Phd Coincident Time Stamp Observation Profile
The Coincident Time Stamp Observation Profile is used to compare the timelines of the PHD with the timeline of the PHG. The primary elements are the Observation.effectiveDateTime which has the current time of the PHG and the Observation.valueDateTime or Observation.valueQuantity which has the current time of the PHD. The valueDateTime is used when the PHD uses either an Absolute or Base-Offset time clock and the valueQuantity is used when the PHD uses a relative time clock. The PHG reports its current time at the time it reads the current time of the PHD. For more details on the interpretation of the Coincident Time Stamp see the section Coincident Time Stamp.
A Phd Observtion will always reference a Coincident Time Stamp Observation if the measurement reported from the PHD contains a time stamp. It will not reference a Coincident Time Stamp Observation if the measurement contains no time stamp.
If a PHD has its time clock altered, a Date-Time-Adjustment attribute is sent to the PHG. The attribute can come in a live measurement, come by itself, or be part of the PM Segment information in perisitently stored data. When a Date-Time-Adjustment occurs by itself, a new Coincident Time Stamp Observation is generated and all data sent after the adjustment will reference the new Coincident Time Stamp Observation. If it comes as part of the data, the Date-Time-Adjustment tells how much one has to adjust the time stamp of the measurement to bring it to the current time line of the agent.
The Coincident Time Stamp Observation is created every connection so data duplication is not an issue. Therefore the identifier element of this resource is not used in this profile.
The Structure Definition for the Phd Coincident Time Stamp Observation Profile is as follows:
Observation | I | Observation | Element idObservation Measurements and simple assertions Alternate namesVital Signs, Measurement, Results, Tests DefinitionThe PhdCoincidentTimeStampObservation reports the current time of the PHD sensor at the current time of the PHG. Used to record the correction the PHG applied to the PHD measurement time stamps (if any) and to be able to recover the original time stamps reported by the PHD should that be needed. Observation Constraints
| |
id | Σ | 0..1 | id | There are no (further) constraints on this element Element idObservation.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. id Constraints
|
meta | Σ | 1..1 | Meta | Element idObservation.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. Implementations must indicate the PhdCoincidentTimeStampObservation profile this resource adheres to. Meta Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idObservation.meta.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.meta.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
versionId | Σ | 0..1 | id | There are no (further) constraints on this element Element idObservation.meta.versionId Version specific identifier DefinitionThe version specific identifier, as it appears in the version portion of the URL. This values changes when the resource is created, updated, or deleted. The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes. id Constraints
|
lastUpdated | Σ | 0..1 | instant | There are no (further) constraints on this element Element idObservation.meta.lastUpdated When the resource version last changed DefinitionWhen the resource last changed - e.g. when the version changed. This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. instant Constraints
|
profile | Σ | 1..* | uri | Element idObservation.meta.profile Profiles this resource claims to conform to DefinitionA list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. At least one entry must be PhdCoincidentTimeStampObservation It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. uri Sliced:Unordered, Open, by PhdCoincidentTimeStampObservation(Value) Constraints
|
phdProfile | Σ | 1..1 | uriFixed Value | Element idObservation.meta.profile:phdProfile Profiles this resource claims to conform to DefinitionA list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. uri Constraints
PhdCoincidentTimeStampObservation
|
security | Σ | 0..* | CodingBinding | There are no (further) constraints on this element Element idObservation.meta.security Security Labels applied to this resource DefinitionSecurity labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. The security labels can be updated without changing the stated version of the resource The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Coding BindingSecurity Labels from the Healthcare Privacy and Security Classification System. ?? (extensible)Constraints
|
tag | Σ | 0..* | Coding | There are no (further) constraints on this element Element idObservation.meta.tag Tags applied to this resource DefinitionTags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. Coding BindingCodes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones" ?? (example)Constraints
|
implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idObservation.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. uri Constraints
|
language | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.language Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). code BindingA human language. ?? (extensible)Constraints
| |
text | I | 0..1 | Narrative | There are no (further) constraints on this element Element idObservation.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later. Narrative Constraints
|
contained | 0..* | Resource | There are no (further) constraints on this element Element idObservation.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Resource Mappings
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idObservation.identifier Business Identifier for observation DefinitionA unique identifier assigned to this observation. Allows observations to be distinguished and referenced. Identifier Constraints
|
