{
"description": "Measurements and simple assertions made about a patient, device or other subject.",
"_filename": "Observation.json",
"package_name": "hl7.fhir.r4.id.core",
"date": "2021-12-31T08:42:50.9802927+00:00",
"derivation": "specialization",
"meta": {
"lastUpdated": "2021-12-31T08:44:07.117+00:00"
},
"publisher": "Health Level Seven International (Orders and Observations)",
"fhirVersion": "4.0.1",
"purpose": "Observations are a key aspect of healthcare. This resource is used to capture those that do not require more sophisticated mechanisms.",
"name": "Observation",
"mapping": [ {
"uri": "http://hl7.org/fhir/workflow",
"name": "Workflow Pattern",
"identity": "workflow"
}, {
"uri": "http://snomed.info/conceptdomain",
"name": "SNOMED CT Concept Domain Binding",
"identity": "sct-concept"
}, {
"uri": "http://hl7.org/v2",
"name": "HL7 v2 Mapping",
"identity": "v2"
}, {
"uri": "http://hl7.org/v3",
"name": "RIM Mapping",
"identity": "rim"
}, {
"uri": "http://hl7.org/fhir/fivews",
"name": "FiveWs Pattern Mapping",
"identity": "w5"
}, {
"uri": "http://snomed.org/attributebinding",
"name": "SNOMED CT Attribute Binding",
"identity": "sct-attr"
} ],
"abstract": false,
"type": "Observation",
"experimental": null,
"resourceType": "StructureDefinition",
"title": null,
"package_version": "0.1.0",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-category",
"valueString": "Clinical.Diagnostics"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 5
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category",
"valueCode": "patient"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "oo"
} ],
"status": "active",
"id": "ffead2fd-a18b-499d-bb63-a518e968d176",
"kind": "resource",
"url": "https://fhir.kemkes.go.id/r4/StructureDefinition/Observation",
"version": "4.0.1",
"differential": {
"element": [ {
"id": "Observation",
"path": "Observation",
"alias": [ "Vital Signs", "Measurement", "Results", "Tests" ],
"short": "Measurements and simple assertions",
"comment": "Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.",
"mapping": [ {
"map": "Event",
"identity": "workflow"
}, {
"map": "< 363787002 |Observable entity|",
"identity": "sct-concept"
}, {
"map": "OBX",
"identity": "v2"
}, {
"map": "Observation[classCode=OBS, moodCode=EVN]",
"identity": "rim"
} ],
"constraint": [ {
"key": "obs-7",
"human": "If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present",
"xpath": "not(f:*[starts-with(local-name(.), 'value')] and (for $coding in f:code/f:coding return f:component/f:code/f:coding[f:code/@value=$coding/f:code/@value] [f:system/@value=$coding/f:system/@value]))",
"source": "http://hl7.org/fhir/StructureDefinition/Observation",
"severity": "error",
"expression": "value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()"
}, {
"key": "obs-6",
"human": "dataAbsentReason SHALL only be present if Observation.value[x] is not present",
"xpath": "not(exists(f:dataAbsentReason)) or (not(exists(*[starts-with(local-name(.), 'value')])))",
"source": "http://hl7.org/fhir/StructureDefinition/Observation",
"severity": "error",
"expression": "dataAbsentReason.empty() or value.empty()"
} ],
"definition": "Measurements and simple assertions made about a patient, device or other subject."
}, {
"id": "Observation.identifier",
"path": "Observation.identifier",
"type": [ {
"code": "Identifier"
} ],
"short": "Business Identifier for observation",
"mapping": [ {
"map": "Event.identifier",
"identity": "workflow"
}, {
"map": "FiveWs.identifier",
"identity": "w5"
}, {
"map": "OBX.21 For OBX segments from systems without OBX-21 support a combination of ORC/OBR and OBX must be negotiated between trading partners to uniquely identify the OBX segment. Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4.",
"identity": "v2"
}, {
"map": "id",
"identity": "rim"
} ],
"isSummary": true,
"definition": "A unique identifier assigned to this observation.",
"requirements": "Allows observations to be distinguished and referenced."
