id": "Observation.device.identifier.system",
      "min": 1,
      "path": "Observation.device.identifier.system"
    }, {
      "id": "Observation.device.identifier.value",
      "min": 1,
      "path": "Observation.device.identifier.value"
    }, {
      "id": "Observation.device.display",
      "min": 1,
      "path": "Observation.device.display"
    } ]
  },
  "baseDefinition": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation"
}