basedOn | Σ I | 0..* | Reference(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/ProcedureRequest | http://hl7.org/fhir/StructureDefinition/ReferralRequest) | There are no (further) constraints on this element Element idObservation.basedOn Fulfills plan, proposal or order Alternate namesFulfills DefinitionA plan, proposal or order that is fulfilled in whole or in part by this event. Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon. 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. Reference(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/ProcedureRequest | http://hl7.org/fhir/StructureDefinition/ReferralRequest) Constraints
|
status | Σ ?! | 1..1 | codeBindingFixed Value | Element idObservation.status registered | preliminary | final | amended + DefinitionThe status of the result value. Always 'final' Need to track the status of individual results. Some results are finalized before the whole report is finalized. The value shall be set to 'final' code BindingCodes providing the status of an observation. ?? (required)Constraints
final
|
category | 0..* | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.category Classification of type of observation DefinitionA code that classifies the general type of observation being made. Used for filtering what observations are retrieved and displayed. 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. CodeableConcept BindingCodes for high level observation categories. ?? (preferred)Constraints
| |
code | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.code Type of observation (code / type) Alternate namesName DefinitionDescribes what was observed. Sometimes this is called the observation "name". Knowing what kind of observation is being made is essential to understanding the observation. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. CodeableConcept BindingCodes identifying names of simple observations. ?? (example)Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.code.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
coding | Σ | 1..* | Coding | Element idObservation.code.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Coding Sliced:Ordered, Open, by system(Value) Constraints
|
11073Type | Σ | 1..1 | Coding | Element idObservation.code.coding:11073Type The 11073-10101 code for the type of time clock used by the PHD DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. PHDs use one of absolute time, base offset time, relative time, or high resolution relative time. Coding Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.coding:11073Type.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.code.coding:11073Type.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
system | Σ | 1..1 | uriFixed Value | Element idObservation.code.coding:11073Type.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously. uri Constraints
urn:iso:std:iso:11073:10101
|
version | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.coding:11073Type.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. string Constraints
|
code | Σ | 1..1 | code | Element idObservation.code.coding:11073Type.code Symbol in syntax defined by the system DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. The code for absolute time is 67975 with reference id MDC_ATTR_TIME_ABS, for base offset time is 68226 with reference id MDC_ATTR_TIME_BO, for relative time is 67983 with reference id MDC_ATTR_TIME_REL, and for high resolution relative time is 68072 with reference id MDC_ATTR_TIME_REL_HI_RES. code Constraints
|
display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.coding:11073Type.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size string Constraints
|
userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idObservation.code.coding:11073Type.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. boolean Constraints
|
text | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.code.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings. string Constraints
|
subject | Σ I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Group | http://hl7.org/fhir/StructureDefinition/Device | http://hl7.org/fhir/StructureDefinition/Location) | There are no (further) constraints on this element Element idObservation.subject Who and/or what this is about DefinitionThe 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. Observations have no value if you don't know who or what they're about. 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. If the target of the observation is different than the subject, the general extension observation-focal-subject. may be used. However, the distinction between the patient's own value for an observation versus that of the fetus, or the donor or blood product unit, etc., are often specified in the observation code. Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Group | http://hl7.org/fhir/StructureDefinition/Device | http://hl7.org/fhir/StructureDefinition/Location) Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idObservation.subject.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.subject.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
reference | Σ I | 1..1 | string | There are no (further) constraints on this element Element idObservation.subject.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. string Constraints
|
identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idObservation.subject.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Identifier Constraints
|
display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.subject.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. string Constraints
|
context | I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Encounter | http://hl7.org/fhir/StructureDefinition/EpisodeOfCare) | There are no (further) constraints on this element Element idObservation.context Healthcare event during which this observation is made Alternate namesEncounter DefinitionThe healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made. For some observations it may be important to know the link between an observation and a particular encounter. 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 or episode but still be tied to the context of the encounter or episode (e.g. pre-admission lab tests). Reference(http://hl7.org/fhir/StructureDefinition/Encounter | http://hl7.org/fhir/StructureDefinition/EpisodeOfCare) Constraints