}, {
"path": "Observation.basedOn",
"requirements": "Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.",
"definition": "A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.",
"short": "Fulfills plan, proposal or order",
"mapping": [ {
"map": "Event.basedOn",
"identity": "workflow"
}, {
"map": "ORC",
"identity": "v2"
}, {
"map": ".inboundRelationship[typeCode=COMP].source[moodCode=EVN]",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/CarePlan", "http://hl7.org/fhir/StructureDefinition/DeviceRequest", "http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation", "http://hl7.org/fhir/StructureDefinition/MedicationRequest", "http://hl7.org/fhir/StructureDefinition/NutritionOrder", "http://hl7.org/fhir/StructureDefinition/ServiceRequest" ]
} ],
"alias": [ "Fulfills" ],
"id": "Observation.basedOn",
"isSummary": true
}, {
"path": "Observation.partOf",
"definition": "A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.",
"short": "Part of referenced event",
"mapping": [ {
"map": "Event.partOf",
"identity": "workflow"
}, {
"map": "Varies by domain",
"identity": "v2"
}, {
"map": ".outboundRelationship[typeCode=FLFS].target",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/MedicationAdministration", "http://hl7.org/fhir/StructureDefinition/MedicationDispense", "http://hl7.org/fhir/StructureDefinition/MedicationStatement", "http://hl7.org/fhir/StructureDefinition/Procedure", "http://hl7.org/fhir/StructureDefinition/Immunization", "http://hl7.org/fhir/StructureDefinition/ImagingStudy" ]
} ],
"alias": [ "Container" ],
"id": "Observation.partOf",
"comment": "To link an Observation to an Encounter use `encounter`. See the [Notes](observation.html#obsgrouping) below for guidance on referencing another Observation.",
"isSummary": true
}, {
"path": "Observation.status",
"requirements": "Need to track the status of individual results. Some results are finalized before the whole report is finalized.",
"min": 1,
"definition": "The status of the result value.",
"isModifier": true,
"short": "registered | preliminary | final | amended +",
"mapping": [ {
"map": "Event.status",
"identity": "workflow"
}, {
"map": "FiveWs.status",
"identity": "w5"
}, {
"map": "< 445584004 |Report by finality status|",
"identity": "sct-concept"
}, {
"map": "OBX-11",
"identity": "v2"
}, {
"map": "status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of \"revise\"",
"identity": "rim"
} ],
"type": [ {
"code": "code"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "default: final"
} ],
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/observation-status|4.0.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationStatus"
} ],
"description": "Codes providing the status of an observation."
},
"max": "1",
"id": "Observation.status",
"comment": "This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.",
"isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary": true
}, {
"path": "Observation.category",
"requirements": "Used for filtering what observations are retrieved and displayed.",
"definition": "A code that classifies the general type of observation being made.",
"short": "Classification of type of observation",
"mapping": [ {
"map": "FiveWs.class",
"identity": "w5"
}, {
"map": ".outboundRelationship[typeCode=\"COMP].target[classCode=\"LIST\", moodCode=\"EVN\"].code",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "preferred",
"valueSet": "http://hl7.org/fhir/ValueSet/observation-category",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationCategory"
} ],
"description": "Codes for high level observation categories."
},
"id": "Observation.category",
"comment": "In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set."
}, {
"path": "Observation.code",
"requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
"min": 1,
"definition": "Describes what was observed. Sometimes this is called the observation \"name\".",
"short": "Type of observation (code / type)",
"mapping": [ {
"map": "Event.code",
"identity": "workflow"
}, {
"map": "FiveWs.what[x]",
"identity": "w5"
}, {
"map": "< 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|",
"identity": "sct-concept"
}, {
"map": "OBX-3",
"identity": "v2"
}, {
"map": "code",
"identity": "rim"
}, {
"map": "116680003 |Is a|",
"identity": "sct-attr"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/observation-codes",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationCode"
} ],
"description": "Codes identifying names of simple observations."