|
effectiveDateTime | Σ | 0..1 | dateTime | Element idObservation.effective[x]:effectiveDateTime Clinically relevant time/time-period for observation Alternate namesOccurrence DefinitionThe time of the PHG at the time the current time of the PHD is ascertained. Knowing when an observation was deemed true is important to its relevance as well as determining trends. This element is absent if the PHD has superior time synchronization relative to the PHG. Wnen this element is absent it indicates that the PHG reported the measurement time stamps of the PHD without modification. dateTime Constraints
|
issued | Σ | 0..1 | instant | There are no (further) constraints on this element Element idObservation.issued Date/Time this was made available DefinitionThe date and time this observation was made available to providers, typically after the results have been reviewed and verified. Updated when the result is updated. instant Constraints
|
performer | Σ I | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/Organization | http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/RelatedPerson) | There are no (further) constraints on this element Element idObservation.performer Who is responsible for the observation DefinitionWho was responsible for asserting the observed value as "true". May give a degree of confidence in the observation and also indicates where follow-up questions should be directed. 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. Reference(http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/Organization | http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/RelatedPerson) Constraints
|
value[x] | Σ I | 0..1 | Element idObservation.value[x] Actual result DefinitionThe current time reported by the PHD unless there is a time fault in which case this element is absent and the dataAbsentReason indicates 'unknown' The primary reason for the coincident time stamp is to know the details of any time stamp corrections the PHG may have applied. This observation is a measurement of the PHDs current time at the current time of the PHG and is present to allow a comparison and auditing. PHGs are responsible for assuring the measurement time stamps are correctly aligned to UTC and local offset. If the PHD has superior time synchronization than the PHG (very rare with PHDs) only the current time of the PHD is shown and the effectiveDateTime element is absent. If the PHD has a time fault (the current time line of the PHD cannot be ascertained for the measurements uploaded) the value[x] element is absent. If the PHD reports no time stanps in its measurements, this resource is not needed. Unordered, Open, by system(Exists) Constraints
| |
(All Slices) | There are no (further) constraints on this element | |||
valueCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type CodeableConcept | ||
valueString | string | There are no (further) constraints on this element Data type string | ||
valueBoolean | boolean | There are no (further) constraints on this element Data type boolean | ||
valueRange | Range | There are no (further) constraints on this element Data type Range | ||
valueRatio | Ratio | There are no (further) constraints on this element Data type Ratio | ||
valueSampledData | SampledData | There are no (further) constraints on this element Data type SampledData | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type Attachment | ||
valueTime | time | There are no (further) constraints on this element Data type time | ||
valuePeriod | Period | There are no (further) constraints on this element Data type Period | ||
dateTimeValue | Σ I | 0..1 | dateTime | Element idObservation.value[x]:dateTimeValue Actual result DefinitionThis reports the current time of the PHD when the real time clock uses either absolute time or base offset time An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations. Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type). If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples see the notes section below. dateTime Constraints
|
relativeTimeValue | Σ I | 0..1 | Quantity | Element idObservation.value[x]:relativeTimeValue Actual result DefinitionThe information determined as a result of making the observation, if the information has a simple value. An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations. Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is derived). If a value is present, the datatype for this element should be determined by Observation.code. This element has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueString, valueBoolean, valueRange, valueRatio, valueSampledData, valueAttachment, valueTime, valueDateTime, or valuePeriod. (The name format is "'value' + the type name" with a capital on the first letter of the type). If the data element is usually coded or if the type associated with the Observation.value defines a coded value, use CodeableConcept instead of string datatype even if the value is uncoded text. A value set is bound to the ValueCodeableConcept element. For further discussion and examples see the notes section below. Quantity Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idObservation.value[x]:relativeTimeValue.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.value[x]:relativeTimeValue.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
value | Σ | 1..1 | decimal | Element idObservation.value[x]:relativeTimeValue.value Numerical value (with implicit precision) DefinitionThe current relative or high resolution relative time reported by the PHD scaled to units of microseconds. Precision is handled implicitly in almost all cases of measurement. The current relative time forms the 'origin' of the time axis allowing the PHG to convert the PHD's relative time stamps to wall-clock time. The PHG knows the current wall clock time at this current relative time. Any measurement relative time stamp can be converted to wall clock time by subtracting this value from the measurement relative time stamp and adding that to the current wall-clock time recorded at the 'origin' relative time. decimal Constraints