},
"alias": [ "Name" ],
"max": "1",
"id": "Observation.code",
"comment": "*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.",
"isSummary": true
}, {
"path": "Observation.subject",
"requirements": "Observations have no value if you don't know who or what they're about.",
"definition": "The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the `focus` element or the `code` itself specifies the actual focus of the observation.",
"short": "Who and/or what the observation is about",
"mapping": [ {
"map": "Event.subject",
"identity": "workflow"
}, {
"map": "FiveWs.subject[x]",
"identity": "w5"
}, {
"map": "PID-3",
"identity": "v2"
}, {
"map": "participation[typeCode=RTGT]",
"identity": "rim"
}, {
"map": "FiveWs.subject",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/Group", "http://hl7.org/fhir/StructureDefinition/Device", "http://hl7.org/fhir/StructureDefinition/Location" ]
} ],
"max": "1",
"id": "Observation.subject",
"comment": "One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.",
"isSummary": true
}, {
"id": "Observation.focus",
"path": "Observation.focus",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource" ]
} ],
"short": "What the observation is about, when it is not about the subject of record",
"comment": "Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., \"Blood Glucose\") and does not need to be represented separately using this element. Use `specimen` if a reference to a specimen is required. If a code is required instead of a resource use either `bodysite` for bodysites or the standard extension [focusCode](extension-observation-focuscode.html).",
"mapping": [ {
"map": "FiveWs.subject[x]",
"identity": "w5"
}, {
"map": "OBX-3",
"identity": "v2"
}, {
"map": "participation[typeCode=SBJ]",
"identity": "rim"
}, {
"map": "FiveWs.subject",
"identity": "w5"
} ],
"isSummary": true,
"definition": "The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus."
}, {
"path": "Observation.encounter",
"requirements": "For some observations it may be important to know the link between an observation and a particular encounter.",
"definition": "The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.",
"short": "Healthcare event during which this observation is made",
"mapping": [ {
"map": "Event.context",
"identity": "workflow"
}, {
"map": "FiveWs.context",
"identity": "w5"
}, {
"map": "PV1",
"identity": "v2"
}, {
"map": "inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ]
} ],
"alias": [ "Context" ],
"max": "1",
"id": "Observation.encounter",
"comment": "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).",
"isSummary": true
}, {
"path": "Observation.effective[x]",
"requirements": "Knowing when an observation was deemed true is important to its relevance as well as determining trends.",
"definition": "The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the \"physiologically relevant time\". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.",
"short": "Clinically relevant time/time-period for observation",
"mapping": [ {
"map": "Event.occurrence[x]",
"identity": "workflow"
}, {
"map": "FiveWs.done[x]",
"identity": "w5"
}, {
"map": "OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)",
"identity": "v2"
}, {
"map": "effectiveTime",
"identity": "rim"
} ],
"type": [ {
"code": "dateTime"
}, {
"code": "Period"
}, {
"code": "Timing"
}, {
"code": "instant"
} ],
"alias": [ "Occurrence" ],
"max": "1",
"id": "Observation.effective[x]",
"comment": "At least a date should be present unless this observation is a historical report. For recording imprecise or \"fuzzy\" times (For example, a blood glucose measurement taken \"after breakfast\") use the [Timing](datatypes.html#timing) datatype which allow the measurement to be tied to regular life events.",
"isSummary": true
}, {
"path": "Observation.issued",
"definition": "The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.",
"short": "Date/Time this version was made available",
"mapping": [ {
"map": "FiveWs.recorded",
"identity": "w5"
}, {
"map": "OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)",
"identity": "v2"
}, {
"map": "participation[typeCode=AUT].time",
"identity": "rim"
} ],
"type": [ {
"code": "instant"
} ],
"max": "1",
"id": "Observation.issued",
"comment": "For Observations that don’t require review and verification, it may be the same as the [`lastUpdated` ](resource-definitions.html#Meta.lastUpdated) time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the `lastUpdated` time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.",
"isSummary": true
}, {
"id": "Observation.performer",
"path": "Observation.performer",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization", "http://hl7.org/fhir/StructureDefinition/CareTeam", "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ]
} ],
"short": "Who is responsible for the observation",
"mapping": [ {
"map": "Event.performer.actor",
"identity": "workflow"
}, {
"map": "FiveWs.actor",
"identity": "w5"
}, {
"map": "OBX.15 / (Practitioner) OBX-16, PRT-5:PRT-4='RO' / (Device) OBX-18 , PRT-10:PRT-4='EQUIP' / (Organization) OBX-23, PRT-8:PRT-4='PO'",
"identity": "v2"
}, {
"map": "participation[typeCode=PRF]",
"identity": "rim"
} ],
"isSummary": true,
"definition": "Who was responsible for asserting the observed value as \"true\".",
"requirements": "May give a degree of confidence in the observation and also indicates where follow-up questions should be directed."
}, {
"path": "Observation.value[x]",
"requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
"definition": "The information determined as a result of making the observation, if the information has a simple value.",
"short": "Actual result",
"mapping": [ {
"map": "< 441742003 |Evaluation finding|",
"identity": "sct-concept"
}, {
"map": "OBX.2, OBX.5, OBX.6",
"identity": "v2"
}, {
"map": "value",
"identity": "rim"
}, {
"map": "363714003 |Interprets|",
"identity": "sct-attr"
} ],
"type": [ {
"code": "Quantity"
}, {
"code": "CodeableConcept"
}, {
"code": "string"
}, {
"code": "boolean"
}, {
"code": "integer"
}, {
"code": "Range"
}, {
"code": "Ratio"
}, {
"code": "SampledData"
}, {
"code": "time"
}, {
"code": "dateTime"
}, {
"code": "Period"
} ],
"max": "1",
"id": "Observation.value[x]",
"condition": [ "obs-7" ],
"comment": "An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.",
"isSummary": true
}, {
"path": "Observation.dataAbsentReason",
"requirements": "For many results it is necessary to handle exceptional values in measurements.",
"definition": "Provides a reason why the expected value in the element Observation.value[x] is missing.",
"short": "Why the result is missing",
"mapping": [ {
"map": "N/A",
"identity": "v2"
}, {
"map": "value.nullFlavor",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "extensible",
"valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationValueAbsentReason"
} ],
"description": "Codes specifying why the result (`Observation.value[x]`) is missing."
},
"max": "1",
"id": "Observation.dataAbsentReason",
"condition": [ "obs-6" ],
"comment": "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\". \n\nThe 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."
}, {
"path": "Observation.interpretation",
"requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
"definition": "A categorical assessment of an observation value. For example, high, low, normal.",
"short": "High, low, normal, etc.",
"mapping": [ {
"map": "< 260245000 |Findings values|",
"identity": "sct-concept"
}, {
"map": "OBX-8",
"identity": "v2"
}, {
"map": "interpretationCode",
"identity": "rim"
}, {
"map": "363713009 |Has interpretation|",
"identity": "sct-attr"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "extensible",
"valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationInterpretation"
} ],
"description": "Codes identifying interpretations of observations."
},
"alias": [ "Abnormal Flag" ],
"id": "Observation.interpretation",
"comment": "Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result."
}, {
"id": "Observation.note",
"path": "Observation.note",
"type": [ {
"code": "Annotation"
} ],
"short": "Comments about the observation",
"comment": "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.",
"mapping": [ {
"map": "NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)",
"identity": "v2"
}, {
"map": "subjectOf.observationEvent[code=\"annotation\"].value",
"identity": "rim"
} ],
"definition": "Comments about the observation or the results.",
"requirements": "Need to be able to provide free text additional information."
}, {
"path": "Observation.bodySite",
"definition": "Indicates the site on the subject's body where the observation was made (i.e. the target site).",
"short": "Observed body part",
"mapping": [ {
"map": "< 123037004 |Body structure|",
"identity": "sct-concept"
}, {
"map": "OBX-20",
"identity": "v2"
}, {
"map": "targetSiteCode",
"identity": "rim"
}, {
"map": "718497002 |Inherent location|",
"identity": "sct-attr"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/body-site",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BodySite"
} ],
"description": "Codes describing anatomical locations. May include laterality."