|
comparator | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.value[x]:relativeTimeValue.comparator < | <= | >= | > - how to understand the value DefinitionHow the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value. If there is no comparator, then there is no modification of the value code BindingHow the Quantity should be understood and represented. ?? (required)Constraints
|
unit | Σ | 0..1 | string | Element idObservation.value[x]:relativeTimeValue.unit Unit representation DefinitionA human-readable form of the unit. This should be the UCUM code 'us' for microseconds. There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Note that FHIR strings may not exceed 1MB in size string Constraints
|
system | Σ I | 1..1 | uriFixed Value | Element idObservation.value[x]:relativeTimeValue.system System that defines coded unit form DefinitionIdentifies the MDC coding system Need to know the system that defines the coded form of the unit. see http://en.wikipedia.org/wiki/Uniform_resource_identifier uri Constraints
urn:iso:std:iso:11073:10101
|
code | Σ | 1..1 | codeFixed Value | Element idObservation.value[x]:relativeTimeValue.code Coded form of the unit DefinitionThe 32-bit 11073 10101 code for microseconds which is 264339. Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. The 11073-10101 code is used as this comes from the device. This usage allows gateways responsible for translating device measurements to FHIR to handle future specializations they may introduce new codes. If a translation to another coding system is done instead, that gateway would not be able to process the measurement. code Constraints
264339
|
dataAbsentReason | I | 0..1 | CodeableConceptBinding | Element idObservation.dataAbsentReason Why the result is missing DefinitionIn this profile this element indicates that the current time of the PHD for the measurements reported is not known and is unable to be obtained For many results it is necessary to handle exceptional values in measurements. This situation arises when the PHD has a time fault, perhaps by battery change. The sensor device may have stored data with time stamps taken at a time when the clock was running but after the fault the original time line was not able to be recovered. Thus the current time line, if any, has an unknown relationship to the previous time line. CodeableConcept BindingCodes specifying why the result (Observation.value[x]) is missing. ?? (extensible)Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idObservation.dataAbsentReason.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.dataAbsentReason.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
coding | Σ | 1..1 | Coding | There are no (further) constraints on this element Element idObservation.dataAbsentReason.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Coding Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idObservation.dataAbsentReason.coding.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.dataAbsentReason.coding.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
system | Σ | 1..1 | uriFixed Value | Element idObservation.dataAbsentReason.coding.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously. uri Constraints
http://hl7.org/fhir/data-absent-reason
|
version | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.dataAbsentReason.coding.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. string Constraints
|
code | Σ | 1..1 | codeFixed Value | Element idObservation.dataAbsentReason.coding.code Symbol in syntax defined by the system DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size code Constraints
unknown
|
display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.dataAbsentReason.coding.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size string Constraints
|
userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idObservation.dataAbsentReason.coding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. boolean Constraints
|
text | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.dataAbsentReason.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings. string Constraints
|
interpretation | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.interpretation High, low, normal, etc. Alternate namesAbnormal Flag DefinitionThe assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag. For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. CodeableConcept BindingCodes identifying interpretations of observations. ?? (extensible)Constraints
| |
comment | 0..1 | string | There are no (further) constraints on this element Element idObservation.comment Comments about result DefinitionMay include statements about significant, unexpected or unreliable values, or information about the source of the value where this may be relevant to the interpretation of the result. Need to be able to provide free text additional information. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
bodySite | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.bodySite Observed body part DefinitionIndicates the site on the subject's body where the observation was made (i.e. the target site). 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. If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension body-site-instance. CodeableConcept BindingCodes describing anatomical locations. May include laterality. ?? (example)Constraints
| |
method | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.method How it was done DefinitionIndicates the mechanism used to perform the observation. In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results. Only used if not implicit in code for Observation.code. CodeableConcept BindingMethods for simple observations. ?? (example)Constraints
| |