},
"max": "1",
"id": "Observation.bodySite",
"comment": "Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. \n\nIf the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension[ bodySite](extension-bodysite.html)."
}, {
"path": "Observation.method",
"requirements": "In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.",
"definition": "Indicates the mechanism used to perform the observation.",
"short": "How it was done",
"mapping": [ {
"map": "OBX-17",
"identity": "v2"
}, {
"map": "methodCode",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/observation-methods",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationMethod"
} ],
"description": "Methods for simple observations."
},
"max": "1",
"id": "Observation.method",
"comment": "Only used if not implicit in code for Observation.code."
}, {
"id": "Observation.specimen",
"max": "1",
"path": "Observation.specimen",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Specimen" ]
} ],
"short": "Specimen used for this observation",
"comment": "Should only be used if not implicit in code found in `Observation.code`. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).",
"mapping": [ {
"map": "< 123038009 |Specimen|",
"identity": "sct-concept"
}, {
"map": "SPM segment",
"identity": "v2"
}, {
"map": "participation[typeCode=SPC].specimen",
"identity": "rim"
}, {
"map": "704319004 |Inherent in|",
"identity": "sct-attr"
} ],
"definition": "The specimen that was used when this observation was made."
}, {
"id": "Observation.device",
"max": "1",
"path": "Observation.device",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Device", "http://hl7.org/fhir/StructureDefinition/DeviceMetric" ]
} ],
"short": "(Measurement) Device",
"comment": "Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.",
"mapping": [ {
"map": "< 49062001 |Device|",
"identity": "sct-concept"
}, {
"map": "OBX-17 / PRT -10",
"identity": "v2"
}, {
"map": "participation[typeCode=DEV]",
"identity": "rim"
}, {
"map": "424226004 |Using device|",
"identity": "sct-attr"
} ],
"definition": "The device used to generate the observation data."
}, {
"constraint": [ {
"key": "obs-3",
"human": "Must have at least a low or a high or text",
"xpath": "(exists(f:low) or exists(f:high)or exists(f:text))",
"source": "http://hl7.org/fhir/StructureDefinition/Observation",
"severity": "error",
"expression": "low.exists() or high.exists() or text.exists()"
} ],
"path": "Observation.referenceRange",
"requirements": "Knowing what values are considered \"normal\" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.",
"definition": "Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an \"OR\". In other words, to represent two distinct target populations, two `referenceRange` elements would be used.",
"short": "Provides guide for interpretation",
"mapping": [ {
"map": "OBX.7",
"identity": "v2"
}, {
"map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]",
"identity": "rim"
} ],
"type": [ {
"code": "BackboneElement"
} ],
"id": "Observation.referenceRange",
"comment": "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."
}, {
"id": "Observation.referenceRange.low",
"max": "1",
"path": "Observation.referenceRange.low",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"short": "Low Range, if relevant",
"mapping": [ {
"map": "OBX-7",
"identity": "v2"
}, {
"map": "value:IVL_PQ.low",
"identity": "rim"
} ],
"condition": [ "obs-3" ],
"definition": "The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3)."
}, {
"id": "Observation.referenceRange.high",
"max": "1",
"path": "Observation.referenceRange.high",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"short": "High Range, if relevant",
"mapping": [ {
"map": "OBX-7",
"identity": "v2"
}, {
"map": "value:IVL_PQ.high",
"identity": "rim"
} ],
"condition": [ "obs-3" ],
"definition": "The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3)."
}, {
"path": "Observation.referenceRange.type",
"requirements": "Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.",
"definition": "Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.",
"short": "Reference range qualifier",
"mapping": [ {
"map": "< 260245000 |Findings values| OR \r< 365860008 |General clinical state finding| \rOR \r< 250171008 |Clinical history or observation findings| OR \r< 415229000 |Racial group| OR \r< 365400002 |Finding of puberty stage| OR\r< 443938003 |Procedure carried out on subject|",
"identity": "sct-concept"
}, {
"map": "OBX-10",
"identity": "v2"
}, {
"map": "interpretationCode",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "preferred",
"valueSet": "http://hl7.org/fhir/ValueSet/referencerange-meaning",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationRangeMeaning"
} ],
"description": "Code for the meaning of a reference range."