specimen | I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Specimen) | There are no (further) constraints on this element Element idObservation.specimen Specimen used for this observation DefinitionThe specimen that was used when this observation was made. Should only be used if not implicit in code found in Reference(http://hl7.org/fhir/StructureDefinition/Specimen) Constraints
|
device | I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Device | http://hl7.org/fhir/StructureDefinition/DeviceMetric) | Element idObservation.device (Measurement) Device DefinitionThe device used to generate the observation data. This field will reference the DeviceComponent when the updated fixes are in place. In the meantime it will reference the DeviceMetric Reference(http://hl7.org/fhir/StructureDefinition/Device | http://hl7.org/fhir/StructureDefinition/DeviceMetric) Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idObservation.device.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.device.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
reference | Σ I | 1..1 | string | Element idObservation.device.reference Reference to the device responsible for the measurement DefinitionReference to the device-related resources that describe the sensor device taking the measurement and the gateway that handled it. This reference points to the DeviceComponent resource chain containing information about the sensor device that took the measurement and gateway (if any) that handled it. string Constraints
|
identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idObservation.device.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Identifier Constraints
|
display | Σ | 0..1 | string | There are no (further) constraints on this element Element idObservation.device.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. string Constraints
|
referenceRange | I | 0..* | BackboneElement | There are no (further) constraints on this element Element idObservation.referenceRange Provides guide for interpretation DefinitionGuidance on how to interpret the value by comparison to a normal or recommended range. 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. 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 may 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. BackboneElement Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idObservation.referenceRange.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.referenceRange.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.referenceRange.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Constraints
|
low | I | 0..1 | http://hl7.org/fhir/StructureDefinition/SimpleQuantity | There are no (further) constraints on this element Element idObservation.referenceRange.low Low Range, if relevant DefinitionThe 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). The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. http://hl7.org/fhir/StructureDefinition/SimpleQuantity Constraints
|
high | I | 0..1 | http://hl7.org/fhir/StructureDefinition/SimpleQuantity | There are no (further) constraints on this element Element idObservation.referenceRange.high High Range, if relevant DefinitionThe 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). The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. http://hl7.org/fhir/StructureDefinition/SimpleQuantity Constraints
|
type | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.referenceRange.type Reference range qualifier DefinitionCodes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range. Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc, - for proper interpretation. This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed. CodeableConcept BindingCode for the meaning of a reference range. ?? (extensible)Constraints
| |
appliesTo | 0..* | CodeableConcept | There are no (further) constraints on this element Element idObservation.referenceRange.appliesTo Reference range population DefinitionCodes 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. Need to be able to identify the target population for proper interpretation. This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed. CodeableConcept BindingCodes identifying the population the reference range applies to. ?? (example)Constraints
| |
age | I | 0..1 | Range | There are no (further) constraints on this element Element idObservation.referenceRange.age Applicable age range, if relevant DefinitionThe 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. Some analytes vary greatly over age. The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3. Range Constraints
|
text | 0..1 | string | There are no (further) constraints on this element Element idObservation.referenceRange.text Text based reference range in an observation DefinitionText 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'. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
related | Σ | 0..* | BackboneElement | There are no (further) constraints on this element Element idObservation.related Resource related to this observation DefinitionA reference to another resource (usually another Observation) whose relationship is defined by the relationship type code. Normally, an observation will have either a value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and a set of related observations or sometimes a QuestionnaireResponse from which the measure is derived. For a discussion on the ways Observations can assembled in groups together see Notes below. BackboneElement Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idObservation.related.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.related.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.related.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Constraints
|
type | 0..1 | codeBinding | There are no (further) constraints on this element Element idObservation.related.type has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by DefinitionA code specifying the kind of relationship that exists with the target resource. A relationship type SHOULD be provided. The "derived-from" type is the only logical choice when referencing the QuestionnaireAnswer resource. code BindingCodes specifying how two observations are related. ?? (required)Constraints