},
"max": "1",
"id": "Observation.referenceRange.type",
"comment": "This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed."
}, {
"path": "Observation.referenceRange.appliesTo",
"requirements": "Need to be able to identify the target population for proper interpretation.",
"definition": "Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple `appliesTo` are interpreted as an \"AND\" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.",
"short": "Reference range population",
"mapping": [ {
"map": "< 260245000 |Findings values| OR \r< 365860008 |General clinical state finding| \rOR \r< 250171008 |Clinical history or observation findings| OR \r< 415229000 |Racial group| OR \r< 365400002 |Finding of puberty stage| OR\r< 443938003 |Procedure carried out on subject|",
"identity": "sct-concept"
}, {
"map": "OBX-10",
"identity": "v2"
}, {
"map": "interpretationCode",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/referencerange-appliesto",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationRangeType"
} ],
"description": "Codes identifying the population the reference range applies to."
},
"id": "Observation.referenceRange.appliesTo",
"comment": "This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed."
}, {
"id": "Observation.referenceRange.age",
"max": "1",
"path": "Observation.referenceRange.age",
"type": [ {
"code": "Range"
} ],
"short": "Applicable age range, if relevant",
"mapping": [ {
"map": "outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=\"age\"].value",
"identity": "rim"
} ],
"definition": "The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.",
"requirements": "Some analytes vary greatly over age."
}, {
"id": "Observation.referenceRange.text",
"max": "1",
"path": "Observation.referenceRange.text",
"type": [ {
"code": "string"
} ],
"short": "Text based reference range in an observation",
"mapping": [ {
"map": "OBX-7",
"identity": "v2"
}, {
"map": "value:ST",
"identity": "rim"
} ],
"definition": "Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of \"Negative\" or a list or table of \"normals\"."
}, {
"id": "Observation.hasMember",
"path": "Observation.hasMember",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Observation", "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse", "http://hl7.org/fhir/StructureDefinition/MolecularSequence" ]
} ],
"short": "Related resource that belongs to the Observation group",
"comment": "When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see [Notes](observation.html#obsgrouping) below. Note that a system may calculate results from [QuestionnaireResponse](questionnaireresponse.html) into a final score and represent the score as an Observation.",
"mapping": [ {
"map": "Relationships established by OBX-4 usage",
"identity": "v2"
}, {
"map": "outBoundRelationship",
"identity": "rim"
} ],
"isSummary": true,
"definition": "This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group."
}, {
"id": "Observation.derivedFrom",
"path": "Observation.derivedFrom",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/DocumentReference", "http://hl7.org/fhir/StructureDefinition/ImagingStudy", "http://hl7.org/fhir/StructureDefinition/Media", "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse", "http://hl7.org/fhir/StructureDefinition/Observation", "http://hl7.org/fhir/StructureDefinition/MolecularSequence" ]
} ],
"short": "Related measurements the observation is made from",
"comment": "All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see [Notes](observation.html#obsgrouping) below.",
"mapping": [ {
"map": "Relationships established by OBX-4 usage",
"identity": "v2"
}, {
"map": ".targetObservation",
"identity": "rim"
} ],
"isSummary": true,
"definition": "The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image."
}, {
"path": "Observation.component",
"requirements": "Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.",
"definition": "Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.",
"short": "Component results",
"mapping": [ {
"map": "containment by OBX-4?",
"identity": "v2"
}, {
"map": "outBoundRelationship[typeCode=COMP]",
"identity": "rim"
} ],
"type": [ {
"code": "BackboneElement"
} ],
"id": "Observation.component",
"comment": "For a discussion on the ways Observations can be assembled in groups together see [Notes](observation.html#notes) below.",
"isSummary": true
}, {
"path": "Observation.component.code",
"requirements": "Knowing what kind of observation is being made is essential to understanding the observation.",
"min": 1,
"definition": "Describes what was observed. Sometimes this is called the observation \"code\".",
"short": "Type of component observation (code / type)",
"mapping": [ {
"map": "FiveWs.what[x]",
"identity": "w5"
}, {
"map": "< 363787002 |Observable entity| OR \r< 386053000 |Evaluation procedure|",
"identity": "sct-concept"
}, {
"map": "OBX-3",
"identity": "v2"
}, {
"map": "code",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/observation-codes",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationCode"
} ],
"description": "Codes identifying names of simple observations."
},
"max": "1",
"id": "Observation.component.code",
"comment": "*All* code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.",
"isSummary": true
}, {
"path": "Observation.component.value[x]",
"requirements": "An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.",
"definition": "The information determined as a result of making the observation, if the information has a simple value.",
"short": "Actual component result",
"mapping": [ {
"map": "363714003 |Interprets| < 441742003 |Evaluation finding|",
"identity": "sct-concept"
}, {
"map": "OBX.2, OBX.5, OBX.6",
"identity": "v2"
}, {
"map": "value",
"identity": "rim"
}, {
"map": "363714003 |Interprets|",
"identity": "sct-attr"
} ],
"type": [ {
"code": "Quantity"
}, {
"code": "CodeableConcept"
}, {
"code": "string"
}, {
"code": "boolean"
}, {
"code": "integer"
}, {
"code": "Range"
}, {
"code": "Ratio"
}, {
"code": "SampledData"
}, {
"code": "time"
}, {
"code": "dateTime"
}, {
"code": "Period"
} ],
"max": "1",
"id": "Observation.component.value[x]",
"comment": "Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section](observation.html#notes) below.",
"isSummary": true
}, {
"path": "Observation.component.dataAbsentReason",
"requirements": "For many results it is necessary to handle exceptional values in measurements.",
"definition": "Provides a reason why the expected value in the element Observation.component.value[x] is missing.",
"short": "Why the component result is missing",
"mapping": [ {
"map": "N/A",
"identity": "v2"
}, {
"map": "value.nullFlavor",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "extensible",
"valueSet": "http://hl7.org/fhir/ValueSet/data-absent-reason",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationValueAbsentReason"
} ],
"description": "Codes specifying why the result (`Observation.value[x]`) is missing."
},
"max": "1",
"id": "Observation.component.dataAbsentReason",
"condition": [ "obs-6" ],
"comment": "\"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 \"test not done\". \n\nThe 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. Because of these options, use-case agreements are required to interpret general observations for exceptional values."
}, {
"path": "Observation.component.interpretation",
"requirements": "For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.",
"definition": "A categorical assessment of an observation value. For example, high, low, normal.",
"short": "High, low, normal, etc.",
"mapping": [ {
"map": "< 260245000 |Findings values|",
"identity": "sct-concept"
}, {
"map": "OBX-8",
"identity": "v2"
}, {
"map": "interpretationCode",
"identity": "rim"
}, {
"map": "363713009 |Has interpretation|",
"identity": "sct-attr"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "extensible",
"valueSet": "http://hl7.org/fhir/ValueSet/observation-interpretation",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationInterpretation"
} ],
"description": "Codes identifying interpretations of observations."
},
"alias": [ "Abnormal Flag" ],
"id": "Observation.component.interpretation",
"comment": "Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result."
}, {
"constraint": [ {
"key": "obs-3",
"human": "Must have at least a low or a high or text",
"xpath": "(exists(f:low) or exists(f:high)or exists(f:text))",
"source": "http://hl7.org/fhir/StructureDefinition/Observation",
"severity": "error",
"expression": "low.exists() or high.exists() or text.exists()"
} ],
"path": "Observation.component.referenceRange",
"requirements": "Knowing what values are considered \"normal\" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.",
"definition": "Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an \"OR\". In other words, to represent two distinct target populations, two `referenceRange` elements would be used.",
"short": "Provides guide for interpretation",
"mapping": [ {
"map": "OBX.7",
"identity": "v2"
}, {
"map": "outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]",
"identity": "rim"
} ],
"type": [ {
"code": "BackboneElement"
} ],
"id": "Observation.component.referenceRange",
"comment": "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."