| |
target | I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Observation | http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse | http://hl7.org/fhir/StructureDefinition/Sequence) | There are no (further) constraints on this element Element idObservation.related.target Resource that is related to this one DefinitionA reference to the observation or QuestionnaireResponse resource that is related to this observation. 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. Reference(http://hl7.org/fhir/StructureDefinition/Observation | http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse | http://hl7.org/fhir/StructureDefinition/Sequence) Constraints
|
component | Σ | 0..* | BackboneElement | There are no (further) constraints on this element Element idObservation.component Component results DefinitionSome 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. 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. For a discussion on the ways Observations can be assembled in groups together see Notes below. BackboneElement Constraints
|
id | 0..1 | string | There are no (further) constraints on this element Element idObservation.component.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
| |
extension | I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
|
modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idObservation.component.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Constraints
|
code | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idObservation.component.code Type of component observation (code / type) DefinitionDescribes what was observed. Sometimes this is called the observation "code". Knowing what kind of observation is being made is essential to understanding the observation. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. CodeableConcept BindingCodes identifying names of simple observations. ?? (example)Constraints
|
value[x] | Σ | 0..1 | There are no (further) constraints on this element Element idObservation.component.value[x] Actual component result DefinitionThe information determined as a result of making the observation, if the information has a simple value. An observation exists to have a value, though it may not if it is in error, or if it represents a group of observations. Normally, an observation will have either a single value or a set of related observations. A few observations (e.g. Apgar score) may have both a value and related observations (for an Apgar score, the observations from which the measure is 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 boolean values use valueCodeableConcept and select codes from http://hl7.org/fhir/ValueSet/v2-0136 (these "yes/no" concepts can be mapped to the display name "true/false" or other mutually exclusive terms that may be needed"). The element, Observation.value[x], has a variable name depending on the type as follows: valueQuantity, valueCodeableConcept, valueRatio, valueChoice, valuePeriod, valueSampleData, or valueString (the name format is "'value' + the type name" with a capital on the first letter of the type).
| |
valueQuantity | Quantity | There are no (further) constraints on this element Data type Quantity | ||
valueCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type CodeableConcept | ||
valueString | string | There are no (further) constraints on this element Data type string | ||
valueRange | Range | There are no (further) constraints on this element Data type Range | ||
valueRatio | Ratio | There are no (further) constraints on this element Data type Ratio | ||
valueSampledData | SampledData | There are no (further) constraints on this element Data type SampledData | ||
valueAttachment | Attachment | There are no (further) constraints on this element Data type Attachment | ||
valueTime | time | There are no (further) constraints on this element Data type time | ||
valueDateTime | dateTime | There are no (further) constraints on this element Data type dateTime | ||
valuePeriod | Period | There are no (further) constraints on this element Data type Period | ||
dataAbsentReason | I | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component.dataAbsentReason Why the component result is missing DefinitionProvides a reason why the expected value in the element Observation.value[x] is missing. For many results it is necessary to handle exceptional values in measurements. "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". 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. Because of these options, use-case agreements are required to interpret general observations for exceptional values. CodeableConcept BindingCodes specifying why the result (Observation.value[x]) is missing. ?? (extensible)Constraints
|
interpretation | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idObservation.component.interpretation High, low, normal, etc. Alternate namesAbnormal Flag DefinitionThe assessment made based on the result of the observation. Intended as a simple compact code often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Otherwise known as abnormal flag. For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result. The component interpretation applies only to the individual component value. For an overall interpretation all components together use thes Observation.interpretation element. CodeableConcept BindingCodes identifying interpretations of observations. ?? (extensible)Constraints
| |
referenceRange | 0..* | see (referenceRange) | There are no (further) constraints on this element Element idObservation.component.referenceRange Provides guide for interpretation of component result DefinitionGuidance on how to interpret the value by comparison to a normal or recommended range. 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. 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 may 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.