}, {
"id": "Observation.component.referenceRange.low",
"max": "1",
"path": "Observation.component.referenceRange.low",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"short": "Low Range, if relevant",
"mapping": [ {
"map": "OBX-7",
"identity": "v2"
}, {
"map": "value:IVL_PQ.low",
"identity": "rim"
} ],
"condition": [ "obs-3" ],
"definition": "The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3)."
}, {
"id": "Observation.component.referenceRange.high",
"max": "1",
"path": "Observation.component.referenceRange.high",
"type": [ {
"code": "Quantity",
"profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ]
} ],
"short": "High Range, if relevant",
"mapping": [ {
"map": "OBX-7",
"identity": "v2"
}, {
"map": "value:IVL_PQ.high",
"identity": "rim"
} ],
"condition": [ "obs-3" ],
"definition": "The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3)."
}, {
"path": "Observation.component.referenceRange.type",
"requirements": "Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.",
"definition": "Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.",
"short": "Reference range qualifier",
"mapping": [ {
"map": "< 260245000 |Findings values| OR \r< 365860008 |General clinical state finding| \rOR \r< 250171008 |Clinical history or observation findings| OR \r< 415229000 |Racial group| OR \r< 365400002 |Finding of puberty stage| OR\r< 443938003 |Procedure carried out on subject|",
"identity": "sct-concept"
}, {
"map": "OBX-10",
"identity": "v2"
}, {
"map": "interpretationCode",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "preferred",
"valueSet": "http://hl7.org/fhir/ValueSet/referencerange-meaning",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationRangeMeaning"
} ],
"description": "Code for the meaning of a reference range."
},
"max": "1",
"id": "Observation.component.referenceRange.type",
"comment": "This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed."
}, {
"path": "Observation.component.referenceRange.appliesTo",
"requirements": "Need to be able to identify the target population for proper interpretation.",
"definition": "Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple `appliesTo` are interpreted as an \"AND\" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.",
"short": "Reference range population",
"mapping": [ {
"map": "< 260245000 |Findings values| OR \r< 365860008 |General clinical state finding| \rOR \r< 250171008 |Clinical history or observation findings| OR \r< 415229000 |Racial group| OR \r< 365400002 |Finding of puberty stage| OR\r< 443938003 |Procedure carried out on subject|",
"identity": "sct-concept"
}, {
"map": "OBX-10",
"identity": "v2"
}, {
"map": "interpretationCode",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/referencerange-appliesto",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ObservationRangeType"
} ],
"description": "Codes identifying the population the reference range applies to."
},
"id": "Observation.component.referenceRange.appliesTo",
"comment": "This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed."
}, {
"id": "Observation.component.referenceRange.age",
"max": "1",
"path": "Observation.component.referenceRange.age",
"type": [ {
"code": "Range"
} ],
"short": "Applicable age range, if relevant",
"mapping": [ {
"map": "outboundRelationship[typeCode=PRCN].targetObservationCriterion[code=\"age\"].value",
"identity": "rim"
} ],
"definition": "The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.",
"requirements": "Some analytes vary greatly over age."
}, {
"id": "Observation.component.referenceRange.text",
"max": "1",
"path": "Observation.component.referenceRange.text",
"type": [ {
"code": "string"
} ],
"short": "Text based reference range in an observation",
"mapping": [ {
"map": "OBX-7",
"identity": "v2"
}, {
"map": "value:ST",
"identity": "rim"
} ],
"definition": "Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of \"Negative\" or a list or table of \"normals\"."
} ]
},
"contact": [ {
"telecom": [ {
"value": "http://hl7.org/fhir",
"system": "url"
} ]
}, {
"telecom": [ {
"value": "http://www.hl7.org/Special/committees/orders/index.cfm",
"system": "url"
} ]
} ],
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource"
}