|
Code
The code element is used to report the type of time clock used by the PHD. The PHG obtains the type of time clock and its current setting by reading the MDS attributes. There are four types of clocks as follows:
Attribute | Type of clock | Description | FHIR mapping |
---|---|---|---|
Date-and-Time | Absolute time | Wall-clock time with offset to UTC | Observation.code.coding.code = 67975 |
Base-Offset-Time | Base offset time | Wall-clock time with offset to some base time, often UTC | Observation.code.coding.code = 68226 |
Relative-Time | relative time | a sequence of ticks with 1/8th millisecond resolution | Observation.code.coding.code = 67983 |
HiRes-Relative-Time | relative time | a sequence of ticks with microsecond resolution | Observation.code.coding.code = 68072 |
Subject
The subject element points to the PhdPatient resource using the logical id of the Patient resource, for example 'Patient/123546'
Populating the PHG Current Time
The PHG is required to have the capability to report local time and offset to UTC. The PHG records its current time in the Observation.effectiveDateTime element regardless of the type of time clock used by the PHD unless the PHD has superior time synchronization than the PHG see the section Coincident Time Stamp on this topic. In that case, the Observation.effective[x] element is not populated.
Populating the PHD Current Time
If the PHD uses an Absolute or Base-Offset time clock, the current time of the PHD is reported in an Observation.valueDateTime element. FHIR requires the presence of an offset to UTC so if the PHD uses an absolute time, the PHG adds its offset to the value. Since all PHDs currently use local transports, the PHD and PHG are logically in the same time zone and thus have the same offset to UTC. However, if the PHD is using Base offset time, the offset reported by the PHD is used even if it is NOT the offset of the PHG.
If the PHD uses a relative time clock the current tick time is reported in an Observation.valueQuantity element scaled to microseconds.
If the PHD has a time fault, the Observation.value[x] element is absent and an Observation.dataAbsentReason.coding.code element is present with the code "unknown". A time fault is reported if the PHD itself indicates a time fault or the PHD uses a time stamp in its measurements but does not report its current time.
Attribute | FHIR mapping |
---|---|
Date-and-Time.value | Observation.valueDateTime |
Base-Offset-Time.value | Observation.valueDateTime |
Relative-Time.value | Observation.valueQuantity.value = Relative-Time.value * 125 |
HiRes-Relative-Time.value | Observation.valueQuantity.value = HiRes-Relative-Time.value |
Device
The Observation.device element is a reference to the Device resource representing the PHD that took the measurement.
Additional information
There is no additional information reported in component elements in this profile.
Phd Coincident Time Stamp Observation JSON Example
The following JSON example is the Coincident Time Stamp Observation associated with a Blood Pressure measurement.
{ "resourceType":"Observation", "meta":{ "profile": [ "http: //pchalliance.org/phdfhir/StructureDefinition/PhdCoincidentTimeStampObservation" ] }, "status":"final", "code":{ "coding": [ { "system":"urn:iso:std:iso:11073:10101", "code":"67975", "display":"MDC_ATTR_TIME_ABS" } ] }, "subject":{ "reference":"Patient/PatientId-sisansarahId" }, "effectiveDateTime":"2017-12-12T09:13:39-05:00", // If the effectiveDateTime is absent, it means that the PHD has superior // time synchronization than the PHG. All reported times stamps are then taken directly from // the PHD and reported in the metric Observations unmodified. To date there are no PHDs that // have external synchronization "valueDateTime":"2017-12-12T09:13:39-05:00", // If the value[x] element is absent, it means that the PHD has experienced // a time fault or is non-compliant by reporting a time stamp but no current time. All reported // times stamps are then taken directly from the PHD and reported in the metric Observations // unmodified. However, the time stamps are not reliable. // A consumer of this resource can restore the original time reported by the PHD // by taking (effectiveDateTime - valueDateTime) and subtracting it from the time stamp reported in // times stamps are then taken directly from the PHD and reported in the metric Observations // the metric Observation. If there is a valueQuantity element for the PHD time, the PHD uses // a relative time stamp. One can use a similar approach to find the relative time sent by the PHD // but the value is already reported in a component element of the metric Observation "device":{ "reference":"DeviceComponent/SysId-01040302f0000000" } }